Toric IOLs (Intraocular Lenses) for Astigmatism

If you have a cataract and are getting it surgically removed, your doctor may recommend a toric IOL.

These tools can help to correct astigmatism and vision problems after your surgery. They come in a variety of options.

What Are Toric IOLs & When Are They Used?

Toric intraocular lenses are small, man-made lenses that are placed inside a patient’s eye to correct their vision. This lens would be placed after the natural lens is removed during cataract surgery.

Cataracts involve the clouding of the lens within a person’s eye, and they are very common in older patients. In fact, over 50 percent of Americans 80 years old and above have had a cataract at some point in their life. 

In addition to older people, cataracts can be caused by injuries to your eye and some diseases. Cataracts require surgery because they can severely impact a person’s vision, and they may lead to further problems with your eyes.

Astigmatism is an eye condition caused by a misshapen cornea that may cause your vision of objects at a distance or up close to become blurred. 

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How Do Toric IOLs Work?

Because a cataract causes the lens of your eye to become clouded, the primary surgery done to remove cataracts involves removing a patient’s natural lens entirely. In cases where a patient’s natural lens is removed, a toric IOL may be put in its place if the patient has an astigmatism.

A toric IOL effectively works as a new and properly functioning lens for your eye. Some toric IOLs correct vision at a certain range, while others correct vision at multiple distances.

Outcomes  

Toric intraocular lenses generally have a predictable, positive outcome, and they are effective in treating astigmatism in patients who receive them. 

According to the American Academy of Ophthalmology, the vast majority of these procedures performed by an experienced doctor result in very good outcomes for patients. In addition, a 2017 study on toric IOLs found that they are safe and effective in treating corneal astigmatism during cataract surgery.

Given that many toric intraocular lenses are monofocal, people who receive this type of lens may only see clearly at one range of distance if they have issues at different distances. For example, if the toric IOL corrects for distance vision, the person may still need reading glasses to see things clearly up close. If you receive a multifocal IOL, you may not need glasses or contact lenses after your surgery, as you may be able to clearly see objects both near and far.

Comparing Brands

The main difference between the types of toric IOLs comes down to whether they are monofocal or multifocal. 

Some brands of monofocal toric IOLs include Alcon Labs, Hoya iSert 351, Staar Surgical, and Abbott Medical Optics.

For multifocal Toric IOLs, some brands include Abbott Medical Optics, Alcon Labs, and Bausch + Lomb.

Before you have cataract surgery, your doctor will analyze your eye and advise on the toric IOL they feel would work best for you.

Costs of Toric IOLs

Toric IOLs are considered a premium type of IOL, so you can expect to pay more than you would for a basic IOL. While some toric IOLs may cost about a third more than standard IOLs, one study found that the higher first-year cost of toric lenses was offset by lifetime savings.

According to one refractive surgeon, the general range for pricing when it comes to having a toric IOL implanted is between $1,000 to $2,000 per eye. 

Insurance can greatly reduce your out-of-pocket costs for cataract surgery and IOLs. It’s common for insurance to cover the cost of a standard IOL, and you may have to pay the difference in price for a premium IOL, such as a toric lens.

Surgery to Place a Toric IOL

Before surgery begins, a doctor will take some measurements of different parts of your eye. This is to ensure that the toric IOL is placed correctly and to stop potential issues from arising once it has been put in place.

During toric IOL surgery, a patient is given anesthesia eye drops to numb their eye, which should reduce discomfort while the lens is removed and a toric IOL is put in its place. The first step to the surgery is to remove the clouded cataract, which is done through a small cut into the eye.

Once the cut has been made, a small tool is used to break apart the cataract in the eye, and the same tool is then used to remove them. Once the entire cataract has been removed, the toric IOL will be placed inside the eye.

Overall, toric IOL surgery should last around one hour. Once it has been completed, you will have to wait in a recovery area for a short amount of time before you are able to leave. 

