Clinical reviews

Purpose: To compare the visual results and patient satisfaction after bilateral implantation between a bifocal and a trifocal intraocular lens (IOL).

Methods: This study is a prospective, randomized, controlled study involving bilateral implantation of one of two multifocal IOLs. Patients were assessed for uncorrected and distance-corrected near (33 cm), intermediate (66 cm), and distance visual acuity. Distance contrast sensitivity under photopic (85 cd/m2) conditions with and without glare was also measured. Using a subjective questionnaire, patient satisfaction, spectacle independence, and the perception of glare and halo phenomena were evaluated at the final follow-up; a defocus curve analysis was conducted.

Results: Fifteen patients (30 eyes) were implanted with the FineVision IOL (PhysIOL, Liége, Belgium) and 12 patients (24 eyes) received the Tecnis ZMB00 IOL (Abbott Medical Optics, Santa Ana, CA). The average follow-up was 6 months. The mean binocular uncorrected visual acuity was 0.02 ± 0.04 logMAR in the FineVision group and 0.04 ± 0.05 logMAR in the Tecnis group and the mean binocular uncorrected near visual acuity was 0.01 ± 0.00 logMAR in both groups. In the intermediate range of the defocus curve, there was a statistically significant difference between the two IOLs (P < .05). Contrast sensitivity was within normal limits under photopic conditions in both groups.

Conclusions: Both the Tecnis and FineVision IOLs provide a satisfactory range of vision, including a high level of uncorrected distance, intermediate, and near acuity and improved contrast sensitivity under photopic conditions.

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Purpose: To assess refractive and visual outcomes of bilateral implantation of an isofocal optic-design intraocular lens (IOL) or a monofocal IOL following cataract surgery.

Methods: A total of 127 patients were recruited into a prospective, single-masked, randomized trial. Sixty-five patients bilaterally implanted with the Isopure Isofocal IOL and 62 patients with the Micropure Monofocal IOL were followed for 4-6 months. Refraction, monocular and binocular uncorrected-distance-visual acuity, corrected-distance-visual acuity (CDVA), uncorrected-intermediate-visual acuity and distance-corrected-intermediate-visual acuity (DCIVA, 66/80 cm), uncorrected-near-visual acuity, and distance-corrected-near-visual acuity (DCNVA, 40 cm) were evaluated. Binocular defocus curve, binocular contrast sensitivity (photopic, mesopic with/without glare), and glare and halo phenomena were also measured.

Results: 99.23% of eyes were within ±1.00D and 84.62% of eyes within ±0.50D for the Isopure patients and 98.39% and 82.26% for the Micropure patients, respectively. The mean spherical-equivalent was -0.06 ± 0.36D and 0.10 ± 0.32D for the Isopure and Micropure patients, respectively. 98.5% and 100% of patients implanted with the Isopure and Micropure IOLs showed a cumulative binocular CDVA value ≥20/20, respectively. 80% and 67.70% of patients implanted with the Isopure presented a binocular DCIVA ≥20/25 at 80 and 66 cm, respectively. These percentages were 46.8% and 40.3% with the Micropure IOL, respectively. For Isopure, 7.7%, 30.8%, and 58.5% of patients presented a DCNVA ≥20/25, ≥20/32 and ≥20/40, respectively. These values were lower for the Micropure: 1.6%, 19.4% and 46.8%, respectively. Defocus curves showed similar good visual acuity at distance for both lenses with better intermediate vision for the Isopure. Both groups presented good contrast sensitivity, and the size and intensity of halo and glare phenomena were similar between the two. No adverse-events were reported.

Conclusion: Our trial shows that both IOLs provide excellent visual acuity and contrast sensitivity for far vision with similar photic phenomena, and the Isopure IOL improved unaided intermediate vision performance.

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Purpose: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision^® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month.

Methods: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision^® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively.

Results: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 log-MAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05).

Conclusions: The Physiol FineVision^® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit.

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Purpose: To report visual outcomes and patient-perceived satisfaction after trifocal or extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a real-world scenario.

Methods: Three months after bilateral cataract surgery, corrected and uncorrected visual acuity for far, intermediate and near distances and binocular defocus curves and contrast sensitivity were measured. The patients also completed the Catquest SF-9 questionnaire and reported on dysphotopsia and spectacle use.

