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Are toric lens worth the cost?
I'm having cataract surgery and I'm debating whether to go with a toric lens to correct my astigmatism or just have a monofocal lens inserted. There is an extra cost to the toric and I may still need to wear glasses afterwards. I'm not opposed to wearing glasses but it would be in the form of contacts for me since I've worn them literally all my life. If I can achieve good vision and only wear readers occationally, that's fine. I just don't want to be seaching for glasses to read price tags in stores.
Can anyone share their experiences?
Can anyone share their experiences?
Your level of astigmatism is one most people would find useful to have corrected during surgery, but the recommended method for doing so varies between surgeons and depends on the patient.
Many surgeons now would use toric lenses with that level of astigmatism, but many others would still use incisions to correct the astigmatism during surgery instead (whether with laser or conventional surgery). Both approaches have pros and cons since unfortunately although both usually work well and have great results for most people, neither is a perfect option (e.g. toric lenses can be set at the wrong angle or rotate after surgery and need to be moved back, but the calculation for incisions can sometimes be off since individuals vary and some people see their eyes return to their old shape). It sounded from your post on another threat that you might wish to talk to another surgeon, so you might wait to see what knowledgeable surgeon you decide to use to see what their preferred method to correct that level of astigmatism is.
If you are comfortable with bifocal contact lenses, it may be that you would be comfortable with bifocal IOLs (although the optics aren't exactly the same). Most people have good luck with multifocal IOLs and don't have issues with halo&glare, but a minority do. I suspect multifocal IOLs are less likely to have visual artifacts like halos than multifocal contacts, but I hadn't seen studies. The newest bifocals approved this year have much lower risk of halo&glare issues than older ones, and in fact patients in a study rated a low add Tecnis bifocal as being perhaps better for night driving overall than a monofocal. Unfortunately *some* minority will have problems, nothing is guaranteed, but then some minority will have problematic halos with a monofocal. It is a matter of playing the odds, which is why its useful to base your decision on the results of studies rather than only what individual patients say about the results.
It partly depends on whether you have more need for intermediate vision (for say reading on a computer) or for very close in vision. The new low add bifocals are better than the old ones for intermediate (with near that is likely good enough, but not quite as good as the high add ones), but the Crystalens can also be an option for intermediate and some possibility of good near (I've seen some doctors suggest a 50-50 chance of needing reading glasses for near). The other issue is that in some patients the Crystalens doesn't seem to accommodate much so it winds up being closer to a monofocal. Older versions had risks of some complications like z-syndrome that I think the newer lenses have reduced, but I haven't seen good figures.
If you get the Crystalens or a monofocal then it is still possible to wear bifocal contacts over top of them to get more near vision. One caveat with that is with a monofocal IOL, unless you have some monovision, you might need a high add bifocal contact lens. I don't know what add you use now, but I gather some people have luck with multifocal contacts with low or medium add and less luck with a high add. I suspect that its likely that people who have used a low or medium add for years can adapt to a high add, but I don't know the statistics.
I had good luck with multifocal contacts before surgery, which was part of why I was considering a multifocal IOL (I initially planned to go outside the US for a trifocal we don't have approved here, and then instead got the new Symfony lens not approved here yet).
Another option is that if you discover you don't have enough near vision after surgery if you get a monofocal or Crystalens and decide later its worth spending some money, you could later get a corneal inlay, which is a new treatment for presbyopia and for people with IOLs who want more near vision. Those are inserted just under the surface of the eye and can be removed if you don't like the results, so it is procedure somewhat comparable to lasik in terms of being near the surface of your eye and not as big a deal as cataract surgery (but like any treatment, not without risks, even if minimal). The Kamra inlay is approved in the US now for treating presbyopia, I don't know if surgeons are able to use it "off label" here to treat people with IOLs. Elsewhere in the world the Kamra and the Raindrop inlay have been studied for use with people with monofocal IOLs and show good results. The Raindrop is approved outside the US, but is only in trials to get FDA approved in the US. My reading of the studies suggest they are mostly comparable in results, but that the Raindrop may reduce contrast sensitivity less (i.e. it may give better night vision than the Kamra).
Many surgeons now would use toric lenses with that level of astigmatism, but many others would still use incisions to correct the astigmatism during surgery instead (whether with laser or conventional surgery). Both approaches have pros and cons since unfortunately although both usually work well and have great results for most people, neither is a perfect option (e.g. toric lenses can be set at the wrong angle or rotate after surgery and need to be moved back, but the calculation for incisions can sometimes be off since individuals vary and some people see their eyes return to their old shape). It sounded from your post on another threat that you might wish to talk to another surgeon, so you might wait to see what knowledgeable surgeon you decide to use to see what their preferred method to correct that level of astigmatism is.
If you are comfortable with bifocal contact lenses, it may be that you would be comfortable with bifocal IOLs (although the optics aren't exactly the same). Most people have good luck with multifocal IOLs and don't have issues with halo&glare, but a minority do. I suspect multifocal IOLs are less likely to have visual artifacts like halos than multifocal contacts, but I hadn't seen studies. The newest bifocals approved this year have much lower risk of halo&glare issues than older ones, and in fact patients in a study rated a low add Tecnis bifocal as being perhaps better for night driving overall than a monofocal. Unfortunately *some* minority will have problems, nothing is guaranteed, but then some minority will have problematic halos with a monofocal. It is a matter of playing the odds, which is why its useful to base your decision on the results of studies rather than only what individual patients say about the results.
