thoughts on astigmatic presbyopia?

[susieyes]

Hi, I'm 52, with a large cataract in the right eye.  The doctor suggested a toric lens, but this would be a lens for distance only, I believe.  I read constantly, it's part of my work, and I am quite nearsighted as well as needing the reading correction and astigmatic correction.  I see that some people may have used accomodative lenses for close and far vision, and then followed up with a corrective LASIK or other procedure for the astigmatism.

  Any thoughts on this?  It seems like a lot, and I would like to find people who have had similar experiences and what theirs were.  I'm hoping that I can gather enough information to make a better decision that just "going with the flow"

thanks

[Restorsucess]

Good doctor opinion article....

http://www.eyeworld.org/article-presbyopia-correcting-iols--evolving-options

[pickyeyes]

I'm facing a similar question.  I'm 61, have a cataract in my right eye that has reached the point where it needs surgery.  I'm about -6 diopters nearsighted, with about 1.75 diopters astigmatism.  The left eye is beginning to show a cataract, but if the right eye is any indicator it will be some time before that eye requires surgery.  

My primary objectives are to (a) get the best vision possible and (b) minimize risk.   If I can regain some ability accomodate, that would be wonderful.   If I need glasses to get optimal vision in some contexts (e.g. driving at night, computer work) that is acceptable.

I've seen some excellent cataract surgeons, including a couple with national reputations.  Unfortunately, their recommendations don't agree.  One, who does nothing but cataracts, has said that because of my astigmatism a toric lens is the only reasonable option.   Another, who has a lot of experience with CrystalLens but is primarily known as a leading Lasik researcher, has suggested CrystalLens with follow-up Lasik to address the astigmatism.  

One question I have is how good the toric lenses are at correcting for astigmatism over time.   Reviewing my eyeglass prescriptions over they years, there seems to be some fluctuation in the power and angle of the astigmatism correction, though that my reflect the vararies of refractive exams.  

A related question is that, given that you're essentially correcting one astigmatic lens (the cornea) with another (the toric intraoccular lens), it would seem to me as a layman that it you'll likely end up with some weird subtle abberations that are hard to further correct with glasses if needed.  

Crystalens plus lasik would seem to hold out the promise of giving me an optimal image projected on the retina, but with a lens that seems to have some greater potential for complications, may not provide as much accomodation as one might hope, and the risks, though small, of Lasik.  

Am I even thinking about these questions properly?  

[Ray T Oyakawa, MD]

I would suggest you see a doctor who does all types of lenses.   Astigmatism management is critical in multifocal and accommodating IOL.  Most surgeon can correct around 1.5 diopters of corneal astigmatism and some can correct a little over 3 diopters.

Use the search function.

Dr. O.