Theoretical Relationship Between the Anterior-Posterior Corneal Curvature Ratio, Keratometric Index, and Estimated Total Corneal Power.

Purpose: To predict the relationships between the keratometric index value that would match the total Gaussian corneal power and its related variables: anterior and posterior radii of curvature of the cornea, anterior-posterior corneal radius ratio (APR), and central corneal thickness.
Methods: The relationship between the APR and the keratometric index was approximated by calculating the analytical expression for the theoretical value of the keratometric index, which would make the keratometric power of the cornea equal to the total paraxial Gaussian power of the cornea.
Results: The study of the impact of variations in the radius of anterior and posterior curvature and central corneal thickness showed that the difference between exact and approximated best-matching theoretical keratometric index was less than 0.001 for all of the performed simulations. This translated to a variation in the total corneal power estimation of less than ±0.128 diopters. After refractive surgery, the estimated optimal keratometric index value is a function of the preoperative anterior keratometry, the preoperative APR, and the delivered correction. The larger the magnitude of myopic corrections, the greater the increase in postoperative APR value.
Conclusions: It is possible to estimate the most compatible value of the keratometric index that allows simulated keratometric power to equal the total Gaussian corneal power. The obtained equations enable the evaluation of the impact of corneal variables such as the APR on the ideal keratometric index value. The use of 1.3375 for the keratometric index results in an overestimation of the total corneal power in most clinical situations. [ J Refract Surg . 2023;39(4):266-272.] .