Real-world outcomes of low-cylinder-power toric intraocular lenses in eyes with mild corneal astigmatism

Purpose: To evaluate the effectiveness of astigmatism correction using low-cylinder-power monofocal toric intraocular lenses (IOLs) in eyes with mild corneal astigmatism. Setting: Tertiary care center in Osaka, Japan. Design: Single-center ambispective observational cohort study. Methods: Eyes were categorized into the T2 group (toric IOL with 1.0 diopter (D) cylinder power at the IOL plane), nontoric IOL (T0) group, or Tx group (T3 or higher toric IOLs; ≥1.5 D cylinder power). Eyes with irregular corneal astigmatism or prior ocular surgery were excluded. Three-month outcomes included uncorrected distance visual acuity (UDVA), refractive and subjective astigmatism, and vector analysis. Results: Seventy-five eyes (25 per group, 46 patients) were analyzed. At 3 months, the T2 group showed significantly lower mean refractive astigmatism (0.45 ± 0.25 D) and subjective astigmatism (0.28 ± 0.34 D) than the T0 group (0.92 ± 0.31 D and 0.69 ± 0.33 D; both P = .000), with better UDVA (logMAR -0.05 ± 0.12 vs 0.08 ± 0.15; P = .002). In paired-eye analyses, T0 eyes had greater refractive astigmatism (0.92 ± 0.32 D) and subjective astigmatism (0.69 ± 0.33 D) than their Tx fellow eyes (0.53 ± 0.33 D; P < .001 and 0.39 ± 0.32 D; P = .002). T2 achieved astigmatism correction comparable to that of Tx in mild-astigmatism eyes. Tx eyes trended toward better UDVA than their T0 fellows ( P = .060). Conclusions: Low-cylinder-power toric IOLs effectively corrected astigmatism and improved visual outcomes in eyes with mild corneal astigmatism, a population previously excluded from toric IOL implantation.