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astigmatism

Im thinking of having lens replacement surgery
But im finding it hard to get a straight answer from the clinics that I have contacted
as most seem to want to sign me up there and then

Ten years ago I enquired about laser surgery but was told due to my prescription I wasn't suitable
Would this still be the case now?
Is it realistic to want to be glasses free after lens replacement
Im 53

r sph +5.50  cyl+1.50 axis 110
l        +4.50       +2.00          80

  Kind regards  Gary  (UK)



This discussion is related to Astigmatism.
Best Answer
Avatar universal
I'll address options in another post, but the first thing to consider is whether getting rid of the need for correction is worth the risk. Most  people have good results with laser correction, or lens replacement, the issue is of course that  neither is 100% safe and therefore *someone* winds up being the statistic. Usually there are risk factors involved that they are aware of in advance that lead to the problems that do occur , but not always. This site and others contain posts from people who have had problems after surgery. Obviously the posts here are not representative since most people with good results don't bother posting (except for those who searched for information here beforehand and wish to do a public service posting their results later). The vast majority of cases go well, but you still need to be prepared for the worst case of an unexpected problem.

I had bilateral cataract surgery done a few months ago at the age of 52 with no other eye health issues and every reason to expect a great outcome, and surgery that went well. For the most part I had a great result, and the problems I have sound like they are rarer than 1 out of a thousand (possibly due in part to having been a high myope, or some other oddity of my eye anatomy, the exact cause isn't clear). This  may still resolve with time, but at almost 6 months postop  I have problems with reading at usual hardcopy reading distance due to flickering lights & text jiggling (though the text jiggling has mostly subsided). It isn't merely annoying, its headache inducing and I struggle to make it through a page of hardcopy. Fortunately computer distance for a large monitors is better and I'm finally almost able to function normally at that distance.  I still get headaches that I'm hoping will stop soon. The odds are vastly against you having the problems I had, the point is that nothing is guaranteed.

Everyone's risk tolerance is different. I was highly myopic my whole life  (-9.5D and -6D) but never thought the risks of lasik were worth considering, and wouldn't have considered lens exchange before I needed cataract surgery at age 52 a few months back.  It is odd though since my attitude has changed after doing more research about vision issues due to my cataracts, despite the bad luck with the cataract surgery. I might consider a laser touchup  if my visual glitch ever resolves to make it worth it.  I'm only slightly hyperopic in one eye after surgery, and it would be useful to switch that to being slightly myopic for better near.  (the risks are lower for small corrections and it seems a shame have been just a little bit off and be losing a bit of near vision, the odds of hitting the refractive target are a bit lower in high myopes than for most people).
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Avatar universal
If you don't have glaucoma you don't have it. Some people are at risk for it because they have smaller eyes. (Farsighted people like you have smaller eyes and tend to have a greater risk of developing glaucoma.) Whether or not to operate for it prophylactically is a personal decision. If you don't have any problems I wouldn't do anything. Eye surgery tends to cause problems.

I would see someone else with the specific complaint that you cannot see  even with your glasses. You want to know why other people can see better than you, even when you are wearing your glasses. See someone who works with rigid gas permeable contact lenses.
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Avatar universal
Wow what a great post
Sorry for the slow response I have waited till now to post as I had an eye examination  scheduled for today
Pressure tests were  good no signs of cataracts prescription unchanged
The examiner told me that my left eye was shaped at an extreme angle
causing the channel to be very narrow which may lead to glaucoma  
and suggested seeing a specialist Who would probably recommend a lens replacement Which would leave a Chanel large enough to drive a bus through  His words I guessing that's not a medical term
    If I wasn't confused when I went in  I am now

   Than you so much for taking the time to answer my questions
        Kind regards  Gary

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Avatar universal
Sure. I can try.
For the best vision, you basically want the refractive state of your eye to 0.00, with no astigmatism. The eye can be too large, (nearsighted) which causes light to fall infront of the retina/ too small (farsighted) where light lands behind the retina/ or not perfectly round (astigmatism) where light might be bent a little bit as it passes through your eye. At 0.00 light lands directly on the retina.

