Residual Astigmatism after toric implants?

[Craig10x]

I had Acrysof Toric lenses implanted in both eyes about a year ago...my dominant right eye was done to 20/20 and left eye to 20/150 for mini monovision....I see all 3 ranges clearly (distance, mid, close) but in all 3 ranges i experience some blurriness around things i look at...

I figured perhaps i am a poor adapter to the blended vision (mini monovision) technique but i was wondering, is it possible to have residual astigmatism after getting a toric lens and could that possibly be a reason why one would have that blurring effect in all 3 ranges?

If it was that, what could be done for it (that would work well and be relatively safe)?

Thanks for any input...

[Craig10x]

sorry for typo...i meant Hi Jodie!  (shouldn't do these things late at night...lol)...

[Craig10x]

His Jodie...noticed you were around on the forum again!
Just an update...remember the experiment with glasses i was going to try with mini-monovision (instead of monovision like i currently have with my iols)...

Apparently there was a miscommunication, and the doctor had given me a FULL correction for my non dominant eye (no wonder why it was so sharp!....lol)...and that was the glasses i had made up that i was "experimenting" with...

About a week ago i got the correct prescription and will have my new glasses this weekend!  
The Correction is actually equivalent to 20/75 (i am currently 20/150 in that non dominant eye)....so we are talking real mini monovision now....

I'll see how it goes in my daily activity and report back...hopefully, it will help me decide if the lasik enhancement will be worth it for me...

[Craig10x]

Thanks so much...i will...and yes, probably the doctors do not keep reading the posts unless it is a new question...so i will probably do that (post a new question specific to this)...

Actually, even now, if i was going to read for extended period of time, like you, i'd need to pop on the readers...while i love the fact that right now, as i get close to something, it doesn't get all fuzzy, the reading, while clear is not sharp enough to be able to read for long periods without feeling eye strain..

So, maybe it would be better to hopefully have very sharp distance and midrange...even though i would need to use the readers more often...

I'll keep you posted...and when i get a chance, i will frame a new post to the doctors here...

I hope things get better for you...in my case, i waited a year and kept hoping it would get to the point where i would no longer notice and blur, but it doesn't seem like that is going to happen for me...

If i had only know this, i would have had him put a 20/100 lens in initially in the left eye...but of course, since my cataracts (especially in the left eye) was so bad already, there wouldn't have been anyway to tell...even if he had popped a contact lens in there to try it...

[Luvtoski]

Actually, that is the exact same problem I am having.  I had cataract surgery on only my left eye (it developed from previous Vitrectomy) and my right eye is 20/20 ish.  My left eye IOL ended up giving my eye a -.50 Diopter (a bit nearsighted) with my right eye naturally at +1, (a bit farsighted).  

Hence, my brain is still adapting 9 weeks post cataract surgery.  The images are starting to merge together a little better everyday, but I know what you mean about the vision not being "crisp" at any distance.  I also need reading glasses, of which I have needed the past 10 years anyways.

For now, I am leaving things alone in an effort to let my brain accomplish all that it can on its own.  My cataract specialist mentioned Lasik as a possibility also, but has not really pushed it, so I get the impression that he thinks I should quit while I am ahead.  I had a previous Vitrectomy, so my case is different from yours in that regard.

Just read lots about dry eye, etc. and perhaps if you don't hear from one of the doctors on this post, re-frame your question on a new post.  I am not sure if the doctors keep reading all of these posts

Let me know what you decided and how you are doing, as I would be real interested..

[Craig10x]

Also aside from input from Jodi and others and you...if the doctor could comment...and also address whether he feels it would be safe for me to do...i have had eye floaters for many years..i wonder if there is any chance of making that worse if i do lasik? also about the dry eyes business...

I imagine my doctor feels and explant would not be advisable to such a small change...and that a lasik touch up would be the best way to go if i wanted to go ahead with it...

