Achieving refractive accuracy in cataract surgery

A large meta-analysis of many years’ worth of LASIK studies showed that 99.5% of patients achieved an uncorrected vision of 20/40 or better and 91% of patients achieved 20/20 or better. These 91% of patients were corrected to within ±0.5 D of plano or the intended target. In comparison, cataract surgery is not nearly as good, with only about 60% of patients achieving the same result. Published guidelines for cataract surgeons list 55% as the appropriate target. Surely, we can do better than this.There have been a lot of improvements in the expensive machines that we use to measure the eye. Going from ultrasound A-scan to optical coherence biometry improved the accuracy of axial length measurement dramatically, by up to 10 times, but that did very little to improve the refractive outcomes in most cases. We are now in the age of microscope-mounted intraoperative aberrometers, and I am in the midst of trying the newest generation of these devices. I must admit, however, that I am disappointed in the initial results, and it strikes me as odd that these devices all request so much input data. If these devices are so accurate, then why do I have to enter any data? Does your autorefractor require you to enter the current prescription before measuring the new one?