Toric IOL or Monofocus IOL

I am 55 years old. I have cataract in both eyes. Left eye is worse. Doctor suggests Cataract surgery on my left eye first. Since I have astigmatism, the aspherical AcrySof Toric IQ IOL is suggested for implant. Since Toric IOL needs to be implanted with an angle and it rely on capsular bag fibrosis to hold the IOL in place. It may hold very well for first several years. I wonder, Can it be held in the same place after 10, 15 20 years. I mean the tissue around the capsular bag stays at the same location after many years.  IF IOL is shifted, Can vision be corrected by eye glasses?

As far as I know, the IOL is not custom made for each patient. It is chosen from the already made IOLs to best fit to the patient. Patient may still need to wear the eye glasses after implant to get 20/20 vision. If this statement is true, why not just leave the burden of correcting stigmatism to eye glass and implanted with mono focus IOL and forgets about Toric IOL rotation problem for good. I love to play table tennis. It needs two eyes pin down the location of the ping pong ball. If after Toric IOL implant, I lost some of capability to catch the ball. I will be disappointed. May be implanted with monofocus IOL and use proper eye glasses to tailor the correction of astigmatism to get the best vision I want. My thought may be craze, I need your opinion.

Regards

Jim

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

1. No problem, implants properly placed in a capsular bad with normal zonules will last much longer than you will.
2. It all depends on how good you want your uncorrected vision (without glasses) and how willing you are to wear glasses. If you don't care about either than a monofocal is safest and least expensive. Some residual astigmatism can actually help you pseudofocus at near.
3. If you want be uncorrected vision without glasses and wear glasses as little as possible then consider the toric monofocal aspheric IOL.

JCH MD

[peakhope]

There are three common ways to address astigmatism as part of a cataract procedure: Toric IOL, LRI's, and Laser surgery. Plus the option of not treating it and either correcting it with glasses or contacts or just living with astigmatism.

Each has pros and cons, so each person has to decide which is best for them, after consulting with their doctor. Depending on how severe your astigmatism is, some of those options may not be available to you.

Personally, I chose LRI's. I didn't like the idea (and expense) of a toric IOL, and have always been squeamish about laser surgery. My doctor is very experienced with LRI's, and performed them free as part of the IOL implant procedure. I would only consider LRI's if your surgeon has a lot of experience and confidence with them.

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

A fourth way is to place the surgical incision in the axis of the astigmatism, make the incision slightly larger than normal and use more steroids than normal. That can often correct up to 0.75 diopters of astigmatism.

JCH MD