Prevalence of corneal astigmatism before cataract surgery in Indian population

Predictive accuracy of Barrett TK toric calculator compared to measured posterior corneal astigmatism using Pentacam in toric IOL power calculation

PURPOSE

To compare the predictive accuracy of Barrett total keratometry (Barrett TK) toric calculator with the measured posterior corneal astigmatism (PCA) by using Pentacam in toric intraocular lens (IOL) power calculation.

METHODS

A prospective analysis was done on 118 eyes requiring toric IOL power implantation. The absolute prediction error of the Barrett TK toric calculator and the measured PCA in the online toric calculator were assessed and compared to the standard Alcon toric calculator (with Barrett toric calculator incorporated).

RESULTS

The mean absolute prediction error of the online toric calculator (0.32 D) (with Barrett toric calculator incorporated), Barrett TK Toric (0.34 D), and measured PCA of Pentacam in Barrett toric calculator (0.33 D) were found to be similar with no statistically significant difference. Subanalysis in eyes with with-the-rule astigmatism, against-the-rule astigmatism, and oblique astigmatism showed similar results. Alpins analysis showed that all three methods overcorrected corneal astigmatism.

CONCLUSION

The Barrett TK toric calculator and the measured PCA of Pentacam in the Barrett toric calculator have similar predictive accuracy to the online toric calculator (with Barrett toric calculator incorporated).

Comparison of clinical outcomes of Eyecryl toric and Alcon toric intra-ocular lenses - A real world study

Purpose

To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra-ocular lenses (IOLs).

Methods

This retrospective, observational study included 143 eyes of 141 patients who underwent phaco-emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post-op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed.

Results

The mean pre-op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post-op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post-op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post-op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02).

Conclusion

Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post-operative outcomes in terms of UCVA and residual astigmatism. The post-op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group.

Rotational stability of plate-haptic toric intraocular lenses in Asian eyes: risk period for intraocular lens rotation and its influencing factors

PURPOSE

To investigate the rotational stability of plate-haptic toric intraocular lenses (IOLs) during 3-month follow-up.

SETTING

Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective observational study.

METHODS

Patients with cataracts implanted with AT TORBI 709M toric IOLs were enrolled and followed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was applied to investigate the time course of absolute IOL rotation change. The 2-week overall IOL rotation was analyzed in the age, sex, axial length (AL), lens thickness (LT), preexisting astigmatism, and white-to-white subgroups.

RESULTS

A total of 328 eyes of 258 patients were included. The rotation from the end of surgery to 1 hour and 1 day to 3 days was significantly smaller compared with the rotation from 1 hour to 1 day but more than that at other time intervals in the overall group. 2 weeks postoperatively, the mean uncorrected distance visual acuity and remaining positive cylinder were 0.19 ± 0.22 logMAR and 0.60 ± 0.44 diopters, respectively. Significant between-group differences in 2-week overall rotation were found in the age, AL, and LT subgroups.

CONCLUSIONS

Maximum rotation occurred within 1 hour to 1 day postoperatively, and the first 3 days postoperatively was a high-risk period for the plate-haptic toric IOL rotation. Surgeons should make the patients aware of this.

Age- and gender-related characteristics of astigmatism in a myopic population

Purpose

To explore age- and gender-related differences of refractive and corneal astigmatism in myopic patients looking for refractive surgery.

Design

A retrospective cross-sectional study.

Materials and methods

The medical files of candidates looking for corneal refractive surgery between 2019 and 2021 were reviewed, demographic and refractive parameters including age, gender, refractive status, and corneal parameters were analyzed.