It partly depends on whether you have more need for intermediate vision (for say reading on a computer) or for very close in vision. The new low add bifocals are better than the old ones for intermediate (with near that is likely good enough, but not quite as good as the high add ones), but the Crystalens can also be an option for intermediate and some possibility of good near (I've seen some doctors suggest a 50-50 chance of needing reading glasses for near). The other issue is that in some patients the Crystalens doesn't seem to accommodate much so it winds up being closer to a monofocal. Older versions had risks of some complications like z-syndrome that I think the newer lenses have reduced, but I haven't seen good figures.
If you get the Crystalens or a monofocal then it is still possible to wear bifocal contacts over top of them to get more near vision. One caveat with that is with a monofocal IOL, unless you have some monovision, you might need a high add bifocal contact lens. I don't know what add you use now, but I gather some people have luck with multifocal contacts with low or medium add and less luck with a high add. I suspect that its likely that people who have used a low or medium add for years can adapt to a high add, but I don't know the statistics.
I had good luck with multifocal contacts before surgery, which was part of why I was considering a multifocal IOL (I initially planned to go outside the US for a trifocal we don't have approved here, and then instead got the new Symfony lens not approved here yet).
Another option is that if you discover you don't have enough near vision after surgery if you get a monofocal or Crystalens and decide later its worth spending some money, you could later get a corneal inlay, which is a new treatment for presbyopia and for people with IOLs who want more near vision. Those are inserted just under the surface of the eye and can be removed if you don't like the results, so it is procedure somewhat comparable to lasik in terms of being near the surface of your eye and not as big a deal as cataract surgery (but like any treatment, not without risks, even if minimal). The Kamra inlay is approved in the US now for treating presbyopia, I don't know if surgeons are able to use it "off label" here to treat people with IOLs. Elsewhere in the world the Kamra and the Raindrop inlay have been studied for use with people with monofocal IOLs and show good results. The Raindrop is approved outside the US, but is only in trials to get FDA approved in the US. My reading of the studies suggest they are mostly comparable in results, but that the Raindrop may reduce contrast sensitivity less (i.e. it may give better night vision than the Kamra).
To avoid disappointment and to have realistic expectations read this article I wrote the discussions that follow.
http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
JCH MD
http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
JCH MD
Thank you for your comments. I can afford the extra cost of the toric lens but was just worried that they might not give me the vision that I would like. I have worn bifocal contact lenses for many years and am used to be able to see near and far without having to reach for glasses. After cataract surgery, I am fearful that I may have to be reaching for reading glasses all day.
My astigmatism is 1.5 in one eye and 1.00 in the other so looks like I should go with the toric.
My astigmatism is 1.5 in one eye and 1.00 in the other so looks like I should go with the toric.
Toric lens share the same excellent optics as monofocal IOLs and do not have the unwanted images (dysphotopsia), poor night vision, waxy vision that plaque many multifocal and accommodating IOLs. They are especially useful in large amounts of astigmatism (say 1.5 diopters or greater).
The verdict on laser assisted cataract surgery is still out. Like any procedure a lot depends on the experience of the surgeon and the surgical team. If you are not rolling in money its not necessary for safe surgery with excellent results.
JCH MD
The verdict on laser assisted cataract surgery is still out. Like any procedure a lot depends on the experience of the surgeon and the surgical team. If you are not rolling in money its not necessary for safe surgery with excellent results.
JCH MD
It's your vision for the rest of your life. Hard to put a price on that.
Yes, toric lenses are worth the cost.
Yes, Laser assisted surgery is worth the cost.
My out-of-pocket cost was supposed to be $5100 for laser and Trulign torics by Crystalens. Ended up to be $4500 after the surgery center sent me a check a couple months after the surgery.
If you can afford it, go for the best.
Yes, toric lenses are worth the cost.
Yes, Laser assisted surgery is worth the cost.
My out-of-pocket cost was supposed to be $5100 for laser and Trulign torics by Crystalens. Ended up to be $4500 after the surgery center sent me a check a couple months after the surgery.
If you can afford it, go for the best.
Ive just had lens replacement in both eyes Mainly to correct my astigmatism in both eyes which has caused me to be short sighted and long sighted all my life I had symphony multifocals fitted
My surgeon promised great distance and intermediate but warned I may need readers for small print I asked him was I being realistic expecting to be able to read my mobile phone without glasses Something I couldn't do before His answerer was that is achievable
I could read news paper print the following day and six weeks on I can see the tiny print on the back of food items Something I couldn't do before with readers
Good luck with your choices
Gary
My surgeon promised great distance and intermediate but warned I may need readers for small print I asked him was I being realistic expecting to be able to read my mobile phone without glasses Something I couldn't do before His answerer was that is achievable
I could read news paper print the following day and six weeks on I can see the tiny print on the back of food items Something I couldn't do before with readers
Good luck with your choices
Gary
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