Effect of astigmatism on visual acuity after multifocal versus monofocal intraocular lens implantation

John P. Berdahl, David R. Hardten, Brent A. Kramer, Richard Potvin

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Purpose: To determine whether there is a difference in how much residual astigmatism impacts uncorrected distance visual acuity (UDVA) after multifocal versus monofocal intraocular lens (IOL) implantation. Setting: Database study. Design: Retrospective data review. Methods: An online toric IOL back-calculator allows users to input preoperative toric planning information and postoperative IOL orientation and refractive results. These data are used to determine the optimal orientation of the IOL to minimize residual refractive astigmatism. Aggregate data were extracted from this calculator to investigate factors associated with UDVA and relative magnitudes of residual astigmatic refractive error up to 2.5 diopters (D) after implantation of toric IOLs. Results: Of 1919 pertinent records (455 multifocal toric IOLs and 1464 monofocal toric IOLs), a statistically significant difference by refractive cylinder category (P <.01) and a statistically significant difference by IOL type (P =.042) were noted. This difference was mostly driven by patients with residual refractive astigmatism of 1.5 D. The mean change in UDVA was 0.16 logarithm of the minimum angle of resolution per 1.0 D of astigmatism. Evaluating a more homogenous dataset with the same monofocal and multifocal IOL design, there was a statistically significant effect of refractive cylinder (P <.01) but no significant effect of IOL type (monofocal or multifocal, P =.45). The differences in UDVA at different refractive cylinder values was not statistically significantly different by orientation of the current astigmatism (P =.28). Conclusion: Residual astigmatism after toric IOL implantation impacts visual acuity similarly in patients who had multifocal and monofocal toric IOL implantation.

Original languageEnglish (US)
Pages (from-to)1192-1197
Number of pages6
JournalJournal of cataract and refractive surgery
Issue number10
StatePublished - Oct 2018

Bibliographical note

Funding Information:
Data analysis and the preparation of this manuscript were supported with an investigator-initiated research grant to Ocular Surgical Data, LLC, Sioux Falls, South Dakota from Alcon Laboratories, Inc., Fort Worth, Texas, USA.

Publisher Copyright:
© 2018 ASCRS and ESCRS


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