Paired Phaco Incisions to Treat Astigmatism

During cataract surgery we can also address the patient’s astigmatism in order to provide the best possible vision without the reliance on glasses. We can do this by using a toric IOL to neutralize the corneal astigmatism, we can perform limbal relaxing incisions (LRIs) to make the cornea more spherical, and we can even alter the position of our phaco incision to place it on the steep axis.

Pairing a second phaco incision on the steep axis of astigmatism, opposite the main phaco incision, will increase the power of the dioptric flattening. This can help us to improve the patient’s vision. We have done a small study of patients who have with-the-rule (WTR) and against-the-rule (ATR) astigmatism to see how they did with paired phaco incisions.

superior incisions will cause more flattening than identical temporal incisions

The results were very encouraging and the full nomogram is simple but there is some variation depending on incision size, patient age, tunnel length, incision position, and more.

My nomogram for astigmatism correction with paired 2.8 mm-wide incisions is:

Click below for the video about paired phaco incisions to treat astigmatism:

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