Toric IOL for high myope?

[sgreenstreet]

I know toric vs. non-toric lens implants for cataract patients has been discussed a lot here.  But often people don't  post their vision prescriptions and that makes it hard for me to tell just how similar their situation is to mine.

I've worn thick glasses or contacts forever. I'm -13 in my non-dominant lazy left eye and -12 in my dominant right one.  The astigmatism in my right eye is -2.50 at 90 degrees.  (For years I wore non-toric soft contact lenses and could see just fine.)  The MD is not forthcoming with my current vision prescription.

I've just had an advanced cataract removed from my left eye  and monvision iol used and I hoped for a big vision improvement, but there is significant glaucoma involvement and what I thought I was a fully ripe cataract seems to be glaucoma vision loss. (I'm still still just 2 weeks post op.)  A lot of my peripheral vision remains, though this has yet to be tested post op.  I was completely unaware I had developed glaucoma in one eye.

The extra $1000 for the toric lens implant is not covered by insurance.  Will that make an important difference for me?  Should I be more concerned about  what my  target vision  -- plano, slightly nearsighted or farsighted --   in my good eye should be? Do I need a second opinion from another cataract specialist?  (I've already seen  a cataract  specialist, a glaucoma man, and a retina specialist.)  Thanks for your help.

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

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[sgreenstreet]

These are meds  I was put on to lower my excessive iop as quickly as possible and not a normal glaucoma treatment plan.  My iop was too darn high to phase in the usual meds.

The glaucoma surgeon wasn't kidding when he considered operating the day he first examined me.

Thank you for your help.

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

Some cataract surgeons do stop latanoprost, lumigan, travatan and zylantan for 6-8 weeks post cataract surgery in the believe it reduces inflammation and the risk of macular edema. However since the pills work by the same mechanism as the dorzolamide in co-sopt a better choice if you needed extra IOP lowering would be alphagan-P

JCH MD

[sgreenstreet]

I forgot to mention this is not my standard glaucoma meds regimen.  I usually use Lantanoprost drops, but the cataract surgeon had me discontinue it after the cataract procedure, substituting the carbonic anhydrase inhibitor pills.

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

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[sgreenstreet]

Well, I didn't want to tell my glaucoma story, but the day I first met my glaucoma surgeon at 4pm, he measured my intraocular pressure in the affected eye and asked, "Have you eaten today?"  He was considering immediate surgery.

Post glaucoma op, I have been as low as 11 in that eye and as high as the low 30's. Pretty lousy. Taking Diamox produced  a significant drop to the low 20's.

It does sound like all these meds whether oral or eye drops are using the same method of action.

There may well be other glaucoma experts to see here in town.

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

I would suggest you get a second opinion on your situation. Almost no modern physician uses Diamox anymore and Cosopt contains a carbonic anhydrase inhibitor and that is what neptazane is so Cosopt and neptazane are rarely used together. You might try and get in to see a glaucoma specialist even if you have to go to Phoenix, while there you can ask the toric question plus there is a lot written about that on this website that you can find with wearch feature and archives.

JCH MD

[sgreenstreet]

My dominant right eye, thank goodness, does not have glaucoma.

However, I hear what you are saying about glaucoma in my weaker left eye.  I'm on Cosopt, and Neptazane pills. I did take Diamox for a while, but the side effects are bad.  I have had a laser photocoagulation procedure in that eye as well.  My cataract surgeon thinks that  my cataract, long overdue for removal,  in that eye contributed to the pressure problem. One doctor called the cataract diamond hard.

I wish there were a home test device for IOP.  Apparently, someone at the University of Arizona has invented one, but it is still being tested..

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

Your biggest problem is not deciding whether to plop down the extra money to a toric lens but getting the glaucoma under control and determining if the other eye has glaucoma also.

JCH MD