Toric lens

To: Dr. Kutryb, Dr. Hagan, JodieJ, Laura4

As mentioned in previous posts, I will have cataract surgery in a few weeks.  I don't have cataracts yet but am unable to wear contact lenses anymore because of mild bilateral pterigia. Glasses don't correct my vision very well because of my high prescription (-8 and -12, with -1.5 and -2.0 D of astigmatism).  I also have some cornea warping from a previous HSV-1 infection and bilateral epiretinal membranes for which I will likely have an ERM peel soon after the cataract surgery.  Recently, I've been seeing a smaller image with the right eye and have some double vision (probably aniseikonia caused by the ERM).

A few days ago, I saw the cataract surgeon again.  He again recommended the Acrysof Toric lenses and confirmed that they are available (in Canada) in the power I need.  I asked him whether conventional spherical lenses might be better for me, given the fact that I have smaller pupils, some corneal warping with possible recurrence of the HSV and will be having further surgery.  I also asked him about the risk of dysphotopsia.  

He said that the ERM peel, being in the back part of the eye, would not affect the placement of the IOL.  He also felt that LRI were not very precise in correcting astigmatism and that, if I wanted him to use spherical lenses, he would wait til my eyes had healed and do PRK.  He told me that dysphotopsia occurs in about 30% of cataract patients, regardless of the type of lens, and that it will go away for about half of the people who experience it.

After reading and communicating with the doctors and members on this site, I'm very apprehensive about the toric lenses, even though in theory they seem like a good solution for me.  If not for some dryness already from the pterigia, I would request the spherical lenses and LRI or PRK.

My inclination now is just to trust my cataract surgeon's advice and hope for the best.  I would very much appreciate any thoughts or ideas you might have.  However, you've very kindly given me a lot of your time already, especially Jodie, so please don’t feel obliged to respond.  

[twikle]

I had an Acrysof IQ lens implanted in my left eye with an LRI done to fix the astigmatism. My doctor said the astigmatism wasn't enought to warrant a toric lens. He did implant an Acrosof Toric lens in my right eye. Both eyes are working well and I can see 20/20. I have been pleased so far with the results.

[JodieJ]

My retinal surgery involved sutures, which caused a lot of inflammation.  Perhaps my experience is the exception, but there was a shift in the my axis of astigmatism which was stable long after the sutures had dissolved.  (Sphere and astigmatism numbers were the same.)   My vision noticeably improved when I wore the correct rx.  If this type of shift occurs frequently post vitrectomy, it might be a problem for someone with a toric implant.      

[naoye]

wikle, congratulations on the very good outcome of your cataract surgery!  Thank-you for taking the time to let me know.  My cataract surgeon is recommending the toric lens for my right eye, but said he might recommend an Acrysof IQ for the left eye which has less astigmatism.

JodieJ, thank-you again for sharing your experience with me.  It makes sense to be cautious because I truly don't know what else lies down the road.  

I'm hoping one of the doctors will have time to comment on the likelihood of a shift in my axis of astigmatism from an ERM peel and vitrectomy.

[Laura4]

An update for you on the dyphotopsia's I've had with my Toric lens implanted in Jan.
The flickering off the edge and the glare has improved to being livable and may continue to improve, but not the dark shadow at the edge of temporal vision.  That was the least difficult to live with.  

Best to you with whatever decision you make.

Laura4

[naoye]

Thanks for the update, Laura.  I'm really glad that the dysphotopsias are getting less for you and hope they'll continue to improve!
I appreciate knowing that too, as I think very near-sighted people like me are more likely to experience them.
Best wishes to you too.  I believe you posted that you've decided to wait for the technology to improve before doing the other eye.  You're fortunate that you can wait and it sure seems like a wise decision to me.