Achieving Astigmatism Correction In The Nhs: Visual, Refractive And Patient-Reported Outcome Measures In A High-Volume Cataract Service

Toric intraocular lenses (IOLs) offer the unique opportunity to correct pre-existing corneal astigmatism during cataract surgery and enable patients to achieve emmetropia and reduce spectacle dependence. Despite these known benefits, toric IOLs are still not widely used in the public healthcare system with only very few units across the UK routinely using them. Furthermore, there is limited literature on their impact on patient-reported outcome measures (PROMs). The main aim of our study was to assess the visual, refractive and visual function outcomes in this cohort using the Cat-PROM5 questionnaire, administered by Dora, a novel artificial intelligence–based conversational agent.

Stoke Mandeville NHS Foundation Trust, Aylesbury, United Kingdom

This retrospective observational case series included all patients undergoing routine cataract surgery with toric IOL implantation at Stoke Mandeville Hospital, UK between March 2024 and May 2025. Eligible patients were identified from MediSite and cross-referenced with those who had completed both pre- and post-operative calls via Dora. The pre-operative assessment was conducted 1–2 weeks before surgery and post-operative follow-up approximately 12 weeks after surgery. Dora administered the Cat-PROM5 survey adapted for voice conversation to evaluate subjective visual function before and after surgery. The main outcome measures were visual, including vision and refraction, and CAT-PROM5 scores.

A total of 5722 cataract surgeries were performed during the study period and 642 utilised toric IOLs. 73 eyes from 53 patients that had vision, refractive and visual function outcomes were included. The mean pre-op corneal astigmatism was 2.04±0.93D. A paired t-test demonstrated that there was a significant improvement in BCVA from 0.30±0.15 logMAR  pre-operatively to 0.11±0.02 logMAR post-operatively (p<0.0001). The mean post-op residual astigmatism was 0.73D and the mean absolute deviation from predicted spherical equivalent was 0.10 D. There was also a significant improvement in Cat-PROM5 score from 50.5±14.0 pre-operatively to 74.7±18.8 post-operatively (p<0.0001).

Routine use of toric IOLs in a high-volume NHS setting yields good improvement in vision and effective reduction in astigmatism. Patients also experienced perceivable improvement in subjective vision following toric IOL implantation. By offering NHS patients with high pre-existing corneal astigmatism toric IOLs, units may able to offer superior visual, refractive and visual function outcomes.