ArticleClinical ophthalmology (Auckland, N.Z.)2026
IOL Calculators Variability in Toric Lens Planning: A Retrospective Paired Comparison of the Planning Discrepancies Between the Johnson & Johnson Toric Calculator and ESCRS-Hosted Engines.
Article in Clinical ophthalmology (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Comparison of Prediction Accuracy of Six Toric IOL Power Calculation Formulas, Including Four Available on the ESCRS Online Calculator.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Inter-Formula Variability in IOL Power Planning in Short and Long Eyes: A Retrospective Paired Comparison of Seven ESCRS-Hosted Formulas and the Ladas Super Formula 2.0.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
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6 authors.
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Abstract
Purpose: To determine the frequency, magnitude, and direction of toric intraocular lens (IOL) planning discrepancies between the Johnson & Johnson (J&J) official calculator and European Society of Cataract and Refractive Surgeons (ESCRS)-hosted toric engines, and to identify preoperative predictors of clinically relevant disagreements. Methods: This retrospective, single-center study included 182 eyes of 127 patients undergoing toric IOL implantation (TECNIS). For each eye, planning results were generated using identical biometric data (IOLMaster 700, CASIA2 keratometry) across all calculators. The primary comparison was J&J with posterior corneal astigmatism correction enabled (PCA-ON) versus ESCRS-Barrett - secondary comparisons included Kane, EVO 2.0, and Hoffer QST. Clinically relevant discrepancy (ClinRel) was defined as a toric cylinder step difference ≥ 1 and/or axis difference ≥ 10°. Logistic regression, including Firth-penalized estimation, identified predictors of ClinRel. The primary analysis set comprised one eye per patient (n=127). Results: ClinRel between J&J PCA-ON and Barrett occurred in 59.8% of eyes (76/127; 95% CI: 51.1-68.0%), driven almost only by step differences. J&J PCA-ON recommended a higher step in 56.7% of eyes, with only 2.4% showing the opposite. Discrepancies were concentrated in with-the-rule eyes (72.3%) and nearly absent in against-the-rule eyes (5.6%). Rates were higher for secondary engines (Kane 83.8%, EVO 74.4%, Hoffer QST 76.7%). An Alpins-style paired-planning analysis yielded a Correction Index of 1.20, with the Difference Vector concentrated at the vertical meridian (84°). Posterior corneal astigmatism grade was the strongest independent predictor (Firth-adjusted OR = 203.5; p=0.014). An empirical PCA threshold of 0.36 D (Youden index; sensitivity 91.6%, specificity 56.0%) identified eyes at elevated risk of calculator disagreement. Conclusion: Calculators' variability in toric IOL planning is substantial (~60% of eyes) and concentrated in with-the-rule eyes with elevated posterior corneal astigmatism. In this subgroup, consulting multiple calculators is recommended; in against-the-rule eyes, calculator choice rarely alters the recommendation.
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