Comparison Of Toric Intra-Ocular Lens Outcome In A Public Hospital Versus A Private Center

Success with toric intraocular lenses (IOLs) requires meticulous measurements and calculations. The purpose of the current study is to compare the results of toric IOLs in a public hospital (PH), which conducts fewer preoperative exams and employs a variety of surgeons, with those of a private center (PC), offering extensive preoperative examinations and two experienced surgeons.

Ophthalmology Department, Wolfson Medical Center, Israel; Ein-Tal Medical Center, Israel.

A retrospective chart review of patients who underwent uneventful cataract surgery with toric IOL implantation in PH and PC was conducted. Data were compared for demographics, ocular characteristics, postoperative spherical equivalent (SE) refraction, postoperative residual refractive astigmatism (RA), and IOL stability.

Included in the study were 238 eyes, 121 (51%) from the PH. A lower rate of SE within ±0.5D was achieved in the PH compared to PC (87% vs. 96%, respectively, p=0.03). Similar results, with no significant differences, were seen in the respective mean ± SD SE (-0.08D ± 0.33 vs. -0.11D ± 0.27); mean absolute SE (0.21D vs. 0.21D); percentage of SE within ±0.25D (78% vs. 77%), ±0.75D (97% vs. 99%) and ±1.0D (100% vs. 99%); the percentage of postoperative RA within <0.5D (83% vs. 83%), <0.75D (92% vs. 95%) and <1.0D (96% vs. 97%); postoperative mean centroid RA (0.11D@41±0.49 vs. 0.05D@54±0.47); mean absolute RA (0.29D vs. 0.34D); and IOL misalignment  (3.28±3.20 vs. 3.55±3.81).

Comparable outcomes were achieved in most accuracy metrics between PH and PC. Our results suggest that in standard cases, extensive preoperative evaluations do not necessarily correlate with improved post-operative outcomes, even in the presence of highly experienced surgeons. Nevertheless, caution must be taken into account when discussing challenging cases.