Just thirty years ago you may have never even gotten an IOL due to tradition or cost. After adoption in the developed world there was a huge push to prevent lower income countries from accessing the technology because they “didn’t need” that technology and could benefit from lower cost interventions such as glasses.

So as companies started to innovate and lower cost, single vision non toric IOLs became cheap enough for insurance to cover. Then to make some money on premium lenses companies (and ophthalmologists, sadly) really started to push torics and multifocal lenses.

The fact of the matter is that few patients benefit all that much from toric lenses that fix astigmatism. Most people have less than 1 diopter of astigmatic error, which they don’t even manufacture a toric lens for at any usable tolerance (the FDA allows a +/-0.50D tolerance to all lenses including torics), and surgical modifications can nullify that to some extent. Veterans get it free at most VA hospitals though, so they probably get more implanted than the average population.

In the next fifteen years though I bet Medicare will begin to cover toric lenses, and the rest of the insurance industry will follow. The surgery doesn’t change much between toric and non toric. The Multifocal IOLs will remain “premium” for a while to come I expect.