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PseudophakiaFORMULEX-OVNCT07724795

IOL Power Formula Prediction Accuracy at the Extremes of Axial Length: A Prospective Outcome Verification Study

An observational study of Pseudophakia and Refractive Error, run by Vienna Hospital Association at 1 site in Austria.

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Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record

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Trial summary

This single-center, prospective, cross-sectional study evaluates how accurately eight modern intraocular lens (IOL) power calculation formulas predicted the postoperative refractive result in eyes with extreme axial length after cataract surgery. Read more about this study

Who is it for?
Any age
Conditions the study is for
Pseudophakia, Refractive Error
What is being tested?
Standardized postoperative outcome visit
Type of treatment
Pill or oral medicine
How many people
200 participants
Where
1 siteAustria
Study dates
1 Aug 2026to 1 Jul 2027
How long will I take part?
6 Months
Phase
Observational

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: Adults previously enrolled in the retrospective IOL power formula comparison study at the extremes of axial length at the study center, who underwent cataract surgery with a spherical (non-toric) monofocal IOL (HOYA Vivinex XY1, HOYA Vivinex Impress XY1-EM, or Johnson \& Johnson Tecnis 1-Piece DIB00) between January 2022 and December 2025, and whose preoperative axial length was below 22.0 mm or above 26.0 mm. A stratified random sample of 200 patients (110 short-eye, 90 long-eye) is drawn from this source cohort and invited to a single outcome visit.

Who may be able to join

  • - Participation in the retrospective IOL power formula comparison study at the extremes of axial length (pseudonymized study ID assigned; complete preoperative biometry and archived formula outputs for all eight formula pathways)
  • Cataract surgery with a spherical (non-toric) IOL of one of the three reference models (HOYA Vivinex XY1, HOYA Vivinex Impress XY1-EM, or Johnson \& Johnson Tecnis 1-Piece DIB00) at the study center between January 2022 and December 2025
  • Preoperative axial length below 22.0 mm (short stratum) or above 26.0 mm (long stratum), measured on IOLMaster 700
  • Documented implanted IOL model and power available from the operative record
  • At least 3 months since cataract surgery at the time of the outcome visit
  • Written informed consent for the outcome visit, including linkage of newly acquired postoperative data with the previously collected, pseudonymized preoperative planning data

Who cannot join

  • - Interval ocular surgery on the study eye since the original cataract surgery that may affect refraction or IOL position (e.g., corneal refractive surgery, IOL exchange or repositioning, secondary IOL implantation, or any intraocular surgery). Uncomplicated YAG laser capsulotomy without IOL repositioning is not an exclusion criterion
  • Implanted IOL not matching one of the three reference platforms (e.g., toric, multifocal or EDOF IOL, a different monofocal platform, or a sulcus-fixated IOL)
  • Toric IOL implantation
  • Acute ocular pathology preventing reliable refraction or biometric measurement
  • Cognitive or physical limitations precluding standardized subjective manifest refraction
  • Documented intraoperative complication with confirmed or suspected IOL malpositioning (e.g., posterior capsule rupture with vitreous loss, zonular dialysis requiring a capsular tension ring, sulcus placement)
  • Withdrawal of informed consent
  • Note: macular pathology is not an exclusion criterion; macular status is documented on OCT and analyzed as a covariate.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Michal Klimek, MD contact

+436504607496

klimek.michael@gmx.at

Austria1 site
  • Klinik Hietzing, Augenabteilung

    Vienna, State of Vienna, 1130

    Michal Klimek, MD, 06504607496, michak485@gmail.com

Other trials in Austria

About this study

Official title: Clinical Outcomes of Formula-dependent IOL Power Selection at the Extremes of Axial Length: a Cross-sectional Outcome Verification of Seven ESCRS-hosted Formulas and the Ladas Super Formula 2.0 in Short (<22.0 mm) and Long (>26.0 mm) Eyes Using Refractive, Biometric, and Tomographic Assessment

This single-center, prospective, cross-sectional study evaluates how accurately eight modern intraocular lens (IOL) power calculation formulas predicted the postoperative refractive result in eyes with extreme axial length after cataract surgery. Patients previously operated at the study center who had a very short (axial length < 22.0 mm) or very long (> 26.0 mm) eye and received a spherical monofocal IOL are invited to a single, non-invasive outcome visit. At this visit, standardized manifest refraction, optical biometry, corneal tomography, slit-lamp examination and, in long eyes, macular OCT are performed. The measured postoperative spherical equivalent is compared with the residual refraction that each of the eight formulas had predicted for the actually implanted IOL power, separately in short and long eyes. The study aims to identify which formula predicts the postoperative outcome most accurately at the extremes of axial length, where formula choice is most consequential and least well studied.

Read the detailed description

Modern IOL power formulas achieve high refractive predictability in average-length eyes but deteriorate at the extremes of axial length, where effective lens position modelling diverges most between formulas. A preceding retrospective study at this center quantified the formula-dependent variability of IOL power recommendations at the axial length extremes using fully standardized biometric inputs; however, planning discrepancy alone does not indicate which formula's recommendation yields the better clinical outcome. This prospective outcome verification study closes that gap by linking a standardized postoperative assessment to the pre-existing, pseudonymized preoperative planning dataset.

