Which IOL to choose during cataract surgery?

Hello,

I am having cataract surgery on July 30th and have to make a decision of putting in the Acrysof Toric lens or  a muitifocal lens with limbal relaxing incisions.  I am debating which one to choose but am leaning towards the toric lens because I am a little frightened about the incisions and complications that can occur.  My left eye has a diameter of 14.4 and the power is -4.00/-2.25 x 160.  I already have signs of Presbyopia and am 39 years old.  Can you please offer any advice.

Thank you!

[JodieJ]

I'm not an eye care professional, but I think you have way too much astigmatism to consider a multifocal implant, unless you willing to do a laser correction procedure at a later date (and at your expense.)  It's my understanding that limbal relaxing incisions are somewhat unreliable and probably would leave you with significant astigmatism post-surgery (too much for good vision from a multifocal lens.)  It would be worth your time to read some of the posts on that topic in the archives of this site before making a decision.  (What about your other eye?)

[John C Hagan]

Hello CD 1968   In the hands of experienced cataract surgeons limbal relaxing incisions can work quite nicely as can varying the site of the cataract incision and placing it along the steeper axis of the cornea. I have limited experience with toric implants nor does anyone one in my large eye surgery group use many toric lens. However other physicians at our national meetings have reported good results.

As I have said before in this forum I would not want a multifocal implant in my eye and the three eye doctors in my office also feel this way. We would choose a monofocal aspheric implant in our eyes aiming to leave the eye a little under corrected for distance on the first eye (probably about -1.00) and on the second eye decide whether to emphasize the near vision on the second eye (shoot for about -2.00) or emphasize the distance vision on the second eye (aim for about -0.25).  Of course this means we all would accept wearing multifocal no-line bifocal/trifocal (really the same thing) after surgery.  You have worn glasses so I assume you're not the rabid "glasses hater" that is the ideal candidate for a multifocal implant.

The surgeon could probably reduce the astigmatism by at least one diopter just by putting the incision superiorly at the vertical 70 degree position.  

I would put a lot of thought into your choice of implant. Please review the many postings on problems and dissappointments with multifocal implants by using the search feature and search: crystalens, restor, rezum and multifocal implants.

JCH MD Eye Physician & Surgeon

[cd1968]

Thank you for your prompt response.  My right eye already has a small cataract and will have to be taken out one day but it is not bothering me right now.  My right eye has a diameter of 14.4 and the power is -2.75/2.25 x 010.  I have been on the site all day doing research and have decided not to do the multifocal lens.  If I get the monofocal lens will I be able to wear contacts afterwards?  Also, if I undercorrect the first eye how will that affect my vision until I do the second eye?

[JodieJ]

Yes, you can wear a contact lens after cataract surgery.  Undercorrecting the first eye would give you modified monovision, which could be changed to a full distance correction with contact lenses or glasses.  In the literature for eye care professionals, Alcon's AcrySof toric IOL has gotten excellent press.  It's reported to be less prone to rotate in the eye than other toric IOLs, and it's also said to be a more reliable way to correct significant astigmatism than limbal relaxing incisions.  I think that it would be an excellent choice for you.

[cd1968]

Thank you again for your response. I am so confused and I have to decide by tomorrow what lens to choose.  I am wondering if I should postpone this until a later date when I have acquired more information to make a choice.  I went to the doctor my eye doctor recommended. His name is Dr. Kalski hear is Miami.  I am wondering if I should go the Baskin and Palmer Eye Institute to get a second opinion. The more I read the more choices I see there are.  I don't want to regret my decision.

[JodieJ]

I don't think you'd regret your decision to get a monofocal implant, either toric or aspheric, especially if your surgeon is experienced.  Some people prefer to trust their doctor with the decision-making.  (One of my friends who is ecstatic about his post-surgery vision has no idea which lens he received, what his targeted refraction was, or what his surgeon did to reduce his astigmatism.)  I'm the opposite--I did hours of research beforehand and got more than one opinion before having the surgery.  (I'm happy with my results, too.)  My best advice is to do whatever makes you feel the most comfortable.  I suspect that you will be pleased with your results regardless.

[John C Hagan]

Let us know how things turn out and what you decide.

JCH MD

[cd1968]

Thank you for the advice.  I am postponing the surgery until December so I can do a little more reearch and also to get a second opinion.  I just want to make sure I pick what is best for my situation.  Thanks again and I will let you know.