Strategy for Astigmatism Management in Refractive Cataract Surgery
Narrative Responses:
Purpose
Residual astigmatism has a negative impact on patient satisfaction and spectacle independence in refractive cataract surgery. This paper explores the evolution of a successful approach to astigmatism management.
Methods
The following approach to astigmatism management is detailed: Patients with 0.5 D to 1.0 D of astigmatism get “smart blade” limbal relaxing incisions (LRIs) with placement guided by intraoperative aberrometry (ORA with Verifeye), rather than femtosecond laser arcuate incisions that are programmed based on preoperative information. Patients with >1.0 D of astigmatism get femtosecond laser surgery with a toric IOL, with lens selection and axis position guided by intraoperative aberrometry. Objective aphakic vs. pseudophakic astigmatism results are calculated for each group.
Results
Smart-blade LRIs permit the surgeon to take advantage of high-precision measurement of astigmatism. This produces excellent results for lower astigmats, while toric IOLs are more reliable above 1.0 or 1.25 D. Objectively, cylinder in the IOL group (n=36) was reduced from 1.36 ± 0.4 D at the aphakic ORA measurement to 0.36 ±0.24 D at the final pseudophakic measurement on the table. Cylinder in the LRI group (n=29) was reduced from 0.72 ± 0.3 D at the aphakic measurement prior to LRI to 0.33 ± 0.17 D at the final pseudophakic /post-LRI measurement.
Conclusion
In the current era of advanced technology for refractive cataract surgery, it is important to develop a personal algorithm based on the magnitude of astigmatism for the treatment of refractive cataract patients. Intraoperative aberrometry-guided smart-blade LRIs for lower astigmats and toric IOLs for higher astigmats offer excellent results.