Your prescription is
r sph +5.50  cyl+1.50 axis 110
l        +4.50       +2.00          80


The +5.50 means our right eye is 5 1/2 diopters farsighted, and your left is 4 1/2 diopters farsighted. It means that you need 5 1/2 diopters of focusing strength added to your eyes to make them 0.00 at distance, otherwise light falls behind your retina.
Now, I'm sure your distance vision has always been better than your near vision without glasses because the human lens has the ability to change shape to add + to itself so people can see close up and far away. You can add some plus by focusing to see distance better but your lens cannot change shape enough to give you the whole range of vision. Now if your wife is nearsighted, or her prescription has a minus sign in the front instead of a plus like yours, it would explain why her vision is much worse than yours without glasses, because the human eye cannot shift to subtract power from the lens, it can only add.
The next figure, the +1.50 in your right means that you have 1 1/2 diopters of astigmatism. It means that you need a lens 1.50 diopters in strength that BENDS light sideways in the opposite direction of where your eye is bending it so it lands on the center of your retina. This compensates for the fact that your eye is not completely round. In the left eye, you need a slightly stronger lens, +2.00 to bend the light back onto your retina.
  The third figure is the axis, the 110 in your right eye and the 80 in your left. If your eye is a circle, that number tells you WHERE on your eye the light is bending from. The astigmatism causes the light to go sideways, but they need to know at what angle it goes sideways from so they know what angle to put the astigmatism correction at in your glasses to bend it back in the right direction. If you put your glasses on upside down, it should make your vision worse, because it would about double the amount of astigmatism because the bend in the glasses will bend light further to the side of your retina as opposed to closer to it because the correction will be in the wrong place.
       If you had two prescriptions in your glasses, the numbers would look like this
+5.50  cyl+1.50 axis 110
+2.00
or
+4.50       +2.00          80
NEAR ADD +2.00

The +2.00 would be the number of diopters of additional power on the lower portion of your lenses to help you see up close. As people get older, their lens gradually loses the ability to add + to itself by changing shape that I mentioned earlier. Eventually it loses all of it, and they need to use glasses to compensate for it. Either reading glasses, (used ONLY for reading) for people who already have a 0.00 prescription, or multifocal glasses for people who already needed glasses.

Your glasses correct your distance vision to 0.00 so that light from distant objects falls directly on your retina. I asked if you had progressives/multifocals because you said your reading vision was bad. Just because your distance vision is 0.00 with your glasses does not mean that your near vision is. Based on your age, you should need some kind of near add to make your near vision perfectly focused. You are also telling me that your distant vision is not perfectly focused with your glasses which means there is something wrong that glasses cannot correct. Refractive surgery can only correct what your single vision glasses can. (It cannot make your vision any better than it is with glasses)
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Avatar universal
No Second prescription in my glasses

Would it be possible for you to explain my prescription Please
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Avatar universal
You still haven't told me whether your glasses have a second prescription in them. Im guessing they don't have one.

The doctor told you that your astigmatism is the reason, but your spectacle prescription only shows 1-2 diopters. I'm guessing that you have irregular astigmatism. (Also known as higher order abberations) This type cannot be corrected by glasses. It basically means your cornea is "wavy" which means light doesn't pass through cleanly.

I know that rigid gas permeable contact lenses can correct for some irregular astigmatism that glasses or soft contacts cannot because they create a smooth surface on the cornea for light to reflect through. Custom lasek/prk treatments can to some extent correct preexisting irregular astigmatism although lasik induces some as well. I know that PRK with corneal crosslinking is sometimes used for people who had kerataconus which is corneal weakness that causes large amounts or irregular astigmatism.

I would find a doctor who is an expert at fitting hard contacts. You'll probably find them extremely uncomfortable, but see if your vision is significantly better than it is with glasses. If it is, we've figured out what your problem is.

Then I would go see some specialists. (not just refractive surgeons, but doctors who do all kinds of eye surgeries) Your standard lasik farm isn't going to know anything about this. You want to find someone who does refractive surgery AND corneal transplants or intacs for kerataconus. They will have experience dealing with people who have similiar issues and they would be able to best advise you on how to proceed. Corneal cross linking with PRK could then be used to fix some of the irregular astigmatism, and if afterwards you are still very hyperopic, you could then consider lens exchange if you want your glasses gone, although you will need reading glasses afterwards, and you will not be able to see distance while wearing them.

