Options for patients who have cataracts and astigmatism.

Cataract extraction with intraocular lens implantation is one of the most commonly performed procedures in the United States. Removal of a cataract involves exchanging an opacifying, natural lens of the eye with a synthetic intraocular lens (IOL). (For a more dynamic representation of cataracts and cataract extraction, visit our website at www.frangieeye.com).

Astigmatism is a common condition where the eye is unable to focus light into a single focal point without the use of a prosthesis – contact lenses or spectacles. Occasionally, the patient’s cataract is the source of astigmatism, therefore, simple cataract extraction simultaneously improves the quality of a patient’s vision and decreases or eliminates the astigmatic refractive error in their eye.

More frequently, astigmatism is a property of the outer window of the eye, the tissue known as the cornea. In corneal astigmatism, the outer window of the eye has two different curvatures. For years, ophthalmic surgeons attempted to modify the curvature of astigmatic corneas during cataract extraction by either modifying the surgical incision or placing “relaxing” incisions in the cornea. While these measures improved patient outcomes, there was still a high variability in patient outcomes. Essentially, the ability to correct corneal astigmatism at the time of cataract surgery was limited in predictability and effectiveness.

Approximately five years ago, intraocular lenses were designed with specific contouring designed to reduce the corneal astigmatism at the time of cataract surgery. These lenses are called TORIC lenses and have revolutionized cataract surgery as they reliably improve visual performance without any additional intraoperative risk. Technologic breakthroughs such as toric lenses are another major advance which allow eye surgeons the ability to customize patient’s treatments to maximize vision.

John P. Frangie, M.D.

Eye Physician & Surgeon