Real-world outcomes of low-cylinder-power toric intraocular lenses in eyes with mild corneal astigmatism

Purpose: To evaluate the effectiveness of astigmatism correction using low-cylinder-power monofocal toric intraocular lenses (IOLs) in eyes with mild corneal astigmatism.

Setting: Tertiary care center in Osaka, Japan.

Design: Single-center ambispective observational cohort study.

Methods: Eyes were categorized into the T2 group (toric IOL with 1.0 diopter [D] cylinder power at the IOL plane), nontoric IOL (T0) group, or Tx group (T3 or higher toric IOLs; ≥1.5 D cylinder power). Eyes with irregular corneal astigmatism or prior ocular surgery were excluded. 3-month outcomes included uncorrected distance visual acuity (UDVA), refractive and subjective astigmatism, and vector analysis.

Results: 75 eyes (25 per group, 46 patients) were analyzed. At 3 months, the T2 group showed significantly lower mean refractive astigmatism (0.45 ± 0.25 D) and subjective astigmatism (0.28 ± 0.34 D) than the T0 group (0.92 ± 0.31 D and 0.69 ± 0.33 D; both P = .000), with better UDVA (logMAR -0.05 ± 0.12 vs 0.08 ± 0.15; P = .002). In paired-eye analyses, T0 eyes had greater refractive astigmatism (0.92 ± 0.32 D) and subjective astigmatism (0.69 ± 0.33 D) than their Tx fellow eyes (0.53 ± 0.33 D; P < .001 and 0.39 ± 0.32 D; P = .002). T2 achieved astigmatism correction comparable with that of Tx in mild-astigmatism eyes. Tx eyes trended toward better UDVA than their T0 fellows ( P = .060).

Conclusions: Low-cylinder-power toric IOLs effectively corrected astigmatism and improved visual outcomes in eyes with mild corneal astigmatism, a population previously excluded from toric IOL implantation.