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The Role of Sex in Ocular Biometry: A Large-Scale Study of Cataract Candidates in Greece

Year: 2026

Type: article

Abstract: Accurate intraocular lens (IOL) selection in cataract surgery relies on precise ocular biometry, yet variability between patients remains a challenge in achieving optimal refractive outcomes. Sex-related differences in biometric parameters and age-related changes in corneal astigmatism may contribute to this variability. This study aimed to evaluate sex-related differences in ocular biometry and age-related astigmatic changes in Greek cataract candidates using swept-source optical coherence tomography (SS-OCT). This retrospective observational study included 6258 eyes from 3726 adult patients. Patients were scheduled for cataract surgery between July 2024 and July 2025 at a tertiary eye hospital in Athens, Greece. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), keratometry (K1, K2), corneal astigmatism (CA), and white-to-white (WTW) were measured using the Argos SS-OCT biometer. Predicted IOL power distribution was evaluated using the Hoffer Q formula for descriptive purposes, targeting emmetropia. Sex- and age-stratified analyses were performed. Male eyes demonstrated longer AL (by 0.46 mm), deeper ACD (by 0.13 mm), and larger WTW (by 0.20 mm) (p < 0.01), whereas female eyes had steeper K1 (by 0.78 D) and K2 (by 0.70 D) (p < 0.01). An age-related shift from with-the-rule (WTR) to against-the-rule (ATR) astigmatism was observed in both sexes, occurring approximately one decade earlier in male eyes. Female eyes were overrepresented below the 5th (5.54% vs. 4.00%, p < 0.01) and above the 95th (4.42% vs. 2.88%, p < 0.01) percentiles of the predicted IOL power distribution. Sex-related differences in ocular biometry and age-related changes in corneal astigmatism were observed in this cohort. These findings provide population-specific data and highlight variability in biometric characteristics among patients with cataracts which may be relevant for preoperative assessment and surgery planning. During cataract surgery the natural lens is removed, and an artificial one is implanted. To achieve the best visual outcomes accurate measurements of the eye are required to select the most appropriate lens. These measurements can vary between individuals and may be influenced by sex. This study examined 6258 eyes from adult patients undergoing cataract surgery in Greece. Several eye measurements were analyzed, including eye length, corneal curvature, and lens thickness. Differences between men and women were evaluated, along with changes across different age groups. The potential impact of these differences on lens selection was also explored. Men were found to have longer and deeper eyes, whereas women had steeper corneas. Age-related changes in astigmatism were observed, with these changes occurring earlier in men. Women were also more frequently represented at the extreme ends of the range of lens powers required for surgery. These findings suggest that sex and age are important factors in planning cataract surgery.

Source: Ophthalmology and Therapy

DOI: 10.1007/s40123-026-01402-4