Toric lens Vs LRI

[taurus1203]

I met a cataract surgeon he confirmed my astigmatism (-2.0) is regular and can be corrected by LRI during the cataract surgery he thinks the -2.0 is not seriouis. I wonder why not using Acrysoft IQ to fix astigmatism. His explanation is he thinks the astigmatism is a problem in the cornea, it is more appropriate to fix it at the cornea but not at the lens. He also thinks that the toric lens can rotate in the future. He is also a fans of Tecnis Aspheric lens and the believe the quality of Tecnis is much better than Ascrysoft.

My major concern is I already had the dry eye problem. I would rather touching the cornea as little as possible. Honestly, I don't even mind the toric lens rotate a bit in the future and this can corrected by glasses. I will wear glasses anyway. Once the rotation doesn't happen every month and that's fine.

Can someone tell me will LRI introduce dry eye or worsen the dry eye problem ?
In general, what is the normal way to deal with Astigmatism during the cataract surgery ?

[taurus1203]

Sally/Jodie.
I just got the message from my friend from other newsgroup.  His astigmatism drop a little bit after the cataract surgery even he didn't have the toric lens or LRI. The reason is some of his astigmatism is caused by the natural lens. This is a bit new to me. He told me that replacing the naturals lens automatically decrease 40% of his astigmatism.

[taurus1203]

Sally/Jodie,
Thanks for your response.
Due to the light sensitivity, my indoor glasses are also slightly tinted to yellow/brown. It may sounds a little weir to you, my left lens are tinted more than the right one as only my left eye has the light sensitivity. I guess I may feel ok with the yellow tinted.
Do you think if there are pictures simulating how the image looks like with the sn6atX model ? I will address my concern of dry eye to my doctor and properly will not go for LRI.
That means I will either fix the (1.75D) astigmatism with toric lens or glasses.

I heard someone from other newsgroup told me that his astigmatism drop a little bit after the cataract surgery. He did have the toric lens or LRI. I post a message to ask is it possible that the astigmatism just drop a little bit by controlling the location of the incision.

[sally987]

thanks, Jodie, for describing the yellow tint.  I have the alcon toric iols, one sn6at4 and one is sn6at5.  For me, the tint is not a bother at all, but I do notice that one has ever so slightly more yellow than the other.  I have heard that blue filter helps prevent melanoma of the eye. Taurus, my surgeries were last August (2009), and I am pleased w/ the toric.  They were an additional $800 per.

[taurus1203]

Thanks a lot for your valuable advice.
One of the reasons I don't want to have the cataract surgery immediately is to wait for a while to see if my dry eye will get better. Hopefully I will receive the restasis in 2 weeks. I started 2 tablets of Omega3 daily 1 months ago.

I think I may not go for the LRI at this moment. I will discuss with my surgeon about how much the yellow tint of Alcon AcrySof willo impact me.

[JodieJ]

The yellow tint in Alcon's IOLs is the result of their "blue-light filtration" feature, which allegedly helps to prevent age-related macular degeneration.  I researched this feature extensively before I agreed to have these lenses implanted in my own eyes.  Based on the research I reviewed, there is very little (no?) evidence that blue-light filtration has any effect on preventing macular degeneration.  I actually wondered whether "blue-light filtration" was something that someone in Alcon's marketing department dreamed up to increase their sales.  On the other hand, I could find no evidence that blue-light filtration was in any way harmful.  Strangely, the amount of blue-light filtration (and the intensity of the yellow tint) varies with the power of the IOL.  Lenses to correct severe farsightness have the most intense yellow tint; lenses to correct severe nearsightness have the least tint.  My eyes were highly myopic, and the tint made no noticeable difference in my vision.

It's my opinion that surgical outcome is very much dependent on the skills of the surgeon, which vary considerably among practioners.  Alcon's toric IOLs are reputed to be a more dependable way to correct astigmatism than LRIs (when implanted by an experienced surgeon.)  If reduced dependency on glasses is not your goal, than regular aspheric IOLs will do just fine.  

[Ray T Oyakawa, MD]

It should have said 3 months to six months.  I would recommend getting your dry eyes in the best condition as possible BEFORE surgery.  This would include Restatis, omega 3s, and make sure you do not have some component of blepharitis and plugs.  If you still need frequent tears, I would suggest a PRK after cataract surgery rather than an LRI OR GLASSES.

Dr. O.

[taurus1203]

Dr Oyakawa,
Do you mean '3 weeks to 3 months' or '3 days to 3 months' ?
My dry eye is classified as moderate to severe. I put eye drop every 1 hour during the morning time and 2 to 3 hours in the afternoon. I put a temporary plug and it seems nothing happen. I am going to try restasis in 2 weeks and may try a permanent plug.

Given my situation, do you think I am suitable to have LRI ? Or you think I should use the Tencis spheric lens and leave the astigmatism be corrected by the glasses. I don't know any toric lens other than Aryscoft IQ in North America.

Thanks

[taurus1203]

Dr Oyakawa,
How likely a toric lens will rotate after the implant ?
Thanks for reminding me I do only one eye and blue filter may cause some weir feeling.
Can I choose a AcrySoft without the blue filter ?
Thanks

[taurus1203]

Thanks for your advice.
Yes, I only plan to have surgery in one eye. I heard that the AcrySoft has blue filter. Does it cause the yellow tint ?
Dryness is a big concern of me. Will the dryness caused by LRI is similar to that of LASIK ? If yes, I would rather leave the astigmatism to be corrected by the glasses.

Thanks in Advance

[JodieJ]

I can only offer you a non-professional opinion based on personal experience.  I'd advise you to get a second opinion from a surgeon who is experienced with Alcon's toric IOLs.  This would be my first choice for astigmatism correction.  At the time I had cataract surgery, Alcon did not make toric IOLs in the power that I needed, so I had limbal relaxing incisions.  The results were (initially) excellent, but each time I've had an eye exam a little bit more of my astigmatism has returned.  I suspect that this type of regression with LRIs is not that uncommon.  I've read that LRIs can cause dry eyes but I did not have this problem.

[Ray T Oyakawa, MD]

Two diopter is easy to fix with an LRI for an experienced surgeon.  Also, I recall you will only be having cataract surgery in one eye.  The Acrysoft has a yellow tint and this bothers some patients.   The LRI will temporarily make the dry eyes worse.

Dr. O.