After your surgery, your doctor will schedule some amount of follow-up appointments to examine your eye and how it is healing. In most cases, you should be fully recovered within about a month.

Potential Complications

According to the National Eye Institute, cataract surgery is one of the safest and most reliable surgeries. However, surgeries always have a variety of complications that may occur, such as these:

• Eye infections
• Bleeding
• Swelling of the eye
• Loss of vision
• Seeing double
• More or less pressure around the eye
• Retinal detachment
• Persistent pain

Formation of a secondary cataract, which is the return of cataract symptoms, is possible. This is not an actual return of the cataract since cataracts cannot form on an artificial lens. Secondary cataracts, or posterior capsular opacification, can be easily treated with a YAG laser capsulotomy.

In some cases, toric IOLs may overcorrect or under correct astigmatism, leading to faulty vision for the patient. The patient may need to wear corrective lenses, such as glasses, following surgery.

Over time, a toric IOL may shift within a patient’s eye. This may lead to decreased quality of vision, depending on how much the IOL moves. 

In these cases, the IOL must be realigned, which should correct vision, returning it to where it was. These cases are relatively rare, with one study finding the rate of realignment to be just over 0.5 percent.

All of these potential side effects are treatable, especially if caught early.

Alternatives to Toric IOLs

Because cataracts can cause severe vision loss that cannot be treated with glasses or contacts, there is no alternative to cataract surgery. Before a cataract becomes severe, it is possible to simply treat some of the symptoms by using glasses or contacts, but over the course of time, surgery is needed to remove it.

While the cataract must be removed, it is not necessary to receive a toric IOL. Some patients may choose to have a different type of IOL inserted. They may then simply use glasses or contacts after their procedure instead of having a toric IOL inserted once their faulty lens is removed. 

If you are experiencing symptoms of a cataract or otherwise believe you might have a cataract, contact your doctor to explore your options.

Toric IOLs for Astigmatism FAQs

What is a toric IOL?

A toric IOL corrects for astigmatism. It can be placed during cataract surgery after the natural lens has been removed.

Is a toric lens worth the cost? 

Toric IOLs can correct astigmatism, so you don’t always need to use contacts or glasses. Since many people no longer need to buy corrective lenses, most patients find that the benefits of toric IOLs are worth the additional cost.

What is the success rate of toric IOLs? 

Patient satisfaction rates are incredibly high for toric IOLs. Patients achieve vision that is better than 20/40 in 97 to 100 percent of cases with toric IOLs. 

How much astigmatism justifies a toric IOL?

Toric IOLs are available to correct astigmatism between 0.75 D to 4.75 D at the corneal plane.

References

1. Toric IOLs. (October 2021). EyeWiki, American Academy of Ophthalmology.

2. Cataracts. (August 2022). National Eye Institute.

3. What Is Astigmatism? Symptoms, Causes, Diagnosis, Treatment. (August 2022). American Academy of Ophthalmology.

4. Astigmatism. (June 2019). National Eye Institute.

5. Toric Intraocular Lenses: Expanding Indications and Preoperative and Surgical Considerations to Improve Outcomes. (January 2022). Indian Journal of Ophthalmology.

6. Approximately How Much Extra I Should Expect to Pay for a Toric Lens? (March 2014). American Academy of Ophthalmology.

7. The TECNIS® Toric IOL Patient Information Brochure. (2012). Abbott Medical Optics, Inc.

8. Cataract Surgery. (September 2020). National Eye Institute.

9. Are You at Risk for a Secondary Cataract? (November 2019). Harvard Medical School.

10. Optimizing Outcomes With Toric Intraocular Lenses. (December 2017). Indian Journal of Ophthalmology.

11. Incidence and Outcomes of Repositioning Surgery to Correct Misalignment of Toric Intraocular Lenses. (August 2017). Ophthalmology.

12. Economic Evaluation of Toric Intraocular Lens: A Short- and Long-Term Decision Analytic Model. (July 2010). Archives of Ophthalmology.