Cataract Surgery With Astigmatism: A Comprehensive Guide for Patients

If you have astigmatism and are considering cataract surgery, it is important to be aware of the risks involved. Toric intraocular lenses (IOLs) are a popular surgical device used to correct astigmatism during cataract surgery, but they may not be the best option for all patients. Toric IOLs are designed to be centered with a specific angle, or kappa, and must not be tilted in order to be effective. Other techniques for correcting astigmatism during cataract surgery include ray tracing, topography, and wavefront measurement. Toric IOLs offer surgeons a convenient and effective solution to correct astigmatism, but some surgeons are concerned about using the device when the cornea has a high degree of astigmatism. This is because changing the cornea's shape during cataract surgery requires predicting its healing pattern. To properly position the toric IOL, the ocular surface should be inspected for irregularities, and a small amount of capsulorhexis should be created to increase the IOL's rotational stability. In addition to a toric IOL, a phacoemulsification incision can be selectively placed to correct astigmatism. This can be accomplished by placing the phacoemulsification incision near the steepest meridian of the cornea. Other techniques for correcting astigmatism include using custom GP/scleral lenses, high index spectacle lenses, and expanding parameters for toric soft contact lenses. If you are considering having cataract surgery, you may have heard that toric IOLs are a good option. They correct astigmatism and allow patients to have better distance vision after surgery. However, toric IOLs have a high cost, so weighing the cost against the benefits is essential. In a systematic review, researchers looked at the effectiveness of toric IOLs compared to non-toric IOLs and found that toric IOLs improved visual acuity and reduced total astigmatism. A toric IOL is a single-piece lens with a unique marking on the lens periphery, which allows the surgeon to see where the correction is going. The markings also will enable the surgeon to verify that the IOL is in the correct position. The best candidates for toric IOL implantation are those with mild to moderate corneal astigmatism. A toric IOL is generally less likely to cause an adverse effect than a non-toric IOL, but it is essential to select the right patient. It's not a good idea to use a toric IOL if there is a history of corneal scarring, synechia, poorly controlled inflammation, or developmental abnormalities. Toric IOLs are considered safe for implantation but have higher upfront costs than standard IOLs. Therefore, discussing the long-term costs with patients is a good idea. Sometimes, a toric IOL and relaxing incision are good ways to compensate for astigmatism. In these cases, your doctor should be careful with the closure of the surgical wound and the positioning of the lens.

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