AcrySof Toric IOL

[Quill]

I am a candidate for IOL in both eyes.  I have considerable astigmatism & my surgeon is suggesting the new AcrySof Toric lens.  However, I would be the first patient she is doing with this lens.  I would like any input from patients who have had this lens & the success rate.  I also have a high degree of presbyopia. Currently wearing custom toric soft lens with one eye for distance & one for intermediate.  Need to wear readers to read.  My dominant eye had optic neuritis 30 years ago so it is color blind & vision is not as sharp as it would have been.
When my optometrist tried monofocal contacts-using distance for right & close up for left-it did not work because of that domination.  Does work with intermediate in left though.
So I have some issues & am hesitant to be the first for the AcrySof although it sounds like it should really help me.
Thx

[big island]

Folks -- I was just reading on the acrysofToric site and found this paragraph (pasted below).  It states that these implanted toric lens will likely rotate...which is one of my big concerns about getting this IOL in January (see my previous post, 11/10).  I know that when my custom soft toric contact lens is slightly out of rotation, I do not have 'best' vision.  Now that I know an implant can be pemanantly out of rotation by a few degrees, I don't think that this is what I will choose.  Rather, I will probably go with conventional IOL and deal with another contact or glasses if I still need correction post-op.  Opinions/comments appreciated.

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As part of the FDA clinical study, 250 AcrySof Toric implants have been evaluated for rotation. The cumulative data was presented by Paul Ernest, M.D., at ASCRS. The data showed that the mean rotation at 3 months was 4

[bless129]

A related discussion, toric lens to correct astigmatism was started.

[Pattynstone]

A related discussion, Why do my Toric IOL's make my eyes continue to "flash"? was started.

[JodieJ]

With a conventional lens, you will get no astigmatism correction.  With a toric lens which rotates 5 degrees, you will still get significant astigmatism correction.  If the toric lens rotates, say, 25 degrees, you will probably get no astigmatism correction.

Limbal relaxing incisions and laser vision corrections are alternatives methods for correcting astigmatism.

I just got some excellent contacts that might work well for you post surgery:  Triton soft bifocals.  Not only will they correct your astigmatism, but they will give you excellent distance and near vision.  Plus, they're actually comfortable.

[big island]

I also have a question/concern about the new toric implants to accommodate astigmatism.  I am in bad need of an implanted lens soon, as my nite driving is glary and with phantom images.  I am about to schedule surgery for early next year at Duke Eye Center.  My concern is that there is little information about the results of these implants (as another poster here expressed).

    My concern is exacerbated by me being a high risk patient, and so far all my eye 'issues' have led to poor results (two surgeries for a retinal detachment... this eye now has an implant....but I don't use the eye because (i) surgery left it out of alignment; (ii) my retina, re-attached, is no longer flat and vision is wavy;, and (iii) my implant on that eye clouded up in two days...but I have not had YAG to 'clean' it up because the cloudiness enables me to not have a secondary image interfering with my 'good' eye vision.  I get by with one eye, now producing nasty phantom images.

    My base-line feeling is to NOT fool with new types of lenses...keep matters simple and go with a 'standard' implant....as, based on my eye experiences, I'm likely to be the one for which the toric  will 'bomb', and I can't afford to have anything go wrong considering that I only use that one eye.  On the other hand, the doctor I selected for the surgery feels it is right for me to address the astigmatism issue (which is many diopters; I forgot exact number).  I'm also concerned that because this toric must be aligned perfectly, what are the chances of that happening or the lens slipping slightly out of place.  (I presently use a custom toric soft contact lens, so I know about 'out of alighnment'.)

   Any comments, suggestions, or first-hand information out there about toric implant lens to address astigmatism??  -- many thanks -- BI

[Pandoraj]

While the clinical trials outcomes on the Acrysoft Toric lens are exciting and hold great promise for astigmatic patients, it is important to remember that to date, these lens are NOT classified as "premium" lens by either Medicare or other payers, nor are they "new technology" lens.  

That means that CMS has not yet decided whether or not Medicare patients can be charged "extra" for the use of toric lens the way they can for presbyopic-correcting IOL's.

