Preoperative corneal astigmatism is common in cataract patients and impairs uncorrected distance visual acuity. The study compared toric and non-toric IOLs in patients with cataracts and corneal astigmatism based on twelve clinical trials. The primary outcome was postoperative residual refractive astigmatism, secondary UDVA, corrected distance visual acuity, proportion of eyes with residual cylinder ≤ 0.5 D, and spherical equivalent. Toric lenses achieved lower residual refractive astigmatism (SMD = -1.03, 95% CI -1.16 to -0.90) and better UDVA (SMD = -0.91, 95% CI -1.07 to -0.76) than non-toric lenses. More eyes with toric lenses had a residual cylinder ≤ 0.5 D (OR = 3.31, 95% CI 2.44 to 4.48). Differences in spherical equivalent were small (MD = 0.07 D, 95% CI 0.02 to 0.13). Toric lenses provide more accurate astigmatism correction and better uncorrected distance vision.