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Anterior Segment, Cataract Surgery
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Imaging in Cataract Surgery

Published Online: February 3rd 2020 European Ophthalmic Review. 2019;13(2):71–5
Authors: Mahmood Khan, Zaina Al-Mohtaseb
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With increased patient expectations for precise post-operative refractive results, the need for accurate keratometry, biometry, and appropriate intraocular lens power formula selection is of paramount importance. The past decade has brought improvements in topography, biometry, and intraocular lens (IOL) calculations and the advent of intra-operative imaging and aberrometry has assisted in achieving more accurate post-surgical refractive outcomes. This review aims to provide an overview of imaging modalities used in the pre-operative and intra-operative setting in anterior segment cataract surgery. Intraoperative imaging can be used in: capsulorhexis centration, wound and astigmatic keratometry placement, IOL centration and toric alignment. Specifically, we aim to provide an overview on the Zeiss Callisto® (Zeiss, Oberkochen, Germany) imaging system used in toric lens alignment, the Alcon Verion (Alcon, Fort Worth, Texas, USA) used in combination with the ORA SystemTM (WaveTec Vision, Aliso Viejo, California, USA) for toric lens alignment and intraoperative aberrometry for lens selections, and the TrueVision 3D System (TrueVision 3D Surgical, Goleta, CA, USA) used in toric lens alignment. The utility of intraoperative imaging in correcting astigmatism and selecting IOL powers in routine cataract surgery remains an adjuvant to current pre-operative keratometry and biometry. Although studies have shown effectiveness of utilising intraoperative imaging in cataract surgery, there remains a need for larger retrospective studies that compare the accuracy of current IOL formulas versus intraoperative aberrometry in both normal and post-refractive surgery.


Cataract, toric alignment, intraoperative imaging, lens

Article Information:

Zaina Al-Mohtaseb is a financial consultant to Alcon, Johnson & Johnson and Zeiss. Mahmood Khan has nothing to declare in relation to this article.

Review Process

Double-blind peer review.


The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.


Zaina Al-Mohtaseb, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin St, Houston, TX 77030, US. E: zaina1225@gmail.com


No funding was received in the publication of this article.


14 October 2019

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