Digital Image-Guided Systems May Cut Cataract Surgery Time

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Researchers put a digital image-guided system for toric IOL alignment to the test.

Cataract surgery time was reduced when a digital image-guided system was used to align the intraocular lens (IOL) compared with manual marking, researchers in Spain conclude. The system maintained the same efficacy in terms of toric IOL misalignment, residual refraction, and visual acuity, according to the findings published in the Journal of Cataract & Refractive Surgery.

Toric IOL implantation is safe and effective for correcting corneal astigmatism and improving visual quality compared to spherical IOLs. However, according to researchers, there are some limitations with the procedure, including toric IOL tilt, decentration, and misalignment that could impact optical and visual quality after surgery.

To compare the time spent on toric IOL implantation during cataract surgery using manual marking vs a digital image-guided system for toric IOL alignment, investigators conducted an experimental and longitudinal (1-month follow-up) study. A total of 98 eyes of 65 participants (68.2±12.2 years) were divided into 2 groups: 49 eyes operated with toric IOL alignment using a manual-marking technique and another 49 eyes operated using image-guided marking. 

They found that total cataract surgery time was 2:09 minutes shorter (P <0.001) with the image-guided marking system (12:12±2:20 minutes) compared with surgical procedures performed using manual marking (15:27±3:04 minutes). A month after surgery, they noted no statistical differences in toric IOL misalignment between the image-guided marking group (3.38 °±2.95 ˚) and the manual group (4.66 °±3.95 ˚). They also reported no statistical differences in refractive and visual outcomes (P ≥0.05) between the groups.

The study’s authors note several limitations of their study, including its short follow-up time and that the results obtained with the image-guided marking system have not been compared with other image-guided systems for toric IOL alignment. 

Disclosure: This research was supported by a grant from Alcon. Please see the original reference for a full list of disclosures.


Barberá E, Basanta I, Vázquez J, et al. Time-efficiency assessment of guided toric IOL cataract surgery. J Cataract Refract Surg. Published online May 10, 2021. doi:10.1097/j.jcrs.0000000000000688