Cataract Surgery With Astigmatism

Cataract surgery is one of the safest and most commonly performed eye-care procedures, in which an eye doctor replaces a patient’s clouded lens with an artificial ocular lens to improve vision.

While cataract surgery is primarily used to treat cataracts, it can also correct other ocular conditions. One of these is astigmatism. There are several ways to correct astigmatism through cataract surgery, so it is vital patients understand more about this procedure and the options available.

Astigmatism is a common refractive error that affects around 1 in 3 Americans. It occurs when the cornea of the eye is unevenly curved.

A healthy eye has a round shape that looks similar to a basketball ball. Patients with astigmatism have a curved eye that resembles a football.

This uneven curvature affects how light passes through the eye and can cause blurry, fuzzy, or distorted vision at close and long ranges.

There are many ways to treat astigmatism. Patients can opt for non-invasive treatments such as eyeglasses or contacts.

Patients can also choose from a variety of refractive surgeries where an eye doctor reshapes their cornea with a laser. These include LASIK, LASEK, PRK, and cataract surgery.

Cataract surgery is one of the surgical treatments for astigmatism. During the procedure, patients can treat astigmatism in conjunction with their cataracts.

When considering cataract surgery with astigmatism, patients can select between several treatment options. These include receiving specialty lens implants that correct astigmatism or getting additional incisions during surgery that reshape the cornea.

Having cataract surgery with astigmatism offers many benefits for patients:

Data suggests that, when left untreated, astigmatism often gets worse after cataract surgery. Even if astigmatism does not worsen, without treatment patients will continue to experience vision problems related to astigmatism.

People’s vision deteriorates as they age. Correcting conditions such as astigmatism as early as possible can improve a patient's future visual outlook.

Many patients experience higher satisfaction when they correct multiple visual problems in one procedure.

Toric lenses are specialty lens implants that patients can choose during cataract surgery. They differ from standard monofocal lenses used in cataract surgery as they have different powers in different meridians.

When a doctor inserts a toric lens into a patient's eye, they can rotate the lens on its axis to correct astigmatism. At our office, some monofocal lenses and all presbyopia-correcting premium IOLs are available in a toric version.

Toric lenses come with several pros and cons:

• Patients can usually enjoy a quick recovery time.

• Lenses are unlikely to induce irregular astigmatism.

• With advancing lens technology it may be possible to correct higher amounts of astigmatism.

• Toric lenses are not covered by health insurance. Patients will need to pay out of pocket for the procedure.

• Lenses can rotate in the eye and cause problems. If this occurs, the patient may need to return to the operating room to realign the intra-ocular lens.

• Toric lenses cannot correct certain types of astigmatism, such as irregular astigmatism.

Limbal relaxing incisions (LRIs) are minor incisions that can be made during cataract surgery. The procedure entails partial thickness incisions made on the outer, non-seeing corner of the eye, the limbus, which causes the steepest part of the cornea’s curvature to relax and be more evenly round.

The goal of the incisions is to flatten the steep curvature of the cornea and allow the eye to mold into a spherical shape. This rounded shape improves the focusing ability of the eye and corrects astigmatism. When done properly it can reduce or even eliminate the need for distance glasses or contacts.

The Limbal Relaxing Incisions procedure takes about five minutes per eye, can be performed with anesthetic eye drops solely, and does not require stitches.

Limbal relaxing incisions come with pros and cons:

• The technique is quick and easy to perform. It adds minimal time to the cataract procedure.
  

• The incisions address the source of the problem (the cornea).
  

• No possibility of rotating lenses like with Toric lenses.
  

• Can work well for asymmetric corneal astigmatism.

• Incisions can be more irritating than lens replacements.
  

• Large incisions are less predictable, occasionally gape, can be difficult to hydrate, and sometimes require sutures.
  

• LRIs cannot be used in a patient with keratoconus.