Femtosecond Laser AKs versus Toric IOLs for the Correction of Low-Magnitude Astigmatism During Cataract Surgery
For low astigmatism, femtosecond laser AKs achieved outcomes comparable to low-power toric IOLs.
The Annual ACES/SEE Caribbean Eye Meeting presents hot topics for anterior segment surgeons and healthcare professionals.
Mark your calendar for the 2027 Caribbean Eye meeting, taking place February 12–15 at the luxurious JW Marriott Los Cabos in San José del Cabo, Mexico. Join Program Chairs William Wiley, MD, and Robert Weinstock, MD, alongside esteemed ophthalmology experts, for an inspiring event focused on advancing eye care. Earn CME/COE credits while gaining insights, building connections, and boosting your clinical skills in a breathtaking tropical setting. Below is a summary of one of the standout presentations from the 2026 meeting—a preview of the rich content Caribbean Eye has to offer. Click here to watch this and other key sessions from the meeting.
During cataract surgery, patients with low but clinically meaningful astigmatism may fall into a gray zone between arcuate keratotomy and toric IOL correction. To that end, my collegues and I aimed to answer the question: Should surgeons treat eyes with approximately 0.60 to 1.10 D of astigmatism with femtosecond arcuate keratotomy or choose a low-power toric IOL?
The Clinical Conundrum
Some patients do not distinctly fit into one correction strategy. For example, a patient with 0.80 D of astigmatism could receive two 28º arcuate incisions using a formula that my colleague and I created (the Wörtz-Gupta Formula™), or an enVista toric IOL (Bausch + Lomb) that would correct about 0.90 D at the corneal plane.
Key decision factors include astigmatism that is residual or surgically induced, its orientation, and potential overcorrection from a toric lens. Colleagues and I previously demonstrated the benefit of correcting low levels of astigmatism versus leaving it untreated, and the advantages of toric lenses for astigmatism above 1.00 D and arcuate keratotomy for correctlons below 1.00 D.1,2 However, the unresolved question is the “coin flip” range of 0.60 to 1.10 D.
Study Design and Conclusion
We conducted a retrospective, single-surgeon series examining 105 eyes with an astigmatism target of 0.60 to 1.10 D. We established two cohorts with the objective of comparing their visual, refractive, and vector outcomes following femtosecond-assisted arcuate keratotomy versus toric IOLs for low-magnitude astigmatism:
- 52 eyes underwent femtosecond-assisted arcuate keratotomy with the ALLY® Adaptive Cataract Treatment System (LENSAR) using the Wörtz-Gupta Formula™
- 53 eyes received an enVista MX60ET toric IOL, selected via the Barrett Toric Calculator and implanted with the ALLY’s IntelliAxis® guidance.
Postoperative astigmatism was low in both groups, averaging < 0.25 D (88% < 0.25 D, and 92% < 0.50 D; Figure). Both groups achieved about 20/15 BCVA and an MSE near plano, with no statistical difference.
We concluded that femtosecond-assisted arcuate keratotomy using ALLY with IntelliAxis and the Wörtz-Gupta Formula™ delivered equivalent outcomes compared with low-power toric IOLs in eyes with low astigmatism. Not only does this laser option expand the tools we have in our treatment armamentarium, it also demonstrates a practical, customizable, and cost-effective alternative when toric IOLs are unavailable or not clinically preferred for some patients.
To learn more about the 2027 Caribbean Eye Meeting and register to attend, visit CaribbeanEyeMeeting.com
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