Marta Jiménez-García 1,✉, Martín Puzo 1, Galadriel Giménez-Calvo 1, Francisco J Segura-Calvo 1, Jose Manuel Larrosa Povés 1, Francisco J Castro-Alonso 1, on behalf of the UFR-ARCCA Group Zaragoza
The sample selection for evaluating IOL power formulas lacks consensus. LAKE classification offers a systematic approach to categorizing eyes according to their ocular biometry ensuring consistency in future research.
Abstract
Purpose:
To create a classification for cataractous eyes based on their ocular biometry and thus provide a standard to stratify eyes when evaluating intraocular lens (IOL) formulas performance in different groups.
Setting:
High-resolution cataract surgery unit.
Design:
Monocentric, observational, retrospective study.
Methods:
Data of 21 797 patients (both eyes explored) were acquired between 2016 and 2024. An exploratory analysis on the most relevant biometric variables determined the presence of uncommon eyes, justifying the need of a stratification. Eyes were classified in 27 subgroups based on axial length (AL), anterior chamber depth (ACD), and mean keratometry (Km). Subgroups were named with 3 letters corresponding to 3 levels—high (H), normal (N), or low (L)—for AL, ACD, and Km, respectively. Cutoffs were created on average ± SD. Linear mixed models were used to evaluate differences between groups, where α < 0.05 meant significant.
Results:
43 954 eyes were classified, and all the subgroups contained at least 1 eye. The commonest subgroup was NNN (18 297 eyes, 41.97%), including eyes with (22.13 mm ≤ AL < 24.84 mm) AND (2.64 mm ≤ ACD < 3.43 mm) AND (42.50 diopters [D] ≤ Km < 45.60 D). Rarest subgroups were HLH and LHL (5 eyes and 1, respectively). Subgroups’ characteristics (age, lens thickness [LT], LT/ACD, etc) reflect patterns seen frequently in clinical practice, for example, older patients with delayed surgeries, high LT and narrow ACD.
Conclusions:
There is no consensus on how to subdivide eyes when evaluating IOL power formulas performance. LAKE classification addresses this need by providing a systematic method for categorizing cataractous eyes based on their biometry.
