Anterior segment optical coherence tomography (AS-OCT) has emerged as a crucial imaging technique in ophthalmology, particularly for evaluating intraocular structures and the behavior of phakic and secondary intraocular lenses (IOLs). This narrative review summarizes the latest findings and clinical applications of OCT regarding phakic and secondary IOLs, focusing on their effectiveness, safety, and factors influencing performance. Through a comprehensive analysis of current literature, we explore how OCT facilitates the assessment of IOLs on key anatomical parameters—such as vault, angle configuration, lens centration, tilt, and haptic positioning—essential for optimizing surgical outcomes and minimizing postoperative complications. In phakic IOLs, including posterior chamber lenses such as the Implantable Collamer Lens (ICL, STAAR Surgical, Monrovia, CA, USA) and iris-fixated lenses, such as Artiflex (Ophtec BV, Groningen, The Netherlands), OCT enables precise evaluation of the anterior segment, aiding both candidate selection and long-term monitoring. In secondary implants for aphakia—especially iris-fixated lenses like Artisan (Ophtec BV, Groningen, The Netherlands) and sutureless scleral-fixated lenses such as the Carlevale IOL (Soleko, Rome, Italy)—or those implanted via the Yamane technique, OCT provides high-resolution visualization of haptic fixation, IOL stability, and potential complications, including tilt or decentration. This review also highlights comparative insights between fixation techniques, underscores the need for standardized OCT protocols, and discusses the integration of artificial intelligence tools. In summary, the routine use of OCT in the preoperative and postoperative management of phakic and secondary IOLs has been increasingly incorporated into clinical practice, as it enhances clinical decision-making and improves patient outcomes.

Corneal astigmatism correction is a key factor when planning refractive treatment for ametropies with intraocular lenses. We aim to obtain normative anterior and posterior corneal astigmatism (ACA and PCA, respectively) data in a local population and to describe their axis distribution and their association with other parameters. A total of 795 patients with no ocular diseases were evaluated with corneal tomography and optical biometry. Only data of the right eye were included. Mean ACA and PCA were 1.01 ± 0.79 and 0.34 ± 0.17 D, respectively. Vertical steep axis distribution was 73.5% for ACA and 93.3% for PCA. Axis orientation between ACA and PCA matched best for vertical orientation (especially 90° to 120°). Vertical ACA orientation frequency decreased with age, with a more positive sphere and less ACA. Vertical PCA orientation frequency increased with higher PCA. Eyes with vertical ACA orientation were younger and showed a greater white-to-white (WTW) measurement, anterior corneal elevations, ACA and PCA. Eyes with vertical PCA orientation were younger and showed greater anterior corneal elevations and PCA. Normative ACA and PCA data in a Spanish population were presented. Steep axis orientations presented differences with age, WTW, anterior corneal elevations and astigmatism.