Cataract Surgery in Patients with Astigmatism: What to Know

Around 33% of Americans have astigmatism, according to the American Academy of Ophthalmology. How this affects your eyesight is unique to you, with symptoms including blurred, fuzzy vision that’s often worse at near and far distances.

Options for treatment include wearing corrective lenses or even laser eye surgery. However, many people living with the condition who also need cataract removal don’t realize that the two can be done at the same time. 

Correcting astigmatism during cataract removal is performed using a laser-assisted procedure. This differs slightly from the traditional method, giving the surgeon the necessary tools for treating both issues at the same time.

Cataract Surgery for Astigmatism: the two surgical options

In its simplest terms, astigmatism is an unevenly shaped cornea. Instead of being round (like a basketball), it’s curved (like a football). This causes issues with how the light passes through the eye, causing focusing difficulties and other vision abnormalities.

Correcting this in conjunction with cataract surgery can be done in two different ways:

1. Reshaping the cornea.
2. Implanting a special kind of lens, called a Toric lens, that overcomes the irregularity.

1. Reshaping the cornea

This takes advantage of the lasers that are used during the operation. Tiny, precise incisions are made in the cornea that cause it to relax and reduce the abnormal curvature. These are known as limbal relaxing incisions (LRIs). Once done, this allows light to travel more normally through the eye, reducing focusing issues.

It adds around five minutes to the cataract surgery with no extra anesthetic needed, other than the numbing drops (and potentially light sedation, if required) that you’ll need for the cataract removal. 

2. Implanting a Toric lens during cataract surgery

This is a premium intraocular lens (IOL), which is what’s implanted in place of the cataract-diseased lens. There are various types of IOLs, and the choice is increasing all the time as advanced technology pushes the boundaries of possibility. 

Some provide focused vision at one distance (either near or far) and are called monofocal). Others allow dual, or even tri-distance focus—something referred to as “multifocal”—and yet others offer what’s known as “extended depth of focus” (EDOF), which uses a different technique to allow for good vision at various distances.

If this option is deemed suitable, you and your surgeon will decide before the procedure which one will best suit your requirements.

Do I Actually Need Cataract Surgery for Astigmatism and, If So, Which Option is Best?

While it’s not essential, there are a lot of pressing reasons why you might want to consider it.

At the top of the list is that astigmatism often worsens after cataract surgery. Add in the fact that vision naturally deteriorates with age—and that includes the severity of astigmatism—and you can see how strong the case is for correcting astigmatism during cataract removal.

Naturally, each of the above-mentioned procedures comes with pros and cons. Your surgeon will discuss these with you, but the bullet points to know include that:

A Toric lens is…

• Quick and easy to implant.
• Offers fast recovery.
• With advancing technology, there are now lenses that can correct quite high levels of astigmatism.

• However, they’re not suitable in all cases, including irregular astigmatism.
• There’s a chance, albeit small, that the lens can rotate, potentially requiring another surgical procedure.
• The cost generally isn’t covered by health insurance.

A LMI procedure is…

• Definitive, meaning that it corrects the problem at the source.
• Works well for asymmetric/irregular astigmatism.
• Adds minimal time to the cataract procedure.

• However, an LMI procedure can’t be done if you have keratoconus (a condition where the cornea becomes thin and bulges).
• If the surgeon needs to make larger incisions, these may require stitches.
• Can potentially be a little more irritating during the healing stage.

The key to effectively correcting astigmatism during cataract removal is to a) have the right option to suit you and b) partner with an ophthalmologist who’s highly experienced in such treatments.

At the Modern Cataract Surgery Clinic, we lead the way in advanced cataract surgery—and that includes performing cataract surgery in conjunction with astigmatism correction.

More details can be found at https://www.moderncataractsurgery.com/ and our expert team is ready to take your call to answer any questions you might have.