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PURPOSE To evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOL) with plate-haptic, c-loop haptic and a rhexis fixated lens were compared. SETTING Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Department of Ophthalmology, Goethe-University, Frankfurt, Germany. nordBlick Eye Clinic, Kiel, Germany. DESIGN Retrospective, multicenter, comparative case series. METHODS The study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic or a novel rhexis fixated IOL. Biometry and refraction measurements were conducted pre- and three months postoperatively. Lens constant optimization was performed. RESULTS Seventy eyes of 56 subjects were included. ELP for rhexis fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis fixated IOL and both plate-haptic (P=0.001) and c-loop haptic IOL (P=0.000). ACD adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P<0.05). For the rhexis fixated IOL the differences in refraction ranged from +0.039 D for the Hill-RBF to +0.096 D for Haigis. The other two lenses showed mean differences in refraction between -0.046 D for Hill-RBF and -0.097 D for Haigis. CONCLUSION The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.