Monofocal IOL

[Lilith_D]

I aa 54f with cataracts and glaucoma.  My vision is -11.5 and -12.  My doc wants me to spend extra fr the toric IOL.  But my question is whether the basic IOL can get me to a -4 or -5???

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

Befor commenting I want to tell you something even more important.  You have pathological high myopia. Your eye is extremely long. That puts you at high risk of a number of problems: myopic macular degeneration, glaucoma and especially retinal detachment (RD). The risk of RD goes way up after cataract surgery in an eye like yours, as high as 5-10% depending on your retina. I would stronly advise you be referred to a retinal specialist for a detailed exam of your retina and to see if any weak spots need to be treated. THIS IS VERY IMPORTANT DO IT.

Your vision is not -11.50 and -12 that is a glasses prescription.  That shows no astigmatism and no need for a toric lens.  If you have astigmatism your glasses Rx will have 2 additional numbers CYLINDER AND AXIS.  You need to post those. Ron AKA's comments are right on. Read them. Many offices put a lot of pressure on patients to upgrade to so called premium lens, which are much more expensive and have to be paid out of pocket. Part of that, at least in the USA, is that medicare payments for routine spherical IOLs has been reduced so low that surgeons come close to losing money doing them. Some offices are even stopping doing spherical IOL surgery and will only do people that upgrade to a toric or light adjusted IOL

[Ron_AKA]

What you need to ask the surgeon is the predicted cylinder after surgery for each eye, if a non toric lens is used. The normal guideline is to use a toric if the astigmatism (cylinder) is predicted to be more than 0.75 D in magnitude. And, unless eyeglasses free vision is a priority, there is still no need to correct the astigmatism as it can be easily corrected with eyeglasses. A toric is only needed if you want the best eyeglass free vision, and it is predicted to be over 0.75 D for cylinder.

Whether or not you correct cylinder tends to not have a large effect on after surgery refraction, unless it is really large. You should easily get to much less than -4.0 with a non toric lens.

What is your full eyeglass prescription now?