Astigmatism considerations in cataract surgery

As refractive surgery advances, there are growing patient expectations to minimize astigmatism and be free of corrective lenses following cataract surgery. Currently, the options for correcting astigmatism at the time of cataract surgery include steep meridian incisions, single or paired peripheral corneal relaxing incisions, and toric intraocular lens (IOL) implantation. Phacoemulsification incision placement on the steep corneal axis corrects small amounts of astigmatism and is sufficient for most eyes with 0.5 to 1.0 diopters of astigmatism. Peripheral corneal relaxing incisions correct greater amounts of astigmatism. Toric intraocular lenses are also safe and effective for treating more than 1 diopter of astigmatism, and they now have excellent rotational stability. Precise measurement, accurate marking, and perfect IOL implantation, in addition to understanding the drawbacks and limitations of toric IOLs, are pivotal to patient satisfaction. Good uncorrected postoperative distance visual acuity can be obtained in most patients. For those with less than optimal astigmatic results, postoperative keratorefractive surgery is another available option.