The Toric Allocation Pathway (TAP): outcomes of a standardised pathway for toric lens allocation at a tertiary referral hospital.

Aims: To determine if a standardised Toric Allocation Pathway (TAP) improved visual and refractive outcomes for patients undergoing cataract surgery at a tertiary referral teaching hospital.

Methods: Demographic, visual, and refractive data from all patients who underwent cataract surgery and toric intraocular lens (IOL) insertion with an emmetropic target between January 2015 and December 2019 were retrospectively collected and separated into pre-TAP and TAP groups. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), postoperative spherical equivalent refraction (SER) and postoperative cylinder were compared using multivariate regression analysis and Mann-Whitney U testing.

Results: A total of 118 eyes were divided into pre-TAP (n = 59, 50%) and TAP (n = 59, 50%) groups. Case-mix and surgeon rank was comparable between the two groups (all variables p > 0.05). The TAP group outperformed the pre-TAP group in postoperative mean UDVA (6/7.5 ± 0.13 LogMAR vs. 6/9 ± 0.19 LogMAR, p = 0.049, respectively) and residual cylinder (0.47 ± 0.54D vs. 0.87 ± 0.78D, p < 0.001). As well, the TAP group was more consistent, with significantly smaller standard deviations for all outcomes. Consequently, a higher proportion of patients achieved a SER of ≤ 0.5D from emmetropia in the TAP group (78% vs. 58%, p < 0.001).

Conclusions: The TAP improved the visual and refractive outcomes for patients with regular astigmatism while minimising inappropriate implantation of toric IOLs. It is ideal for large teaching hospitals and provides a framework for developing surgeons in correctly selecting patients who would most benefit from toric IOLs.