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PURPOSE: To assess the effect of intraocular lens (IOL) orientation (vertical versus horizontal) and haptic design (1-piece versus 3-piece) on centration and tilt using a Purkinje meter. SETTING: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. DESIGN: Randomized pilot study with intrapatient comparison. METHODS: In part 1 of this study, patients received plate-haptic IOLs (Akreos Adapt) in both eyes that were positioned vertically in 1 eye and horizontally in the other eye. In part 2, patients received a 1-piece IOL (Acrysof SA60AT) in 1 eye and a 3-piece IOL (Acrysof MA60AC) in the contralateral eye. Decentration and tilt were measured 1 month and 3 months postoperatively with a new Purkinje meter. RESULTS: In part 1 (n = 15), the mean decentration of plate-haptic IOLs was 0.4 mm ± 0.2 (SD) with vertical orientation and 0.4 ± 0.2 mm with horizontal orientation and the mean tilt, 1.5 ± 1 …