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]

Naoye, as far as I can determine, Alcon's Acrysof toric iol is still only available in a limited spherical power range (16.0 D to 25.0 D).  If you are very myopic and wanting to correct your vision for distance, it is extremely unlikely that anything in this range would work for you.  So you might not even be a candidate for the toric lens.  (For comparison, I was about -6.75 D and needed a 14.0 D lens--lower numbers correct more myopia.)

Laura4, according to Alcon's toric power calculator, the 1.50 D toric model is supposed to be appropriate for eliminating between .75D and 1.50D of astigmatism.  So I guess you were in the range (but barely).

    

[naoye]

In early April, I'll see with my cataract surgeon to decide on the type of lens.  I would like to ask you a few more questions, if you have time to consider them.

Just to summarize things I've already mentioned:  

My prescription is high, pupils are small and astigmatism in my left eye is -1.5 and in my right eye is between -1.5 and -2.  I won't be able to wear contact lenses afterwards because of pterygia.  Lately, I've been seeing more distortion and a smaller image in my R eye with some double vision - but hopefully this will be improved with an ERM peel after the cataract surgery.

My cataract surgeon has recommended a toric lens because it would correct the astigmatism without LRI and without wearing glasses all the time.  He says he has implanted many of them since last year.  However, he'd probably be quite willing to use another lens as he says I'm borderline.

In a 2007 post, Jodie mentioned  that the aspheric lenses work better with larger pupils and that they improve contrast sensitivity and distance vision. She also mentioned that near and intermediate vision are not as good as with a conventional lens but that was not important to her because she planned to wear multi-focal contacts post-surgery.

Here are my questions:

- Because of my small pupils and inability to wear contacts, do you think I would be better with just a conventional lens rather than an aspheric one?  

- With either an aspheric or a conventional lens, I would have LRI or wear glasses all the time.  Would LRI be risky for me because of a previous HSV infection?

- If I did get a toric lens, would my small pupils make me less prone to dysphotopsia?

- On the other hand, would my high prescription or other factors make me more prone to it?

- Are there any particular questions I should ask my cataract surgeon?

Thanks very much for reading this long post and for considering my questions.  

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

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[JodieJ]

.8 D of astigmatism is very little, and it could have been corrected with a limbal relaxing incision, as Dr. Hagan stated.  My technical knowledge about toric lenses is limited, but I remember reading an article someplace about determining  which toric lens to use.  I'll try to find it again.   Would it be possible to safely explant your toric lens?

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

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[Laura4]

The only reason given for both the negative and positive dysphotopsia is the usual answer - it can sometimes happen.

I hope I am understanding the technology of these Toric lenses.  I believe there are 3 models in 3 different powers.  Mine was the lowest, an SN60T3.  If Dr. Hagan is correct, and it's not possible to do more adjustment of the power from the 1.5 of my model than it would be true that I would not medically have been a candidate for even the lowest power Toric.  But I still am not sure of my technical understanding.  I was also told that a 1.5 would adjust back to a 1.0.  Even so, that's crazy if I only had .80 to begin with.  

Laura4

Laura4