Results: There were 23 patients in the Symfony, 32 patients in the Finevision and 36 patients in the Panoptix group. The percentage of eyes receiving a toric IOL was 41.2%. There were no differences in uncorrected binocular visual acuities, save for near vision, which was lower in the Symfony group. Binocular defocus curves for the trifocal IOLS were almost identical, while vision achieved with the Symfony IOL was significantly lower starting at - 1.5 D defocus. Contrast sensitivity, as well as the perception of halos and glare and the difficulty for night-driving was similar for all groups, except for contrast sensitivity at 6 cycles per degree, which was lower in the Symfony group compared to both Finevision and Panoptix. For near vision, only 47.6% of the Symfony patients reported being completely spectacle-free, compared to 93.3% and 94.4% for the Finevision and Panoptix groups.

Conclusions: Clinically relevant differences were only detected for near vision, with lower values for EDOF IOLs. In order to achieve patient satisfaction, it is imperative to explain the results expected with each IOL; for EDOF IOLs, patients should be advised that they may require near-spectacle correction.

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Purpose: To report the refractive and visual outcomes after implantation of a trifocal, diffractive, hydrophobic intraocular lens (IOL) in Japanese eyes following cataract surgery.
Methods: A total of 45 eyes implanted with FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this retrospective study. The clinical outcomes assessed after 3-months were refraction and monocular logarithm of the minimum angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm.
Results: 97.78% of the eyes were within ± 0.50D of spherical equivalent and all of them were within ± 1.00D (mean: − 0.00± 0.22 D, with 75.56% within ± 0.13D), while 91.11% of the eyes had ≤ 0.50D residual astigmatism and all of them had ≤ 1.00D (mean: − 0.08± 0.24D, with 88.89% ≤ 0.25D). UDVA and CDVA showed mean values of − 0.05± 0.07 logMAR and − 0.07± 0.06 logMAR, respectively. 86.67% and 95.56% of the eyes had ≥ 20/20 UDVA and CDVA, respectively, with 100% achieving ≥ 20/25 for both UDVA and CDVA. At 80 cm, the mean monocular logMAR UIVA and DCIVA were 0.18± 0.14 and 0.14± 0.14, and at 66 cm the values were 0.20± 0.15 and 0.19± 0.15, respectively. At 80 cm 20% of the eyes had ≥ 20/25 DCIVA and 60% had ≥ 20/32 DCIVA. These values changed to 15.56% and 40% of the eyes at 66 cm. In terms of near vision, the mean monocular logMAR UNVA and DCNVA were 0.04± 0.10 and 0.03± 0.10, respectively. 53.33% of the eyes had ≥ 20/20 UNVA and DCNVA, with 86.67% achieving ≥ 20/25 UNVA and DCNVA.
Conclusion: The FineVision HP trifocal diffractive IOL provided accurate refractive outcomes with good visual acuity at different distances in Japanese eyes.

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But: Évaluer les résultats visuels et réfractifs après implantation de l’implant intraoculaire trifocal FineVision (PhysIOL, Belgique).

Méthodes: Vingt yeux de dix patients ont été implantés consécutivement avec l’implant intraoculaire trifocal FineVision entre juin et novembre 2010. Cet implant intraoculaire est diffractif sur toute sa zone optique et présente une décroissance de la hauteur des marches de diffraction du centre vers la périphérie pour améliorer la vision de loin en conditions mésopiques.

Résultats: L’acuité visuelle non corrigée était de 1,00 dans tous les cas (1,00 ± 0,00). La vision de près était égale ou meilleure à Parinaud 2 dans tous les cas et la vision intermédiaire était meilleure que Parinaud 3. La courbe de défocalisation photopique ne présente pas de décroissance dans la zone intermédiaire. L’acuité visuelle décroit seulement d’une ligne à 10 % de contraste qui est similaire aux données publiées avec des implants intraoculaires bifocaux.

Conclusion: La trifocalité conserve les performances de la vision de loin et de près tout en améliorant les résultats en vision intermédiaire. Le troisième point focal est utilisable et ne crée pas de vision fantôme.

