toric lens

[naoye]

I'm scheduled for cataract surgery next month and was very sorry and dismayed to read about the difficulties Laura4 has had after her surgery.

My cataract surgeon has recommended the acrysof toric lens to me as well.  I mentioned to him my apprehension after reading the posts by Laura4.  His opinion is that these difficulties unfortunately can occur with any type of IOL and are not more prone to occur with the toric lenses.  (He also mentioned that, if Laura4 was going to change the lens, she should try one from a different manufacturer because they all have different ways of making their lenses and a different method may be more suited to her eyes.)

Because my 1.5 D astigatism is on the borderline for the toric lens, I think he would be willing to use an aspheric lens with limbal relaxing incisions, although he says that the LRI are not very precise and sometimes grow back in.

I would really appreciate any futher thoughts regarding the toric lenses.  At this point, I'm leaning towards the aspheric lenses because being conservative seems less scary.  (The cataract surgery is being done mainly because pyterigia in both eyes have made it very uncomfortable to wear contact lenses and glasses don't correct my high myopia very well.  An ERM peel will probably be done on the right eye soon after the cataract surgery, so the cataract would have progressed quickly in any case.)

Thank-you very much.  This is a great forum - for the information given and shared and for encouraging people to keep looking for solutions.  

[JodieJ]

I really don't think that some ophthalmologists understand the disproportionate anxiety that vision problems can create.  The double vision that I had for several months (prior to having strabismus surgery) had me so stressed out that it impaired my ability to do simple tasks   For example, I had gotten the book-on-tape version of a popular novel from the library, but my concentration was so poor that I couldn't follow the story.  The reader might as well have been speaking Urdu--the book just made no sense to me, even after replaying the first tape several times.  (The day after my strab surgery, which eliminated my double vision, the book made perfect sense.)

Laura, I think your anxiety is normal, given your symptoms.  Hopefully, they will soon be resolved, and you can put an end to this chapter.  

[JodieJ]

I just re-read your post and realize that you're thinking about getting a toric lens rather than ReStor/ReZoom.  So scratch my comments--but I do have another concern.  I think that having a vitrectomy with ERM peeling might affect your astigmatism, especially if the newer sutureless vitrectomy equipment isn't used.  (My astigmatism axis was not the same after retinal surgery.)  Maybe you should get an opinion from a retinal surgeon about how this might affect your vision with a toric lens.

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

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[naoye]

To Laura4,

I'm gIad that having to wear reading glasses post-cataract surgery was not unexpected for you.  

Re-reading your March 16 post, I would just mention that I think reading glasses only correct presbyopia (the far-sightedness that most people get in their 40's), and not astigmatism (irregular curvature of the eye) which is corrected by a toric lens, limbal relaxing incisions, etc.  I don't have any special knowledge in this field, as you can see from my posts, so I hope someone will correct me if I'm wrong.

It's helpful to know that your surgeon says that visual aberrations are quite common with toric lenses.  That would be a good reason for me to choose an aspheric lens if possible.

I can really identify with your feelings of anxiety.  It must be incredibly stressful to try to always carry on calmly, even be a leader of a big event, with double vision jumping out at you.   Like you, I'm trying to keep up all my usual activities but it feels overwhelming at times.  Even making Easter dinner for family will be difficult and I don't want them to feel my stress.  Luckily, my hobby of ballroom dancing doesn't require good vision.  Often, I just feel like not going anywhere and not seeing anyone - which is what convinces me that I have to have the surgery and keep searching for solutions - not give up, as you say.

To JodieJ,

If I have the choice, I will probably ask for an aspheric lens rather than a toric lens to reduce the possibility of visual aberrations - although the aspheric lens my cataract surgeon recommends is the Alcon IQ which is also acrylic.  I don't think I could handle aberrations like Laura4 is dealing with on top of the distortions I already have and facing retinal surgery.

I did see my retinal surgeon who said it was fine with him if I have the catarct surgery first.  He said that he will likely do an ERM peel of the R eye after cataract surgery has been done on both eyes, but he didn't mention anything about this changing the astigmatism.  If he does use the sutureless vitrectomy equipment, does that mean that the ERM peel should not affect the astigmatism?

Do you know whether astigmatism changes a lot from not wearing contact lenses in preparation for cataract surgery?  For many years, my astigmatism has been -2.5 in my R eye and none in my L eye.  Now, after a few months of not wearing my contacts, I'm told that it is -1.5 in each eye.  Perhaps  cataract surgeons measure astigmatism differently?

I'm also experiencing slight double vision (strabismus?) which I've mainly noticed when sitting in the dark watching a play - there are two of each person on the stage.  So will have to look into that at some point as well.

It's immensely reassuring to me, and I'm sure to Laura4 also, that you've dealt with your vision problems successfully.

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

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[JodieJ]

My vitrectomy involved sutures, which caused some inflammation before dissolving.  The amount of my astigmatism stayed the same post-surgery, but the axis got shifted enough to affect my vision with my old glasses.  (I could only see well out of my affected eye if I took the glasses off and twisted them.)  I'm guessing that a sutureless vitrectomy would be less likely to affect astigmatism--but it's definitely a question that requires a professional response.  (I believe that the astigmatism axis is important with either a toric lens or LRIs.)

Not wearing contacts does indeed affect corneal measurements.  The numbers are plugged into a complicated formula used to determine the power of your IOL.

I also have Alcon IQ lenses, and I've never had the type of symptoms that Laura describes.  Many retinal surgeons prefer that their patients get acrylic (rather than silicone) lenses--mine did.  Because Alcon's toric lens is relatively new, there probably isn't much data available about the incidence of negative dysphotopsia.  However, if Laura's doctors state that there is an association, that would be a red flag in my mind.