Comparative accuracy of image-guided systems and smartphone applications for enhanced monofocal toric IOL alignment in cataract surgery.

PURPOSE: To compare the clinical outcomes of cataract surgery with toric intraocular lenses (IOLs) using two different alignment methods: an image-guided system and a smartphone application-guided method, and to evaluate their efficacy, feasibility, and potential for improving accessibility.

METHODS

This retrospective study analyzed 171 eyes of 120 patients undergoing cataract surgery with an enhanced monofocal toric IOL (Eyhance, Johnson & Johnson Inc., USA). Because some patients contributed both eyes, within-patient correlation was accounted for using generalized estimating equations (GEE). Outcomes included toric alignment error and refractive outcomes.

RESULTS

Mean absolute alignment error was 1.37 ± 1.29° in the image-guided group and 1.84 ± 1.47° in the smartphone-guided group. In clustered GEE analysis, the smartphone workflow was associated with higher absolute alignment error (p = 0.04). Postoperative refractive cylinder and spherical equivalent prediction accuracy were similar between groups.

CONCLUSION

Both systems demonstrated excellent refractive outcomes. The image-guided system provides superior accuracy in total absolute alignment error. While the smartphone application also provides comparable outcomes, it offers a cost-effective alternative, expanding accessibility in resource-limited settings.