Thin cornea...MD said can't correct astigmatism

While considering cataract surgery, one of the MD's I was considering said that I had a thin cornea and that he couldn't correct my astigmatism. Another MD said "Baloney".  He said he could do a "PRK" procedure at some point after cataract surgery.

That same MD said another solution would be a toric IOL, however, the Alcon toric IOL, which is the brand he prefers, isn't available in my prescription.  They said a person needs at least -1.50  astigmatism.  I don't understand that but that's what they said.

Question...Do you think the MD who said "Baloney" is too bold or is the other MD too conservative?  I have no idea.

Thank you in advance for any comments/suggestions.

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

Without examining you or looking at your numbers I have no idea either. Get a third opinion and break the tie.

JCH III MD

[JodieJ]

When the AcrySof toric IOL was introduced a couple of years ago, it did not come in the power you would need.  I don't know whether Alcon has expanded the available power range.  However, there is an older silicone toric IOL (the Staar toric) that probably does come in your power.  This lens is reported to be more prone to rotating in the eye than the AcrySof toric.  If the Staar toric lens were you choice, you'd want a surgeon who was experienced implanting it.  BTW, toric IOLs come pre-loaded with a given amount of astigmatism correction, which is why they are not used to correct minimal astigmatism.

What are your surgical goals?  If your primary goal is to minimize your dependence on glasses/contacts, then spending several thousand dollars out-of-pocket for PRK to eliminate astigmatism and residual refractive error might make sense.

Even if you consult only "top" cataract/refractive surgeons, you're going to find a range of opinions on several issues (e.g., the timing of surgery for "high risk" patients, how long to leave contacts out before doing IOL measurements, which IOLs work best, etc.)  That's why I believe that much of the burden of decision-making now falls on the patient rather than the surgeon, since we choose the surgeon.  Fortunately, there's more than one road to a good outcome.

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

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[Capes55]

Thank you for your help.

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

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