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Purpose: This study focuses on the analysis of the rotational stability after implantation of a biconvex aspheric toric monofocal intraocular lens (IOL) with a double C-loop haptic-design in eyes with normal versus high axial lengths.
Methods: This was a prospective comparative study including 150 eyes with corneal astigmatism (≥ 0.75D) implanted with the biconvex aspheric monofocal PODEYE toric IOL and assessed up to 1 year after surgery. From these 150 eyes, 81 and 69 eyes belonged to normal (≤ 23.9mm) and high (≥ 24mm) axial lengths, respectively. About 4– 6 and 11– 13 months postoperatively, refraction and rotational stability of the PODEYE toric IOL were evaluated to find possible differences among both groups.
Results: At the last postoperative-visit, 74.07% of eyes were within ± 0.50D and 95.06% of eyes were within ± 1.00D of the target-refraction for the normal group and 92.75% and 100% for the high axial length group, respectively. For the normal group, 77.78% and 96.30% of eyes had a postoperative refractive cylinder of ≤ 0.50D and ≤ 1.00D, respectively; and for the high axial length group these percentages were 84.05% and 100%, respectively. About 81.84% of eyes in the normal and 94.20% of eyes in the high axial length group were < 5 degrees of the intended axis. The mean IOL rotation was 2.93 ± 2.48 degrees in the normal axial length group, and 2.17 ± 1.73 degrees in the high axial length group. Based on the mixed ANOVA results, there is no evidence of a significant difference in IOL rotation over time, nor is there evidence that axial length plays a statistically significant role in rotational stability between 4– 6 and 11– 13 months postsurgery. Both groups exhibited similar and stable rotation outcomes.
Conclusion: Our results reveal that the biconvex aspheric monofocal PODEYE toric IOL with double C-loop haptic-design shows excellent rotational stability without significant differences between eyes with normal and high axial lengths.

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Purpose: To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL).

Setting: Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier.

Design: Single-center retrospective study.

Methods: This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery.

Results: Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5 mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was ≤ 6̊ (1 month) and ≤ 10̊ (4–6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was −0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D.

Conclusion: The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

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Purpose: To evaluate the rotational stability of nontoric intraocular lenses (IOLs) of the same design and different materials.

Setting: Vienna Institute for Research in Ocular Surgery, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria.

Design: Prospective randomized case series.

Methods: This study included cataract patients with a corneal astigmatism of less than 1.75 diopters measured with the IOLMaster 500. Each patient received a hydrophilic IOL (Pod Ay 26P) in 1 eye and a hydrophobic IOL (Podeye) in the other eye. One hour and 3 months postoperatively, retroillumination photographs were taken to assess rotational stability of the IOLs. In addition, autorefraction, subjective refraction, and Purkinje meter measurements were performed at the 3-month follow-up.

Results: Eighty eyes of 40 patients were included in this study. Three months postoperatively, the IOL rotation within the first 3 months was 2.4 degrees ± 1.85 (SD) in the hydrophilic IOL group and 1.6 ± 1.61 degrees in the hydrophobic IOL group. This difference was statistically significant (P = .016).

Conclusion: The hydrophobic IOL was rotationally more stable than the hydrophilic IOL, although both IOLs provided good capsular bag stability.

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Purpose: To compare the rotational stability, total misalignment, and visual and refractive outcomes achieved with a trifocal toric versus a monofocal toric intraocular lens (IOL).

Methods: In this prospective, interventional case series, eyes of patients consecutively scheduled for cataract surgery who had clinically relevant astigmatism were implanted with a FineVision Pod FT trifocal toric IOL or an Ankoris monofocal toric IOL (both PhysIOL SA, Liège, Belgium). Certain comorbidities, such as pseudoexfoliation syndrome, were allowed. IOL rotation and total misalignment were analyzed 15 minutes, 1 day, 1 week, 6 weeks, 6 months, and 1 year postoperatively.

Results: Seventy-one eyes of 53 patients were assessed: 37 eyes were implanted with the trifocal IOL and 34 eyes with the monofocal IOL. More IOL rotation occurred in the monofocal group compared to the trifocal group (mean 4.23° ± 4.64° vs 2.55° ± 2.62°; P = .043, 12 months). Mean total misalignment was higher in the monofocal group (6.67° ± 6.59° at 12 months vs 3.79° ± 3.59° in the trifocal group) (P = .017). Postoperatively, more eyes achieved a refractive cylinder of 0.50 diopters or below in the trifocal group (65% at 12 months) than in the monofocal group, even in the monofocal subgroup analysis that excluded keratoconic eyes (42% at 12 months; P = .009).

Conclusions: The monofocal and trifocal toric IOLs both appear to effectively reduce refractive astigmatism and provide good visual acuity in astigmatic patients having cataract surgery. The trifocal toric IOL offers better rotational stability than the monofocal IOL, probably due to the higher frictional coefficient of its surface. 

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Objectif: Étudier la stabilité rotationnelle et les résultats visuels de patients implantés avec une nouvelle lentille intraoculaire torique monofocale.

Cadre: Service d’ophtalmologie, clinique Beausoleil, avenue de Lodève, Montpellier.

Conception: Étude rétrospective monocentrique.

Méthodes: Inclusion de patients opérés de cataracte avec implantation du PODEYE torique (BVI/PhysIOL SA, Liège, Belgique) à l’aide du ZEISS CALLISTO eye®. Les données biométriques et kératométriques, les résultats réfractifs, la stabilité rotationnelle et la correction de l’astigmatisme ont été collectés. La rotation de l’IOL a été évaluée à l’aide d’une technique d’analyse d’image. Les évaluations ont été effectuées à 1 semaine, 1 mois et 4 à 6 mois après l’opération.

