Does healing time of LRI related to the length of incision ?

Dr Oyakawa,
I met my cataract surgeon 2nd time to discuss the option of Toric lens. The doctor spent more than 1/2 hr and patiently explain to me if the problem is in the corneal, he should fix it in the corneal unless it is really necessary.
He told me that part of  the 1.75D astigmatism I have is lenticular (about 0.5D, the exact number will be known after the IOL master measurement) and which will be gone when the lens is removed. With the placement of the incision for IOL, he can correct another 0.5D.
He also tends to under-correct than over-correct the astigmatism and he think I have less than 0.75D astigmatism left to be corrected by the LRI. He told me that he CANNOT agree to implant an toric lens in my scenario.
He thinks that he only needs a very small LRI (around 3mm) to correct such a small amount of astigmatism. The healing time will be short.
In some of your early posting you mentioned that the dry eye induced by LRI should recover in 3 to 6 months and this number really give me a concern. Does the healing time related to the length of the incision ? If the LRI incision is very small, will the healing time less than 3 months ? I heard that LRI incision depth is 0.6mm, how much is it compared to the incision done by the incision for the IOL ?
Finally, how common people's astigmatism is lenticular ?

Thanks a lot

[Ray T Oyakawa, MD]

The length of recovery from LRI is dependent on the length .  A shorter one will heal quicker.  LRI depth depends on the technique.  One need to go to about 90% depth for a good effect.  Many surgeons uses a fixed 600 micron blade.  This is good for about 60+ % of cases.  You can not compare to a cataract incision which is about  2.4 to 3.2 mm wide but tunnels into the cornea.  Most patients have lenticular astigmatism.  You should review my Youtube videos again.  I do not mention lenticular astigmatism in the treatment of astigmatism during cataract surgery since the cataract is removed.


Dr.O.

[Ray T Oyakawa, MD]

The length of recovery from LRI is dependent on the length .  A shorter one will heal quicker.  LRI depth depends on the technique.  One need to go to about 90% depth for a good effect.  Many surgeons uses a fixed 600 micron blade.  This is good for about 60+ % of cases.  You can not compare to a cataract incision which is about  2.4 to 3.2 mm wide but tunnels into the cornea.  Most patients have lenticular astigmatism.  You should review my Youtube videos again.  I do not mention lenticular astigmatism in the treatment of astigmatism during cataract surgery since the cataract is removed.


Dr.O.

[taurus1203]

Dr Oyakawa,
Do you mean the LRI incision is not as deep as a cataract/IOL incision  ?
Can I expect a small LRI incision (3mm) healing time will be much less than 3 months ?
To correct a 1D or less astigmatism, would you suggest a Toric lens or LRI ?

Thanks

[Ray T Oyakawa, MD]

Think of it as 100% is full thickness corneal depth.

No one can predict healing time.  This depends on the individual.

I always do LRIs.  I can control it better than using toric.  I use a toric with an LRI for large amounts of astigmatism. One diopter of corneal astigmatism can  be fixed with a the cataract incision on the steep axis and a small LRI 180 from the cataract wound.  This would only be one small LRI incision which will heal faster than the cataract wound.

Dr. O.

[taurus1203]

Dr Oyakawa,
Thanks a lot for your info.
Do you make the cataract incision at any angles depending on the shape of the corneal ? Or it is more convenient for the surgeon to do it temporal ?

Thanks again.

[Ray T Oyakawa, MD]

I do bimanual cataract surgery and enlarge one wound to insert the IOL.  I can position the location for the IOL insertion from about 100 to 260 degrees on a right eye-straight temporal would be 180 degrees.

Dr. O.