Minimizing Astigmatism in Cataract Surgery

Sumit (Sam) Garg, MD


October 19, 2017

Toric Outcomes: Computer-Assisted Registration Versus Intraoperative Aberrometry

Solomon JD, Ladas J
J Cataract Refract Surg. 2017;43:498-504

Delivering Optimal Outcomes

As patient expectations continue to rise, refractive cataract surgery is becoming the norm for many cataract surgeons around the world.

As such, the management of astigmatism is crucial in delivering optimal outcomes to patients. An increasingly popular way to manage astigmatism is with the use of a toric (astigmatism correcting) intraocular lens (IOL).

Study Summary

Solomon and Ladas compared outcomes using intraoperative aberrometry and intraoperative markerless guidance for toric IOL placement.

This was a consecutive contralateral eye study, where the first eye was randomly assigned to aberrometry or markerless guidance, and the fellow eye received the other modality.

They found that both groups showed a meaningful improvement in refractive astigmatism, with over 75% of patients having <0.50 diopters postoperatively. That being said, the markerless guidance group showed a statistically significant improvement in mean remaining refractive astigmatism compared with intraoperative aberrometry in this matched cohort.

The study was not without limitations. One notable limitation was the lack of inclusion of posterior corneal astigmatism in toric calculations. The authors did, however, place the cataract incision at the horizontal meridian, thereby offsetting the average amount of posterior cylinder as determined by Koch and colleagues.[1] Another limitation was that patients in the aberrometry group were not oriented with the newest version of the software (VerifEye+™).


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