Comparative evaluation of traditional and AI-based intraocular lens power calculation formulas in highly myopic eyes.

Purpose: To assess the accuracy of artificial intelligence (AI)-based intraocular lens (IOL) power calculation formulas compared with traditional methods in highly myopic eyes, and to evaluate their performance across varying axial lengths and corneal curvatures.

Methods: This retrospective case series included 115 highly myopic eyes that underwent phacoemulsification with IOL implantation. IOL power was calculated using four conventional formulas (SRK/T, Haigis, Holladay 2, Barrett Universal II) and seven AI-based formulas (Hill-RBF 3.0, Karmona, Hoffer QST, PEARL-DGS, Ladas Super Formula, Kane, HM-ZL). The outcomes were evaluated using standard deviation (SD), assessed with Heteroscedastic test; root-mean-square absolute error (RMSAE), assessed with bootstrap-t method; mean absolute error (MAE), assessed with Friedman test; and the percentage of eyes within ± 0.25 D to ± 1.00 D of prediction error, assessed with Cochran's Q test. Subgroup analyses were performed based on axial length (AL) and corneal curvature (Kmean).

Results: Most AI-based formulas-especially Hill-RBF 3.0, PEARL-DGS and Kane-demonstrated higher accuracy than traditional formulas.

Results: Overall, the MAEs of Hill-RBF 3.0, PEARL-DGS, and Kane were significantly lower than that of Holladay 2 (P < 0.05). The SD of PEARL-DGS also differed significantly from Holladay 2 (P < 0.05). In the long axial length group, Hill-RBF 3.0, PEARL-DGS, and Kane showed significantly lower MAEs than Holladay 2 (P < 0.05). In the moderate corneal curvature group, BUⅡ, Hill-RBF 3.0, Hoffer QST, PEARL-DGS, and Kane had significantly lower MAEs than Holladay 2, and the SDs of Hill-RBF 3.0 and PEARL-DGS differed significantly from both Holladay 2 and SRK/T (P < 0.05). Trend lines showed that AI-based formulas exhibited more consistent and stable performance across different AL and K_mean.

Conclusion: AI-based formulas provide superior refractive prediction in highly myopic eyes compared with traditional methods. Tailored formula selection based on biometric profiles may enhance refractive outcomes in cataract surgery.