What cataract surgery can and cannot do for astigmatism
Cataract surgery can correct astigmatism, but only if your surgeon uses special techniques or lens implants designed for that purpose. Standard cataract surgery removes your clouded lens and replaces it with an artificial one — this alone does not fix astigmatism. However, your surgeon can add a procedure called limbal relaxing incisions (small cuts at the edge of your cornea) or implant a toric intraocular lens (a specially shaped artificial lens) to address the astigmatism at the same time.
The key difference is that your surgeon must know about your astigmatism before surgery and plan for it. If you have both cataracts and astigmatism, talk to your eye doctor about whether correcting the astigmatism during cataract surgery makes sense for you. Not every person with both conditions needs or wants both corrected together.
Key Takeaways
- Standard cataract surgery removes the clouded lens but does not correct astigmatism unless your surgeon uses additional techniques.
- Toric intraocular lenses and limbal relaxing incisions are two methods your surgeon can use to correct astigmatism during cataract surgery.
- Your surgeon needs to measure your cornea and plan for astigmatism correction before the operation, so tell your eye doctor about any astigmatism you have.
- Correcting astigmatism during cataract surgery may cost more than standard cataract surgery, and insurance coverage varies.
How toric intraocular lenses work
A toric intraocular lens is an artificial lens with different powers in different meridians — similar to how bifocals work, but for astigmatism correction. When your surgeon implants a toric lens during cataract surgery, it bends light differently in two directions to correct the uneven curvature of your cornea that causes astigmatism.
For a toric lens to work, your surgeon must measure your cornea precisely before surgery and position the lens at exactly the right angle during the operation. If the lens rotates even a few degrees after surgery, the astigmatism correction may not work as planned. Your surgeon will discuss how stable toric lenses typically are and what to watch for after surgery.
Toric lenses are the most common way to correct astigmatism during cataract surgery. Many insurance plans cover part of the cost of a standard intraocular lens but may not cover the additional cost of a toric lens, so ask your eye doctor and insurance company about out-of-pocket costs before you decide.
Limbal relaxing incisions as an alternative
If you prefer not to use a toric lens, your surgeon can make small, precise cuts at the edge of your cornea called limbal relaxing incisions. These cuts relax the tight part of your cornea and flatten it slightly, reducing astigmatism. The incisions are made during cataract surgery at the same time your clouded lens is removed.
Limbal relaxing incisions work best for mild to moderate astigmatism. For severe astigmatism, a toric lens usually gives better results. The incisions are permanent, so this choice cannot be reversed if you want to change your correction later. Ask your surgeon whether your amount of astigmatism is a good fit for this method.
What to ask your eye doctor before surgery
Before cataract surgery, ask your eye doctor these specific questions about astigmatism correction:
- Do I have astigmatism, and how much?
- Can my astigmatism be corrected during cataract surgery?
- What are my options — toric lens, limbal relaxing incisions, or neither?
- What is the cost difference between standard cataract surgery and astigmatism correction, and what will my insurance cover?
- How stable is the correction after surgery, and what happens if the lens rotates or the incisions heal differently than expected?
- If I don't correct astigmatism now, can I do it later with another procedure?
- What will my vision be like after surgery if I do or don't correct the astigmatism?
When astigmatism correction during cataract surgery makes sense
Correcting astigmatism during cataract surgery is worth considering if your astigmatism bothers you now and you want to reduce your dependence on glasses or contact lenses after surgery. If your astigmatism is mild and you are comfortable wearing glasses, you may decide to skip the extra procedure and correct it with glasses instead.
Some people find that correcting astigmatism during cataract surgery improves their quality of life significantly — they see better at all distances and need glasses less often. Others find the improvement modest and decide the extra cost is not worth it. Your eye doctor can help you think through what matters most to you.
If you have had cataract surgery already without astigmatism correction, you still have options. You can wear glasses, contact lenses, or ask your eye doctor about other procedures that correct astigmatism after the fact, such as laser eye surgery or implanting a special contact lens inside your eye.
What happens if astigmatism is not corrected during surgery
If you choose not to correct astigmatism during cataract surgery, your astigmatism will still be there after surgery. You will need glasses or contact lenses to see clearly, just as you did before — but your vision through those glasses or lenses should be sharper because the cataract is gone.
Some people are surprised to find that their astigmatism seems worse after cataract surgery, even though it was not corrected. This can happen because the cataract was masking the astigmatism, or because the surgery itself caused a small change in your cornea's shape. Talk to your eye doctor if your astigmatism feels different after surgery.
Insurance and cost considerations
Medicare covers standard cataract surgery but typically does not cover the extra cost of toric lenses or limbal relaxing incisions for astigmatism. You may be responsible for the difference, which varies by surgeon and facility but can range from several hundred to over a thousand dollars per eye. Private insurance plans vary widely — some cover part of the toric lens cost, and others do not.
Ask your eye doctor's office to contact your insurance company before surgery to find out exactly what is covered and what you will owe. Get a written estimate of your out-of-pocket costs so there are no surprises. If cost is a concern, discuss with your surgeon whether limbal relaxing incisions might be a less expensive option, or whether waiting and correcting astigmatism later with glasses or another procedure makes sense for your situation.
Frequently Asked Questions
Will my astigmatism come back after surgery if I have it corrected?
Astigmatism itself does not come back, but your cornea can change slightly over time due to aging or healing. If you have a toric lens, it stays in place permanently. If you have limbal relaxing incisions, the cornea may shift slightly as it heals, which could reduce the correction slightly. Your eye doctor can measure your vision after surgery to see if any change has occurred.
Can I wear contacts or glasses after cataract surgery if I don't correct astigmatism?
Yes. If you choose not to correct astigmatism during cataract surgery, you can still wear glasses or contact lenses afterward to correct it. Many people do this successfully. Your eye doctor can write you a new glasses prescription after your eye has healed from surgery.
What if I have astigmatism in one eye but not the other?
You can choose to correct astigmatism in the eye that has it and not in the other eye. Some people do this to balance their vision. Discuss with your surgeon how this might affect your overall vision and whether it is a good choice for you.
Is astigmatism correction during cataract surgery safe?
Yes, both toric lenses and limbal relaxing incisions are well-established, safe methods. Complications are rare. The main risk with toric lenses is that the lens might rotate slightly, which could reduce the astigmatism correction. Your surgeon will discuss any risks specific to your situation.
How long does it take to recover vision after astigmatism correction during cataract surgery?
Recovery time is the same as for standard cataract surgery — usually a few weeks for your vision to stabilize. You may notice improvement within days, but your final vision may not be clear until four to six weeks after surgery. Your eye doctor will schedule follow-up visits to monitor your healing.