I would not recommend even considering lens exchange at this time. The problems you have are with your cornea. I would figure that out before you do anything about your lens. Of course, this is assuming that your problem is irregular astigmatism. Because you are telling me that your vision is not satisfactorily correctable with glasses, refractive surgery is not the right step for your at this time. Lens exchange will not correct anything that your glasses cannot correct and will cause some  additional problems.
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Avatar universal
Hi Thanks for taking time to comment

At each eye test im told that my eyes are healthy
and that my astigmatism is the reason that my glasses don't make a massive difference unlike some people

My wife wears glasses for distance and can see much further than I can when we both have glasses on
But when we remove our glasses I can see much better than she can
One colleague can barely tie his shoe laces without glasses
but can read much smaller print than I can when he puts his spectacles on

As I stated in my post I first wore glasses to take my driving test
I was border line at Sixteen With glasses I could read just one line further
not a great improvement but enough to get by Im about the same now
about midway on the eye test chart and about a line up without

My prescription has changed once over the years I have slightly stronger reading glasses which have become my everyday glasses
My optician suggested using a magnifying glass to read small print which isn't ideal

Ive always been told that my poor sight was down to the shape of my eyes
Rugby ball is usually the term used
Which prompted me to go for laser eye surgery about ten years ago
I didn't get as far as the eye exam One look at my prescription and I was told that I was suitable Due to the shape of my eyes
But no  explanation
This forum is a real find
   Kind regards Gary
Helpful - 0
Avatar universal
You are struggling with small print because as you get older the range of shift in power that your natural lens can produce lessens. As a child you had approximately 10 diopters of accomodation. By the time people are sixty they usually only have 1 diopter or so remaining. Good close up vision requires 3 diopters plus a "reserve" some that isn't being used to prevent eye strain/squinting. When people get into their fifty's they don't have this required amount anymore making near vision without a second prescription a struggle or impossible. This process happens faster in hyperopes. You need progressive lenses now, with multiple prescriptions. Or you can get your distance prescription in contact lenses, and then use reading glasses for up close. That may help if you cannot tolerate multiple prescriptions in one lens as many people have trouble adjusting.
         I guess what I am asking is--- Do you have single vision lenses, the same kind you had when your were 16, or have you been told your glasses are called any of these- bifocal, trifocal, varifocal, varilux, multifocal, progressive? if you are 53, a hyperope, and still wearing single vision THAT is going  to be causing your problem with near vision right there. If you have lens exchange and get monofocals set for distance (keep the distance vision you have now with glasses) your near vision will be worse than it is now with your glasses.
        Now, if I have misunderstood you and you are telling me that you can't see distance WITH your distance prescription or near WITH your near prescription thats a different story. If you are not correctable to "normal" vision with properly made glasses then LASIK, ICL or RLE will not help that in the slightest. If lens exchange is successful, your best corrected vision after will be the same as it is now. (And your near prescription will be stronger than it is now since after cataract surgery you have 0 diopters of accomodation.)
      If your vision cannot be corrected to normal, you need to find out the reason why. You have some other eye disorder, many of which are treatable. Now, the only scenario in which you cannot see well with your glasses and lens exchange will solve your problems is if the reason for your vision loss is cataracts. Maybe its not severe enough where they're recommending surgery, but you can have some vision loss due to cataracts that can begin years before they tell you that they're bad enough to operate. (This is because generally if the vision loss is very slight, insurance will not pay for it, and it would be considered cosmetic and may be referred to as lens exchange by your doctors instead of cataract surgery since cataract surgery is covered by insurance. Insurance doesn't cover it until it affects your vision to a certain point, at least thats how it is in the US. I know people with mild cataracts who have been wandering around with not completely correctable vision or poor night vision for years as its not bothering them enough to go through with surgery, or their vision is better than what insurance companies consider the threshold.)

      I guess I need more information. Is your distance vision 20/20 or I think in the uk its called 6/6 with your glasses? Do you have single vision glasses or do they have multiple prescriptions in them?
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Avatar universal
Thank you for your reply's Its not that I have a problem with my glasses
My problem is that I am just under the required driving standard without my glasses and just over with The same for close up I struggle with small print with my glasses I had my first glasses at 16 and my optician tells me that my prescription for distance has barely changed  I would just like to be able to see better Distance would be fine What I would like to know is If I had lens replacement would I be able to see better with my reading glasses
or would I still struggle as I do now

Than you again It is so refreshing to receive all this information without a sales pitch
                  Kind regards Gary   (UK)



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Avatar universal
For that kind of hyperopia lasik would induce significant abberations. It is possible, but your outcome is more likely be suboptimal due to the amount of corneal tissue they woudl need to remove.  (Same goes for PRK and LASEK.) You have high hyperopia and significant astigmatism. The chances of getting this satisfactory with a corneal treatment is very slim.

