Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery

Abstract

A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel.

Zaina N. Al-Mohtaseb, MD;¹ Walter Allan Steigleman III, MD;² Seth M. Pantanelli, MD, MS;³ Charles C. Lin, MD;⁴ Kathryn M. Hatch, MD;⁵ Jennifer R. Rose-Nussbaumer, MD;⁶ Marcony R. Santhiago, MD;⁷ Timothy W. Olsen, MD;⁸ Stephen J. Kim, MD;⁹ and Julie M. Schallhorn, MD¹⁰

Ophthalmology, Vol. 131, Issue 3, P383-92 © 2024 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Objective: To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States.

Methods: A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II.

Results: Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism.

Conclusions: Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism.

¹Whitsett Vision Group, Cataract, Refractive, & Cornea Surgeon, Director of Research, Clinical Associate Professor, Baylor College of Medicine 
²University of Florida College of Medicine, Gainesville, Florida
³Penn State College of Medicine, Hershey, Pennsylvania  
⁴Stanford Eye Institute, Palo Alto, California 
⁵Cornea and Refractive Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts 
⁶Associate Professor, Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California 
⁷University of Sao Paulo, Sao Paulo, Brazil 
⁸Department of Ophthalmology, Mayo Clinic, Rochester, Minneapolis 
⁹Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN 
¹⁰Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California