Comparative effectiveness of toric IOLs and LRIs for correction of moderate regular astigmatism during phacoemulsification

Corneal astigmatism frequently coexists with age-related cataract and may impair uncorrected distance visual acuity (UDVA) if not addressed during surgery. Limbal relaxing incisions (LRI) and toric intraocular lenses (toric IOL) are two common methods for astigmatism correction, but evidence comparing their effectiveness in patients with moderate regular astigmatism remains limited. A prospective study was conducted at Yuyao Maternity and Child Health Care Hospital between January and December 2024. Ninety-three patients aged 55-80 years with moderate regular corneal astigmatism undergoing cataract surgery were allocated to either the LRI group (n = 45) or the toric IOL group (n = 48) based on informed voluntary choice following standardized preoperative counseling. All procedures were performed by a single experienced surgeon. The primary outcome was residual refractive cylinder at 6 months postoperatively. Secondary outcomes included UDVA, best-corrected visual acuity (BCVA), corneal astigmatism (K2-K1), and subjective visual satisfaction. Both groups showed significant improvement in UDVA and reduction in refractive cylinder postoperatively. At 6 months, the toric IOL group had significantly lower residual cylinder (0.67 ± 0.28 D vs. 0.94 ± 0.30 D, P < 0.001) and superior UDVA (0.15 ± 0.03 vs. 0.20 ± 0.03 LogMAR, P < 0.001) compared to the LRI group. No differences in BCVA were observed. Subjective satisfaction was significantly higher in the toric IOL group (P = 0.009). Toric IOL provide more favorable refractive and subjective outcomes than LRI for correcting moderate astigmatism during cataract surgery. These findings support a personalized approach that considers visual expectations, cost, and access to technology.