IOL for astigmatism & 4th Nerve Palsy

[gj117]

A couple of weeks ago I wrote in with a question regarding best IOL for cataract surgery when one has Strabismus.
My doctor was not forthcoming with much information and I didn't seem to be involved with decisions.  Wrong move. So, I went for a second opinion.  Much to my surprise, this opthalmologist said I did not have Strabismus but had 4th nerve palsy.  The condition had come on quite suddenly many years ago, and, lo and behold, I do have slight head tilt.  After quite the examination and several tests this diagnosis was made.  Everything he said about my eyes was right on target.  Needless to say, I did cancel the other surgery.

Since I also have astigmatism, the AcrySof Toric IOL was suggested.  Maybe even going with the mini mono vision and, possibly end up with only wearing reading glasses.  This would be after muscle for 4th nerve palsy was corrected and he suggested working on that after cataract implants as there would be a small shot I would not have to do anything else.  

Has anyone else had this problem?   What do you think of the Toric lens?  I am reading everything as fast as I can but help from others is always better.

[gj117]

Now I am thinking that I am the one who thought that this was definitely not strabismus after he told me that it was the 4th nerve palsy.  Just didn't realize it would be the same.
This doctor thinks it could be corrected if it still needs to be after IOL implants.  Have you seen good results with this?

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

A 4th cranial nerve paralaysis (trochlear nerve) IS strabismus. Strabismus just means eye muscle disorder. All cranial nerve palsy's that effect the eye: 3,4,6 are forms of strabismus.

JCH MD

[londonbridge]

I do not have 4th nerve palsy, but I did have an AcrySof Torric IOl implanted for minimonovision a month ago. I am pleased with the result. I did my nondominant eye for intermediate. My dominant eye has only a mild cataract at this point. It is -7.5 and I am using a distance contact. If and when I need to I will have another IOL implant for distance in it. My range of vision is very good. I can drive, use my computer, read items on the grocery shelf, cook, watch TV etc without glasses. I have reading glasses for when I need to see fine print.
I took this route only after having a Restor multifucal explanted from my nondominant eye after expericing horrible vision with it. From what I have learned on this forum at the present time you can have a high quality lens with a good range of vision (as good if not better than a premium lens) going with a monofocal lens. Many like and have adapted well to mini monovision. Generally you would target -.25 in your dominant distance eye and -1.25 in your nondominant intermediate eye. I would take the advice of my surgeon on exactly what to target and keep in mind that results may vary slightly. See other posts on this. Good luck