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Implantable collamer lens sizing optimization based on the anterion AS-OCT biometric parameters

Eye volume 39, pages 1730–1736 (2025)Cite this article

Subjects

Abstract

Objectives

To develop regression formulas for determining optimal Implantable Collamer Lens (ICL) size based on Anterion AS-OCT (anterior segment optical coherence tomography) biometric data.

Methods

In this retrospective interventional case series, 89 patients were included in the development phase and 57 patients were included in the (internal) validation phase. The study developed the SN (Salouti-Nowroozzadeh) formula, a multiple step-wise linear regression model, incorporating anterior chamber width (ACW), lens thickness, and anterior chamber volume (ACV) as predictors, to determine optimal ICL size (R-square=0.602). Another formula predicted ICL vault using a cubic non-linear model and the difference (Delta) between implanted and predicted ICL size as an explanatory variable (R-square = 0.599). Logistic regression determined the probability of achieving optimal vault or acceptable vault post-surgery. We also present findings from 73 consecutive prospective cases from a separate dataset, where the ICL was determined using the SN formula (external validation).

Results

Delta was the sole independent factor predicting postoperative ICL vault. A ∆ value of 0.3 mm corresponded to a 65% probability of achieving optimal vault, while a ∆ value of 0.15 resulted in an 80% probability. The SN formula matched with the STAAR nomogram in 69.9% of cases (79/113). Compared to the STAAR formula, the SN formula recommended a larger size in 10 eyes (8.8%) and a smaller size in 24 (21.2%). The 95% LoA for SN-predicted and actual ICL vault were (−339 to 518) µm. The mean absolute error was 191 µm (SD,139), and 72 eyes (63.7%) had a difference of ≤200 µm. The external validation analysis confirmed the primary findings.

Conclusions

The developed regression formula provided acceptable predictions for proper ICL sizing in our patients. However, its performance may vary across different populations or measurement devices. This study also highlights the need for smaller increments of ICL sizes to improve postoperative outcomes with any given formula.

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Fig. 1: Analysis of postoperative ICL vault.
The alternative text for this image may have been generated using AI.
Fig. 2: Agreement between actual and predicted ICL vault.
The alternative text for this image may have been generated using AI.

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Data availability

Data are available on reasonable request.

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Authors and Affiliations

  1. Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Ramin Salouti, Mostafa Nazarpour-Servak, Mohamad Mehdi Dehghani & M. Hossein Nowroozzadeh

  2. Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran

    Ramin Salouti, Mohammad Zamani & Maryam Ghoreyshi

  3. Science Department, The University of British Columbia, Vancouver, BC, Canada

    Kia Salouti

Authors
  1. Ramin Salouti
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  2. Mostafa Nazarpour-Servak
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  3. Mohamad Mehdi Dehghani
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  4. Mohammad Zamani
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  5. Kia Salouti
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  6. Maryam Ghoreyshi
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  7. M. Hossein Nowroozzadeh
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Contributions

Conception and design: RS, MHN, MNS, MMD; Acquisition and interpretation of data: MNS, MZ, KS, MG; Data analysis: MHN; Drafting: All authors; Critical reviewing: RS, MHN; Final approval: All authors; Agreement to be accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to M. Hossein Nowroozzadeh.

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Competing interests

The authors declare no competing interests.

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Informed consent was obtained from all participants. The study was in conformity with the tenets of the Declaration of Helsinki.

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Salouti, R., Nazarpour-Servak, M., Dehghani, M.M. et al. Implantable collamer lens sizing optimization based on the anterion AS-OCT biometric parameters. Eye 39, 1730–1736 (2025). https://doi.org/10.1038/s41433-025-03741-1

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