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Preoperative Corneal Irregular Astigmatism and Long-Term Visual Outcomes After Multifocal Intraocular Lens
Raimo Tuuminen1,2,3, Piotr Kanclerz1,4, Sohee Jeon5
1Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Journal of Cataract and Refractive Surgery
|August 13, 2026
Summary
High corneal irregular astigmatism negatively impacts long-term visual acuity and quality after multifocal intraocular lens (MIOL) implantation. Preoperative assessment of total corneal irregular astigmatism (TCIA) is crucial for predicting outcomes.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Visual Optics
Background:
- Multifocal intraocular lenses (MIOLs) offer spectacle independence but are typically contraindicated in patients with corneal irregularities.
- The impact of subclinical corneal irregular astigmatism on long-term visual outcomes following MIOL implantation is not well understood.
Purpose of the Study:
- To investigate the association between preoperative total corneal irregular astigmatism (TCIA) and long-term visual performance after PanOptix MIOL implantation.
- To determine if subclinical corneal irregularities affect visual acuity and quality of vision.
Main Methods:
- A retrospective cohort study involving 474 eyes implanted with PanOptix MIOLs.
- Eyes were stratified into low, moderate, and high TCIA groups based on Scheimpflug tomography.
- Visual acuity, Strehl ratio, and AULCSF were assessed over a 3-year follow-up period.
Main Results:
- Eyes with high TCIA exhibited higher rates of prior refractive surgery and greater spherical aberration.
- High TCIA was significantly associated with worse uncorrected and corrected distance visual acuity at 1 and 3 years postoperatively.
- Reduced Strehl ratio and AULCSF (area under the contrast spread function) were observed in the high TCIA group at 3 years.
Conclusions:
- Elevated preoperative TCIA is a significant predictor of suboptimal long-term visual acuity and reduced quality of vision after MIOL implantation.
- Ophthalmologists should consider TCIA assessment before MIOL surgery to manage patient expectations and predict outcomes.
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