Purpose: To evaluate prediction accuracy of formulas included in the ESCRS online intraocular lens (IOL) calculator using standard keratometry (K) or total keratometry (TK). Setting: Hospital-based academic practice. Design: Retrospective case-series. Methods: 523 patients with cataract (523 eyes) were included in this study. The outcome measures were trimmed means of the spherical equivalent prediction error (SEQ-PE, trueness), precision and absolute SEQ-PE (accuracy) of all 7 formulas available on the ESCRS online IOL calculator, as well as mean (Mean-All) and median (Median-All) of the predicted SEQ refraction of all formulas. Subgroup analyses evaluated the effect of axial length on formula accuracy. Results: Trimmed-mean SEQ-PE range of all formulas varied from −0.075 to +0.071 diopters (D) for K-based and from −0.003 to +0.147 D for TK-based calculations, with TK-based being more hyperopic in all formulas (P < .001). Precision ranged from 0.210 to 0.244 D for both K-based and TK-based calculations. Absolute SEQ-PE ranged from 0.211 to 0.239 D for K-based and from 0.218 to 0.255 D for TK-based calculations. All formulas, including Mean-All and Median-All, showed high accuracy, with 84% to 90% of eyes having SEQ-PEs within 0.50 D. Myopic trimmed-mean SEQ-PEs significantly different from zero were observed in long eyes for Pearl DGS (−0.110 D, P = .005), Hill RBF (−0.120 D, P < .001), and Hoffer QST (−0.143 D, P = .001) and in short eyes for EVO 2.0 (−0.252 D, P = .001), Kane (−0.264 D, P = .001), Hoffer QST (−0.302 D, P < .001), Mean-All (−0.122 D, P = .038), and Median-All (−0.125 D, P = .043). Conclusions: Prediction accuracy of all ESCRS IOL calculator formulas was high and globally comparable. TK-based calculations did not increase prediction accuracy and tended toward hyperopia. Observations indicating formula superiority in long and short eyes merit further evaluation.

Purpose of review: To showcase the majority of online intraocular lens (IOL) calculation tools and highlight some of their characteristics.Recent findings: Online tools are available for preoperative and postoperative IOL-related calculations, including IOL power and toricity selection for standard patients, patients who underwent prior refractive surgery, keratoconus, limbal relaxing incisions for astigmatism management, realignment of a misplaced or rotated toric IOL, surgical induced astigmatism (SIA), formulae comparison, and other tools.Summary: As there are new online developments and technology is advancing rapidly, we hope that this review will assist ophthalmologists in becoming acquainted with a large variety of online tools.

Purpose: To present a reproducible method to calculate the toricity needed at the intraocular lens (IOL) plane with toric phakic IOLs (ICL, Staar Surgical) and compare its results with those obtained with the online calculator provided by the manufacturer. Design: Retrospective case series Setting: Private practice, Buenos Aires, Argentina Methods: The formula originally described by Holladay to calculate the IOL power in phakic eyes was used to calculate the required spherical power along the less refractive meridian and along the more refractive meridian. Meridional analysis was applied to calculate the required toricity at the IOL plane and the surgically induced corneal astigmatism was incorporated into the calculations. The refractive cylinder predicted by this method and by the online calculator of the manufacturer were compared to the postoperative refractive cylinder by means of vector analysis. The possible changes in the ratio of toricity in patients with different amounts of astigmatism and anterior chamber depth are assessed in a theoretical section. Results: In 35 eyes, the measured mean postoperative refractive cylinder was 0.09 D @ 99°, the mean predicted postoperative refractive astigmatism was 0.04 D @ 102° according to the manufacturer's online calculator and 0.09 D @100° according to our method. With both methods, 91.43% of eyes had an absolute cylinder prediction error within ±0.50 diopters. Conclusions: The method described in this article to calculate the toricity of phakic IOLs has a refractive accuracy similar to that of the original calculator developed by the manufacturer.