Results

A total of 1,417 eyes of 1,417 patients (453 males and 964 females) were included. Males had thicker cornea than females, while females had steeper cornea than males, there was no gender-related difference in refractive and corneal astigmatism depending on patients’ age. There was no difference in refractive astigmatism among different age group from 18 to 50 years, while corneal astigmatism had a shift from with-the rule (WTR) to against-the-rule (ATR) with increasing age. Age, central corneal thickness (CCT), sphere, refractive astigmatism (RA), and corneal curvature (Km) were correlated with corneal astigmatism (CA) (standardized coefficients of are 0.006, p = 0.011 for age, −0.001, p = 0.004 for CCT, and −0.027, p < 0.001 for sphere, 0.61, p < 0.001 for RA, −0.05, p < 0.001 for corneal curvature).

Conclusion

Refractive astigmatism is stable until the age of 50 years in myopic patients looking for refractive surgery, while corneal astigmatism showed a shift from WTR to ATR with advancing age. Age, CCT, sphere, refractive astigmatism and corneal curvature (Km) were correlated with corneal astigmatism.

Saving of Time Using a Software-Based versus a Manual Workflow for Toric Intraocular Lens Calculation and Implantation

Background: To determine whether there is a significant saving of time when using a digital cataract workflow for digital data transfer compared to a manual approach of biometry assessment, data export, intraocular lens calculation, and surgery time. Methods: In total, 48 eyes of 24 patients were divided into two groups: 24 eyes were evaluated using a manual approach, whereas another 24 eyes underwent a full digital lens surgery workflow. The primary variables for comparison between both groups were the overall time as well as several time steps starting at optical biometry acquisition until the end of the surgical lens implantation. Other outcomes, such as toric intraocular lens misalignment, reduction of cylinder, surgically induced astigmatism, prediction error, and distance visual acuity were measured. Results: Overall, the total diagnostic and surgical time was reduced from 1364.1 ± 202.6 s in the manual group to 1125.8 ± 183.2 s in the digital group (p < 0.001). The complete time of surgery declined from 756.5 ± 82.3 s to 667.3 ± 56.3 (p < 0.0005). Compared to the manual approach of biometric data export and intraocular lens calculation (76.7 ± 12.3 s) as well as the manual export of the reference image to a portable external storage device (26.8 ± 5.5 s), a highly significant saving of time was achieved (p < 0.0001). Conclusions: Using a software-based digital approach to toric intraocular lens implantation is convenient, more efficient, and thus more economical than a manual workflow in surgery practice.

Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes

Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.

Clinical outcomes, predictability and rotational stability following implantation of Eyecryl toric versus TECNIS toric intraocular lenses-A comparative study

PURPOSE

To compare the visual outcomes, predictability and rotational stability following implantation of Eyecryl toric versus TECNIS toric intraocular lenses.

METHODS

This retrospective study included 100 eyes of 78 eligible patients who underwent phacoemulsification followed by implantation of either Eyecryl Toric IOL or TECNIS Toric IOL (n = 50 eyes in each group), using an intraoperative image-guided marker less system. All toric IOL implantations were performed under balanced salt solution. At 2 weeks, 3 months and 6 months, uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent refraction, residual astigmatism, and rotational stability of the toric IOL was evaluated and compared. Rotational stability was assessed using ray tracing.

RESULTS

Mean age of the participants was 67.8 ± 9.26 years in Eyecryl toric group and 64 ± 11 years in TECNIS toric group. The mean pre-op corneal astigmatism was 1.75 ± 0.62 D and 2.00 ± 0.71 D in the Eyecryl and TECNIS group, respectively (p = 0.07). At 2 weeks and at 6 months post-op, there was no statistically significant difference between the UDVA, CDVA, and residual astigmatism between the two groups (p < 0.05). Mean post-operative toric IOL rotation was 3.94 ± 2.27 degrees in the Eyecryl Toric group, and 4.44 ± 2.77 degrees, in the TECNIS Toric group, respectively, the difference was not statistically significant (p = 0.32). One IOL in the Eyecryl group and two IOLs in the TECNIS group required re-positioning for significant post-op rotation at 1 week post-op.

CONCLUSION

At 6 months, both Eyecryl toric and TECNIS toric IOLs showed comparable post-operative outcomes in terms of UDVA, CDVA, residual astigmatism and rotational stability.

