Toric IOL Problem

[emmachas]

I had an Alcon toric IOL to correct for distance implanted following cataract surgery 15 weeks ago.  My distance vision in that eye is now 20/40 and the astigmatism is worse than before surgery. There is also an ache or soreness in the outer top quardrant of the eye that remains.  A second opinion advised that the lens, instead of sitting flat, actually sits like a bowl with the center curving towards the back of my eye. She suggested that the lens is also turned at an incorrect angle to correct for distance vision.  She felt the original surgeon should attempt to turn the lens. He declined to do so, instead would like to attempt to correct the new astigmatism with LRI.  The second opinon felt that was not the best answer.  I'm desperate for answers as to what would cause the lens to sit like that. And, how it can best be corrected at this point?
Thank you for any help you can provide.    

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

Lasik correction is less risky than explantation.  Getting that third opinion is probably a good idea.

JCH MD

[aml57]

Anne here.  Second opinion Dr. suggests to remove the Toric and put a regular lens because Toric over corrected the lens.  Option to do Laser if corrective soft contact really makes vision clear.Looks like I may be headed for a third opinion because the first Dr. wants to correct the lens with laser.  Am undecided which way to go.  Want to go with monofocal and MUST have clear vision in the distance eye.  Your thoughts please.

Anne

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

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[aml57]

I had Alcon toric IOL implanted after cataract surgery on May 15, 2008.  I am seeing star bursts and do not have clear vision.  Procedure was done by a reputable surgeon in Houston, TX.  I am very frustrated about this.  Dr. says it can be corrected with Lasix but I am not inclined to do it.  I have worn glasses since I was seven and am now a senior citizen.  Want a second opinion but not sure where to turn.  Hope your surgery went well.

Anne

[texas2step]

After reading Emma's post here...I will not have the Toric IOL placed during my cataract surgery in 2 weeks.  I do not need a repeat story on this Lens.  Thanks so much for alerting us to your problem,  I wish you better days ahead.  I am in Houston, a close by neighbior to you.  Healing Hugs to you.
Nana in Houston

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

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[emmachas]

Thank you so very much for the advice, suggestion---and for the explaining the "bowl" problem in terms I understand!  I will call LSU Monday AM!

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

1. Ask the first physician to remove the toric and replace with a monofocial aspheric like the technis IOL. Then plan on having residual astigmatism corrected by laski or LRI.
2. If the implant is twisted or torqued on itself instead of being relatively vertical is can become concave or convex. (like taking a card and pressing toward the center with a finger on the top and bottom. Neither the LRI or lasik will correct the shape of the IOL in the eye.
3. LSU has a find department of ophthalmology you might get that third opinion there.

JCH III MD

[emmachas]

Thank you so much for the response.  Although both physicians are competent and well respected, I'm sure you are right about the 3rd opinion.  I just don't know where else to go.  These two are the best in our south Louisiana area.
Physician #1 feels a repositioning is too risky.
Physician #2 will not take the responsibility of repositioning.  She will consider an attempt to correct with lasik or lasek(?).
It's the "bowl shape" I'm struggling with.  Would you venture an opinion as to whether LRI, lasik, or lasek will likely correct that?  Or, is that a common or insignificant occurrence with the toric lens?
If physician #1 will not reposition, I'm fairly certain I will be unable to find one who will.  I would love to have it the toric removed!!  

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

Just like there are often several different routes to follow to get to the same destination in medicine there are often different treatments to get to the same result.

You have several options. No surgeon will do something he feels inappropriate because a second opinion disagrees with his approach. You do need to have something done.

1. You can understand that both methods are trying to get to the best possible vision. If you are comfortable with your first surgeon go with his/her recommendations. Be sure and discuss cost of the procedure so you can take this into account.
2. You can ask the second opinion ophthalmologist if he/she will repostion and rotate the IOL. Discuss costs.
3. you can get a third opinion to breat the tie.

Do it rather soon.

JCH III MD