Does astigmatism-correcting cataract surgery extend the recovery process?

While a normal cornea has the shape of a slightly peaked dome, similar to the smaller end of an egg, we often talk about the cornea as a round sphere like a basketball. Astigmatism is the name we give to a cornea that looks more like a football than a basketball. For example, if you picture a football lying on a clock face with the long axis running from 3:00 to 9:00, the curvature is steeper in the axis at 12:00 on the clock face and flatter in the axis at 3:00, 90 degrees away. This is called “regular” astigmatism.

This difference in the curvature produces two or more focus points on the retina which creates blurred vision. Eyeglasses and contact lenses are used to correct astigmatism and can produce excellent vision. There are times when a person might wish to correct his/her astigmatism with surgery to remove this astigmatism and it is common to do this at the time of cataract surgery, either with a toric implant lens or with limbal reading incisions. However, if the axis of astigmatism does not line up to make a perfect cross (perpendicular lines) then it is called “irregular” astigmatism and may require a hard contact lens or corneal surgery to correct.

Limbal relaxing incisions correct regular astigmatism by flattening the overly steep curves in the cornea. The ophthalmologist can make these incisions by hand with a tiny blade or with a laser. Since relaxing incisions are an elective procedure, most insurance programs consider them to be cosmetic in nature and do not cover the added cost of this procedure.

There are really two different aspects to recovering after cataract surgery: one that deals with the healing of the eye and the other deals with the final clearness of vision. The “recovery” from surgery is not prolonged with the relaxing incisions. There can be a mild scratchy feeling for a few days, but this seldom causes any recovery issue. The final visual sharpness you will have after cataract surgery can take a bit longer with astigmatism-correcting incisions. The cornea takes a little more time to stabilize after relaxing incisions, but this usually happens within a few weeks, depending on the degree of astigmatism.