ICL – TORIC CORRECTION
This page is for patients with astigmatism who are considering ICL surgery and want to understand how toric ICL corrects both myopia and astigmatism simultaneously, what the risks are, and how outcomes compare to laser astigmatic correction.
Toric ICL Corrects Astigmatism at the Same Time as Myopia or Hyperopia
Standard ICL corrects spherical refractive error only, myopia or hyperopia. Toric ICL incorporates a cylindrical correction aligned to the patient’s astigmatic axis, addressing both the spherical and cylindrical components of the prescription in a single implant.² No separate astigmatic procedure is required. For patients with significant astigmatism (≥1.0D cylinder) who are ICL candidates, toric ICL is the preferred implant.
Axis alignment is critical to outcome. The toric ICL must be positioned precisely on the correct axis during surgery, a 10-degree misalignment reduces cylindrical correction efficiency by approximately 30%.³ This is why the axis is marked on the patient’s cornea at the slit lamp before surgery while the patient is sitting upright, preventing the cyclotorsion (axis rotation) that occurs when a patient lies down on the operating table.
Toric ICL vs Laser for Astigmatism
Toric ICL correction mechanism: cylindrical optic in the implant. Corneal tissue is untouched. Suitable for up to 6D cylinder correctable.² Residual cylinder ≤0.5D: over 90% in published series.² Toric rotation risk: under 5%, and the implant is repositionable. The procedure is reversible; the implant is removable.
LASIK for astigmatism correction mechanism: elliptical laser ablation of the cornea. Corneal tissue is permanently altered. Limited by corneal tissue above approximately 4D. Residual cylinder ≤0.5D: over 85% in published series. No toric rotation risk (permanent ablation). The procedure is irreversible.
Toric Rotation: What It Is and How It Is Managed
Toric ICL rotation occurs when the implant rotates away from its intended axis in the post-operative period. A rotation of 10 degrees reduces cylindrical correction by approximately 30%; 30 degrees produces near-zero cylindrical correction; 90 degrees reverses the cylindrical effect. Clinically significant rotation occurs in under 5% of toric ICL cases in published series³ and is identified at the one-week or one-month review by measuring the residual refraction and comparing it to the expected outcome.
Management is straightforward: repositioning under topical anaesthesia returns the ICL to the correct axis. Outcomes after repositioning are equivalent to primary implantation in published series. The procedure is brief and typically performed within weeks of the primary surgery.
Clinical Perspective
At Blue Fin Vision® clinic, Mr Mfazo Hove uses preoperative toric marking with the patient seated upright and intraoperative alignment guidance to minimise the rotation risk at implantation. In our 2024-2025 toric ICL series, the clinically significant rotation rate requiring repositioning was under 2%, and 95% of patients achieved residual cylinder of 0.5D or less at the one-month review. For patients with astigmatism above 2D considering ICL, toric correction is the default recommendation, leaving significant astigmatism uncorrected at an intraocular procedure is a missed opportunity.
Clinical Takeaway
Toric ICL corrects both myopia or hyperopia and astigmatism in a single implant. Axis alignment is the critical intraoperative step. Toric rotation occurs in under 5% of cases and is managed by repositioning. At Blue Fin Vision®, 95% of toric ICL patients achieve residual cylinder of 0.5D or less at one month. For astigmatism above 2D in an ICL candidate, toric is the standard recommendation. If you have significant astigmatism and are considering refractive surgery, ask specifically whether toric ICL has been assessed, it is often not raised proactively at LASIK-focused consultations.
References
- Kamiya K, Shimizu K, Igarashi A, Komatsu M. Four-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia. Arch Ophthalmol. 2009;127(7):845-50.
- Packer M. Meta-analysis and review: effectiveness, safety, and central port design of the intraocular collamer lens. Clin Ophthalmol. 2016;10:1059-77.
- Manzouri B, Vossen C, Weldon D, Feizi S, Bhatt U, Doane JF. Toric phakic intraocular lens to correct myopic astigmatism: 1-year results. J Cataract Refract Surg. 2008;34(1):90-5.
- Igarashi A, Shimizu K, Kato S, Kamiya K. Predictability of the vault after posterior chamber phakic intraocular lens implantation using anterior segment optical coherence tomography. J Cataract Refract Surg. 2012;38(11):2016-21.
- Alfonso JF, Lisa C, Fernandez-Vega L, Montes-Mico R, Valcarcel B, Ferrer-Blasco T. Collagen copolymer toric posterior chamber phakic intraocular lens in eyes with keratoconus. J Cataract Refract Surg. 2010;36(6):906-16.
