inability to correct vision at intermediate distance, which is mostly important for
younger presbiops oftenly using computers or other tasks at the distance of
60–80 cm. Later on, the so-called trifocal IOLs were invented, successfully
correcting vision for all visual needs: at distance, intermediate, and near. Although
these lenses were able to fully correct vision in high percentage of patients, they
were not applicable in eyes with the astigmatism since such eyes have an individual
need for correction of cylindrical power and axis, which is different in each eye.
The most recent advancement in IOL technology is a combination of multifocal
and toric design, resulting in multifocal toric design of the lens that provides a
complete visual recovery for patients with astigmatism and presbyopia.^15 ,^16 ,^17
Based on the positive visual outcome with the implantation of newer generation
of lenses in a cataract surgery, modern IOLs have become the treatment of choice
for many patients with presbyopia and astigmatism even when their natural lens is
still clear and has no cataract.^18 ,^19 Namely, refractive errors such as hyperopia and
low myopia with or without astigmatism, combined with presbyopia, cannot be
fully treated with refractive surgery on the cornea. Laser corneal ablation is highly
effective in the correction of low to moderate levels of astigmatism and may be the
best option for younger population.^20 For patients aged 45 or more, only distance
vision can be corrected by laser ablation, but the problem of presbyopia remains.
With the surgery on the lens, called refractive lens exchange, and implantation of
multifocal lenses, both distance and near visions can be corrected, and on top of it
also the preexisting astigmatism if a multifocal toric lens is used.
6 Conclusion
Personalized medicine is finding its place in most medical subspecialties, ophthal-
mology alike. Patients with the refractive error called astigmatism have an individ-
ual amount and axis of their astigmatism that has to be precisely determined prior to
cataract surgery. Recently, such patients could not see well both at distance and
near after cataract removal without spectacle wear due to the fact that conventional-
monofocal IOLs could not correct patient’s astigmatism. With the invention of
technologically advanced intraocular lenses (IOL), every refractive error, including
astigmatism and presbyopia, became treatable during cataract surgery. Monofocal
toric IOL, which has to be produced individually, according to the specific mea-
surements of each astigmatic eye, will enable patients to see well at distance even
(^15) Belluci et al. ( 2013 ).
(^16) Alfonso et al. ( 2014 ).
(^17) Visser et al. ( 2011 ).
(^18) Liekfeld et al. ( 2010 ).
(^19) Barisˇic ́et al. ( 2010 ).
(^20) Mozayan and Lee ( 2014 ).
238 I. Dekaris et al.