good refractive outcome in cataract and refractive surgery relies on accurate and precise keratometry, particularly in procedures to correct astigmatism. Erroneous keratometric measurements may be a source of intraocular lens (IOL) power calculation errors, 1,2 which lead to postoperative refractive surprises. In addition, appropriate measurement of cylinder axis is important in toric IOL implantation because every degree of misalignment reduces the corrective effect.
3,4The manual Javal-Schiøtz keratometer, invented in the late 19th century, has largely given way to a variety of automated keratometers. These devices employ different techniques to provide automated analogues of traditional, manual keratometry readings. Commonly used keratometers are based on reflections of Placido rings, reflections of monochromatic lightemitting diodes (LEDs), Scheimpflug images, or a combination of these. Although of proven clinical value, topography based on Placido rings holds the disadvantage of neglecting skew rays, 5 which may lead to inaccuracies in measuring features of the cornea that are not rotationally symmetric (eg, corneal cylinder). [6][7][8] This may be solved by using a corneal reflection source that allows for point-to-point reconstruction.9,10 Simulations have shown that such a technique might be more accurate and precise than topography based on Placido rings. METHODS: Sixty-three eyes of 63 patients with virgin corneas underwent keratometry with color-LED corneal topography (Cassini; i-Optics, The Hague, The Netherlands) and with devices based on Placido ring reflections (Keratron; Optikon, Rome, Italy), monochromatic LED reflections (Lenstar; Haag-Streit, Koeniz, Switzerland), and Scheimpflug imaging (Pentacam; Oculus Optikgeräte, Wetzlar, Germany). Three repeated measurements were performed with each device. Comparability and repeatability of corneal power and cylinder measurements were assessed. The Bonferroni-corrected α-threshold for statistical significance was 0.016.
RESULTS:Corneal power measurements with the Cassini topographer were not statistically significantly different from those with the Pentacam (P = .64). They were statistically significantly lower than those with the Keratron and Lenstar (P < .01), but the differences were of negligible clinical relevance. Cylinder measurements with the Cassini topographer were not statistically significantly different from those with any other device (P = .46). Repeatability of Cassini corneal power measurements was not statistically significantly different from that of the Keratron (P = .02), but was statistically significantly lower than that of the Lenstar and Pentacam (P < .001). Repeatability of Cassini cylinder measurements was statistically significantly higher than that of the Pentacam and Keratron (P < .001), but was not statistically significantly different from that of the Lenstar (P > .05).
CONCLUSIONS:Corneal power and cylinder measurements with color-LED corneal topography yielded values that were comparable to those of other commonly used d...