Reducing postoperative astigmatism

As cataract surgery techniques have improved over the years, so too have the criteria for success. The development of astigmatism-correcting IOLs and lenses that treat presbyopia in particular demand precise refractive outcomes. Yet postoperative astigmatism continues to challenge surgeons and their patients. Naturally, astigmatism cannot be managed effectively without reliable preoperative measurements of the cornea.

In this issue, Kobashi et al. (pages 648–654) investigated the precision of corneal astigmatic measurements with current devices, including keratometers, topographers, and other imaging modalities, eg, Scheimpflug or ray-tracing devices. The study highlights some of the current issues with preoperative measurement. Incision manipulation is a common method for treating astigmatism, but surgeons disagree on where to place these incisions, how to measure them, and what the long-term effects are. Wang et al. (pages 660–665) report short- and long-term effects of astigmatic manipulation seen even with microincisional lens surgery. These three studies highlight the fact that measurement and manipulation of astigmatism has improved significantly but still needs our attention. With more advanced and standardised diagnostics to determine and measure astigmatism (eg, anterior and posterior corneal surface, lenticular components) and more standardised surgical methods (eg, femtosecond laser to create the incision), the astigmatic component of lens surgery will be even more predictable, controllable and reliable in the near future.

T Kohnen, JCRS, “Astigmatic manipulation with modern small-incision intraocular lens surgery (editorial)â€, Volume 38, Issue 4, 563.