Toric IOLs are an option for people who have cataracts and astigmatism.

It is very common for people to have astigmatism after and before cataract surgery. In the U.S., it is estimated that approximately one in three people who can have cataract surgery have some degree of astigmatism that causes noticeable vision problems.

There are different brands of toric IOLs to choose from. All of these are slightly different, so it is important to explore all the options before making a final decision.

Once a doctor determines that someone is a good candidate for toric IOLs, the next step is to perform the surgery. The doctor will remove the natural lens of the eye and implant a toric IOL.

What Are Cataracts?

young woman with cataractsCataracts are an all-too-common breakdown of the lens of the eye, a process that often comes with age and leads to a slow but progressive loss of clear vision. People who develop cataracts often experience more blurry vision and also notice changes in how they see colors. More than half of U.S. adults over the age of 80 get cataracts, and it’s estimated that more than 24 million people have them.

The good news is this: cataracts are easy to treat. For most people, the repair means surgery. There are three types of surgery, and they all do essentially the same thing. The damaged eye lens comes out. A new IOL usually is inserted, but not always.

Young children can also have cataracts. Doctors typically avoid surgery in these cases, preferring prescription eyedrops instead.

Many adults have cataracts in both eyes. If surgery is needed, doctors will operate on one eye, let it heal, then tackle the other eye a few weeks later.

What Is Astigmatism?

Astigmatism is a type of refractive error that affects approximately one in three people in the U.S. It is common for people with astigmatism to also have other refractive errors, including nearsightedness and farsightedness.

There are three types of primary astigmatism types (hyperopic, myopic and mixed), and with each of them astigmatism, vision appear distorted or blurry at all distances. Untreated, the condition causes eyestrain and headaches.

Doctors usually recommend prescription eyeglasses or contact lenses as a first line of treatment.

astigmatism vs normal vision graphic

What Are Toric IOLs?

In the past, intraocular lenses were not capable of correcting astigmatism when used to replace the lens removed during cataract surgery. At this time, the surgeon may have made incisions into the cornea to reduce the severity of the astigmatism. Toric IOLs changed this completely and gave people a viable treatment option for astigmatism.

multifocal intraocular lensesToric IOLs have things in common with toric soft contacts for astigmatism. In different meridians on the lenses, there are different powers. This helps to improve the eye’s asymmetric power, which occurs with astigmatism.

Comparing the Different Brands

The toric intraocular lenses that are FDA-approved include Abbott Medical Optics TECNIS Toric, Bausch and Lomb TRULIGN Toric, and Alcon AcrySof IQ Toric.

The TECNIS Toric lens promises the best low-light performance, sharpest vision, and long-term sustainability. It is used for those with astigmatism. Its power ranges from +5.0 to 34.0. It is made from a UV-blocking hydrophobic acrylic material.

The Bausch and Lomb TRULIGN Toric lenses work for astigmatism, presbyopia, and cataracts at the same time. This ensures a broader range of vision that is sharper and clearer. The manufacturer says that people get increased independence from their corrective lenses after getting these lenses implanted.

The Alcon AcrySof IQ Toric IOLs work for cataracts and astigmatism. They come in powers from +6.0 to 34.0. The seven-cylinder powers allow these lenses to treat preexisting corneal astigmatism. The manufacturer states that these lenses improve visual acuity and offer a decreased residual refractive cylinder.

Toric IOL Surgery

Surgeons performing an eye surgery under the microscope at the hospital - healthcare and medicine conceptsImplanting a toric lens for astigmatism is very similar to cataract surgery. The same general steps are used for both procedures. The surgeon removes the natural lens of the eye and replaces it with a toric IOL.

The surgery only takes about 15 minutes per eye and people are not put under general anesthesia. Before the procedure, eyedrops are used to anesthetize the eye, so the person does not experience discomfort during the procedure. Since only local anesthesia is used, it reduces the post-surgical recovery time in the hospital.

There are two surgical procedures the surgeon may perform to remove and replace the lens.

  • Extracapsular surgery removes the lens core in a single piece since the incision in the cornea is a little larger. This technique might be considered if the person has an advanced cataract.
  • Small incision cataract surgery uses a tiny probe and a small incision in the cornea. The probe sends ultrasound waves to the cataract to break up the lens. The doctor then suctions the pieces out. Sutures are usually not necessary for this technique.

Once the procedure is over, people will go to a recovery room for a short while. After this, most people are able to go home to continue recovery.

It may take up to a month for full recovery. The doctor will schedule follow-up visits at specific intervals to ensure the lens removal and implant recovery is going well.

The doctor often prescribes anti-inflammatory and antibiotic eyedrops after this procedure. This reduces inflammation and the risk of infection. During the first week of recovery, the eye may need to remain covered.

Before having the surgery, it is important to understand the potential complications. These may include the following:

  • Infection
  • Swelling
  • Dislocation of the artificial lens
  • Glaucoma
  • Inflammation
  • Bleeding
  • Eyelid drooping
  • Retinal detachment
  • Vision loss

Following your recovery instructions exactly can help to reduce the risk of these complications. Should any complications arise, immediately contact your doctor for further instructions.

With this information, you can make an informed choice about whether these IOLs are the best option for your astigmatism. Your doctor will perform a complete examination and ensure that your body and eyes are healthy enough for the procedure before replacing the lenses.

What Do IOLs Cost?

As with many other things in the vision care world, the cost of IOLs depends on where you live, your surgeon and your insurance plan. In general, you can expect to pay between $900 and $1,500 per eye for toric IOLs. Other implants can cost from $1,500 to $3,000 per eye.

But insurance plays a key role here. Many insurance providers will pay for an IOL if the procedure is done to correct poor vision. If your surgery is deemed elective, insurance is not likely to cover any part of it. (Even if your insurance doesn’t cover the cost, the surgery still may prove to be cost-effective if you are young enough to need an increasing number of new prescription glasses or contact lenses the rest of your life.)

Insurance, including Medicare, does not cover IOLs for multifocal/accommodating intraocular procedures.

If IOLs are too expensive for your budget, insurance or not, many eye doctors can offer payment plans or financing plans through their office or through a third party. There is ample scientific evidence that toric IOLs pay for themselves over the course of a lifetime if the patient is 65 or younger at the time of surgery.

References

Astigmatism and Cataract? A Toric IOL and Fix Both. All About Vision.

Intraocular Lenses: How to Choose the Best IOL for Your Cataract Surgery. All About Vision.

TECNIS Toric IOL. Johnson and Johnson Vision.

TRULIGN Toric IOL. Bausch and Lomb.

Product Information: AcrySof IQ Toric IOLs. My Alcon.

Cataract Surgery. All About Vision.

Cataract Surgery. American Optometric Association.

How Long is the Recovery Time After Cataract Surgery? VisionAware.

Cataract Surgery. Mayo Clinic.

Eye Health Statistics. American Academy of Ophthalmology.

What Are Cataracts? American Academy of Ophthalmology.

Astigmatism. All About Vision.

Medicare Vision Services. (August 2021). Medical Learning Network.

Economic evaluation of toric intraocular lens: a short- and long-term decision analytic model. (July 2010). Archives of Ophthalmology.

The information provided on this page should not be used in place of information provided by a doctor or specialist. To learn more, read our Privacy Policy and Editorial Policy pages.