Low-level residual astigmatism can degrade visual acuity after intraocular surgery
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Residual astigmatism, even at low levels, can degrade visual acuity after intraocular surgery, according to a study published in the Journal of Cataract & Refractive Surgery.
“There have been no studies that were sufficiently powered to investigate the independent effect of low amounts of astigmatism on the outcomes of pseudophakic patients,” Steven C. Schallhorn, MD, told Healio|OSN. “Hence, the purpose of the study was to evaluate the effect of residual astigmatism on postop acuity and satisfaction in a large cohort of patients undergoing refractive lens exchange or cataract surgery.”
Schallhorn and colleagues assessed the effect of residual astigmatism on 3-month postoperative monocular uncorrected distance visual acuity using data from patients who previously underwent refractive lens exchange or cataract surgery. The analysis was based on outcomes of 17,152 dominant eyes.
The odds of not achieving 20/20 vision in eyes with 0.25 D to 0.5 D of residual astigmatism, compared with eyes with 0 D of residual astigmatism, increased by a factor of 1.7 with monofocal IOLs and 1.9 with multifocal IOLs (both P < .0001). In eyes with 0.75 D to 1 D of residual astigmatism, the odds ratio for not achieving 20/20 vision was 6.1 with monofocal IOLs and 6.5 with multifocal IOLs (both P < .0001).
Residual astigmatism in the range of 0.75 D to 1 D also increased dissatisfaction with vision. The axis of astigmatism had no impact on postoperative unaided vision or satisfaction.
“While some residual astigmatism is inevitable after intraocular surgery, our results provide evidence that it degrades visual acuity and reduces patient satisfaction, even at lower levels,” Schallhorn said. “Although various thresholds for the minimum corneal astigmatism that should be managed during cataract surgery have been recommended, this study demonstrates that corneal astigmatism of 0.5 D or more deserves attention during surgical planning.”
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Schallhorn SC, et al. J Cataract Refract Surg. 2021;doi:10.1097/j.jcrs.0000000000000560.
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