[Craig10x]

very nice feedback which i appreciate...you have given me something to think about...i hope also that the doctor and jodie (and anyone else who would like to) will add their input also...

well, to clarify, actually, it is not a problem of residual astigmatism at all..because although i had a lot of astigmatism originally, these were toric iols (acrysof) and they did a marvelous job of fully correcting that...even my doctor says there is no residual astigmatism..

with that eye glass correction, all the correction does is bring my left eye of 20/150 up to about 20/100 (there is no astigmatic correction on the glasses) and my right eye is just clear plastic lens with no correction 9since my right eye is 20/20)...

then everything is super sharp at distance and mid range with the obvious effect i outlined above in terms of reading capability...

it isn't really an astigmatism problem...probably more that my brain can't entirely "filter out" the left eye blur when using the two eyes together..it blends the image together fine, my depth perception is fine...it is just that in all ranges, there is a bit of the blur around things...i see everything clearing, but with a bit of a sort of "slight smear" effect around it...

It is most noticed when i look at anything with printing...a sign...titles on the tv screen and movies, a poster on a wall, you know stuff like that...

the vision boost in the left eye when i am wearing the glasses, makes everything sharp...in fact, even with that small correction, you would think he upped it to 20/20 (which he did not)...

hope that clarifies...

[Luvtoski]

I am no expert, but my thoughts are this...sometimes it is better to leave well enough alone.  I know the Doctors can tell you what it is possible to accomplish with Lasik, etc...but even they are not certain they can achieve your goal.

Also, so what I am hearing the Doctor say is that you have enough of a remaining astigmatism which he thinks he can correct with Lasik?  Has he told you your exact script=how much astigmatism you have in that eye?  What was it before your cataract surgery?

You may benefit from the lasik, but I would also suggest you do some more research on  the drawbacks of lasik.  From what I've read, lasik often causes "dry eye" which can also decrease the quality of your vision, and then you are stuck with dry eye for life (from what I've read).  Check out some posts on this forum before you make a decision to move forward, and ask some more questions of your Cataract specialist like "what are the potential drawbacks to this lasik ?"   If you don't hit your target of getting closer to plano in that eye with the lasik...what does the Doctor think might be worse case scenario for you?

Proceed with caution as you don't want to kick yourself later.  Hope I am helping and not confusing you more.

[Craig10x]

sorry for the typo above...i meant without the "blur effect" (lol)...

[Craig10x]

Well, i am back with my follow up report...I told my Eye Surgeon that i wanted to do the experiment with prescription glasses to get a better idea of what it would be like if i had a lasik touch-up to boost my non-dominant left eye to 20/100 (from it's current 20/150)...he gave me the prescription and i got the glasses...

Here is my conclusion: Amazingly, just bringing it up to 20/100, i can see very sharp for distance and mid range...in fact, when i look through the corrected left lens of the glasses, the image is just about as good as my 20/20 eye!

So, distance would be very sharp...mid range very sharp...going to the movies, watching television and even doing the computer (as long as i sit about 18" from the screen....very sharp....

The one drawback is that anything closer then 18" would start getting blurred...of course, if he made my left eye 20/20 then i would have to keep things even further away...

So, i could probably manage to do read a menu in a restaurant, sign a credit card slip, write a note or read the time on my watch, if i kept them further away then now (which is about 12 inches i would say)...

But for reading the mail, a newspaper, book, etc...would definitely need the reading glasses..

As i am right now with monovision iols, and my right eye at 20/10 and left eye at 20/150, i can see distance, mid and close with no glasses...but all with a bit of "blue effect"

Seems like the step up would eliminate the blur that my brain can't seem to totally surpress, but at the cost of needing to use the readers for READING...

So, i am a bit conflicted on how to go with this...stay the way i am...or get the lasik enhancement...
Jodie, the Doctor and any other input would be appreciated!

[Craig10x]

Thanks to all...i will do that...should be an interesting "experiment" (lol)....
I will run it by my doctor and see what he thinks...

[Luvtoski]

Please keep us posted on your progress.

[JodieJ]

Great idea!  It's always good to try before you buy.  You could get some weak readers in the drug store.

