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Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial.
JAMA Ophthalmol. 2014 Dec; 132(12):1462-8.JO

Abstract

IMPORTANCE

Spectacle independence is becoming increasingly important in cataract surgery. Not correcting corneal astigmatism at the time of cataract surgery will fail to achieve spectacle independency in 20% to 30% of patients.

OBJECTIVE

To compare bilateral aspherical toric with bilateral aspherical control intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter, hospital-based, randomized clinical trial was conducted. The participants included 86 individuals with bilateral cataract and bilateral corneal astigmatism of at least 1.25 diopters (D) who were randomized to receive either bilateral toric (n = 41) or bilateral control (n = 45) IOL implantation.

INTERVENTIONS

Bilateral implantation of an aspherical toric IOL or an aspherical control IOL.

MAIN OUTCOMES AND MEASURES

Spectacle independency for distance vision, uncorrected distance visual acuity, refractive astigmatism, contrast sensitivity, wavefront aberrations, and refractive error-related quality-of-life questionnaire.

RESULTS

Preoperatively, mean (SD) corneal astigmatism was 2.02 (0.95) D and 2.00 (0.84) D in the toric and control groups, respectively. Four patients (5%) were lost to follow-up. At 6 months postoperatively, 26 (70%) of the patients in the toric group achieved an uncorrected distance visual acuity of 20/25 or better compared with 14 (31%) in the control group (P < .001; odds ratio, 5.23; 95% CI, 2.03-13.48). Spectacle independency for distance vision was achieved in 31 patients (84%) in the toric group compared with 14 patients (31%) in the control group (P < .001; odds ratio, 11.44; 95% CI, 3.89- 33.63). Mean refractive astigmatism was -0.77 (0.52) D and -1.89 D (1.00) D, respectively. Vector analysis of toric IOLs showed a mean magnitude of error of +0.38 D, indicative of overcorrection. No significant differences were found in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life.

CONCLUSIONS AND RELEVANCE

In patients with cataract and corneal astigmatism, bilateral toric IOL implantation results in a higher spectacle independency for distance vision compared with bilateral control IOL implantation. No significant differences were identified in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life following both treatments.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01075542.

Authors+Show Affiliations

University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.Rotterdam Eye Hospital, Rotterdam, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25256624

Citation

Visser, Nienke, et al. "Toric Vs Aspherical Control Intraocular Lenses in Patients With Cataract and Corneal Astigmatism: a Randomized Clinical Trial." JAMA Ophthalmology, vol. 132, no. 12, 2014, pp. 1462-8.
Visser N, Beckers HJ, Bauer NJ, et al. Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial. JAMA Ophthalmol. 2014;132(12):1462-8.
Visser, N., Beckers, H. J., Bauer, N. J., Gast, S. T., Zijlmans, B. L., Berenschot, T. T., Webers, C. A., & Nuijts, R. M. (2014). Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial. JAMA Ophthalmology, 132(12), 1462-8. https://doi.org/10.1001/jamaophthalmol.2014.3602
Visser N, et al. Toric Vs Aspherical Control Intraocular Lenses in Patients With Cataract and Corneal Astigmatism: a Randomized Clinical Trial. JAMA Ophthalmol. 2014;132(12):1462-8. PubMed PMID: 25256624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial. AU - Visser,Nienke, AU - Beckers,Henny J M, AU - Bauer,Noel J C, AU - Gast,Sacha T J M, AU - Zijlmans,Bart L M, AU - Berenschot,Tos T J M, AU - Webers,Carroll A, AU - Nuijts,Rudy M M A, PY - 2014/9/27/entrez PY - 2014/9/27/pubmed PY - 2015/3/5/medline SP - 1462 EP - 8 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 132 IS - 12 N2 - IMPORTANCE: Spectacle independence is becoming increasingly important in cataract surgery. Not correcting corneal astigmatism at the time of cataract surgery will fail to achieve spectacle independency in 20% to 30% of patients. OBJECTIVE: To compare bilateral aspherical toric with bilateral aspherical control intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, hospital-based, randomized clinical trial was conducted. The participants included 86 individuals with bilateral cataract and bilateral corneal astigmatism of at least 1.25 diopters (D) who were randomized to receive either bilateral toric (n = 41) or bilateral control (n = 45) IOL implantation. INTERVENTIONS: Bilateral implantation of an aspherical toric IOL or an aspherical control IOL. MAIN OUTCOMES AND MEASURES: Spectacle independency for distance vision, uncorrected distance visual acuity, refractive astigmatism, contrast sensitivity, wavefront aberrations, and refractive error-related quality-of-life questionnaire. RESULTS: Preoperatively, mean (SD) corneal astigmatism was 2.02 (0.95) D and 2.00 (0.84) D in the toric and control groups, respectively. Four patients (5%) were lost to follow-up. At 6 months postoperatively, 26 (70%) of the patients in the toric group achieved an uncorrected distance visual acuity of 20/25 or better compared with 14 (31%) in the control group (P < .001; odds ratio, 5.23; 95% CI, 2.03-13.48). Spectacle independency for distance vision was achieved in 31 patients (84%) in the toric group compared with 14 patients (31%) in the control group (P < .001; odds ratio, 11.44; 95% CI, 3.89- 33.63). Mean refractive astigmatism was -0.77 (0.52) D and -1.89 D (1.00) D, respectively. Vector analysis of toric IOLs showed a mean magnitude of error of +0.38 D, indicative of overcorrection. No significant differences were found in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life. CONCLUSIONS AND RELEVANCE: In patients with cataract and corneal astigmatism, bilateral toric IOL implantation results in a higher spectacle independency for distance vision compared with bilateral control IOL implantation. No significant differences were identified in contrast sensitivity, higher-order aberrations, or refractive error-related quality of life following both treatments. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01075542. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/25256624/Toric_vs_aspherical_control_intraocular_lenses_in_patients_with_cataract_and_corneal_astigmatism:_a_randomized_clinical_trial_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2014.3602 DB - PRIME DP - Unbound Medicine ER -