Factors Predictive of Refractive Error After Toric Lens Implantation

Abstract

Purpose

To identify factors related to suboptimal refractive outcomes after toric intraocular lens implantation.

Patients and Methods

A retrospective case-control chart review of 446 eyes with toric lens insertion by the same surgeon at a university hospital from 2016 to 2020 was conducted. Pre-operative exam findings, biometry, and one month and three month post-operative vision and refraction were noted. Reviewed charts were considered cases if uncorrected distance visual acuity (UDVA) was worse than 20/40, spherical equivalent (SE) >1 diopter (D) off target, or cylinder >1 D off target. 

Results

Overall, 93.7% (n = 343) of eyes achieved UDVA of 20/40 or better, 92.7% (n = 306) were within 1 D of target SE, and 90.9% (n = 300) were within 1 D of target cylinder. UDVA cases had more eyes with prior LASIK (21.7% vs 7.0%, p = 0.01) and keratoconus (8.7% vs 0.6%, p < 0.001) than controls. More SE cases had prior radial keratotomy (RK) (8.3% vs 0%, p < 0.001) and keratoconus (12.5% vs 0%, p < 0.001) than controls. More cylinder cases had prior LASIK (30.0% vs 8.7%, p < 0.001) and higher mean astigmatism (2.3 vs 1.5 D, p = 0.02) than controls. More cases in all three analyses had higher toric cylinder power (T5-T9) than controls. Age, sex, eye laterality, axial length, anterior chamber depth, lens power, dry eye, anterior basement membrane dystrophy, and Fuchs’ endothelial dystrophy differences were not significant.

Conclusion

Prior LASIK or RK, keratoconus, and higher astigmatism may increase the chance of a suboptimal outcome.

Keywords:

• cataract surgery
• refractive surgery
• astigmatism

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was funded by the Medical Student Training in Aging Research (MSTAR) Program and by an unrestricted grant from the Rosenthal Family.