Preoperative Corneal Irregular Astigmatism and Long-Term Visual Outcomes After Multifocal Intraocular Lens Implantation

Why clinicians should know about it

• Picked for Ophthalmology (paper of the day, 16 August 2026): Pre‑op corneal irregular astigmatism predicts MIOL outcomes

Abstract

PURPOSE: Multifocal intraocular lenses (MIOLs) are disadvised among patients with irregular corneas, but the role of subclinical corneal irregular astigmatism on long-term visual outcomes remains poorly elucidated. SETTING: Keye Eye Center, Seoul, Korea. DESIGN: Retrospective single-center clinical cohort study. METHODS: Bilateral implantation of PanOptix MIOL with 3 years follow-up. Eyes were stratified based on total corneal irregular astigmatism (TCIA) in Scheimpflug tomography into low (≤0.15 µm), moderate (>0.15 to <0.30 µm), and high (≥0.30 µm) TCIA groups. RESULTS: In the cohort of 474 eyes of 237 patients, those with high TCIA had greater prevalence of prior refractive surgery (16% vs 2%; p<0.001), greater spherical aberration (0.45±0.26D vs 0.28±0.10D; p<0.001), and lower central corneal thickness (511±43µm vs 548±30µm; p=0.001) than those with low TCIA. High TCIA resulted in worse uncorrected distance visual acuity (UDVA) at 1-year (0.11±0.10 vs 0.03±0.08 logMAR units; p=0.001) and at 3-years (0.16±0.15 vs 0.04±0.08 logMAR units; p<0.001) compared to low TCIA, despite comparable postoperative refractive outcomes. At 3-years, Strehl ratio (0.024±0.019 vs 0.041±0.027; p=0.001), photopic (1.23±0.14 vs 1.39±0.20; p<0.001) and mesopic AULCSF (0.91±0.16 vs 1.06±0.19; p<0.001) were worse in high TCIA group compared to low TCIA group. Greater preoperative TCIA was associated with poorer age- and sex-adjusted UDVA (B=0.174, 95%CI: 0.101 to 0.248, p<0.001), corrected distance visual acuity (B=0.261, 95%CI: 0.132 to 0.389, p<0.001), and Strehl ratio (B=-0.598, 95%CI: -0.865 to -0.332, p<0.001) at 3-years. CONCLUSIONS: High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after MIOL implantation.

Abstract as published, via PubMed.