Clinical outcomes and rotational stability following implantation of Eyecryl toric intraocular lens - Results of a 12-months prospective study

Purpose:

To evaluate the clinical performance and rotational stability after implantation of Eyecryl Toric monofocal IOL following cataract surgery.

Methods:

Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria were implanted with Eyecryl Toric IOL. All implantations were done under balanced salt solution. A marker-less system Callisto Eye (Carl Zeiss Meditec, Germany) was used to guide the intra-operative alignment of the toric IOL.

Results:

A total of 50 eyes from 39 patients with mean age of 68.2 ± 8.7 years were included in the study. At 12 months, 82% (41) eyes had cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ± 0.50 D for 94% (n = 47) eyes and refractive cylinder accuracy was within ≤0.50 D in 98% (n = 49) eyes. Average post-op rotation at 1 year was 4.06 ± 2.15 degrees. Eighty-four percent of eyes were within 5 degrees and 16% were within 6-10 degrees of intended axis. Two eyes required IOL re-positioning due to significant rotation of the toric IOL (>10 degrees), identified within the 1^st week after surgery.

Conclusion:

Eyecryl toric IOL demonstrated the ability to achieve a significant reduction in astigmatism, improved UDVA outcomes, high levels of spectacle independence, low rates of intra-operative injector related complications and good rotational stability at 12 months post-op.

Clinical differences between toric intraocular lens (IOL) and monofocal intraocular lens (IOL) implantation when myopia is determined as target refraction

BACKGROUND

The aim of this study is to analyze and compare the clinical results of toric intraocular lens (IOL) and monofocal IOL implantation when the target refraction value is -3 diopter (D) in cataract patients with corneal astigmatism > 1.5 diopters (D).

METHODS

We performed a retrospective chart review for patients with corneal astigmatism > 1.5D who underwent cataract surgery and their target refraction is -3D. 100 eyes (100 patients; monofocal IOL, 60; toric IOL, 40) were enrolled in the current study. Near and distant uncorrected visual acuity (UCVA), corrected VA, spherical equivalent and refractive, corneal astigmatism were evaluated before and after surgery.

RESULTS

The near UCVA of the toric IOL group (0.26 ± 0.33) after cataract surgery was significantly better than that of the monofocal IOL group (0.48 ± 0.32) (p = 0.030). The distant UCVA of the toric IOL group (0.38 ± 0.14) was also significantly better than that of the monofocal IOL group (0.55 ± 0.22) (p = 0.026). Best-corrected visual acuity (p = 0.710) and mean spherical equivalent (p = 0.465) did not show significant differences between the toric IOL group and the monofocal IOL group. In the toric IOL group, postoperative refractive astigmatism was - 0.80 ± 0.46D and postoperative corneal astigmatism was - 1.50 ± 0.62D, whereas the corresponding values in the monofocal IOL group were - 1.65 ± 0.77D and - 1.45 ± 0.64D; residual refractive astigmatism was significantly lower with toric IOL implantation compared with monofocal IOL implantation (p = 0.001). There were no postoperative complications.

CONCLUSIONS

When myopic refraction such as -3D was determined as the target power in patients with corneal astigmatism, toric IOL implantation led to excellent improvement in both near and distant UCVA.

Prevalence of Astigmatism in Patients Undergoing Cataract Surgery at a Tertiary Care Center in North India

AIM

To assess the demography, magnitude, and type of corneal astigmatism in patients undergoing cataract surgery in North India.

METHODS

It is a clinic-based, cross-sectional, observational study. Keratometric values and demographic data were collected for eligible patients who had undergone phacoemulsification at a tertiary eye care center between January 2010 and December 2017, using a non contact, optical low coherence reflectometry (OLCR).

