Astigmatism management for modern phaco surgery

Managing low corneal astigmatism in patients with presbyopia correcting intraocular lenses: a narrative review

Cataract surgery has become a refractive procedure in which emmetropia is the goal, with the implantation of extended depth-of-focus or multifocal intraocular lenses (IOLs) being the commonly selected option to restore vision beyond the far distance. The selection criteria for implanting these lenses can differ from those for monofocal IOLs and even between technologies, as eye characteristics can affect postoperative visual performance. Corneal astigmatism is an eye characteristic that can affect visual performance differently, depending on the implanted IOL. The magnitude of corneal astigmatism, the tolerance of the IOL to this astigmatism, economic aspects, comorbidities, and the efficacy of astigmatism treatment are factors that can make surgeons' doubt as to what astigmatism treatment should be applied to each patient. This review aims to summarize the current evidence related to low astigmatism tolerance in presbyopia-correcting lenses, the efficacy achieved through corneal incisions, and their comparison with the implantation of toric IOLs.

Central Corneal Thickness of a Saudi Population in Relation to Age, Gender, Refractive Errors, and Corneal Curvature

Background In this study, we aimed to investigate the relationship between central corneal thickness (CCT) and age, gender, refractive errors, and corneal curvature in a Saudi population. Methodology In this randomized, hospital-based, retrospective study, data were collected from Dr. Sulaiman Al Habib Hospital and Imam Medical Center, Riyadh. A total of 1,005 eyes were included and recruited from patients referred to the refractive surgery clinic for Lasik assessment. The study included patients aged between 17 and 57 years with no history of any ocular pathology, eye surgeries, and systemic disease, as well as all groups with stable refractions. The identifying data were the age and gender of the patients, as well as their CCT, refraction, and corneal curvature. CCT and corneal curvature were measured by ultrasound pachymeter Pentacam. Results The distribution of CCT was 543.81 ± 34.47 μm. A significant difference in the mean CCT was observed across different refractive errors (p = 0.004). Patients with astigmatism had the lowest CCT, followed by myopic and hyperopic patients. An association between the spherical equivalent of patients with myopia and CCT (p = 0.001) was noted. Conclusions In the Saudi population, we found no significant association between mean corneal curvature and CCT in all three groups. Spherical equivalent in myopic patients was significantly associated with CCT. A significant difference in the mean CCT was observed across different refractive errors. There was a significant negative and weak correlation between age in myopic and astigmatism patients and CCT. Gender was significantly associated with CCT in patients with astigmatism.

Consensus on the management of astigmatism in cataract surgery

This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.