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Distribution of preoperative and postoperative astigmatism in a large population of patients undergoing cataract surgery in the UK
  1. Alexander C Day1,2,
  2. Mukesh Dhariwal3,
  3. Michael S Keith3,
  4. Frank Ender4,
  5. Caridad Perez Vives4,
  6. Cristiana Miglio5,
  7. Lu Zou5,
  8. David F Anderson6,7
  1. 1 The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  2. 2 Cataract Service, Moorfields Eye Hospital, London, UK
  3. 3 Alcon Laboratories Inc, Fort Worth, Texas, USA
  4. 4 Alcon Management SA, Geneva, Switzerland
  5. 5 Centre of Excellence for Retrospective Studies, IQVIA, London, UK
  6. 6 Ophthalmology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7 Ophthalmology, University of Southampton, Southampton, UK
  1. Correspondence to David F Anderson, QuintilesIMS, London KT16 8EH, UK; davidanderson3{at}


Purpose To assess the prevalence and severity of preoperative and postoperative astigmatism in patients with cataract in the UK.

Setting Data from 8 UK National Health Service ophthalmology clinics using MediSoft electronic medical records (EMRs).

Design Retrospective cohort study.

Methods Eyes from patients aged ≥65 years undergoing cataract surgery were analysed. For all eyes, preoperative (corneal) astigmatism was evaluated using the most recent keratometry measure within 2 years prior to surgery. For eyes receiving standard monofocal intraocular lens (IOLs), postoperative refractive astigmatism was evaluated using the most recent refraction measure within 2–12 months postsurgery. A power vector analysis compared changes in the astigmatic 2-dimensional vector (J0, J45) before and after surgery, for the subgroup of eyes with both preoperative and postoperative astigmatism measurements. Visual acuity was also assessed preoperatively and postoperatively.

Results Eligible eyes included in the analysis were 110 468. Of these, 78% (n=85 650) had preoperative (corneal) astigmatism ≥0.5 dioptres (D), 42% (n=46 003) ≥1.0 D, 21% (n=22 899) ≥1.5 D and 11% (n=11 651) ≥2.0 D. After surgery, the refraction cylinder was available for 39 744 (36%) eyes receiving standard monofocal IOLs, of which 90% (n=35 907) had postoperative astigmatism ≥0.5 D and 58% (n=22 886) ≥1.0 D. Visual acuity tended to worsen postoperatively with increased astigmatism (ρ=−0.44, P<0.01).

Conclusions There is a significant burden of preoperative astigmatism in the UK cataract population. The available refraction data indicate that this burden is not reduced after surgery with implantation of standard monofocal IOLs. Measures should be taken to improve visual outcomes of patients with astigmatic cataract by simultaneously correcting astigmatism during cataract surgery.

  • angle
  • epidemiology
  • treatment other
  • vision

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  • Presented at The results described in this manuscript were presented at the American Society of Cataract and Refractive Surgery Annual Meeting (Los Angeles, USA, 5–9 May 2017) and the Annual Congress of the Royal College of Ophthalmologists (Liverpool, UK 22–25 May 2017). An additional encore poster was presented at the European Society of Cataract and Refractive Surgery Annual Meeting (Lisbon, Portugal 7–11 October 2017).

  • Contributors ACD, MD, MSK, FE, CPV, CM, LZ and DFA were involved in the conception and design of the work. CM and LZ were involved in the acquisition and analysis of data for the work. ACD, MD, MSK, FE, CPV, CM, LZ and DFA were involved in the interpretation of data. CM drafted the manuscript. ACD, MD, MSK, FE, CPV, CM, LZ and DFA critically reviewed the manuscript.

  • Funding This study was sponsored by Alcon (Fort Worth, Texas, US).

  • Competing interests IQVIA received funding from Alcon Laboratories, Inc to conduct this study. ACD and DFA declare no competing interests. MD and MSK were employees of Alcon Laboratories Inc at the time of research. FE and CPV are employees of Alcon Management SA. CM and LZ are employees of IQVIA.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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