[Quill]

OK.  I am still hoping to hear from someone who has had this lens implanted and their satisfaction level.
Thx
Quill

[Quill]

I spoke more with my optometrist who referred me to surgeon about whether the lens would rotate in the eye or does it remain fixed.  He said it has hooks on it! So it is fixed.
My biggest vision correction is presbyopia-focal point somewhere beyond the moon.

[JodieJ]

The results of the clinical trials with the Acrysof toric lens suggest that it will elminiate most/all of your astigmatism, depending on the accuracy of your surgeon's calculations and the amount of astigmatism you have.  If you do a modified monovision correction like you have with your contacts, you should only need glasses for near vision.  I predict that you'll be pleased with the results.  Best of luck!

[JodieJ]

According to the literature, LRIs eliminate about 50% of preexisting astigmatism on average, with unpredictible results.  (I lucked out, although I've read that LRI results are sometimes prone to regression.) The AcrySof toric lens did much better than this in clinical trials.  There is an older toric IOL (made by B&L, I think), but surgeons have complained that it tends to rotate in the eye, thereby negating the astigmatism correction.  The AcrySof toric is reported to be more stable.

I don't know whether it's "official", but my surgeon considered the AcrySof toric to be a premium lens.  Its implantation does involve additional measurements and calculations.  Some surgeons charge an out-of-pocket fee for LRIs; others do not.  Laser vision correction post-surgery is certainly a reliable way of eliminating astigmatism, but I don't think any insurance will pay for it.  My surgeon charges about $2K per eye.

All things considered, I think the AcrySof toric lens would be an excellent choice for correcting significant astigmatism.  I think it would work well for a modified monovision correction (one eye set for distance, the other for intermediate vision).

[eyecu]

The Acrysof Toric is not considered a premium lens nor does it have NTIOL status. LRI's have been used for many years with great results along with astigmatic laser correction.

[hud]

All I know is what I've heard about the acrysof Toric lens. If you have astigmatism, you are going to wear glasses or contacts with any standard implant. However, with the acrysof Toric, you may have a chance to be spectacle-free post-operatively for distance, depending on the amount of pre-existing astigmatism you have. Other surgical options are LASIK or corneal incisions, which are considered costly and unpredictable, respectively. If you go with a standard implant, you will need glasses for all activities. The proported advantages of the Acrysof Toric is that is does not move in the eye (negating the astigmatism correction), and it does have the extra retina protection from UV and blue light radiation. I have not heard of any downside of this lens.

[JodieJ]

The AcrySof Toric IOL just came out this year, so few surgeons have had much experience with it.  It was my surgeon's first choice for me, since it's supposedly a more predictable way to eliminate astigmatism than limbal relaxing incisions.  From the little I've read about it, it's an excellent lens which performs well and doesn't tend to rotate.  It's also considered a "premium" lens, and I was willing to pay the $1000 (per eye) out-of-pocket surcharge to get it.  Unfortunately, as it turned out, it didn't come in the power I needed.  But if you have only mild/moderate myopia and significant astigmatism, I think it would be an excellent choice.

As a second choice, you might consider the aspheric AcrySof IQ and limbal relaxing incisions, which worked very well for me.  I had two limbal relaxing incisions in each eye, which eliminated all my astigmatism, and my distance vision is now 20/20.  (I'm getting multifocal contacts for near/intermediate vision correction.)  But the best part is that my insurance picked up the entire tab, saving me about $25K!

[hud]

All I know is what I've heard about the acrysof Toric lens. If you have astigmatism, you are going to wear glasses or contacts with any standard implant. However, with the acrysof Toric, you may have a chance to be spectacle-free post-operatively for distance, depending on the amount of pre-existing astigmatism you have. Other surgical options are LASIK or corneal incisions, which are considered costly and unpredictable, respectively. If you go with a standard implant, you will need glasses for all activities. The proported advantages of the Acrysof Toric is that is does not move in the eye (negating the astigmatism correction), and it does have the extra retina protection from UV and blue light radiation. I have not heard of any downside of this lens.

[Forum-OD-MP]

i dont think i have read any poster here having that particular implant, but i could be wrong.  hopefully someone will reply