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    JAMA Ophthalmology

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    Aspheric Toric vs. Aspheric Control IOLs in Patients With Cataract and Corneal Astigmatism

    December JAMA Ophthalmology

    With spectacle independence becoming increasingly important in cataract surgery, Visser et al. compared implantation of bilateral aspheric toric intraocular lenses (IOLs) and bilateral aspheric control IOLs in patients with cataract and corneal astigmatism. The researchers found that bilateral toric IOLs resulted in greater spectacle independence for distance vision.

    This clinical trial included 86 individuals with bilateral cataract and corneal astigmatism of at least 1.25 D who were randomized to undergo either bilateral toric (n = 41) or bilateral control (n = 45) IOL implantation. Main outcomes and measures were spectacle independence for distance vision, uncorrected distance visual acuity, refractive astigmatism, contrast sensitivity, wavefront aberrations, and quality of life. Preoperatively, mean corneal astigmatism was 2.02 and 2.00 D in the toric and control groups, respectively. Four patients in the toric group were lost to follow-up.

    At six months postoperatively, 26 patients (70 percent) in the toric group achieved an uncorrected distance visual acuity of 20/25 or better compared with 14 (31 percent) in the control group. Spectacle independence for distance vision was achieved by 31 patients (84 percent) in the toric group compared with 14 patients (31 percent) in the control group. Mean refractive astigmatism was –0.77 and –1.89 D in the toric and control groups, respectively. The mean magnitude of error for the toric IOLs was +0.38 D, indicative of overcorrection.

    No significant differences were found in contrast sensitivity, higher-order aberrations, or refractive error–related quality of life.

    Effect of Laser Iridotomy on Pigment Dispersion Syndrome

    December JAMA Ophthalmology

    Gandolfi et al. evaluated the role of drug-induced mydriasis and laser peripheral iridotomy (LPI) in patients with pigment dispersion syndrome (PDS) who are at risk for ocular hypertension. They found that phenylephrine testing helped to identify those eyes at high risk for developing intraocular pressure (IOP) elevation, while LPI reduced the rate of elevation.

    In this 10-year clinical trial, 72 patients with PDS underwent phenylephrine testing. Of these, 29 patients (58 eyes) tested positive for subsequent IOP elevation, and 43 patients (59 eyes) tested negative. For the 21 high-risk patients who qualified for follow-up, one eye was randomly assigned to LPI and the fellow eye was left untreated. For the 35 low-risk patients who qualified for follow-up, the affected eyes were left untreated. The researchers defined an event as an IOP elevation of 5 mmHg or more from baseline.

    In the high-risk group, three of 21 eyes that underwent LPI (14.3 percent) and 13 of 21 untreated eyes (61.9 percent) showed an increase in IOP of 5 mmHg or higher. Four of 35 low-risk eyes (11.4 percent) showed a similar increase. Mean event-free time was 7.99 years for high-risk treated eyes, 3.89 years for high-risk untreated eyes, and 7.16 years for low-risk eyes. The log-rank test revealed the following: p < .001 for treated high-risk eyes versus untreated high-risk eyes, p = .74 for treated high-risk eyes versus low-risk eyes, and p < .001 for untreated high-risk eyes versus low-risk eyes.


    JAMA Ophthalmology summaries are based on authors’ abstracts as edited by senior editor(s).

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