Piggy backing a Toric IOL post cataract surgery

[drsparsons]

I just had cataract surgery two weeks ago and had a Toric IOL placed in my left eye for an astigmatism. Today my doctor tells me that the lens has corrected the astigmatism however his calculations on my perscription were off by  3/4 of a dopler. I am now over corrected in that eye and have lost my distance clarity promised by paying the additional $1200. for the toric lens. He has suggested that I could have Lasix or he can remove the original lens and replace it with the correct perscription or he can add a piggy back lens on top of the recently placed toric lens. He said placing an additional lens over the toric is far simpler  and less dangerous than removing the original lens. I am so frustrated by all of this and I am fearful to have a piggy back lens installed because I have never heard of such a thing. I fear with two stacked lens I will be tormented with halos since the light will have to travel through two lens but I am unsure. Does anyone out there know anything about the side effects of piggy backing two IOLs? Thanks, Gail

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

As a generalization staying with a safer, less expensive procedure is the better idea. Thus most patients would be well advised to avoid a piggy-back IOL

JCH MD

[tonyc23]

I had cataract surgery 10 years ago and the right eue was undercorrected. I was told I would adjust to the difference and be able to see and read well without glasses. Well, in order to get good enough vision for driving and for reading, I am back to mwearing glasses pretty much all the time. I can see up close enough for most tasks. I
In order to correct this and even the eyes out and make the weaker, yet dominant, right eye do its job, one surgeon said laski, and the other, who doesn't do lasik, said he would piggyback with another lesn and use limbal incisions for my astigmatism. he did tell me that while my distance vision would be near perfect, I would need stronger reading glasses and use glasses more for up-close activities. I don't know what to do--can someone pls help me? is there anyone who had lasik post-cataract, or is there anyone who had a piggyback lens?
Thanks
Tony
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[JodieJ]

You are articulate and make some valid points.  I hope that you are planning to make your surgeon and his staff aware of your feelings.  Your post (above) would make a very convincing letter to them, with only minor editing needed.

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

Good luck. Thanks for your comments.

JCH MD

[drsparsons]

Thank you for your comments. I am going to go back to eye glasses I suppose. I had the toric lens implanted as my husband and I are moving into retirement and wanted to eliminate the cost of eyeglass replacements every two years from our ever shrinking income. Eyeglasses have become quite expensive and it was a calculated decision to ask our children and grandchildren if we could bypass their Christmas gifts this year to pay for the Toric lens.
Tragically my surgeon owns his own hospital and is the best in the area. His staff  constantly assures you that you will be able to throw your glasses in the trash after the surgery. I had four face to face meetings with my doctor about wanting clear vision at a distance. I tried the monovision and declined on multifocal lenses because of lack in clearity. I even had reservations on the day of my surgery and askked to speak to him one more time. He reassured me that he had less that 1 in a 1000 complications and that I would see perfectly when he was done. I only learned after surgery that there is difficulty in calibrating the exact measurements with the current instruments and while the standard of care was .50 doplar, I fell into the .75 doplor range. This was the first time I had ever heard about calibration issues and error in lens selection calibrations. If I had been told that there were such possibilities I would not have gotten my hopes up. While doctors expalain medical risks, they do not explain the simple fact that the ability to calibrate exact measurements are based on computer programs that I now have learned are not too acurate and error is far more common than surgical complications. That is a very important fact to share with patients I feel. I am going back to my glasses and like many things in life, live with the realities. I do feel that doctors and his employees, in my case, sold me on this surgery along with unrealistic outcomes, to promote business for himself and the hospital that he owns. I do not begrudge him from material success, I simply wish he had disclosed that the current compuet programs are not yet able to accurately determine the proper lens calculations and that error is a factor with vision after the surgery in a cedrtain percentage of time. I feel explaining "BOTH" the complicationjs of surgery "and" the complications in calculating a lens perscription (for lack of stating the correct term). If there are problems with the computer calculations for these IOLs, which I have now read in medical journals then why are we not explained that risk as well. If my doctor had said that 70% of his  patients end up with 20/20 and 10% with 20/40 and 20% with values less than that I would have been better aware and would not be disappointed today.  Patients need to be told more honestly than trying to sell us on procedures, especially when all the staff is assuring you as well as the surgeon that your vision will be perfect. Especially since my doctor and his staff own the practice and the hospital in which they are preformed. I would have made a far better decision and not been lead by high pressure and outcome hipe to "Sell Me". Thanks again for your advice.  

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

Get a second opinion from an experienced and respected cataract/IOL surgeon.

If glasses and contacts are unacceptable the safest is probably lasik.

Surgeons don't "promise" anything. Surgery is at the core unpredictable.  There are no guarentees. that's why you sign a informed consent form. Statistics and surgeons can tell you what usually happens but not every case. It's like driving your automobile. Every time you get in there is no guarentee you won't have a wreck, no guarentee you won't die in an accident. Surgery is the same type of "trip"

JCH MD