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Toric intraocular lenses (IOLs) are commonly used in patients with regular corneal astigmatism who wish to achieve freedom from spectacles following cataract surgery. IOL position and alignment are critical to refractive success; for every degree of misalignment, there is a reduction of 3% of the astigmatism correction. Currently, manual corneal marking systems are the standard in guiding intraoperative toric IOL position. However, manual marking methods introduce multiple potential sources of error that can cause the final toric position to be misaligned. Potential sources of error include patient head tilt causing cyclotorsion of the eye, washout or smearing of preoperative marks, and incorrect spacing of the marks. Various techniques and technologies have been developed to reduce potential misalignment from a manual marking technique. Here, we present a review of a study evaluating a digital image-guided system that utilizes anatomic reference points to accurately identify the target axis and guide the surgeon through the operating microscope.