Monovision IOL or Toric IOL

I had cataract surgery in January on my left eye.  When my original doctor couldn't seem to find any reason for my vision in that eye to switch from 20/30 to 20/40, I went to another doctor for a second opionion.  The second doctor has done many tests and sent me to a retina specialist, who also did numerous tests.  None of the tests have revealed any problems with the retina.  Yesterday on a followup visit with the second doctor, she decided my eye was dry and I should continue with Restasis and come back in three months.  We have discussed when I have my right eye operated on, since I have astigmatism, I should consider having a toric IOL, which would cost an additional $1,000 out of pocket.  I had read on these forums the possibility of having limbar relaxing incisions as an alternative to the toric.  However, the doctor informed me this also would be and additional $500 out of pocket.  Now to my question:  I have been wearing monovision contacts for years and have been very happy with them.  Would I be as well off with just a plain monovision IOL in the right eye as with the more expensive lens or the LRI?  With all these extra tests on my left eye, the $$$ signs are adding up.  I might also add that the second doctor has had great success with the Restor lens so she seems to be very competent.  Thanks.

[JodieJ]

How much astigmatism do you have in your right eye?  A monofocal IOL alone will not eliminate pre-existing astigmatism.  If your goal is to minimize your dependence on glasses after surgery and you have significant astigmatism, it would probably be worth the extra expense involved in getting a toric IOL or LRIs.  If you don't mind wearing glasses, then a monofocal IOL would work fine.

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

JodieJ pretty much summarizes your options.

JCH III MD

[bbuzz]

Thank you for your and Dr. Hagan's comments.  I don't know how much astigmatism I have in my right eye - I just have always had it since I was six.  A resent prescription after cataract surgery for glasses was RIGHT Sph.+0.50, Cyl. Spit, Add +2.75, LEFT Sph. -1.25, cyl. +2.00, Axis 090, Add +2.75.  An old prescription for contacts was Distance O.D. Spherical +4.25, Olem (I think) 9.0, BC 43.75, Distance O.S. +1.50, Olem 9.0, BC 43.50.  This is like reading Chinese to me so hope it makes sense to you.

By the way, about how long after cataract surgery should I go looking for contacts or glasses?  Thanks.  

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

According to your RX listed above your RE does not have astigmatism and your left has 2 diopters. Your surgeon could probably correct at least half of that by making the incision at 12 oclock, making it slighly larger than normal and using a lot of steroid post op.

We prescribe glasses 2-6 weeks post op depending on a number of factors. Very few of our patients wear contacts after eye surgery.

JCH II MD

[JodieJ]

From the glasses script you posted, it looks like you've already had surgery on your right eye (not your left).  The contact lens script has no astigmatism correction, and the two left eye scripts (glasses and contacts) seem to me to be written for different people.  (But I'm not an eye care professional.)  In any case, if your surgeon doesn't follow Dr. Hagan's suggestion, LRIs can always be done at a later time in your doctor's office.

I'd suggest a practical approach to getting new glasses made.  If you can get along well with only drug store readers, you could probably wait a few weeks before getting new glasses.  However, if you have trouble driving or carrying out other daily functions, you'd be better off getting new glasses much sooner (and then taking advantage of the "free re-make" within 30 days, if necessary).  I'm not sure why so few people wear contacts after cataract surgery.  At least in my case, contacts are just as comfortable now as they were before surgery.

[bbuzz]

Thank you both for your answers.  Jodie, I had cataract surgery on the left eye.  The RX for contacts was in 2002 and the glasses RX was last April after my surgery in January.  The right eye is the one my doctor was suggesting the Toric lens when I have cataract surgery in that eye.  She said I had astigmatism in that eye.  At the moment I am functtioning very well with a near contact lens on the right eye for reading and a distant one on the right eye when I drive at night.  Although I have a cataract in the right eye, I feel as if I see better out of that eye than I do out of the left eye.  I'm in no hurry to have the right eye operated on since "if it ain't broke, don't fix it."  After all the tests on the left eye with nothing wrong turning up, I don't know why we keep doing more and more tests.  My last reading in that eye was 20/40 which I guess is good.  (Of course, I would like to get 20/20, but that seems out of reach.)  Again, thank you both for your time and advice.