Résultats: Cent deux patients (136 yeux) ont été analysés. Les patients avaient en moyenne 74 ans, dont 25 % avec une longueur axiale supérieure à 24,5 mm. La rotation médiane postopératoire était de 2̊. À l’exception d’un cas (rotation de 15̊), la rotation était ≤ 6̊ (1 mois) et ≤ 10̊ (4–6 mois) dans 100 % des yeux. Aucun implant n’a été repositionné. En postopératoire, l’acuité visuelle de loin corrigée médiane était de −0,08 logMAR, et le cylindre subjectif médian entre 0,25 et 0,50 D.

Conclusion: Le PODEYE torique a montré une grande stabilité rotationnelle, permettant la correction de l’astigmatisme cornéen au décours de la chirurgie de la cataracte.

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Purpose: To compare rotational stability, centration and visual outcomes provided by three trifocal lens models that have the same optical zone design but different material, composition, and/or toricity.

Methods: The study included 78 patients with symmetric bilateral intraocular lens implantation. The lenses under evaluation were trifocal intraocular lenses made of hydrophilic acrylic material: a spherical lens 26% hydrophilic acrylic (POD FineVision), a similar lens but having a toric design (POD Toric FineVision), and a trifocal lens 25% hydrophilic acrylic material (FineVision/MicroF). Moreover, the lenses share the same optical zone design. The lenses' rotational stability and centration were measured by means of the PIOLET software, which relies on recording and image processing techniques to determine lens rotation and centration based on slit-lamp images. We also assessed patients' visual quality by means of 25, 40, and 80 cm VA tests.

Results: The best centration results were achieved with the POD Toric FineVision model, although the differences were not statistically significant. As for lens rotation, it was below 5° in all cases under study. Regarding VA, all subjects attained at least 0.3 logMAR for far distance uncorrected VA, at 80 cm VA was about 0.2 logMAR, at 40 cm it was above 0.15 logMAR, and at 25 cm it was about 0.3 logMAR for both lens types.

Conclusion: All three intraocular lens models yield excellent visual results at far, near as well as intermediate distances. The POD FineVision and POD Toric FineVision models, with double C-loop design, yielded the best results centration-wise and rotation-wise. Differences had no clinical relevance.

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Purpose: To compare visual outcomes, rotational stability, and centration in a randomized controlled trial in patients undergoing cataract surgery who were bilaterally implanted with two different trifocal intraocular lenses (IOLs) with a similar optical zone but different haptic shape.

Methods: Twenty-one patients (42 eyes) with cataract and less than 1.50 D of corneal astigmatism underwent implantation of one FineVision/MicoF IOL in one eye and one POD FineVision IOL in the contralateral eye (PhysIOL, Liège, Belgium) at IOA Madrid Innova Ocular, Madrid, Spain. IOL allocation was random. Outcome measures, all evaluated 3 months postoperatively, included monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near (DCNVA) visual acuity (at 80, 40, and 25 cm) under photopic conditions, refraction, IOL centration, haptic rotation, dysphotopsia, objective quality of vision and aberration quantification, patient satisfaction, and spectacle independence.

Results: Three months postoperatively, mean monocular UDVA, CDVA, DCIVA, and DCNVA (40 cm) under photopic conditions were 0.04 ± 0.07, 0.01 ± 0.04, 0.15 ± 0.11, and 0.16 ± 0.08 logMAR for the eyes implanted with the POD FineVision IOL and 0.03 ± 0.05, 0.01 ± 0.02, 0.17 ± 0.12, and 0.14 ± 0.08 logMAR for those receiving the FineVision/MicroF IOL. Moreover, the POD FineVision IOL showed similar centration (P> .05) and better rotational stability (P < .05) than the FineVision/MicroF IOL. Regarding halos, there was a minimal but statistically significant difference, obtaining better results with FineVision/MicroF. Full spectacle independence was reported by all patients.

Conclusions: This study revealed similar visual outcomes for both trifocal IOLs under test (POD FineVision and FineVision/MicroF). However, the POD FineVision IOL showed better rotational stability, as afforded by its design. 

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Surgeons share their current lens preferences, look ahead to promising new designs, and comment on the effects laser cataract surgery could have on this sector.

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Purpose: To see whether surgical success and complication rates in surgery for full-thickness macular holes (FTMH) followed by 5 days prone posturing are comparable to those obtained with longer posturing regimes recorded in the literature.

