Minimizing Astigmatism in Cataract Surgery

Sumit (Sam) Garg, MD


October 19, 2017


I found this study to be interesting given the various approaches that surgeons have to orient toric IOLs.

One key to toric IOL orientation is accurate determination and marking of the reference axis. In my experience, marking "freehand" with a pen is fraught with potential errors. For all measurements (eg, biometry, topography/tomography), it is important that patients be measured in an upright position. If not, one can experience significant errors in the orientation of the toric IOL.

Additionally, management of the ocular surface (eg, dry eye disease, tear film quality) and repeatability of measurements are vital.

This study highlights that both intraoperative aberrometry and intraoperative markerless guidance are effective in helping to achieve low amounts of astigmatism with a slight edge toward markerless guidance.

With the increasing availability of presbyopia-correcting toric IOL platforms, accurate and repeatable methods for toric IOL orientation are needed. There is no foolproof method for toric IOL orientation, and there are certainly patient factors that play a role. Perhaps with additional studies, diagnostics, IOL technologies, improved toric calculators, and intraoperative tools, we may approach LASIK-like predictability for our refractive cataract patients.


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