Toric Lens Implants Outperform Femtosecond Laser in Correcting Astigmatism After Cataract Surgery

two doctor doing cataract surgery in operating room
Investigators review and compare 2 surgical techniques for reducing astigmatism.

Compared with femtosecond laser–assisted arcuate keratotomy (FSAK), toric intraocular lens (TIOL) implantation is more effective for correcting moderate astigmatism after cataract surgery, according to a study published in the Journal of Cataract & Refractive Surgery. However, FSAK is a safe procedure for reducing astigmatism, according to the report. 

The prospective study included 75 eyes of 67 patients who underwent age-related cataract surgery from January 1, 2019 to December 31, 2020. Participants were randomly assigned to either the FSAK group (n=37 eyes) or the TIOL implantation group (n=38 eyes). All participants had moderate preoperative corneal astigmatism of 1.25 to 3.0 D. 

The preoperative assessment included corrected distance visual acuity (CDVA), anterior and posterior segment examination, corneal topography, autokeratometry, and ocular biometry. At 1 month and 3 months, postoperative examinations were performed and included CDVA, uncorrected distance visual acuity, manifest refraction, autokeratometry, and corneal topography. Researchers performed vector analysis of astigmatic changes by using the Alpins vector method.

The team noted no statistically significant differences in preoperative characteristics between the FSAK and TIOL groups. The residual refractive astigmatism values among both groups did not reveal any statistically significant differences at 1 month and 3 months postoperatively, according to the study. 

At 3 months postoperatively, the TIOL group had residual refractive astigmatism of 0.50 D or less in 21 eyes (55%) and of 1.00 D or less in 32 eyes (84%). At 3 months postoperatively, the FSAK group had residual refractive astigmatism of 0.50 D or less in 14 eyes (38%) and of 1.00 D or less in 25 eyes (68%). 

Researchers found no statistically significant differences between the 2 groups regarding difference vector, angle of error, magnitude error, or correction index during the 3-month follow-up. The index of success was 0.32±0.33 D in the TIOL group and 0.48±0.29 D in the FSAK group (P =.029), the researchers note. No intraoperative or postoperative complications were reported. 

“Effectiveness in correcting astigmatism was higher in the TIOL group than that in the FSAK group,” according to the researchers. “Despite not being as predictable as TIOL implantation, FSAK is a safe technique that should be taken into account in correction of corneal astigmatism.”

Limitations of the study included a limited sample size and the short follow-up period.


Hernandez R, Almenara C, Soriano D, et al. Toric intraocular lens implantation vs femtosecond laser–assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery. J Cat Refract Surg. Published online August 1, 2022. doi:10.1097/j.jcrs.0000000000000879