Comparison of Methodologies Using Estimated or Measured Values of Total Corneal Astigmatism for Toric Intraocular Lens Power Calculation

PURPOSE: To compare the prediction error in the calculation of toric intraocular lenses (IOLs) associated with methods that estimate the power of the posterior corneal surface (ie, Barrett toric calculator and Abulafia–Koch formula) with that of methods that consider real measures obtained using Scheimpflug imaging: a software that uses vectorial calculation (Panacea toric calculator: http://www.panaceaiolandtoriccalculator.com) and a ray tracing software (PhacoOptics, Aarhus Nord, Denmark). METHODS: In 107 eyes of 107 patients undergoing cataract surgery with toric IOL implantation (Acrysof IQ Toric; Alcon Laboratories, Inc., Fort Worth, TX), predicted residual astigmatism by each calculation method was compared with manifest refractive astigmatism. Prediction error in residual astigmatism was calculated using vector analysis. RESULTS: All calculation methods resulted in overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. Both estimation methods resulted in lower mean and centroid astigmatic prediction errors, and a larger number of eyes within 0.50 diopters (D) of absolute prediction error than methods considering real measures (P < .001). Centroid prediction error (CPE) was 0.07 D at 172° for the Barrett toric calculator and 0.13 D at 174° for the Abulafia–Koch formula (combined with Holladay calculator). For methods using real posterior corneal surface measurements, CPE was 0.25 D at 173° for the Panacea calculator and 0.29 D at 171° for the ray tracing software. CONCLUSIONS: The Barrett toric calculator and Abulafia–Koch formula yielded the lowest astigmatic prediction errors. Directly evaluating total corneal power for toric IOL calculation was not superior to estimating it.