Toric intraocular lenses for patients with cataract

Evidence Summaries for Current Care Guidelines
Jorma Komulainen

Level of evidence: B

Toric intraocular lenses reduce need for spectacles and improve acuity compared to nontoric intraocular lenses in patients with regular corneal astigmatism having cataract surgery.

A systematic review and meta-analysis «Kessel L, Andresen J, Tendal B ym. Toric Intraocul...»1 aimed to evaluate the benefit and harms associated with implantation of toric intraocular lenses (IOLs) during cataract surgery. Outcomes were postoperative uncorrected distance visual acuity (UCDVA) and distance spectacle independence. Harms were evaluated as surgical complications and residual astigmatism. Randomized clinical trials (RCTs) were included, if they compared toric with non-toric IOL implantation (± relaxing incision) in patients with regular corneal astigmatism and age-related cataracts.

Alltogether 13 RCTs with 707 eyes randomized to toric IOLs and 706 eyes randomized to non-toric IOLs were included in the analysis; 225 eyes had a relaxing incision. There was high-quality evidence that UCDVA was better in the toric IOL group (logarithm of the minimum angle of resolution (logMAR) mean difference, -0.07; 95 % CI, -0.10 to -0.04) and provided greater spectacle independence (risk ratio [RR], 0.51; 95 % CI, 0.36–0.71) and moderate quality evidence that toric IOL implantation was not associated with an increased risk of complications (RR, 1.73; 95 % CI, 0.60–5.04). Residual astigmatism was lower in the toric IOL group than in the non-toric IOL plus relaxing incision group (mean difference, 0.37 diopter (D); 95 % CI, -0.55 to -0.19).

  • Study quality: high
  • Appicability: good
  • Comment: Level of evidence is downgraded due to marked heterogeneity in some of the outcomes.


  1. Kessel L, Andresen J, Tendal B ym. Toric Intraocular Lenses in the Correction of Astigmatism During Cataract Surgery: A Systematic Review and Meta-analysis. Ophthalmology 2016;123:275-86 «PMID: 26601819»PubMed