Astigmatism Correction Methods

Are You Ready to Offer Every Cataract Patient
the Highest Quality of Vision?

Managing cataract patients' astigmatism can mean a few things: glasses, LRIs, toric IOLs. Delivering great visual outcomes for your patients starts with your method of Astigmatism Management.

What is the optimal Astigmatism Management method for this astigmatic eye?


Opting for spectacles for astigmatic cataract patients means leaving corneal astigmatism unmanaged.

With glasses, only the center of the visual field achieves full astigmatism and spherical correction.

With glasses, only the center of the visual field achieves full astigmatic and spherical correction.

  • Peripheral vision remains poor.
  • Optimal correction moves with the patient’s head, not their moving line of sight.

Corneal Incisions

When you decide to manage a cataract patient's astigmatism at the time of surgery, you may consider limbal relaxing incisions. However, manual LRIs have been shown to produce suboptimal outcomes1,2:

  • Degrade over time, resulting in increased refractive error1,2
  • Inferior astigmatic reduction1
  • Inferior post-op UCDVA and residual astigmatism1,2
  • Less predictability
    • Learn more about the unpredictable nature of corneal incisions

Distance Spectacles Required After Cataract Surgery1

More LRI patients required glasses for distance vision 3 months after surgery than toric IOL patients.

Patient-reported need for distance spectacles 3 months postoperatively. Preoperative spectacle usage by group: toric IOL n=17 (85%); incision n=18 (80%). Postoperative spectacle usage by group: toric IOL n=3 (15%); incision n= 9 (45%). No statistical analysis was undertaken of patient-reported data.

Toric IOLs

Toric IOLs can deliver optimal quality of vision, both for patients with significant astigmatism (> 1.5 D) and for those with less (0.5 D–1.5 D).*,3-6

Toric IOLs can help you target precise outcomes.   Target precise outcomes7
Toric IOLs predictable, longer-lasting results than LRIs.   Predictable, longer-lasting results than LRIs1,2
Toric IOLs are designed to reduce spectacle dependence for distance vision.   Designed to increase spectacle independence for distance vision8
Toric IOLs with high stability can help secure optimal outcomes.   Established rotational and axial stability9-13

Toric IOLs like those designed by Alcon can help you deliver precise, optimized outcomes for patients with astigmatism as low as 0.5 D ATR.*,9-14 Learn more about how AcrySof® IQ Toric IOLs can help you manage astigmatism.

*Potential Astigmatism Management patients may have 0.75 D or higher total corneal astigmatism, including those with 0.5 D or higher against-the-rule (ATR) anterior cylinder, as well as patients with 1.25 D or higher with-the-rule (WTR) anterior cylinder.

Discover the Keys to Planning Astigmatism Management Procedures


  1. Mingo-Botín D, Muñoz-Negrete FJ, Kim HRW, Morcillo-Laiz R, Rebolleda G, Oblanca N. Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery. J Refract Surg. 2010;36(10):1700-1708.
  2. Kessel L, Andresen J, Tendal B, Erngaard D, Flesner P, Hjortdal J. Toric intraocular lenses in the correction of astigmatism during cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2016;123(2):275-285.
  3. Watanabe K, Negishi K, Kawai M, Torii H, Kaido M, Tsubota K. Effect of experimentally induced astigmatism on functional, conventional, and low-contrast visual acuity. J Refract Surg. 2013;29(1):19-25.
  4. Miller A, Kris M, Griffiths A. Effect of small focal errors on vision. Opt Vis Sci. 1997;74(7):521-526.
  5. Hill Distribution Data. Provided courtesy of Dr. Warren Hill. Accessed November 16, 2016.
  6. Pineda R, Denevich S, Lee WC, Waycaster C, Pashos C. Economic evaluation of toric intraocular lens: a short- and long-term decision analytic model. Arch Ophthalmol. 2010;128(7):834-840.
  7. Ernest P, Potvin R. Effects of preoperative corneal astigmatism orientation on results with a low-cylinder-power toric intraocular lens. J Refract Surg. 2011;37:727-732.
  8. Ahmed I, Rocha G, Slomovic A, et al. Visual function and patient experience after bilateral implantation of toric intraocular lenses. J Refract Surg. 2010;36:609-616.
  9. Lane SS, Burgi P, Milios GS, Orchowski MW, Vaughan M, Schwarte E. Comparison of the biomechanical behavior of foldable intraocular lenses. J Cataract Refract Surg. 2004;30:2397-2402.
  10. Lane SS, Ernest P, Miller KM, Hileman KS, Harris B, Waycaster CR. Comparison of clinical and patient reported outcomes with bilateral AcrySof® Toric or spherical control intraocular lenses. J Refract Surg. 2009;25(10):899-901.
  11. Wirtitsch MG, et al. Effect of haptic design on change in axial lens position after cataract surgery. J Cataract Refract Surg. 2004;30(1):45-51.
  12. Nejima R, et al. Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece hydrophobic acrylic foldable intraocular lenses. Ophthalmology. 2006;113(4):585-590.
  13. Koshy JJ, Nishi Y, Hirnschall N, et al. Rotational stability of a single-piece toric acrylic intraocular lens. J Cataract Refract Surg. 2010;36(10):1665-1670.
  14. AcrySof® IQ Toric IOL Directions for Use.



CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ Toric posterior chamber intraocular lenses are intended for primary implantation in the capsular bag of the eye for visual correction of aphakia and pre-existing corneal astigmatism secondary to removal of a cataractous lens in adult patients with or without presbyopia, who desire improved uncorrected distance vision, reduction of residual refractive cylinder and increased spectacle independence for distance vision.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Toric IOLs should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation. All viscoelastics should be removed from both the anterior and posterior sides of the lens; residual viscoelastics may allow the lens to rotate.

Optical theory suggests that high astigmatic patients (i.e., > 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ Toric Cylinder Power IOLs.

Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.