Clinicians referring patients for cataract surgery should factor in corneal astigmatism when seeking the right referring practitioner, according to a new study. Rather than recommend a surgeon who performs manual limbal relaxing incisions (LRIs) during traditional phacoemulsification surgery, they should consider someone well-versed in femtosecond laser–assisted cataract surgery. That’s because patients who underwent non-penetrating femtosecond laser arcuate keratotomy during cataract surgery had better astigmatism correction than those who had LRIs, according to researchers in the United Kingdom.

They studied 51 eyes that received LRIs and 53 eyes that had femtosecond arcuate keratotomies and measured visual acuity, postoperative refraction and corneal topography four weeks post-op.

They found 44% of patients in the femtosecond arcuate keratotomy group and 20% in the LRI group attained a postoperative cylinder of less than 0.50D.

The mean target induced astigmatism was 1.50D and 1.38D, respectively, with 1.02D and 1.23D surgically induced astigmatism, creating a smaller difference vector for the femtosecond arcuate keratotomy group (1.17D vs. 0.89D) and a greater correction index (0.48 vs. 0.73).

Although both procedures were safe, easy to perform and achieved reduced corneal astigmatism, the laser group had a correction of greater magnitude than the LRI group four weeks post-op, the researchers conclude.

Roberts HW, Wagh VK, Sullivan DL, et al. Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery. J Cataract Refract Surg. 2018;44(8):955-63.