Astigmatism is a common ocular condition that causes reduced visual acuity. The condition is highly prevalent in cataract patients, with preoperative astigmatism of at least 0.5 diopters being present in 78 percent of cataractous eyes. Residual uncorrected astigmatism after cataract surgery is associated with significant costs, primarily driven by the lifetime cost of spectacles (estimated at EUR 1,608 to EUR 3,608 in Europe). Toric intraocular lenses (IOLs) are a safe and effective way of correcting astigmatism, while also reducing the need for spectacles after cataract surgery. The objective of this review was to assess the published evidence relating to spectacle independence in patients implanted with toric IOLs, compared with those receiving non-toric IOLs with or without astigmatism reducing surgical interventions (SI).

A systematic literature search was conducted of the EMBASE, MEDLINE, and Cochrane Library databases. Articles were selected if they included adult patients undergoing phacoemulsification who had age-related cataracts and preoperative regular corneal astigmatism of at least 0.5 diopters, and assessed spectacle independence as an outcome.

Seven studies met the inclusion criteria: four randomized controlled trials and one non-randomized comparative study comparing toric IOLs with non-toric IOLs, and two randomized controlled trials comparing toric IOLs with non-toric IOLs plus SI. Spectacle independence was evaluated as the number of patients who reported not requiring spectacles for distance viewing at 3 or 6 months. Figures for spectacle independence ranged from 60 to 100 percent for toric IOLs, 31 to 50 percent for non-toric IOLs, and 36 to 65 percent for non-toric IOLs plus SI. In each study, toric IOLs demonstrated superior spectacle independence compared with the control group.

The benefits of toric IOL implantation for astigmatic cataract patients included a higher rate of spectacle independence, compared with non-toric IOLs with or without SI. For this group of patients, the lifetime economic burden of spectacle acquisition costs can be reduced with the implantation of toric IOLs during cataract surgery.