Visual outcomes and cost-utility analyses of toric intraocular lens implantation in cataract patients over 80 with corneal astigmatism: a retrospective cohort study.

Introduction: This study aimed to assess visual and refractive outcomes and cost utility of toric intraocular lens (IOLs) implantation in cataract patients over 80 with corneal astigmatism.

Methods: Patients >= 80 years with corneal astigmatism >= 1.50 diopters (D) who underwent cataract surgery with toric or monofocal IOLs were enrolled. Uncorrected distance visual acuity (UDVA) and residual refractive astigmatism at the 3-month postoperative follow-up were compared between the toric and non-toric groups. Cost data were gathered, long-term quality-adjusted life years (QALYs) were calculated, and the incremental cost-effectiveness ratio (ICER) was determined.

Results: The study included 50 eyes from 50 patients, with 25 eyes receiving toric IOLs and the remaining 25 receiving non-toric IOLs. Three months after surgery, both the mean UDVA (P < 0.0001) and the mean residual refractive astigmatism (P < 0.0001) in the toric group significantly outperformed those in the non-toric group. An average of 4.04 ± 0.25 QALYs were obtained in the toric group through cataract surgery, while 3.78 ± 0.26 QALYs were obtained in the non-toric group. The median ICER stood at 11,222 CNY (1,753 USD) per QALY [95% CI: 5,840 ~ 25,295 CNY (913 ~ 3,952 USD) per QALY], which is lower than the threshold of cost-effectiveness in China (80,976 CNY (12,653 USD) per QALY).

Conclusion: In cataract patients aged over 80 with corneal astigmatism and no complicating vision-threatening conditions, toric IOL implantation not only improved UDVA and reduced residual astigmatism but also emerged as a cost-effective intervention compared with non-toric IOL implantation.