Study Finds Toric IOLs Maintain Astigmatism Reduction Through at Least Two Years

A systematic review on long-term outcomes of toric IOLs reinforced the safety and efficacy of this intraocular lens type for patients with astigmatism. Photo: Jonathan Stein, MD. Click image to enlarge. Despite the popularity of toric intraocular lenses (IOLs) for corneal astigmatism, most studies to date have focused on early postoperative outcomes, leaving a gap in the literature on long-term rotational stability and reoperation rates. To investigate, researchers recently conducted a systematic review that determined these IOLs offer durable correction of astigmatism and excellent rotational stability for up to two years, along with a modest reoperation rate of less than 1%.A search of Ovid Embase and PubMed databases yielded 19 studies that reported outcomes of toric IOL implantation at least one year after the procedure. The reports encompassed a total of 1,180 participants and 1,564 eyes, with follow-up periods averaging around 30 months. Patients with other ocular comorbidities were excluded. The analysis revealed that the mean residual astigmatism decreased to -0.65D at one year and to -0.80D at two years—a meaningful reduction from the preoperative average of -2.17D. Furthermore, the review documented a low IOL reoperation rate of only 0.77%, mostly occurring within the first four weeks post-surgery, which the researchers noted in their paper “reinforces the overall safety of the procedure.”Stability was a key finding, as the average rotation of the IOL was measured at 2.27° at one year and slightly increased to 2.82° by two years. “This stability is a critical metric for both surgeons and patients, as it provides confidence for a durable correction,” the researchers explained. There were outliers, however; particularly, most studies that reported cases requiring surgical repositioning involved patients with a high axial length (>25mm), which the authors note “highlights a potential risk factor for [clinicians] before counselling a patient with axial myopia for toric IOL implantation.”The researchers acknowledged several limitations that could affect their conclusions. Most included studies were uncontrolled cohorts and case series, potentially introducing selection and performance biases. Significant clinical heterogeneity was also observed, with follow-up durations ranging from 12 to 96 months and inconsistent pre- and post-operative measurements, limiting analysis of long-term trends beyond two years.Overall, these findings underscore the efficacy and safety of toric IOLs in astigmatism management. “Toric IOL implantation delivers a significant, durable correction of astigmatism with a satisfactory rotational stability for up to two years and a low long-term reoperation rate,” the researchers concluded, while adding, “Future prospective studies with follow-up exceeding five years are warranted to elucidate even longer-term outcomes.”Click here for the journal source. Lam CCY, Tsang A, Mok E, et al. Long-term astigmatism reduction with toric intraocular lenses – a systematic review. J Cataract Refract Surg. February 18, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.