Age- And Sex-Dependent Shift In Corneal Astigmatism Orientation In Greek Cataract Surgery Candidates
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT259 | Type: Poster | DOI: 10.82333/m8fr-hj63
Authors: Dr Athanasios Zisimopoulos* 1 , Dr Dimitra Sakka 1 , Dr Efthymia Kalogera 1 , Dr Efstathios Athanasopoulos 1 , Dr Ioannis Markopoulos 1 , Dr Christina Kourentis 1 , Dr Kalliroi Konstantopoulou 1 , Dr Iakovos Michail 1 , Dr Kalliopi Diamantopoulou 1 , Dr Ioannis Halkiadakis 1 , Dr Efstratios Paroikakis 2 , Dr Vasileios Peponis 1 , Dr Michael Karampelas 1
1A Ophthalmology Department,Ophthalmiatreio Athinon,Athens ,Greece, 2B Ophthalmology Department,Ophthalmiatreio Athinon,Athens ,Greece
Purpose
To investigate age- and sex-related patterns in anterior corneal astigmatism magnitude and axis orientation among phacoemulsification candidates in Greece.
Setting
Ophthalmiatreio Athinon, a public, tertiary, Specialized Eye Hospital, in Athens, Greece
Methods
A retrospective cross-sectional analysis was conducted on consecutive adult phacoemulsification surgery candidates undergoing biometry, using Swept Source – Optical Coherence Tomography (Argos; Alcon, Fort Worth, TX, USA) between July 2024 and July 2025. Corneal astigmatism magnitude was calculated as |K2–K1|. Axis orientation was classified as with-the-rule (WTR) when the steep meridian lay within ±30° of 90°, and against-the-rule (ATR) when within ±30° of 180°. Patients were stratified into predefined age groups of an interval of 10 years.
Results
The study included 6,258 eyes from 3,726 patients (58.9% female; mean age 73.36±8.41 years). Mean anterior corneal astigmatism was 0.99 ± 0.94 D (median 0.78 D). Astigmatism axis orientation demonstrated a significant age-dependent shift from WTR to ATR (p<0.0001). In female eyes, WTR astigmatism predominated through the sixth decade, with ATR becoming dominant from the seventh decade onward and reaching 55.0% in the 80–89-year group. Male eyes showed an earlier and steeper transition, with ATR dominance occurring one decade earlier, accounting for 57.3% in the 70–79-year group and 69.6% in the 80–89-year group. Sex differences in axis distribution were significant in the 60–69 (p=0.0145), 70–79 (p<0.0001), and 80–89 (p<0.0001) age groups.
Conclusions
An age-related shift from WTR to ATR anterior corneal astigmatism was observed in Greek cataract patients, occurring earlier and more prominently in males. These findings may have implications for preoperative astigmatism management and toric intraocular lens planning in older adults.