Preoperative Prediction of the Optimal Toric Intraocular Lens Alignment Meridian

To determine whether any of three keratometry devices is superior to the others in predicting the ideal toric intraocular lens (IOL) alignment meridian.

A retrospective review was performed to identify patients who underwent cataract phacoemulsification with toric IOL implantation from November 2014 to November 2016 at a single academic institution. For each patient, corneal measurements were performed with an optical low-coherence reflectometer/autokeratometer (OLCR), a dual Scheimpflug/Placido analyzer, and a color light-emitting diode (LED) topographer. Postoperatively, the ideal toric IOL alignment meridian that would have resulted in the least amount of residual astigmatism was determined using the online Berdhal & Hardten Toric Results Analyzer (BHTRA). To determine the prediction error, this ideal alignment meridian was compared to the corneal meridian with the highest refractive power, as provided by the three devices.

Fifty-six eyes of 56 patients were included in the study. The mean absolute errors in the toric IOL alignment meridians of the color LED topographer, dual Scheimpflug/Placido analyzer, and OLCR were 5.2° ± 5.2°, 7.6° ± 5.7°, and 5.4° ± 5.1°, respectively. There was no significant difference in the ability of each device to predict the ideal alignment meridian as determined by the BHTRA.

The color LED topographer, dual Scheimpflug/Placido analyzer, and OLCR may all be used to preoperatively determine the best alignment meridian for toric IOL placement. Surgeons should use their best judgment in determining which device to use in preoperative planning for individual patients. [J Refract Surg. 2018;34(8):515-520.].