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【Purpose】To evaluate the selection of toric intraocular lenses (T-IOLs) using total corneal refractive power as measured by anterior segment optical coherence tomography (AS-OCT: CASIA SS-1000; TOMEY, Nagoya, Japan). 【Subjects and Methods】We examined 29 eyes in 20 enrolled patients (mean age, 76.7 ± 8.0 years) who had undergone cataract surgery with implantation of a T-IOL (SN6AT3-7, Alcon, Hünenberg, Switzerland or Micro355T3-4, HOYA Surgical Optics, Singapore). Intraocular lens power was calculated using partial coherence interferometry (PCI) (IOL-Master Advanced Technology ver. 5.4; Carl Zeiss Meditec AG, Jena, Germany) optical biometer using the SRK-T formula. The T-IOL model was selected according to total corneal refractive power as measured by AS-OCT (Real-K value) with Alconʼs web calculator for SN6AT3-7 or with HOYAʼs web calculator for Micro355T3-4. Vector differences between predicted manifest astigmatism and manifest astigmatism at 3 months after surgery were analyzed. First, we divided eyes into 3 groups according to preoperative astigmatism axis, vector difference between astigmatism of Real-K and keratometric power as measured by PCI (PCI-K), and then compared findings. Moreover, we calculated which T-IOL model was selected using the PCI-K value for T-IOL selection. 【Results】Mean difference between predicted manifest astigmatism and postoperative manifest astigmatism was 0.6 D ± 0.31 D. Ultimately, 62% of eyes were corrected within 0.5 D (full correction) of the predicted astigmatism, 35% of eyes were corrected with postoperative manifest astigmatism 0.5 D larger and with the same axis as in preoperative astigmatism (undercorrection), and 3% of eyes were corrected with manifest postoperative astigmatism 0.5 D larger and with the axis 90 ° apart from the preoperative astigmatism (over-correction). In eyes showing “with-the-rule” astigmatism, 83% were fully corrected and 17% were over-corrected. In eyes with “against-the-rule” astigmatism, 55% were fully corrected and 45% were under-corrected. Mean vector difference of Real-K and PCI-K astigmatism was 0.49 D ± 0.31 D. Differences between Real-K and PCI-K values were not statistically significant. In 59% of eyes, the same T-IOL model was selected when the PCI-K value was applied for T-IOL calculation. 【Conclusion】These results suggest that total corneal refractive astigmatism is useful for T-IOL selection.

Evaluation of toric intraocular lens selection using total corneal refractive power