Prevalence and Patterns of Corneal Astigmatism in Cataract Surgery Candidates in the Eastern Province of Saudi Arabia

Background: Corneal astigmatism (CA) is a frequent refractive condition in patients undergoing cataract surgery. Although international data on CA prevalence exist, regional insights from Saudi Arabia remain scarce. Methods: This retrospective observational study analyzed preoperative biometric data from 537 eyes of 453 adult cataract surgery candidates at two ophthalmology centers in the Eastern Province of Saudi Arabia between 2022 and 2024. CA was assessed using optical biometry and Scheimplflug tomography. Astigmatism was categorized by magnitude and axis orientation: with-the-rule (WTR), against-the-rule (ATR), and oblique (OB). Demographic correlations were examined using appropriate statistical methods. Results: The mean CA was 1.08 ± 0.97 diopters (D), with 53.7% of eyes showing astigmatism between 0.51–1.50 D. CA ≥1.5 D was found in 29.6% of eyes, while high astigmatism (>3.0 D) was rare (4.48%). ATR astigmatism was the most prevalent overall, followed by WTR and OB. When stratified by age, both ATR and WTR showed their highest prevalence in the 60–69-year age group. A weak but statistically significant positive correlation was observed between age and CA magnitude ( r = 0.216, P <0.001). OB astigmatism was significantly associated with longer axial length ( P = 0.008), while anterior chamber depth showed no significant variation by astigmatism type ( P = 0.948). Conclusion: Corneal astigmatism is common among cataract surgery candidates in Saudi Arabia, with a substantial proportion having clinically significant levels requiring correction. Higher ATR values were detected in the older age groups compared with the younger. These findings underscore the need for standardized assessment protocols to guide astigmatism management and enhance refractive outcomes in cataract surgery.