Astigmatism deserves planning, not improvisation.
In cataract surgery, the cloudy natural lens is replaced by an intraocular lens. If the patient also has corneal astigmatism, ignoring it may limit final sharpness and increase dependence on distance glasses.
When astigmatism is regular, meaningful and confirmed by reliable measurements, its correction should be a priority in the surgical plan. A toric lens is one of the main tools for that.
What is a toric lens?
A toric intraocular lens has specific correction for astigmatism. It must be calculated and positioned at a planned axis, because rotation can reduce part of the intended effect.
In simple terms, a standard lens mainly corrects spherical power; a toric lens also corrects a specific direction of curvature.
When it often makes sense
- Regular corneal astigmatism repeated across measurements.
- A goal of sharper distance vision with less dependence on glasses.
- Monofocal, EDOF or multifocal planning where residual cylinder would matter.
- A stable ocular surface after dry eye treatment when needed.
If the goal is high-quality vision, astigmatism should not be considered a small detail. It can be the difference between acceptable and cleaner vision.
Multifocal, EDOF and astigmatism
When a multifocal or EDOF lens is being considered, astigmatism correction becomes even more important. These lenses aim to expand the range of focus; to work well, the optical system should be well aligned. In selected cases, a toric version can combine astigmatism correction with greater glasses independence.
This does not mean every patient with astigmatism needs a toric lens. It means every relevant astigmatism should be measured, discussed and planned.
What may change the plan
Irregular cornea, untreated dry eye, inconsistent measurements, previous surgery, keratoconus, retinal disease or mismatched expectations may change the indication. Sometimes the best plan is partial correction, light glasses afterwards or a lens with more predictability.
Practical summary
In cataract surgery, astigmatism correction should be prioritized when technically indicated. A toric lens may improve visual quality and reduce glasses dependence, provided calculation, axis alignment and patient selection are done carefully.
Sources and notes
Educational content; it does not replace a medical consultation. Useful references: National Eye Institute - Cataracts, FDA - What is LASIK?, FDA - LASIK risks, AAO Eye Health and ESCRS Patient Portal.
Would you like to discuss your case?
The Scopo team can help schedule a visit with Dr. Marcelo Muce.