Design: single-center, prospective, cross-sectional, observational (paired within-eye) study. From the retrospective source cohort (approximately 927 short and 769 long eyes; approximately 1,000-1,200 patients; index surgeries January 2022-December 2025), a stratified random sample of 200 patients is drawn (110 short stratum, 90 long stratum; 55:45 ratio) and invited to a single outcome visit. Each eligible eye contributes up to eight paired, formula-specific prediction errors that differ only by the calculation formula, while the postoperative reference (manifest refraction) and all preoperative inputs are held constant. Eyes are stratified a priori into a short (AL < 22.0 mm) and a long (AL > 26.0 mm) stratum and analyzed separately.

Formulas evaluated: Barrett Universal II, Cooke K6, EVO 2.0, Hill-RBF 3.0, Hoffer QST, Kane and PEARL-DGS (via the ESCRS IOL calculator), and the stand-alone Ladas Super Formula 2.0.

Outcome visit (single visit, all non-invasive standard ophthalmic techniques, no study-mandated therapy, medication or surgery): uncorrected and best-corrected distance visual acuity, IOLMaster 700 optical biometry, CASIA2 and Pentacam AXL corneal tomography, autorefraction and standardized subjective manifest refraction (primary outcome measure), slit-lamp examination with posterior capsule opacification grading, and macular OCT (obligatory in the long stratum, recommended in the short stratum).

Primary analysis: for each formula, the spherical equivalent prediction error (SE-PE = measured postoperative spherical equivalent minus the residual spherical equivalent predicted for the actually implanted IOL power step) is computed and the absolute error (|SE-PE|) compared globally across the eight formulas using the Friedman test, with post-hoc pairwise Wilcoxon signed-rank tests (Holm-corrected, 28 formula pairs), separately in each axial length stratum. The primary accuracy metric per formula is the median absolute prediction error.

All data are processed in pseudonymized form and linked via a study ID and laterality, in accordance with the Declaration of Helsinki (2024), ICH-GCP, and the GDPR. The study is reported per STROBE and is registered on ClinicalTrials.gov prior to the start of recruitment.

Being tested
Standardized postoperative outcome visit
Keywords
Intraocular lens power calculation, IOL formula, Axial length, Short eye, Long eye
Medical subject headings
Pseudophakia, Refractive Errors

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Standardized postoperative outcome visitDiagnostic test

    A single, non-invasive multimodal assessment: uncorrected and best-corrected distance visual acuity, IOLMaster 700 optical biometry, CASIA2 and Pentacam AXL corneal tomography, autorefraction and subjective manifest refraction, slit-lamp examination with posterior capsule opacification grading, and macular OCT. No therapeutic intervention, medication or surgery is performed.

Study groups in NCT07724795
Study groupRoleWhat they receive
Short axial length stratum (AL < 22.0 mm)Pseudophakic eyes with a preoperative axial length below 22.0 mm that received a spherical monofocal IOL. These eyes undergo the standardized postoperative outcome visit; the measured spherical equivalent is compared with each formula's prediction for the implanted IOL power.
Receives: Diagnostic Test: Standardized postoperative outcome visit
Long axial length stratum (AL > 26.0 mm)Pseudophakic eyes with a preoperative axial length above 26.0 mm that received a spherical monofocal IOL. These eyes undergo the standardized postoperative outcome visit (including obligatory macular OCT); the measured spherical equivalent is compared with each formula's prediction for the implanted IOL power.
Receives: Diagnostic Test: Standardized postoperative outcome visit

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Spherical equivalent prediction error (SE-PE) across eight IOL power formulas, compared within each axial length stratum

    For each eye, SE-PE is calculated as the measured postoperative spherical equivalent (standardized manifest refraction) minus the residual spherical equivalent predicted by each formula for the actually implanted IOL power step. The absolute prediction error (|SE-PE|) is compared globally across the eight formulas (Barrett Universal II, Cooke K6, EVO 2.0, Hill-RBF 3.0, Hoffer QST, Kane, PEARL-DGS, Ladas Super Formula 2.0) using the Friedman test, with post-hoc pairwise Wilcoxon signed-rank tests (Holm-corrected, 28 formula pairs), performed separately in the short (AL < 22.0 mm) and long (AL > 26.0 mm) strata. The primary accuracy metric per formula is the median absolute prediction error (MedAE).

    Measured: Single study visit, at least 3 months after cataract surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jul 2026
  2. Study start1 Aug 2026 (estimated)
  3. Primary completion1 Jun 2027 (estimated)
  4. Study completion1 Jul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
200 participants (estimated)
Target duration
6 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT07724795
Sponsor's protocol ID
MA_15_EK_26_128_VK
Acronym
FORMULEX-OV
Status last verified
Jul 2026
First submitted
14 Jul 2026
Last updated
24 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

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