Aberrometric And Visual Outcomes Following Toric Intraocular Lens Implantation With Astigmatic Axis Flip

To compare postoperative aberrometric and visual outcomes between eyes with and without an astigmatic axis flip after toric intraocular lens (IOL) implantation.

Tertiary referral ophthalmology center, Instituto de Oftalmologia Conde de Valenciana, Mexico City, Mexico.

This comparative cross-sectional study included patients who underwent uneventful cataract surgery with toric IOL implantation. Eyes were classified into undercorrection without an axis flip and overcorrection with an axis flip. Postoperative evaluation included uncorrected and best-corrected visual acuity, spherical equivalent refraction, and aberrometry using the Pentacam AXL Wave. Aberrometric parameters included total higher-order aberrations (HOA), coma, spherical aberration, and trefoil. Intergroup comparisons were performed using independent-samples t tests. A p value < 0.05 was considered statistically significant.

Eighty eyes of 80 patients (mean age 67.16 ± 11.49 years) were analyzed. No significant differences were found between axis flip and no-axis flip groups in postoperative uncorrected visual acuity (p = 0.628), best-corrected visual acuity (p = 0.685), or spherical equivalent refraction (p = 0.455). Total HOA, coma, and spherical aberration were comparable between groups (all p > 0.05). The axis flip group demonstrated higher trefoil aberration than the no-axis flip group (0.15 ± 0.06 µm vs 0.08 ± 0.09 µm; p < 0.001).

Astigmatic axis flip during toric IOL implantation was not associated with differences in postoperative visual outcomes despite a significant increase in trefoil aberration. When carefully planned preoperatively, axis flip may represent a viable refractive strategy to minimize residual astigmatism without compromising visual performance.