RESULTS

A total of 3597 eyes were recruited for the study. There were 1810 (50.3%) females and 1787 (49.7%) males. The mean age was 59.121±15.19 (range 5-100 years). A total of 3559 eyes were qualified for astigmatism analysis. The mean corneal astigmatism among all patients was 1.17±1.15 D (range 0-12.5 D). There was no astigmatism in 99 eyes (2.78%), with-the-rule (WTR) in 1062 eyes (29.83%), against-the-rule (ATR) in 1843 eyes (51.72%) and oblique astigmatism (OA) in 555 eyes (15.59%). The tendency of a gradual change from with the rule (WTR) to against the rule (ATR) astigmatism was noted as the age advanced.

CONCLUSION

In the present study around 56.69% of eyes had corneal astigmatism of <1.0 D that can be managed by simple cost-effective keratorefractive procedures especially in developing countries. However, our 40.49% patients had >1.0 D of corneal astigmatism, which may benefit by toric intraocular lenses.

Prevalence and Age-Related Changes of Corneal Astigmatism in Patients Undergoing Cataract Surgery in Northern China

Purpose

To examine the magnitude, orientation, and age-related changes of corneal astigmatism of the eyes before cataract surgery. Setting. Hebei Eye Hospital, Hebei, China.

Design

A clinical-based retrospective study.

Results

The study consisted of 5662 eyes of 5662 consecutive cataract surgery patients with a mean age of 68.26 ± 10.39 (mean ± standard deviation (SD)) years (range 40 to 97 years), and 59.86% of the patients were women. Mean corneal astigmatism was 0.98 ± 0.76 diopter (D) (range 0.00-9.61 D). Corneal astigmatism of 0.50-0.99 D was the most common range of values (30.08%), followed by 1.00-1.49 D (22.15%), ≤0.50 D (21.21%), and 1.50-1.99 D (10.28%). There was a strong U-shaped relation between corneal astigmatism and age (p for nonlinearity <.01). With the increase of age, the astigmatism axis gradually changes from with-the-rule (WTR) to against-the-rule (ATR). Moreover, in young patients with age below 65 years, WTR astigmatism was negatively correlated with age, while ATR was positively correlated with age (r = -0.11, p=.001; r = 0.10, p=.010, respectively). However, in the old patients with age above and equal to 65 years, all types of astigmatism were positively correlated with age.

Conclusion

This study may provide valuable and practical information to surgeons when selecting the appropriate surgical method and toric intraocular lens (IOLs).

Prevalence of Corneal Astigmatism in Patients before Cataract Surgery in Western China

Purpose

To investigate the demographics and distribution of corneal astigmatism before cataract surgery in patients from western China and to compare and analyze these findings with those of patients in southern China. Setting. People's Hospital of Xinjiang Uygur Autonomous Region.

Design

Clinical-based cross-sectional study.

Methods

Patients undergoing cataract surgery in the People's Hospital of Xinjiang Uygur Autonomous Region from February 2012 to August 2019 were recruited. Preoperative keratometric data measured by performing preoperative bilateral partial coherence interferometry (IOLMaster), and patient demographics were recorded and analyzed.

Results

This study comprised 12,236 eyes of 7065 patients with a mean age of 64.75 ± 9.66 years, and 52.77% of the patients were female. The mean axial length was 23.14 ± 0.96 mm. Astigmatism ranged from 0 diopters (D) to 6.94 D, with a mean of 1.28 D. Corneal astigmatism was between 0.25 D and 1.25 D in 53.71% of eyes, 1.25 D or higher in 39.06% eyes, and less than 0.25 D in 7.23% of eyes. Astigmatism was with the rule (WTR) in 41.94% of the patients and against the rule (ATR) in 38.80% of patients. The mean flat and steep keratometry measurement was 43.19 ± 1.50 D and 44.24 ± 1.62 D, respectively. After matching, corneal astigmatism in western China was 1.30 ± 1.03 D, and it was significantly higher than that in southern China (0.98 ± 0.67 D, P < 0.001). After matching, the proportion of WTR astigmatism was 40.99% in western China, which was also significantly higher than the proportion (26.46%) in southern China (P < 0.001).

