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J Cataract Refract Surg. 2019 Mar;45(3):272-283. doi: 10.1016/j.jcrs.2018.09.028. Epub 2018 Dec 7.

Improving toric intraocular lens calculations using total surgically induced astigmatism for a 2.5 mm temporal incision.

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Department of Ophthalmology, Baylor College of Medicine, Houston, USA. Electronic address:
Alcon Research Laboratories, Dallas, Texas, USA.



To determine in cataract surgery the total surgically induced astigmatism (SIA) that accounts for all factors that contribute to the difference between preoperative keratometric and postoperative refractive astigmatism other than any toricity of an intraocular lens (IOL).


Twenty surgical sites in the United States.


Retrospective case series.


An analysis was performed of 4 clinical trials involving toric IOLs and nontoric IOLs in standard cataract surgery. Data included preoperative keratometry and manifest refraction measurements at multiple postoperative visits. For each eye with a nontoric IOL, the total SIA vector was calculated as the vector difference between postoperative refractive and preoperative keratometric astigmatism. The relationship between the total SIA vector and meridian of preoperative keratometric astigmatism was determined and used to develop a new calculation algorithm for toric IOL implantation. The algorithm was tested retrospectively to identify optimum candidate eyes for various cylinder power toric IOLs as well as to compare results with the Barrett toric calculator.


The total SIA vector was a significant contributor to surgically associated astigmatic changes in eyes receiving nontoric IOLs. The total SIA vector was dependent on the preoperative steep meridian in a consistent fashion, allowing development of a new calculation algorithm for toric IOL correction. Retrospectively applying this algorithm to toric IOL cases led to significantly improved differences between toric and nontoric control populations.


Total SIA analysis is a new approach for toric IOL surgery. Because it considers all factors that may influence outcomes, the total SIA is a useful inclusion in toric IOL surgical planning.


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