Need IOL - Too many choices!

[deerfern]

I have cataracts in both eyes. I am going to have surgery in two weeks on the right eye first. Then 4 weeks afterward the left eye.

I am a 55 year old female.  
Right eye has 1.0 astigmatism,
Left eye has .50 astigmatism.  
20/20 early in life (actually better than 20/20)
Started wearing glasses around 45 years old.
I am told my eyes are in good condition other than cataracts.
Eye allergies - creates discharge all year, so never wore contacts.
I don't like wearing glasses, would like to never wear them again.

Cataracts became noticable around 3 months ago. Now, I can't drive & have great difficulty at work with reading & computer work, which is set to high contrast with black background, yellow font. A lot of glare with everything. driving, reading, blur, etc.  I didn't understand why they progressed so fast, even though first diagnosis said cataracts were "ripe" (I know, wrong term).  Then I found out that my steriod injections for arthritis last year may have played a part in that, along with my diabetes. My Mother didn't get cataracts until age 75!

I need to figure out what IOL to choose that is best for me.  Can someone help me?

I have seen two doctors.  One does not like Crystal Lens, the other thinks it's great. I understand the Crystal lens is a more involved/more difficult procedure and even though I have heard they are better than a multifocal, they are very difficult to deplant should the need arise.  So while that was my first choice, I am now thinking it might not be the best choice.  Also, I would have to find a certified Crystallens surgen who was also in my insurance network. The doctor who does not care for the Cyrstal Lens says I have three choices.  She also says she uses a Toric Lens for astigmatism when it is 1.0 or over. Since right eye is 1.0, she says she could go either toric, multifocal or monofocal for that eye, and multifocal or mono for the left.

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Choices are:

1. Mono Lens in both eyes, one far & one near.  
They are going to give me a test for a few hours in their office end of this week to see if I can handle it. I have never worn contacts due to good eyesight early in life and allergies in eyes. So I am thinking it won't work for me and perhaps I should just skip it. But then again maybe I should try everything to make sure I've done so before making a final decision.

2. Toric in right eye to correct astigmatism, multifocal in left eye.
Is that going to work? Isn't a Toric really a mono focal just accomodating for the astigmastism?  If so then I will have one multifocal and one mono. I would think that would confuse my brain :)  And I read somewhere on line if multifocal is used, it should be both eyes, not just one.

3. Multifocal in both eyes, then laser later on to correct astigmatism.
Maybe I have that wrong, maybe a limbar incision?  (I think that's what it's called?) to relax the right eye's astigmatism, and still may need laser later anyway. Doctor says maybe blurry if go this route due to astigmastism so that's why possible laser later.
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I don't want to wear glasses anymore, as I was not used them early in life. I need good computer vision as I enjoy that tremendously, but if I have no choice after surgery, of course that is what it must be.

Which of these choices should I go for? I am leaning toward #3, the multifocal in both eyes, but the doctor seemed to be pushing toward the mono lens as it was less expensive and says I might get blurry vision with the multifocal, thus needing laser.

I really don't care about the price since this is going to be with me for the rest of my life.

Any and all comments are most welcome.

Thank you.

[John C Hagan III, MD, FACS, FAAO]

As you might imagine this has been discussed many times before. We understand it is new to you. You can use the search feature and archives to access these discussions.

Astigmatism can be corrected after surgery with glasses or at surgery with 1. Toric IOL  2. Incisions on the cornea with a knife of the new femtosecond laser 3. Smaller amounts corrected with placing the incision in the steep axis and using a lot of steroid drops.

JCH MD

[deerfern]

Dr. Hagan,

Thank you so much.  I am very glad to hear that I understand the choices. I think that was my concern; that I need to understand what those are.

I do realize no one can make that decision for me; I didn't mean to come across as asking for specific advice, I am very independent and would just take it with a grain of salt anyway.

Can you give me any insight on what occurs to correct the astigmatism via surgery?

I am sorry I am new at these forums. I will search for more information directly, however, if there are any particular threads or posts you deem valuable, I would really appreciate a link to them.

Thank you once again I hope to hear from you.

Regards.

[John C Hagan III, MD, FACS, FAAO]

You seem to understand the choices. The topic has been discussed in great detail and can be accessed with the search and archives features. What you don't seem to understand is that someone on the internet can't and shouldn't choose for you. Ultimately there is no correct answer for everyone "Different strokes for different folks".   Only you can make the ultimate decision.

JCH MD