Toric IOLs allow us to surgically treat corneal astigmatism at the time of cataract surgery thereby providing our patients with better vision without spectacles. The key is to have a toric IOL that is matched to the eye and aligned in an appropriate manner.
In the pre-operative evaluation, we need to determine the total corneal astigmatism prior to cataract surgery. Corneal topography, tomography, and keratometry are all helpful and will hopefully be quite similar. Note that of these, only corneal tomography will allow direct measurement of the posterior corneal surface. When the degree of total corneal astigmatism is determined, we must also find the steep and flat axes. We also want the corneal astigmatism to be regular, symmetric, and stable.
The phaco incision that we create will also affect the astigmatism, so we must factor that into the calculations. Remember that astigmatism is a vector which means it has both a magnitude and a direction. With our phaco incision, we will affect the magnitude but we can minimize any change in direction (or axis).
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