 Patients will be offered the same kerato-refractive procedures including manual limbal relaxing incisions or LenSx astigmatic keratotomy that would be offered to patients who are not part of this study. Patients will also be evaluated for benefit from advanced technology intraocular lenses Toric for astigmatism and ReStor multifocal that patients who are not part of the study would be offered. Offering advanced technology lenses or combined kerato-refractive procedures is not expected to influence the visual acuity study outcomes for patients in this study. Patients clinical history, past medical history and ophthalmic medical notes in particular pre-operative evaluation, operative, and post-operative follow up will be reviewed. De-identified data points will be extracted for this project. 