Evaluation of Refractive Accuracy of ORA and the Factors Impacting Residual Astigmatism in Patients Implanted with Trifocal IOLs During Cataract Surgery: A Retrospective Observational Study

PURPOSE: To assess the refractive accuracy of the intraoperative aberrometer Optiwave Refractive Analysis (ORA) and evaluate factors impacting residual astigmatism in eyes implanted with PanOptix (TFNT) trifocal intraocular lenses (IOLs) during cataract surgery. PATIENTS AND METHODS: This retrospective study examined 180 eyes implanted with a toric or non-toric trifocal IOL during cataract surgery. The mean refractive prediction error (RPE), median absolute RPE, and percentage of eyes with an absolute RPE ≤0.25, ≤0.50, ≤0.75, and ≤1.00 diopter (D) were determined for ORA and each of the IOL power formulas (Sanders–‍Retzlaff–Kraft/Theoretical [SRK/T], Barrett Universal II, and Haigis). Correlation analysis of postoperative residual astigmatism and factors associated with it was performed using Pearson’s and Spearman correlations in eyes with non-toric trifocal IOLs. RESULTS: After optimization, the median absolute RPE was 0.19 D, 0.25 D, 0.20 D, and 0.26 D in eyes measured using ORA and the SRK/T, Barrett Universal II, and Haigis formulas, respectively. An absolute RPE ≤0.50 D after optimization was noted in 92.8%, 83.3%, 88.3%, and 81.1% of the eyes using ORA and the SRK/T (p=0.0093), Barrett Universal II (p=0.2071), and Haigis (p=0.0018) formulas, respectively, showing significant differences between ORA and the SRK/T and Haigis formulas. The mean±standard deviation subjective residual astigmatism in non-toric IOL eyes (N=76) was 0.46±0.39 D and showed a strong positive correlation with preoperative objective refractive astigmatism (r=0.2925, p=0.0109), intraoperative ORA–measured astigmatism (r=0.5555, p<0.0001), postoperative objective refractive astigmatism (r=0.8188, p<0.0001), and postoperative total corneal astigmatism (TCA) (r=0.4051, p=0.0003) and a negative correlation with preoperative anterior corneal astigmatism (r=−0.3541, p=0.0017). CONCLUSION: ORA is a salient tool for improving the postoperative refractive accuracy of trifocal IOL power calculations and may help in determining the need for toric IOL use in astigmatic eyes with cataracts. Residual astigmatism correlated with objective refractive astigmatism, ORA-measured astigmatism, and postoperative TCA.