[Craig10x]

Thanks Jodie...you have also been very helpful to me in the past about this (it's been 1 year now)....i didn't realize that it was actually considered full monovision when the doctor targets for 20/150 in the non-dominant eye...

When the doctor popped in the contact lens in that eye and moved me up a step (i forgot to ask him what it was equivalent to: probably ether 20/125 or maybe even 20/100...will check with him next week) then everything in distance and mid range look great (very sharp and clear) in fact it looked so good that i thought that he had put in a 20/20 contact!

Of course, when i then tried to read, the magazine was very sharp and clear (even better then i would see it now) However, i had to hold the magazine MUCH further away to see it without a blur....Mind you, not as far as i would if it had been a 20/20 lens but further away...

He said if i wanted to do it, then it would be done with Laser of course...i assume insurance would likely not cover that (wonder how much lasik touch ups cost)...

The result would be that i would be very happy with distance and mid but i guess there would be more situations where the reading glasses would be needed...

By the way, i had a thought, i wonder if i should have him give me a prescription that would equal what he did with the left eye (with the contact in) and of course no correction for my right eye (the 20/20 eye) and i got some glasses to try it and see if i would be happy in my day to day activities BEFORE deciding whether to get the lasik touchup?

[JodieJ]

What you have now is full monovision (not mini-monovision).  Monovision in any form involves some compromise.  Having 20/25 to 20/30 vision with both eyes is not going to make images as sharp as they would be with 20/20 vision.  One option for you is to wear glasses in particular situations when additional sharpness makes a difference (e.g., driving at night, watching movies, prolonged reading).  Another option would be to convert to mini-monovision by having Lasik.  This would make your distance and mid vision almost as sharp as they would be without monovision, with a loss in close vision sharpness.  Alternatively, you could wear progressive glasses all the time.

[Craig10x]

a bit of a "typo" above....on the eye charts i am about 20/25 to 20/30 for distance and 20/20 for reading (on the charts) but i am talking about visual quality here...which is nost measured by the "chart"...

[Craig10x]

Well i guess the best way i can describe it is that though i see clearly in all 3 ranges (i think my blended vision is 20/25 or 20/30 as far as reading the eye charts) and can read even the smallest type on a page, in all 3 ranges (Distance, Mid, Close) things aren't quite as "crisp" as they could be...

For example, if i am at the movies, and i look at the screen titles through my 20/20 dominant eye, the titles are crisp and sharp...when i i then view them through my blended vision (both eyes) then they have a bit of a "smear" look to them (clear to read but not crisp and sharp)..

This happens in all 3 ranges, and it also seems to tend to make me get more "eyestrain" and tire more easily...

Hope that explains it a bit better...I LOVE having the 3 ranges but i do miss that crispness and sharpness....at the same time, i love being glasses free and really not thrilled about the idea of wearing any glasses again....

[Luvtoski]

When you say you are not adapting to monovision, exactly in what way do you mean ?  Are you seeing double vision when you use both eyes together ???

[Craig10x]

Thanks for your prompt reply....he did try a contact lens in my non-dominate eye to make me slightly less nearsighted in that eye (though i forgot to ask him what that was equivalent to...ex: 20/125 or 20/100) and i did notice that distance and mid range seemed very sharp and clear...the only drawback is that i lost some of the closer vision and had to hold a book much further away to see the page clearly (though not as far as it would be if he had put a 20/20 correction in the eye...

he told me if i wanted to do that he would do it with lasik....
but when i mentioned about losing some of that reading aspect he told me i could think about it..

i didn't think at the time to ask him about the possibility of residual astigmatism so i will call him next week and ask him...i thought perhaps if it might have something to do with that, then maybe it would sharpen me up in the 3 ranges without losing the close reading advantage i have now...

if it isn't that, i'd have to decide if i want to sacrifice a bit on the close end to get the superior vision in the distance and midrange...
tough decision!

[Ray T Oyakawa, MD]

You should ask your doctor about residual astigmatism.  You symptoms suggest you are not adapting to monovision.  You should see if a trial of disposable contact lens in your near eye resolves your symptom.  If you you can consider laser surgery on the near eye.

Dr. O.