The following summary from the ESCRS Publications Committee highlights why they consider this a 'Landmark' article.
In a systematic review and meta-analysis of randomized clinical trials (RCTs), toric IOLs provided better uncorrected visual acuity (UCDVA), greater spectacle independence, and lower amounts of residual astigmatism than non-toric IOLs, even when relaxing incisions were used. From a literature search in the Embase, PubMed, and CENTRAL databases within the Cochrane Library which included 13 randomised controlled trials with 707 eyes randomised to toric IOLs and 706 eyes randomised to non-toric IOLs, including 225 eyes with relaxing incisions. Using the GRADE profiler software and the Cochrane Risk of Bias tool the study’s authors found high-quality evidence that UCDVA was better in the toric IOL group, with a mean difference of -0.077 logMAR. Tpric IOLs provided greater spectacle independence (risk ratio [RR], 0.51; 95% CI, 0.36-0.71) and moderate quality evidence that toric IOL implantation was not associated with an increased risk of complications. Moreover, Residual astigmatism was lower in the toric IOL group than in the non-toric IOL plus relaxing incision group (mean difference, 0.37 diopter [D]; 95% CI, -0.55 to -0.19).