Geneva, October 11, 2018 – Alcon, the global leader in eye care and a division of Novartis, highlights the publication in peer reviewed British Journal of Ophthalmology following a large retrospective study reflecting the real world clinical practice in cataract surgery. The research highlights the significant burden of preoperative astigmatism that tends to worsen following cataract surgery with a standard monofocal intraocular lens (IOL), while astigmatism corrective procedures such as using toric IOLs are infrequently performed.

With a large sample of 110,468 eyes from 76,910 patients aged 65 and older from eight NHS ophthalmology clinics in the UK, the research reflects real world clinical practice in terms of patient visits, treatment decisions and data collection. Findings show that 78% of eyes presented for cataract surgery had at least minimal clinically relevant astigmatism of 0.5D. Moreover, a substantial proportion of eyes have more severe astigmatism of at least 1.0D (42%) and 2.0 D (11%). After surgery, refraction cylinder measurements were available for 39,744 (36%) eyes receiving standard monofocal IOLs, of which 90% (n=35,907) had post-operative astigmatism ≥0.5D and 58% (n=22,886) ≥1.0D. Toric IOLs or additional surgical procedures such as limbal relaxing incisions or opposite clear corneal incisions to reduce astigmatism were used in less than 1% of cases.

“Before this study, there was no strong epidemiological evidence on the prevalence and severity of astigmatism pre- and post-cataract surgery. We hope that this multi-center study will address this knowledge gap by determining the prevalence and severity of pre- and post-operative astigmatism in a large, real-world population of eyes with cataract in the UK. An exploratory objective was also to describe the effect of post-operative residual astigmatism on patients’ visual acuity”, said David F. Anderson, M.D., Ph.D., FRCOphth and lead principal investigator of the study.

Results also indicated that astigmatism burden is not reduced after surgery with implantation of standard monofocal IOLs. It was also indicated that uncorrected distance visual acuity worsens as residual astigmatism increases – which suggests that if left uncorrected, astigmatism can significantly affect patients’ visual outcomes limiting their quality of life. However, in the vast majority of cases (>99%) patients did not receive astigmatism corrective co-procedures.¹

These findings corroborate the results from a manuscript published earlier this year in peer-reviewed Clinical Ophthalmology on the Global prevalence and economic and humanistic burden of astigmatism in cataract patients. This systematic review of the literature demonstrated that in cataract patients, both pre-existing and postoperative residual astigmatism were associated with poor vision-related patient satisfaction and quality of life, as well as a higher spectacle burden. Results also indicated that the cost burden of residual uncorrected astigmatism after cataract surgery was driven by the cost of spectacles, which was estimated to range from $1,786 to $4,629 in Europe over a lifetime. Moreover, the evidence strongly suggests that astigmatism correction with Toric IOLs is a sustainable solution over the long-term leading to improvement in vision related quality of life and reducing post-operative spectacle burden. 

To address the disability related to poor vision for patients with pre-operative astigmatism, some European health authorities such as Poland and Hungary have recognized the value of toric lenses by voting in favour of their reimbursement. Moreover, after a thorough review of evidence, the French National Authority for Health (HAS), an independent public scientific authority in Europe that evaluates healthcare products, procedures, services and technologies from a medical and economic standpoint, issued an opinion last year recommending the use of Alcon toric IOL vs monofocal IOLs in the interest of public health.

“Astigmatism correction during cataract surgery appears to improve visual outcomes and results in overall lifetime cost savings compared to astigmatism correction spectacles after surgery. This is also the conclusion of a few European regulatory bodies who recommend astigmatism correcting IOLs to be offered or reimbursed to cataract patients who most need it. While studies demonstrate the medical and economic benefits of toric lenses for patients, there is still much work to do to broaden access to these treatment options”, said Ian Bell, Region President Europe, Middle East and Africa.

Every year, approximately 4.2 million cataract surgeries are performed in the European Union.³ While the most frequent treatment option remains monofocal IOLs to address cataract, other recent options exist to address pre-existing refractive eye conditions such as astigmatism or presbyopia, two common conditions present in cataract patients. Suboptimal correction of astigmatism during cataract surgery drives the continuous need for vision correction with spectacles after the surgery.