Correcting Astigmatism Using Toric Intraocular Lenses During Cataract Surgery

Astigmatism is one of the most common refractive conditions, with a large proportion of patients undergoing cataract surgery presenting with 1.0 D or more. Toric IOLs are the standard of care for astigmatism correction during cataract surgery. This overview of reviews synthesizes current evidence on the use of toric IOLs, focusing on clinical indications, surgical outcomes, and emerging technologies.

Narrative review of reviews.

The following databases were searched from inception to 2 June 2025: MEDLINE, Embase, the Cochrane Library (including CENTRAL and the Cochrane Database of Systematic Reviews), KSR Evidence, and the Trip Database. Keywords included astigmatism, toric intraocular lenses, cataract surgery, intraocular lens implantation, and postoperative outcomes. Included studies were systematic and narrative reviews, meta-analyses, and clinical guidelines related to the use of toric IOLs in cataract surgery.

Eighty-five reviews were included. This overview summarizes key topics including the prevalence and impact of astigmatism, toric IOL technology, preoperative assessment, power calculation methods, surgical considerations, and postoperative outcomes such as rotational stability and surgically induced astigmatism. Reporting standards, patient-reported outcome measures, adverse events, and considerations in special populations are also discussed. Knowledge gaps and debated areas are highlighted.

Toric IOLs improve uncorrected visual acuity and refractive outcomes in cataract patients with significant astigmatism. Advances in diagnostics, lens design, calculation formulas, and intraoperative tools continue to enhance accuracy and patient satisfaction. Further research is needed to address unresolved questions and support best practices in diverse clinical settings.