Prediction of refractive outcomes with toric intraocular lens implantation.
OBJECTIVE
To evaluate and compare the accuracy of different methods to measure and predict postoperative astigmatism with toric intraocular lens (IOL) implantation.


METHODS
Ein-Tal Ophthalmology Center, Tel-Aviv, Israel.


METHODS
Retrospective case series.


METHODS
Postoperative corneal astigmatism was measured with 3 devices (IOLMaster 500; optical low-coherence reflectometry [OLCR]-based Lenstar LS 900; Atlas topographer) and compared with the manifest astigmatic refractive outcome in patients with toric IOLs. The error in the predicted residual astigmatism was calculated by vector analysis according to the measurement and calculation method used to predict the required toric IOL cylinder power.


RESULTS
The centroid errors in predicted residual astigmatism were against the rule with the Alcon and Holladay toric calculators (0.53 to 0.56 diopter [D]), were lower with the Baylor nomogram (0.21 to 0.26 D), and were lowest for the Barrett toric calculator (0.01 to 0.16 D) (P <.001). The Barrett toric calculator had the lowest median absolute error in predicted residual astigmatism (0.35 to 0.54 D, all devices) compared with the Alcon and Holladay toric calculators with or without the Baylor nomogram (P <.021). The Barrett toric calculator and the OLCR device achieved the most accurate results; 75.0% and 97.1% of eyes were within ±0.50 D and ±0.75 D of the predicted residual astigmatism, respectively.


CONCLUSIONS
Prediction of astigmatic outcomes with toric IOLs can be improved with appropriate measuring devices and methods to establish the required toric IOL power.
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA. Electronic address: adi.abulafia@gmail.com.
Adi
A
Abulafia
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Graham D
GD
Barrett
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Guy
G
Kleinmann
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Shay
S
Ofir
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Adi
A
Levy
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Arie L
AL
Marcovich
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Adi
A
Michaeli
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Douglas D
DD
Koch
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Li
L
Wang
From the Ein-Tal Eye Center (Abulafia, Ofir, Kleinmann, Levy, Marcovich, Michaeli, Assia), Tel Aviv Medical Center (Michaeli), and Tel-Aviv University (Abulafia, Ofir, Michaeli, Assia), Tel Aviv, the Meir Medical Center (Ofir, Assia), Kfar-Saba, and the Kaplan Medical Center (Kleinmann, Marcovich), Rehovot, Israel; the Sir Charles Gairdner Hospital (Abulafia, Barrett), Nedlands, Australia; Cullen Eye Institute (Koch, Wang), Baylor College of Medicine, Houston, Texas, USA.
Ehud I
EI
Assia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001251:Astigmatism / Q000175:diagnosis* / Q000209:etiology; D001699:Biometry / Q000295:instrumentation; D003315:Cornea / Q000473:pathology*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000175:diagnosis; D011474:Prosthesis Design; D012029:Refraction, Ocular; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology