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've had several eye problems, too; learning about them is how I acquired my technical vocabulary.  I hope your cataract surgery goes as well as mine did.  My results exceeded my expectations; not being myopic has really been an (unanticipated) gift.  Best wishes.

[naoye]

Jodie, thank-you for your message and comprehensive information.  I'm happy too that your references were not censored.

My retinal surgeon did say that he would remove the ILM.  I think this reduces the chances of recurrence of the ERM.  If it might also correct the aniseikonia, that would be a a real bonus.

I'll try to see a pediatric/strabismus ophthamologist - hopefully they can fit me in before the cataract surgery.  I also wore contact lenses with monovision (until recently developing pterigia - which is why the cataract surgery is being done first) so it would be good to rule out other causes such as phoria.  (I may have eye problems but my vocabulary is increasing by leaps and bounds.)

[JodieJ]

Aniseikonia secondary to an ERM is described in the medical literature as a "not uncommon" problem.  It's been hypothesized that the wrinkling of the macula changes the photoreceptor distribution, thereby altering the image size in the affected eye.  Surgery to peel the ERM doesn't necessarily fix the image size problem or the associated symptoms (e.g., headaches, double vision, etc.).  Through email correspondence, Dr. Steve Charles (a retinal surgeon in Memphis, TN) suggested to me that peeling the ILM during ERM surgery might be beneficial in that regard.  If you have an image size disparity before surgery, I'd strongly advise you to discuss this with your retinal specialist.  Dr. Charles is well-known nationally, and I'm sure that he'd be willing to communicate with your doctor about the potential value of including an ILM peeling in your procedure.  (BTW, few retinal surgeons relate to the term "aniseikonia"; they seem to have their own vocabulary.  But if you describe the image size problem, they'll understand.)

Dr. Gerard de Wit of the Netherlands is (at least in my opinion) a world authority on retinally-induced aniseikonia.  His website at opticaldiagnostics dot com contains lots of info about this condition and its treatment with corrective lenses.  There's also an aniseikonia support group on yahoo with good info.

My double vision happened before I developed the ERM.  It was caused by the breakdown of a phoria secondary to monovision contact lens wear, so I didn't want to risk even modified monovision post cataract surgery.  It might actually be a good idea for you to determine the cause of your double vision before you have cataract surgery; you'd have to see a pediatric/strabismus ophthalmologist.  (It's probably, but not certainly, related to the ERM.)

I hope my references don't get censored; this website discourages links to other sources of info.  If they do get deleted or you have other questions, send me a personal message.  

[naoye]

Thank-you, Jodie.  What you say confirms what I've been thinking in the last few days - that I should ask my surgeon about a conventional lens.  

I hope you don't mind if I ask you also about the aniseikonia that you had after your ERM surgery.  I've been trying to research this and other matters in posts on this site and also on Google but don't have your great ability to distill the (often contradictory) information into practical conclusions.  Also, I think the matters you've had to deal with are very similar to mine.

I think my right eye has retinally-induced aniseikonia from an ERM (smaller image, double vision).  I'm hoping that this will be at least partly corrected by an ERM peel that will likely be done a few months after the cataract surgery.  Do you think it's ok to just ignore the aniseikonia for now?

However, in the cataract surgery, should I aim for plano for both eyes because of the aniseikonia - rather than the slight weakening (-.5 and -.75) I'm considering to preserve some intermediate vision?  (I think you said that you requested plano for both eyes because of double vision and eye muscle problems but am not sure whether this was double vision related to your aniseikonia.)

Thanks for your cheerful prediction too, Jodie.  I'm sure you're right about freedom from high myopia.  I can't imagine being able to wake up and see without correction.  Even if my vision is not perfect it's bound to be better than the coke-bottle glasses I've been wearing for 3 months.

[JodieJ]

You definitely don't sound like a candidate for the Acrysof toric lens.  And although the aspheric lens represents the latest technology in monofocal IOLs, the few independent studies I uncovered failed to demonstrate the benefits of an aspheric lens over a conventional one.  Instead, they showed that most people who have a conventional lens in one eye and an aspheric in the other eye can't tell the difference.  I predict that you'll be very pleased with your surgery results with either; it's really great not to be burdened with high myopia.  

[naoye]

Jodie, thank-you again for your very helpful response.  I'm about -8 and -12 D so am not sure why the cataract surgeon would be recommending the toric lens.  I'll ask him about this.