# IOL Calcs: PLUS Precision Ladas Universal Superalgorithm

The future of IOL calculations is with methods that can evolve. A static formula is a time-limited method which will soon become outdated.

Many decades ago, ophthalmologists primarily relied on preop refraction to estimate the IOL power for cataract surgery. This evolved into using the keratometry and axial length, first with regression (SRK I and SRK II) and then with theoretical formulae (Holladay 1, SRK/T and Hoffer Q). This proved reliable for most eyes, but it soon became clear that more input variables, such as anterior chamber depth, could help predict the effective lens position (ELP) of the IOL more accurately. This factor, determining the precise ELP, is the primary challenge for truly accurate IOL calculations.

We now use the keratometry and axial length as the two primary factors for IOL calculations, with other data such as anterior chamber depth, white-to-white, refraction, lens thickness and more to help hone the ELP determination. These newer formulae such as the Holladay 2, Haigis, Olsen and Barrett Universal II tend to be more accurate than their predecessors, and many surgeons have abandoned the older methods, which were based on refraction, regression and only two-input variables.

Lens calculation methods continue to evolve, and there will be more factors that play a role in honing IOL calculations, such as the lens equatorial plane, posterior corneal power, and angle measurement, or other future elements or biometric inputs. One thing is certain: Methods of IOL power calculation will continue to evolve, and static formulae will eventually become outdated. This is why the future of IOL calculations will be using methods such as artificial intelligence, neural networks and big data.

The future involves using a known back-bone and then applying the artificial intelligence algorithm to make adjustments in careful increments. This is the approach of the Ladas Super Formula 2.0 AI. But what if you want to use the Barrett Universal II or the Holladay 2 as your back-bone and then make AI-based adjustments to that? Now you can.

Introducing PLUS (TM) from John Ladas, MD, PhD and the team at Advanced Euclidean Solutions. PLUS is the Precision Ladas Universal Superalgorithm and it allows application of our advanced AI to any static formula.

Machine learning methods will also be able to incorporate new factors such as lens equatorial plane to become more accurate. Already, we can achieve more than 90% of patients within 0.5 D of target, and that is a huge improvement compared with just a decade ago. The future is 95%+ accuracy and you can be a part of it.

Click below to learn from this video presentation:

(PLUS is being licensed to major ophthalmic companies and will soon be available to ophthalmologists around the world.)