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PURPOSE To assess the impact of measurement error on cylinder treatment planning in corneal refractive surgery and to compare the reliability of two indices of cylinder change the Correction Index, based on the surgically induced astigmatism, and the Flattening Index, based on the flattening effect. METHODS Preoperative refractions and surgical outcomes were evaluated using a Monte Carlo simulation. Cylinder change was calculated using vector analysis. The initial distribution of cylinder magnitudes was matched to a population sample o