Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.
Population: Adults with corneal astigmatism undergoing cataract surgery
Intervention: Toric IOL
Comparison: LRI
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Postoperative residual refractive astigmatism <0.50 diopters at ≥6 months | Favors intervention | Moderate |
Postoperative residual refractive astigmatism at ≥6 months | Favors intervention | Low |
Uncorrected postoperative distance visual acuity at ≥6 months | Favors intervention | Moderate |
Spectacle independence for distance as reported by the participant at ≥6 months | Favors intervention | Low |
Vision‐related quality of life at ≥6 months | No statistically significant difference | Low |
Adverse effects: postoperative lens rotation requiring second procedure to re‐align toric IOL (timeframe not reported) | See note ᵃ | Low |
Adverse effects: other | See note ᵇ | Low |
Best corrected distance visual acuity | - | The reviewers did not report on this outcome |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) noted that LRIs are still supported due to the increased cost of toric IOLs compared with standard spherical IOLs. It also noted that future studies should include costs of the intervention and cost-effectiveness. ᵃ Five randomized controlled trials (RCTs, 318 eyes) reported no events in either group. ᵇ Six RCTs (420 eyes) considered other adverse events (e.g., corneal edema, endophthalmitis, corneal ectasia). Only two RCTs reported any adverse events. Results reported narratively; see the CCA for more details.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of routine preoperative medical testing for adults awaiting cataract surgery?
- How does day surgery for age-related cataracts compare with in-patient surgery?
- How does a toric intraocular lens (IOL) compare with a limbal relaxing incision (LRI) for people with corneal astigmatism after phacoemulsification?
- How do multifocal and monofocal intraocular lenses compare after cataract extraction?
- What are the effects of intracameral antibiotics for people undergoing cataract surgery?
- How do non‐steroidal anti‐inflammatory drugs (NSAIDs) compare with corticosteroids for controlling inflammation after uncomplicated cataract surgery?
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