• Cataract/Anterior Segment, Cornea/External Disease, Refractive Mgmt/Intervention

    Review of: Toric intraocular lens power calculation in cataract patients with keratoconus

    Ton Y, Barrett G, Kleinmann G, et al. Journal of Cataract and Refractive Surgery, November 2021

    This retrospective case series study analyzed visual and refractive outcomes in patients with keratoconus undergoing cataract surgery with a toric IOL implantation. Investigators compared IOL prediction accuracy between newer keratoconus-adjusted formulas and several conventional formulas.

    Study design

    A total of 23 patients (32 eyes) with keratoconus underwent cataract surgery with toric IOL implantation at a single center in Israel during an 8-year period. Topography was used to confirm the diagnosis of keratoconus, and only eyes with a regular central pattern and high agreement of multiple astigmatism measurements were included. Postoperative refraction outcomes were compared to predictions from a range of formulas: the Barrett Universal II, Barrett True-K for keratoconus with corrected predicted posterior corneal astigmatism (PCA), Barrett True-K for keratoconus with measured PCA, Kane, Kane keratoconus, SRK/T, Haigis, Holladay 1, and Hoffer Q.


    In this set of eyes, the Barrett True-K formulas with measured and predicted PCA were the most accurate and had the lowest standard deviations. The other formulas led to hyperopic outcomes. The Barrett True-K formula with measured PCA had the highest percentage of eyes within 0.5 D of the target, but was not statistically significantly superior to the True-K with predicted PCA. Mean subjective astigmatism declined from 2.95 D preoperatively to 0.95 D postoperatively.


    Five different toric IOL models were used, and the number of patients and eyes was small. Another potential weakness of the study design is its retrospective nature. This does address IOL cylinder power selection.

    Clinical significance

    Using newer, keratoconus-specific formulas can improve spherical IOL power calculation in eyes with keratoconus. The use of conventional formulas generally result in a hyperopic result.