Clinical Outcomes of Toric Intraocular Lenses: Differences in Expected Outcomes When Using a Calculator That Considers Effective Lens Position and the Posterior Cornea vs One That Does Not

PURPOSE: To compare toric intraocular lens (IOL) outcome accuracy after using an online toric calculator that accounted for posterior corneal astigmatism versus a traditional calculator that only accounted for anterior corneal astigmatism. PATIENTS AND METHODS: This was a single-arm, non-masked, non-randomized prospective study in a single private practice in Norfolk, Virginia, USA, evaluating clinical outcomes of toric IOL implantation based on a calculator that considered posterior corneal astigmatism (PCA) and effective lens position (ELP). Of interest was the distribution of the residual refraction (sphere and cylinder) at 40–70 days postoperative. Residual refractive cylinder (RRC) was compared to the back-calculated theoretical results using a legacy calculator that did not consider PCA. Distance visual acuity (best-corrected and uncorrected) and the manifest refraction were also measured, along with preoperative and postoperative keratometry. RESULTS: Forty-six eyes of 34 subjects were available for analysis. All eyes had a spherical equivalent refraction within 0.5D of intended. Uncorrected visual acuity was 20/25 or better in 86% of eyes targeted for emmetropia. Residual cylinder was 0.50D or less in 96% of eyes, with a maximum of 0.75D measured. The difference between residual cylinder and the expected cylinder from calculations was significantly lower for the calculator that included consideration of PCA and ELP relative to the one that did not. CONCLUSION: Use of a toric IOL calculator that includes consideration of posterior corneal astigmatism is recommended to optimize clinical outcomes.