As for ICL- Usually hyperopes have smaller eyes and there may not be room to impant one safely. Also, due to your age this would not be a typical course of action. This increases the risk of cataracts and due to your age you may be developing them soon anyway, so youd likely end up needing to go to option three, (with the additioanl surgery to implant and explant the ICL) in a few years anyway.

Most doctors would recommend refractive lens exchange or clear lens exchange, they call it a few different things but its essentially cataract surgery when you don't have cataracts. Now I'd strongly recommend you read through this forum for what people have to say about their cataracts and their surgical results. Also about their YAG's. Granted, happy people don't post online but this entire message board contains probably thousands of people complaining about their cataract surgeries for various reasons. Please consider if you want out of your glasses badly enough to become one of us. With that said--
High hyperopes with presbyopia are generally the happiest patients after this kind of procedure. You can't see anything clearly without your glasses right now, and even if you went the safest route (bilateral plano monofocal) you'd have good distance vision and only require reading glasses, which still puts you in better shape than you are now. If you can tolerate a difference between your eyes, they can reduce or eliminate your need for even reading glasses through some variation of monovision. If you can't, multifocals will give you better vision at all distances than you have now (without your glasses) but not quite as good vision as you have at any distance (with your glasses) if that puts it in perspective.

It all comes down to how badly you want out of your glasses and what youre willing to risk to do it...
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Avatar universal
There are two issues obviously now at your age: the refractive error and presbyopia. Obviously a lens exchange is often what is suggested since that can tackle both issues. There are laser methods of tackling presbyopia, but surgeons seem to give them mixed reviews. If lasik were available for hyperopia that high (which I'm uncertain of, I think there may be techniques that not all doctors use yet to do so), there are also corneal inlays (lens implants that go into the cornea, instead of replacing the natural lens) like the Raindrop or Kamra which can be used to address presbyopia separately (and are usually reversible so if they don't work well you can take them  out, unlike lasik which can't be as easily undone, though any sort of surgery has risks).

If lasik isn't an option for the refractive error, there are also implantable contact lenses (ICLs), or phakic IOLs  which are lenses implanted over your natural lens. They   are more reversible than a lens exchange since the lenses can be taken out if they don't work (but again still involve risks).  I don't  think there are any multifocal phakic IOL options to correct for presbyopia yet, but I'm not positive. Here are a couple of links mentioning them for high hyperopes:

http://www.eurotimes.org/node/1278
"Phakic IOLs can provide good long-term safety in high hyperopes..."

There are two phakic IOL models available for high hyperopia with or without astigmatism. They are the iris claw IOL (Artisan®, Ophtec)/Verisyse®, AMO) and the posterior chamber implantable collamer lens (VisianICL®, Staar). Both have undergone refinements over the years and have toric versions for the twothirds of hyperopic eyes that have astigmatism greater than 1.5 D."

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/content/tags/abbott-medical-optics/phakic-iols-good-benefit-risk-ratio?page=full
"Phakic IOLs: Good benefit-to-risk ratio
Three different lenses, each with unique features, provide optical quality and fast visual rehabilitation"

If you do go for a lens exchange, I'd suggest getting an IOL recommendation from surgeons, but then researching them on your own as well (since there are some doctors that may be experts in surgery, but don't delve as much into the optics of lenses and go for what the sales reps push). I posted an overview of lens options in a recent thread here:

http://www.medhelp.org/posts/Eye-Care/Cataract-IOL-selection/show/2586465

It is a reasonable goal to expect to be glasses free after lens replacement, but it isn't guaranteed. A trifocal is the best bet for being independent of glasses. The new Symfony lens is a almost as  good a bet for not needing glasses except perhaps at near. The reason I chose that is because its intermediate vision seems likely to be better, and it seems to have better contrast sensitivity than trifocals (comparable to a monofocal), and lower risk of halo&glare (again like a monofocal).  My  visual glitch with reading isn't likely related to the particular lens. Its possible the fact that it isn't a monofocal might impact it,   though another doc thinks I'd have had more trouble with a monofocal, its not clear. Oddly reading a smartphone is a little better than hardcopy in terms of flickering, I can manage to deal with minor bits of email&web, and text messages.
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