Astigmatism from IOL Tilt

[StrugglingwithAstigmatism]

I had the crystalens accomodative IOL lens replacement cataract surgery with LRI done to correct corneal astigmatism at the same time close to 2 months ago.  I had the YAG laser capsulotomy after initially decent (but dissappointing) results were impaired by lens getting pulled forward if I understood correctly, about 6 weeks after surgery.  Now have decent (but dissappointing) results again.  I had residual astigmatism post initial lens replacement surgery and continue to now post YAG.  Based on diffraction pattern I see (a circle would appear like a line down and to the right, as if the circle was smeared diagonally) and what my doctor told me, it seems to be likely the IOL is tilted, and likely this is the primary source of the astigmatism.  I was told that glasses will not be able to correct the astigmatism due to lens tilt, but perhaps LASIK, PRK or even torric contact lenses might work or help improve things.  I don't really understand why glasses would not work but other options might.  I don't feel my doctor has done a good job explaining things in advance or even after. I have a lack of trust I have in his assurances things should be able to improve.  He talks a lot about I'll have neuroadaptation and improved tolerance of HOAs in time.  The astigmatism seems worse near and intermediate than far.  Not sure why, but I think because IOL shifts forward when focussing closer up and distance to retina increased, so more astigmatism created over greater distance perhaps?  I think my correction is off a bit b/c I can see quite well viewing out to the horizon (20/20 or 20/25 I think).  I have a tendency to tilt my head (probably to get the pin hole like pupil) to help my focussing.  I see well at 20 feet, but better out to the horizon.  I was able to read the 20/25 line in the doctor's office, but with effort.  I can't focus well inside of 4 feet away, but can focus 10 feet or so with effort for watching TV.  My doctor did say the IOL did end up ideal not for 20 feet but more for the horizon or even slightly more correction than that (or would that be less).  So focus improves at all distances with slight focussing (or as much as i can).  Lots of info there, but wanted to give sense of where I'm at to precede questions.

Does anyone know how Astigmatism from IOL Tilt / misalignent can be corrected non-surgically?  Or surgically?

I regret the YAG given it makes removing the IOL less safe, but at the time felt it was right thing to do.  I've heard mixed things about trying to remove a Crystalens accomodating IOL after YAG.  I'd prefer to improve my vision non-surgically, but wanted to know if it's possible to replace the IOL?  Perhaps requires a specialist at IOL replacement but can be done?  

[CBCT]

I too had Crystalens problems.  Mine wasn't tilted -- the problem was lack of accommodation and serious glare.  I also had YAGs which did not resolve my issues.  I ultimately had my IOLs exchanged.  The first one was a year later and the second one was a year and a half later.  Post YAG is more complicated, but is certainly possible.  My outcome was good.  I wear progressive lenses and have very good vision at all distances. Find a master surgeon with extensive experience with lens exchange.  Where do you live?

[JohnHaganMD]

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[JohnHaganMD]

In some instances IOL induced astigmatism can be corrected with glasses.  You best bet is to start doing research into experts in post cataract/IOL complication management and get a second and third opinion.  A university department of ophthalmology would be a good  place to start.  In major cities there are usually one or two cataract/refractive surgeons that specialize in care of post cataract/IOL surgery complications.

[StrugglingwithAstigmatism]

I'd add that I'm not sure I'm 20/25 if I manage to avoid squinting or basically squinting by tilting my head up.  I don't trust my UCVA is 20/25 as I think my doctor wants good stats and allowed me to cheat by squinting, not that I wasn't trying not too but feels like it's becoming an ingrained tendency as my brain wants the focus however it can get it I suppose.