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649848 tn?1534633700

Astigmatism and cataract surgery

I'm in the process of arranging for cataract surgery and I have, what they tell me is large amount of astigmatism.  My regular optometrist tells me that the technology is not available to make a lens to correct astigmatism as great as mine.  The ophthalmologist says they've made great improvement in the past couple of years and that my optometrist may not be aware of it, but that they "can" make a lens to correct astigmatism like mine.  

I've worn glasses since I was 16 and they've recently added prisms to help clear my vision.

Can you tell me how much astigmatism can be corrected, so I know whether it's worth spending extra money on or not?

Thank you in advance.
2 Responses
177275 tn?1511755244
I would believe the ophthalmologist not the optometrist.  The optometrists is not a physician, does not do surgery and often not interested in getting you out of glasses.   Toric IOLs can routinely correct up to 4 diopters but other methods including laser, incision placement and LRI can be used for larger amounts.
2 Comments
The issue is that Medicare only pays for the basic correction (for me, that would be distance) and it's my understanding that ophthalmologists don't make much doing that so the optometrist was afraid they would try to "upsell" me in order to make more.  

They placed my astigmatism at about a 3 and the ophthalmologist said she could get me down to about 0.5, which, she said, doesn't need correction.  

I wear bifocals so even after the distance vision and astigmatism are corrected, I'll still need something for close up.  I do a lot of close up work - would you recommend a bifocal-type of glasses or reading glasses.  
For reference, a couple years ago I had cataract surgery only on my right eye which had astigmatism around 3 diopters cylinder.  I got a Tecnis toric monofocal IOL set for distance focus and ended up with about 1.0 diopter cylinder astigmatism, so I now get about 20/25 to 20/30 distance vision without glasses in that eye.  Thats compared to 20/100 or worse before the operation.  I can correct my vision in that eye to better than 20/20 with glasses.  My left eye still has astigmatism (about 2.0 cylinder) so I need glasses for that eye anyway so I use progressive glasses for distance and reading focus.  I also use separate fixed focus glasses for intermediate focus for computer monitor viewing at about 2-3 feet away with about -1 diopter from my distance Rx.
177275 tn?1511755244
Your optometrist is something of a drag and has limited understanding of cataract surgery.   It is true that Medicare and standard insurance only pays for spherical IOLs that do not correct astigmatism. Since astigmatism blurs both distance and near vision it is almost certain that you vision far, intermediate, near will not be acceptable without a toric IOL. The upgrade price is reasonable, the % of patients that need a second procedure to re-align the toric IOL along the axis of astigmatism is less than 1%. I have hundreds of happy patients with toric IOLs.  If you would like to make your vision without glasses as good as possible toric is the way to go. Beyond that is multifocal IOLs, those are much more expensive, have problems with night vision and not a few patients are unhappy that they still need glasses for certain things.
2 Comments
I had been leaning toward proceeding with the correction for the astigmatism, in spite of my optometrist, and you've helped me make the decision to go ahead with it.   Thank you.

I did not consider the multi-focal, partially because of the cost but mostly, because, neither the ophthalmologist nor optometrist advised it.   You've helped finalize that decision as well.

So with the distance vision and astigmatism fixed with the toric IOL, I'd have to have some kind of glasses to do close up work, read, etc.  Is that correct or am I misunderstanding how the IOL works?
First read this article carefully:  LINK  https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You--2019-2020-Update

You can talk with your surgeon about WITHOUT glasses you would prefer your clearest vision.  If you choose distance you are talking about 20 feet or further.  If you look at a TV set 10 feet away it will be fuzzy and 10 ft out of focus. You will no no line multfiocal glasses to see at that distance.  Few people are happy with this.   My article discusses full mono-vision which is not a good choice either for most people. One eye is always out of focus, glasses are difficult to adjust to and intermediate vision  3-5 feet is out of focus.   Most people are happiest with mini-monovision distance bias or mini-monovision near bias.  Discuss this with your surgeon.
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