Methods: A pilot study was carried out of pars plana vitrectomy, autologous platelet adjunct and 16% C2F6 tamponade followed by 5 days prone posturing in 38 eyes of 34 patients with idiopathic FTMH. A follow-up postal questionnaire was used to assess patients' perception of posturing and outcome.

Results: Fifty-three per cent of eyes gained 2 or more lines of Snellen acuity. Twenty-four per cent of patients with symptom duration of 12 months or less (29 patients) achieved a visual acuity of 6/12. Fifty-eight per cent of patients achieved N8 or better near vision. The only significant predictor of post-operative Snellen acuity was the stage of the hole (p = 0.02). Eighty-six per cent of questionnaire respondents felt that surgery had improved their quality of life. Eighty-seven per cent of all patients reported a reduction in, or elimination of, metamorphopsia. Fifty-four per cent of patients described posturing for 5 days as difficult or very difficult. Five patients admitted to posturing for less than 12 h a day, but all stated that they had postured for the full 5 days. Cataract was the commonest complication observed in this series (42% of patients have had or been listed for cataract surgery).

Conclusions: Five days of prone posturing following vitrectomy for FTMH with autologous plaletet concentrate and C2F6 tamponade afforded success and complication rates comparable to those in published studies with longer posturing times.

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Results

The study comprised 155 eyes that underwent cataract surgery using the R-Evo Smart and 146 eyes that underwent cataract surgery with the Centurion Vision System. Within each study group, a sub-group of patients underwent standard phacoemulsification procedure only and the second sub-group underwent to FLACS procedure followed by phacoemulsification. No adverse events were found in the two groups of eyes during the procedures. Table 2 shows the surgical outcomes obtained. For the whole sample, our results revealed that there was no statistically significant difference between cataract degree between both groups of eyes (p > 0.12): mean cataract grade according to LOCS III classification was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System eye groups, respectively. In terms of surgical outcomes, our values revealed that the mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System eye groups, respectively. The differences between both groups of eyes were statistically significant: p <0.01. The mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System eye groups, respectively. In this parameter, we did not find statistically significant differences: p = 0.21. Regarding the possible correlation between cataract grade, ultrasound time and amount of aspirated fluid, Figure 3 shows that the higher the cataract grade, the higher the US time for both phacoemulsification systems (Centurion R²=0.08, R-EVO R²=0.2). Fluid consumption tends to increase slightly with both devices with harder cataracts (Centurion R²=0.01, R-EVO R²=0.01).

For the non-FLACS eyes (98 versus 63 eyes for the R-Evo Smart and Centurion Vision System eye groups, respectively), our results showed no statistically significant differences between the degree of cataract: 2.95 ± 0.74 for the R-Evo Smart and 2.97 ± 0.91 for the Centurion Vision System (p = 0.44). The total ultrasound time was statistically significant between systems: 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System eye groups, respectively (p < 0.01). The mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.56 g and 55.97 ± 13.63 cc for the R-Evo Smart and Centurion Vision System eye groups, respectively (p = 0.49).

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Extending trifocality to a hydrophobic IOL platform.

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Purpose: To evaluate and compare the accuracy of 2 toric intraocular lens (IOL) calculators with or without a new regression formula.

Setting: Ein-Tal Eye Center, Tel-Aviv, Israel, and the Lions Eye Institute, Nedlands, Western Australia, Australia.

Design: Retrospective case series.

Methods: A new regression formula (Abulafia-Koch) was developed to calculate the estimated total corneal astigmatism based on standard keratometry measurements. The error in the predicted residual astigmatism was calculated by the Alcon and Holladay toric IOL calculators with and without adjustments by the Abulafia-Koch formula. These results were compared with those of the Barrett toric calculator.

Results: Data from 78 eyes were evaluated to validate the Abulafia-Koch formula. The centroid errors in predicted residual astigmatism were against-the-rule with the Alcon (0.55 diopter [D]) and Holladay (0.54 D) toric calculators and decreased to 0.05 D (P < .001 [x-axis], P = .776 [y-axis]) and 0.04 D (P < .001 [x-axis], P = .726 [y-axis]) with adjustments by the Abulafia-Koch formula. The Alcon and the Holladay toric calculators had a higher proportion of eyes within ±0.50 D of the predicted residual astigmatism with the Abulafia-Koch formula (76.9% and 78.2%, respectively) than without it (both 30.8%). There were no significant differences between the results of the Abulafia-Koch-modified Alcon and the Holladay toric calculators and those of the Barrett toric calculator.

Conclusion: Adjustment of commercial toric IOL calculators by the Abulafia-Koch formula significantly improved the prediction of postoperative astigmatic outcome.

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