Comparison of 3 Toric IOL Calculators in Patients With Toric IOL Implantation

Monday, April 20, 2015: 9:01 AM
Room 1A (San Diego Convention Center)
James C. Lockwood, BA
J. Bradley Randleman, MD

To analyze postoperative refractive outcomes of one surgeon (JBR) and to compare 3 calculators: Alcon AcrySof IQ Toric Web Based Calculator (Alcon), Holladay IOL Consultant Software (HCS) and Barrett Toric Calculator (Barrett). Attempt to identify optimized strategy for selecting toric IOL by looking at each calculator individually and then together.

Retrospective review of 77 eyes (44 patients) with toric IOL implantation (AcyrSof IQ Toric). Data collected: toric IOL calculator recommended lens and axis of orientation, predicted residual sphere, residual cylinder, and axis of the residual cylinder; one-month postoperative measurements including uncorrected distance visual acuity, corrected distance visual acuity, and manifest refraction sphere, cylinder and axis.  Data analyzed in aggregate as well as separated into cohorts of patients with preoperative astigmatism with-the-rule (WTR), against-the-rule (ATR), and oblique.  Ideal lens was determined by analyzing post-op refractive outcomes.

Six eyes excluded. 1 month average UDVA was 20/27 (20/20 to 20/60) and average postoperative cylinder was 0.56 D (0 to 1.75 D).  Implanted lenses matched the ideal in 45 of 71 eyes (63.4%).  Of the 26 eyes where implanted lens did not match the ideal lens, 8 (30.8%) eyes would have benefited from a stronger lens with more toricity and 18 (69.2%) would have benefited from a weaker lens with less toricity. The ideal lens agreed with recommendation from Alcon in 42 of 71 (59.2%) eyes; HCS in 35 of 71 (49.3%) eyes; and Barrett 33 of 71 (46.5%) eyes.

Outcomes with toric IOLs were good; however, no calculator was optimal in isolation for choosing the ideal lens. There was often disagreement among the three calculator recommendations.  Calculators more likely to recommend lens that would be ideal in WTR patients than ATR. Using multiple calculators improves toric IOL outcomes.