Technis Aspheric IOL vs other IOLS

I am 46 and have a posterior subcapsular cataract causing significant visual impairment in my dominant eye.  I have a "visually demanding occupation".  I have used reading glasses for a few years so wearing readers in the future does not bother me too much.  I need the best vision possible, although I would prefer not to have to wear glasses at all.

I have approx 2D of corneal astigmatism in the left eye.

I am not interested in multifocals or crystalens, and monovision is out.

My question is what is the best IOL strategy.   I have been interested in the synchrony lens due to the ablility to accomodate, but on the other hand since this is a relatively new technology I am not sure about the long term success and stability of the lens.  This lens would presumably be unable to correct for spherical aberration.  I am also concerned about internal reflections from the 2 optical elements in the lens.

I have been told the best quality of vision would be with a monofocal aspheric lens like the Technis 1-piece lens.  I would presume this would require LASIK correction afterward for astigmatism..  Would the Lasik induce new optical aberration to negate the effect of the aspheric lens?

Another option is a Toric lens but then this would not have the advantages of the aspheric lens.  One opthalmologist has recommended this but I am reluctant.

I am also concerned about the possibility of glistenings from the Acrysoft lens products, which is a concern I have with the Acrysoft Toric lens.

I plan to wear a contact lens in the other eye since it is fine.

Any thoughts?

[peakhope]

In addition to the astigmatism options you mentioned (toric lens, lasik) there are two others: PRK and LRI's. Lasik and PRK are both laser procedures, and I believe both would offer good results.

I was told that for Lasik, I would have to have the flap cut before the IOL implant, and then the laser work would happen after. For the PRK, I would have had to have waited a few months, which would have been a frustrating time when my vision was not fully corrected.

So I chose LRI's (short for limbal relaxing incisions, a misnomer). I originally had about 4D of astigmatism, but only 2D of it was corneal (the rest was in my lens, which was removed).

My doc (who has done a lot of LRI's) did them during the lens replacement procedure. He was able to get rid of all the astigmatism in my right eye. Haven't yet tested the left eye but it seems to be gone there too.

The more I researched LRI's, the more impressed I was. I became a big fan of LRI's when done by an expert. Sometimes low-tech is the best solution.

[Ray T Oyakawa, MD]

I believe you have answered your own question.  There is not perfect IOL.

If you ask 10 doctors this question, each will have their own opinion.  I have a very visually demanding occupation, an eye surgeon, and at this time I would get a Crystalens HD and have PRK to correct an astigmatism and any minor refractive error.

A few studies have compared an aspheric IOL and a standard IOL in the fellow eye.  Patients could not tell the difference.  Aspheric IOLs are theoretical  better when the pupil dilates beyond 5  or so mms.

Dr. O.

[FredZq]

Is this your first post? I would suggest that you spend several hours searching the forum and reading posts regarding Crystalens and Tecnis and multifocal IOLs in general. I have had the Tecnis aspheric installed in both eyes in the last eight months. I am delighted with the outcome. You could search my posts among others.

I find Dr. Oyakawa's opinion exceedingly interesting. Another surgeon (Dr. Hagan) that answers questions on this forum has a completely different opinion and has stated several times that the Tecnis aspheric lens is the one he would have installed in his own eye if he needed lens replacement. So two distinguished eye surgeons essentially have vastly different opinions, which goes to show you that medicine is art as well as science. Time goes on and technology progresses, but all things considered, I wouldn't and didn't take a chance using Rezoom, Restore, Crystalens, etc.

Good Luck

[tbever]

Thanks for the above replies.  

Yes this is my first post, although I have been lurking for awhile.  I have done quite a bit a research and purchased a book through Amazon "Mastering Refractive IOL's, The Art and the Science" ed Chang.  This has been a good resource but I am convinced there are several good options and not one "right answer".  I am interested in others' experiences with cataract surgery because I only want to have this done once.  Although the concept of an accommodating IOL is intriguing, this has to last me 40 plus years (hopefully) and I am just not sure if an accommodating IOL like Crystalens will function correctly that long.

The first cataract surgeon I met with was reputable but was a bit dogmatic and not open to discussion, so I am going to get a second and third opinion before I do anything.

[tbever]

After several different consults with very experienced cataract surgeons, I finally decided to proceed with a newer version of the toric lens, the Alcon aspheric Toric next month.  Hopefully this will be a good solution for astigmatism and combine the best of both worlds without having to have LRI etc. As to loss of accomodation, a bit bummed but I have worn glasses most of my life and even the prospect of distance vision without glasses is intriguing.

[sally987]

Hi! Did you get your new Alcon aspheric Toric lenses yet?  This is what my 1st and 2nd opinion doctors have recommended for me.  I am getting very nervous, as my surgery is scheduled very soon.  Please let me know about your results, I hope that all went well.

Anyone else out there have these torics?  please let us know how you like them~

[tbever]

I only needed the left eye done: excellent result, no problems.  The procedure was a piece of cake.  I was able to drive at night the second day. Back to work the next Monday (procedure on a Thurs).  Very very minor flare around bright light sources at night.  No other dysphotopsias.  I wear readers 1.25 for computer but that's it.  I do have a slight residual hyperopic error of +0.75 and 0.5 astigmatism so I wear a glasses for night driving only. What that does without glasses is causes red lights to appear double but with glasses that is fixed. I can still read license plates and signs but it is just easier to drive with glasses. I may get this lasik'd after 6 months or so when everything is stable.  Corrected I see 20/15 with 4 letters of 20/10, uncorrected 20/20 - 20/25.  It varies depending on the ambient light: slightly better with very bright light.  I am pleased with my result and do not regret forgoing an accomodating lens.

[sally987]

thx, tbever.  Sounds like you are getting sharp vision w/ your new iol.  Please stay in touch.  My surgeries are scheduled for Aug. 6 and Aug. 13th.  I am trying not to be too nervous this last week before surgery, it certainly has helped to read everyone's posts (esp. the success stories).  I will be getting the AcrySof Aspheric Toric lenses, both set for distance.