toric lens

[gamevc]

Hi. I have cataract in both eyes. But one eye is still in very early stage (i.e., not interfering with my vision, only found that out in diagnosis) The cataract is more severe in my other eye. I am young patient. High myopia, moderate to severe astigmatism. I have seen 2 cataract surgeons.

One recommended implanting crystalens in both eyes. Then use laser touch up to fix astigmatism.
The other recommend implanting toric in one eye. Then wear contact in the other eye. (cannot wear glasses due to high myopia)

Knowing that there are no perfect solution, (and I think both are good doctors),
(1) which one does it sound like a better solution?
(2) Does it mean that if I implant toric in only one eye, I am stuck with wearing contact lens in the other eye all the time, even though I may occasionally prefer not to wear contact lens due to dry eyes or other reasons? (unless maybe wearing eye patch in one eye =) )
(3) Any drawback of toric lens? Is rotation still a concern? I understand the part on additional cost.

Thanks!

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

Posting of the extended information will need to await technical services of MedHelp.org tomorrow.

JCH MD

[Craig10x]

Yep...but keep in mind that you will be unbalanced with one eye fully corrected and the other eye highly nearsighted....you will have to wear glasses or contacts all the time...

But if you do both eyes, and have them correct the dominant eye first and they are able to get you to plano and then have the non dominant eye corrected to -1.0 diopters you will likely be glasses free 95% of the time (like i am)...

Your decision...but something you should keep in mind...I would not be happy that way....i was very glad i could have both eyes done...

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

JasonHe1991 and gamevc please read the extended posting I just made on options power operatively.

JCH MD

[gamevc]

If possible, I also prefer not to wear contact lenses all the time. I think the 2nd doctor recommended only operated on one eye first because no IOLs can be as good as human natural lens (well....if the human lens is still healthy....:) )

I guess there will be always some compromise like what you said.....

[Craig10x]

By the way...you can have both eyes done even though one eye is not far along as far as the cataract is concerned...That was my situation exactly...one eye (left) was really bad but the other eye (right) wasn't that far along...it is best to have both done...that gives you more options (like mini monovision for example)...

You are going to need to do the other eye eventually anyway so why not get it over with...

If they can get your dominant eye to plano (20/20) then i would suggest considering mini monovision...

Keep in mind..there is no perfection with this...some compromise is required no matter which way you go...

[Craig10x]

I have the acrysof toric lenses...they are really excellent at correcting astigmatism and i was very myopic and had high astigmatism before i developed cataracts...

Have had no problems with any rotation...If the lenses "settle in" properly they should be fine...

I agree with the doctor...personally would not go with multifocals...very expensive and more chance of being unhappy...

I went with monovision to get better accommodation...initially with full monovision which i did not care for...ended up getting a lasik touchup to bring it to mini monovision instead...

If they can get your dominant eye to 20/20 then you can consider mini monovision for the other eye...

I am 20/20 in my right eye and about 20/30 to 20/40 in the left (-1.00 diopters)...Better distance vision then full monovision....excellent mid range (like Computer) and can also do LIGHT READING without reading glasses...but i do have to hold things further away then with full monovision but not too bad for reading mail, writing notes, reading menus, an article in a magazine but for extended reading i pop on my very light readers...

Mini Monovision is probably the best compromise...you would want them to aim for about -1.0 to -1.25 diopters in the non dominant eye...

If both eyes are corrected to 20/20 it will likely be super sharp for distance but you WILL need readers for computer and any reading you do...

[JasonHe1991]

Hi, gamevc. I am a one-eye cataract patient and i am doing the similar research, too. I am worried about the PCO of crystalen. I am also curious that why your first doctor suggest you to do the op while your other eye is not trouble. My doctor suggest me to implant a toric too, but i am afraid of loosing the accommodating power...

[gamevc]

Thanks for your honest advice!

I will stay away from accommodating and multifocal IOLs. I will spend more time thinking and researching the decision if I want to do Toric.

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

You need to continue doing some research:

1. If you have toric IOL one eye and the other eye left high myope you will be wearing glasses AND contact on unoperated eye.
2. You will be at much higher risk of retinal detachment even with a successful uncomplicated surgery, depending on your degree of myopia and what your retina looks like it could be 1-2%. Discuss with your surgeon.
3. Just remember there is considerable pressure in many ophthalmology offices to "upsell" refractive and accommodating IOLs.  In some offices it borders on "brow beating".
4. If I were a high myope needing cataract surgery on both eyes I would not choose     bilateral accommodating or multifocal IOLS. Reasons: greater cause, greater risk, still would need glasses for some things, night vision not as good, higher rates of dysphotopsia.
5. rotation of toric lens is low now. If did rotate repositioning them generally not a problem.

These are major decision. Don't rush in to them. If you want a 3rd or 4th opinion get them.

JH MD

[gamevc]

Thanks for the reply.

I have searched the forum before I posted the question. Indeed, I saw Dr Oyakawa posted in May 24, 2010 that rotation is not common and but happen usually in high myopes. So not sure if things have gotten better.....

Anyway, I assume for high myopes like me, I will have to wear contact lens on my eye that didn't get operated all the time after the surgery on my other eye?

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

This question has been asked and answered many times. You can access the discussions with the search feature and archives. Almost the exact question was asked within by JasonHe1991  "Experience With Accommodating lens? Need HELP!!"  

If you read these you will understand what your options are. There is no "best" choice as it will vary from individual to individual.

JCH MD