How To Correct Astigmatism During Cataract Surgery-Eye Doctor Explains

Cataract surgery is no longer used just to remove cloudy lenses, it is also an opportunity to correct vision at the same time. Many have the goal to be less dependent on glasses, and there are many ways to get there, which is exciting but sometimes confusing! Today, I'll discuss the various ways that astigmatism can be corrected during cataract surgery, the resulting vision expectations, and the vision correction that may be expected to be necessary for each option.

Keep in mind that these expectations assume that there are no other significant ocular diagnoses and surgical results may vary. It's best to discuss with your provider and surgeon what your expectations and desires are for your vision, what lens and treatment options you may be a candidate for, and what is likely to get you the most ideal result possible.

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Lens Implant Options:

Light Adjustable Lens:


Reasonable Vision Correction Expectations for Lens Implants and Other Surgical Options:

Toric IOL:
Mid-range and near glasses needed

Toric Multifocal IOL:
May need reading glasses for some circumstances

Monovision:
May need glasses for some circumstances like night driving and long-term near work

Light Adjustable Lens:
Minimal dependence

Standard IOL:
Will not correct astigmatism
Still dependent on glasses for all distances

AK & LRI (Incisions used to correct astigmatism):
Varies Depending on intraocular lens choice

CCI (Incisions used to correct astigmatism. *Note: No additional incisions made other than what are needed to perform a typical cataract surgery):
Varies Depending on intraocular lens choice

Methods to assist with cataract surgery:

Femtosecond Laser-Assisted Cataract Surgery (FLACS):
Can be utilized to correct astigmatism with LRI, AK, CCI

Intraoperative Aberrometry:
Additional measurements taken DURING cataract surgery after cataract is removed. Goal to increase the likelihood of an excellent visual result.

*The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. Content used with educational and transformative intent within Fair Use Guidelines.*
-Doctor Elisabeth Hottel

[cathym]

I will be 63 in a few days. I have had to wear glasses since I was seven years old due to severe astigmatism. I had cataract surgery in Nov of 2023 and second surgery 3 weeks later. I chose to have toric lens implants. For me, this was a miracle! I no longer need to wear glasses. I have had no problems whatsoever with the implants. I am in awe of how good my vision is now. I still find myself after all these months pushing my glasses back onto my nose properly even though I’m not wearing any lol. People are still getting used to seeing me without glasses. I still need reading glasses and have purchased those from the drugstore as my eye doctor said they’re perfectly fine for reading. I highly recommend the Toric lenses if you have astigmatism. The surgery itself is pain free and only takes 10 or 15 minutes. I am so happy I chose these lenses!

[earlenemurray]

Thanks for summarizing, I will be having the multifocal toric lens in surgery in May.

[janebishop]

What a great video. So informative and so well done. Thank you!

[earlenemurray]

Surgery went very well, just before the second surgery start having floaters. They should gradually go away. I did the toric panoptic. Two weeks into the second eye. The clarity is great but eyes are very sensitive to light. Need to get darker sunshades. Things will get much better in the coming months.

[mikeske]

I had cataract surgery in March 2024 and the decision made between the doctor and myself was just doing the standard IOL. I knew in advance that I need glasses as I had a mild astigmatism and extreme far sightness. I was just so happy after the operation to not have to wear the thick heavy glasses I had my entire life it was life changing. What I wanted and expected were completely far exceeded with the vast improvement of my vision after the operation. Yes I still need glasses but that is for the near vision and I just got a pair of simple bifocals as the for the distance vision in the right eye is none now and the left eye a +0.25 Before I was in the +6.00 for the right eye and a +6.25 and a slight astigmatism correction in the left eye.

[abrahamhannibalthetraveller]

Thank you so much for the very concise explanation. I don't speak English very well, but when I listen to you I understand everything without the help of subtitles!!🌹

[powellmock]

Dr. Elizabeth, very good description of options available to patients going to have cataract surgery. Thank you.

[stevewilday]

Excellent video, subject well explained 👏

[friskydingo]

I’m a 61 yr old female. My right eye astigmatism is -0.50 with a prescription of +8.50. The left lazy eye astigmatism is -2.50 with a +9.50. Both reading corrections are +2.50 (finding frames to fit this prescription is a challenge) I had iriodotomies performed in 2020 for glaucoma. Last week the surgeon performed a Super K on my lazy left eye to remove Map, Dot, Fingerprint Dystrophy. A Super K was done on my right eye 18 months ago. So I have no more corneal astigmatisms. But all these procedures have resulted in dry eyes. I treat my dry eyes with warm compresses, Soothe gel 2xs a day, and drink lots of fluids. My goal is to go from severe myopia to manageable myopia. I know I’m not coming out of next month’s right eye cataract surgery with 20/20 vision.
The surgeon has selected Mono IOL. I’m not a candidate for any of the premium IOLS due to the above complications. I had a consultation with a cataract counselor last week but I was distracted by the Super K procedure. I read my risk for complications like detached retina increases which is why I’m getting cataract surgery early before old age rigidity of the vitreous sets in.
The surgeon is going to set my right eye for midrange vision. I don’t drive so long range vision is not necessary. In most cases, the other eye would be set for close range but with my lazy eye that’s not an option. So will both eyes be set for mid range? Will I have the same vision I have now but with less myopia and thinner eye glass lenses? Is there anything I can do in the next 4 weeks to improve my dry eyes and hopefully get better surgical results?

[bchollis]

My surgeon said if astigmatism is less than 1.0 (mine is 0.6) that a toric lens (nor limbic relaxing incisions) could be used to address that low a value. True? Also could the corneal incisions made during cataract surgery create some astigmatism? I am still blurry with Vivety lens after 3 weeks - I have no other eye conditions except typical dry eyes

[juicer]

If I understand correctly, the astigmatism value as measured by laser is a different number than what is in your eyeglass prescription. The eyeglass prescription cyl is a value that is the combination (net) of the corneal and lens astigmatism.
My eyeglass prescription is -0.75 D but today's laser scan technician said my astigmatism in that same eye was 1.5.
So is that a number that is most accurately treated with a toric lens or a regular lens with one of the laser enhancements mentioned? The surgeon intends on using Eyhance by J&J.

[s.p.]

If someone does not wear Glasses or contacts for distance, but wears reading glasses and they get a pair of reading glasses that correct for astigmatism -will this affect their distance vision when they are not wearing these reading glasses?

[vegnewb]

If you have had far sightedness induced crossed eyes due to fatigue, will lens implants help that? I mean the ciliary muscles will be disconnected. Would your eyes still cross?

[Barnabas]

I'm sure most people couldn't afford the out of pocket price for any premium service!

[dananderson]

Is a .5 astigmatism in both eyes warrant the $4, 200 expense to correct? I want great far vision but it doesn’t need to be spectacular as I’m 70 and not a pro athlete.

[bahumatneo]

All you need is a couple of thousands of dollars for the surgery thats not covered by health insurance.