Conclusion

Corneal astigmatism in patients before cataract surgery in western China was mainly between 0.25 D and 1.25 D. Compared with patients in southern China, patients in western China are younger, have a much higher degree of astigmatism, and have a higher proportion of WTR astigmatism.

Effect of corneal marking features on toric intraocular lens alignment

PURPOSE

The purpose of this study was to investigate the relation of the corneal ink mark size, shape, and location with the corneal perimeter in terms of the corresponding corneal axis.

MATERIAL AND METHODS

This study was designed both prospective experimental and literature search. Contact lenses were used to demonstrate the spreading effect of the surgical ink mark. Open-access published corneal images with corneal ink marks were reviewed. Mark size and perimeter of both contact lenses and corneal images were performed in Image J software.

RESULTS

Twenty contact lenses and 15 corneal images with 32 corneal marks, which were obtained from the literature, were included in the study. Mean degree corresponding to the ink size for the group 1 was 8.3° ± 1.2° (range 5.5-10.3), for group 2 was 11° ± 1.1° (range 8-12), for group 3 was 4.2° ± 0.7° (range 3.2-5.5), for group 4 was 4.2° ± 0.7° (range 3.2-5.5), and for group 5 was 6.3° ± 2.5° (range 2-11.5).

DISCUSSION

Theoretically, it is wise to target further located ink mark from central cornea based on the 360/2π × (r2 - r1)/(r1 × r2) × M formula. It has been experimentally shown that the smaller corneal perimeter and closer mark to the central cornea may lead the more significant deviation from the targeted axis. Preoperative manual corneal marking may be more responsible for residual astigmatism than it is thought.

Frequency of Corneal Astigmatism in Patients Presenting for Senile Cataract Surgery at a Teaching Hospital in Indian Rural Population

PURPOSE

The aim of this study was to assess prevalence of corneal astigmatism before cataract surgery in old age in Indian rural population.

DESIGN

Prospective, cross-sectional, and observational study.

METHODS

Keratometric values were measured with an auto refractokeratometer in patients presenting for cataract surgery between January 2017 and May 2018. The demographic profiles of patients were recorded. Axial length and intraocular lens power were measured. Data were analyzed in SPSS software.

RESULTS

This study included 1000 eyes of 880 patients with a mean age of 65.1 ± 10.12 years. The mean astigmatism was 0.89 ± 0.63 D. A total of 179 eyes (17.9%) had astigmatism between 1.00 and 1.49 D; 34 eyes (3.4%) had astigmatism between 2.00 and 2.5 D; and 20 eyes (2%) had astigmatism >3 D. Overall, 325 eyes (32.5%) had astigmatism >1.00 D. Against the rule astigmatism was seen in 44.6% cases, oblique astigmatism was seen in 32% cases, and with the rule astigmatism was seen in 20.7% cases. Against the rule astigmatism increased with age and reached a maximum between 60 and 69 years. Male eyes had flatter corneal curvature than female eyes. The mean axial length was 25.59 mm, and the mean intraocular lens power was 21.05 ± 1.0D.

CONCLUSIONS

We found that 32.5% patients had corneal astigmatism >1 D and may benefit from toric intraocular lenses implantation. The results of this analysis provide normative data for the hospital to plan for correction of corneal astigmatism in patients undergoing cataract surgery.

Corneal astigmatism in cataract surgery patients from Bosnia and Herzegovina

PURPOSE

To determine corneal astigmatism prevalence, its correlations with age and symmetry pattern in fellow eyes of patients undergoing cataract surgery.

METHODS

This is a clinical-based retrospective cross-sectional study. Keratometry measurements of patients undergoing cataract surgery assigned to University Clinical Center Tuzla, Bosnia and Herzegovina, between January 2011 and June 2012 were recorded and analyzed retrospectively.

