Clinical Outcomes and Astigmatism Vector Analysis of High Toricity Visian ICL

To evaluate visual, refractive, and astigmatism vector outcomes following toric implantable collamer lens (ICL) implantation in eyes with high astigmatism.

A retrospective real-world study was conducted on 25 eyes (16 patients) undergoing toric ICL implantation. Visual acuity, refractive outcomes, and astigmatic correction were assessed at 1 year postoperatively. Vector analysis was performed according to current reporting standards. Postoperative vault and its association with biometric parameters were also analyzed.

Mean UDVA improved from counting fingers to 0.16 ± 0.16 logMAR, and CDVA from 0.26 ± 0.21 to 0.09 ± 0.11 logMAR. The mean residual spherical equivalent was -0.56 ± 0.77D, and the mean residual astigmatism was 0.99 ± 0.72D. Vector analysis showed a correction index of 0.94 ± 0.25, indicating effective and proportional correction. The mean vault measured 615.5 ± 192.3 µm, and was significantly associated with ICL size (p=0.002), whereas no significant correlation was found with white-to-white measurements (ρ=0.15).

Slightly lower refractive predictability may reflect the inclusion of higher astigmatism eyes and limitations of available ICL toricity, while the lack of correlation between white-to-white measurements and vault highlights the role of internal anatomical factors in ICL sizing.

Toric ICL implantation is safe and effective for high astigmatism. Vector analysis confirms accurate astigmatic correction, while postoperative vault is primarily influenced by ICL size rather than external biometric measurements. These findings support sizing strategies based on internal ocular anatomy and offer insights into the astigmatic outcomes in a cohort with high astigmatism, a subgroup underrepresented in current literature.