Correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with different corneal astigmatism degrees: a retrospective cohort study.

PURPOSE: To investigate the correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with varying degrees of corneal astigmatism, and to identify factors influencing patient-reported outcomes following modern cataract surgery.

METHODS

This retrospective cohort study analyzed 682 eyes of cataract patients who underwent phacoemulsification with standard monofocal non-toric intraocular lens (IOL) implantation targeting emmetropia between January 2022 and December 2022. Patients were stratified into four groups based on preoperative corneal astigmatism: Group 1 (< 0.75 D, n = 250), Group 2 (0.75-1.50 D, n = 245), Group 3 (1.51-2.50 D, n = 121), and Group 4 (> 2.50 D, n = 66). Primary outcomes included best-corrected visual acuity (BCVA), uncorrected distance visual acuity (UDVA), and patient satisfaction scores measured using the modified NEI VFQ-25 questionnaire. Secondary outcomes encompassed visual symptoms and spectacle independence for distance vision.

RESULTS

Mean postoperative UDVA improved significantly across all groups (p < 0.001), with Group 1 achieving 0.12 ± 0.08 logMAR compared to 0.36 ± 0.14 logMAR in Group 4. Postoperative BCVA was ≥ 20/30 in 97.1% of all eyes, confirming good visual potential across groups. Patient satisfaction composite scores decreased progressively with increasing astigmatism magnitude (Group 1: 88.4 ± 9.2 vs. Group 4: 67.1 ± 15.8; p < 0.001). Spectacle independence for distance vision was achieved in 92.5% of Group 1 patients versus 45.5% in Group 4. Multiple regression analysis revealed that postoperative UDVA (β =  - 0.42, p < 0.001), residual astigmatism (β =  - 0.38, p < 0.001), and severity of glare symptoms (β =  - 0.21, p = 0.003) were significant independent predictors of reduced satisfaction (adjusted R2 = 0.57).

CONCLUSIONS

Higher degrees of preoperative corneal astigmatism are associated with reduced postoperative visual satisfaction despite good BCVA outcomes. These findings support a low threshold for astigmatism management and highlight the importance of comprehensive patient counseling regarding expected visual outcomes based on preoperative astigmatism magnitude.