RESULTS

The study consisted of 4080 eyes of 2205 consecutive cataract surgery patients with a mean age of 68.24 years ± 9.25 (SD) (range 32-84 years), and 54.0% of the patients were women. Mean corneal astigmatism was 0.72 ± 0.61 D (range 0-6.5 D). The prevalence of corneal astigmatism 1.0 D or more was in 1291 eyes (31.64%), 1.5 D or more in 736 eyes (18.03%), 2.0 D or more in 396 eyes (9.71%) and 3.0 D or more in 108 eyes (2.65%). There was no significant difference in the magnitude of astigmatism between age groups (p = 0.10), male and female (p = 0.29) or right and left (p = 0.75) eyes. The prevalence and amount of astigmatism increased with age (p < 0.05). Gradual shift from with-the-rule astigmatism toward against-the-rule astigmatism was observed (p = 0.03). Patients with higher amount of astigmatism in one eye are more likely to have significant astigmatism in fellow eye (p < 0.01). Symmetry in pairs of eyes is present in eyes with astigmatism greater than 2.5 D (p < 0.01).

CONCLUSION

This study provides useful reference data for cataract surgeons and patients from Bosnia and Herzegovina.

Repeatability of Ophtha Top topography and comparison with IOL-Master and LenstarLS900 in cataract patients

AIM

To determine the repeatability of Ophtha Top topography and assess the consistency with intraocular lens (IOL)-Master and LenstarLS900 (Lenstar) in measuring corneal parameters among cataract patients.

METHODS

Totally 125 eyes were enrolled. Corneas were successively measured with Ophtha Top, IOL-Master and Lenstar at least three times. The flattest meridian power (Kf), the steepest meridian power (Ks), mean power (Km), J0 and J45 were recorded. Intra-class correlation coefficients (ICCs), the coefficient of variance (COV), within subject standard deviation (Sw), and test-retest repeatability (2.77Sw) were adopted to determine the repeatability. The 95% limit of agreement (95%LOA) and Bland-Altman plots were used to assess comparability.

RESULTS

Repeatability of Ophtha Top topography for measuring corneal parameters showed the ICCs were all above 0.93, 2.77Sw was lower than 0.31, and the COV of the Kf and Ks was lower than 0.25. The keratometric readings with Ophtha Top topography were flatter than with the IOL-Master and Lenstar devices, while the Pearson correlation coefficients were over 0.97. The J0 and J45 with Ophtha Top topography were smaller compared with Lenstar and IOL-Master, while was comparable between Lenstar and IOL-Master.

CONCLUSION

Ophtha Top topography shows excellent repeatability for measuring corneal parameters. However, differences between the Ophtha TOP topography and Lenstar, IOL-Master both in cornea curvature and the astigmatism should be noted clinically.

Prevalence of corneal astigmatism before cataract surgery in Western Indian Population

Background

The prevalence and nature of corneal astigmatism among cataract surgery candidates has not been well-documented in Indian population. The purpose of the study is to analyse prevalence and presentation patterns of corneal astigmatism (CA) in cataract surgery candidates.

Methods

Keratometric values were measured in patients before cataract extraction. Descriptive statistics of CA were analysed including the assessment with age ranges.

Results

Mean CA of 223 eyes of 223 patients [mean age 61 ± 10 years (range, 29-90 years)] was 0.88 ± 0.61 (95% CI, 0.80-0.96) with 27.8%, 51.1% and 21.1% having with the rule (WTR), against the rule (ATR) and oblique astigmatism (OBL) respectively. Between 40 and 50 years, ATR exceeds WTR and reaches 100% by 80 years. A trend of less negative CA was seen up to 60 years and then increases up to 90 years. CA was below 0.25 dioptre (D) in 17.5% of eyes, between 0.25 and 1.25 D in 63.7% and ≥1.50 D in 18.8% of eyes.

Conclusions

Considering CA < 1.25 D in majority of cataract surgery candidates, it is preferable to perform inexpensive keratorefractive procedures rather expensive toric IOLs, especially in developing world.