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A randomised prospective study of 'off-the-shelf' use of toric intraocular lenses (IOLs) for cataract patients with pre-existing corneal astigmatism in a public health sector setting

Poster Details

First Author: N.Stanojcic UK

Co Author(s):    S. Koay   H. Roberts   V. Wagh   B. Zuberbuhler   D. O'Brart        

Abstract Details


To compare visual and refractive outcomes of “off-the-shelf” use of toric IOLs, with a fixed 2 diopter (D) cylinder correction, compared to monofocal IOLs with limbal relaxing incisions (LRI) for cataract patients with pre-existing corneal astigmatism.


King's College London/Frost Research Unit, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH


66 patients (66 eyes, first treated eye) with visually significant cataract and pre-operative corneal astigmatism ≥2 D in a public health sector setting, were randomized to receive either “off-the-shelf” toric IOLs, with a fixed 2 D cylinder correction, or monofocal IOLs with limbal relaxing incisions (LRI). The concept of fixing the cylindrical correction at 2 D was to minimize costs, allow a full toric lens bank to be available and eliminate the need for individual toric IOL ordering. The primary outcome measure was uncorrected distance visual acuity (UDVA). The secondary outcome measures were corrected distance visual acuity (CDVA) and refraction.


Mean UDVA improved from logMAR 0.90 (standard deviation [SD] 0.58) pre-op to 0.20 (SD 0.20) post-op in toric group, versus 0.86 (SD 0.60) to 0.28 (SD 0.12) in mono/LRI group (P=.053; 95% confidence interval [CI] -0.16 to 0). Mean CDVA improved from logMAR 0.38 (SD 0.22) to 0.02 (SD 0.12) in toric IOL group, and 0.42 (SD 0.40) to 0.08 (SD 0.12) in monofocal group (P=.046; 95% CI -0.12 to -0.001). Average post-operative refractive cylinder in toric group was -1.39 D (SD 0.92 D) and in monofocal group -1.98 D (SD 1.09 D) (P=.021; 95% CI 0.09 to 1.09).


Our results show that the use of ‘off-the-shelf’ toric IOLs with a fixed cylinder correction during cataract surgery improves CDVA and reduces post-operative cylinder. This simplified approach towards toric IOL selection may allow us to provide better options for cataract patients with astigmatism within the remit of the National Health Service. However, monofocal IOLs with LRIs are also a valid option and appear to be comparable to ‘off-the-shelf’ toric IOLs.

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