LONG-TERM VISUAL AND QUALITY OF LIFE OUTCOMES FROM RANDOMIZED CONTROLLED STUDY COMPARING LIMBAL RELAXING INCISIONS VERSUS TORIC INTRAOCULAR LENS IMPLANTATION FOR CORRECTION OF ASTIGMATISM DURING STANDARD CATARACT SURGERY.

To compare the long-term visual outcomes and vision-related quality of life outcomes in patients undergoing limbal relaxing incision/s (LRI) vs toric intraocular lenses (IOL) for astigmatic correction between 0.75 to 2.5 diopters during standard cataract surgery 

Tertiary care eye hospital; Randomised clinical control trial

Patients for standard cataract surgery with astigmatism between 0.75D to 2.5D who consented to participate were randomised to receive either LRI or toric IOL. All surgeries were performed by a single experienced surgeon. Patients were assessed pre-operatively and at 1-month, 1 year and 5-years after surgery and a validated questionnaire consisting of 20 questions scored on a 5-category response scale was completed on each visit. Primary outcome measure was uncorrected logMAR distance visual acuity (UCDVA); secondary outcome measures were Quality of Life Impact of Refractive Correction (QIRC) score, best-corrected logMAR distance visual acuity (BCDVA), residual spherical equivalent and refractive astigmatism. Statistical analysis was performed using unpaired 2-tailed t-test and P value <0.05 was considered as significant. 

Thirty-four patients toric IOL implantation (group 1) and 36 had LRIs (group 2) during their cataract surgery. Mean age of study population was 73±3 years (M:F=30:40); both groups were comparable in terms of pre-operative axial length, keratometry, astigmatism, UCDVA and BCDVA. For group 1 vs. group 2, mean UCDVA was 0.19±0.19 vs. 0.23±0.24 at 1 month (P=0.43); 0.18±0.20 vs. 0.19±0.20 at 1 year (P=0.85) and 0.21±0.21 vs. 0.18±0.19 at 5 years (P=0.61) respectively. Mean BCDVA was better in group 2 at 1 month (P=0.02); however, there was no statistically sigbificant difference in BCDVA in both groups at 1 year (P=0.51) and 5 years (P=0.18). Residual mean arithmetic spherical equivalent values in group 1 and 2 were -0.08 ±0.69 and -0.15±0.47 at 1 year (P=0.69) and -0.25 ±0.64 and -0.32±0.90 at 5 years (P=0.78). Residual mean arithmetic cylinder values in group 1 and 2 were -0.31 ±0.53 and -0.30±0.50 at 1 year (P=0.97) and -0.81 ±0.51 and -0.77±0.51 at 5 years (P=0.78). Mean overall QIRC scores improved from 47.27±6.34 pre-operatively to 52.43±5.11 at 1-year and 51.06±6.80 at 5 years; sub-group analysis did not reveal any significant difference between the two groups (P>0.05).

Cataract surgery combined with astigmatic correction offered an improvement in quality of life for both groups. Astigmatic correction with LRIs or toric IOLs offers similar 1 year and 5-year visual outcomes for astigmatism between 0.75 to 2.5 dioptres.