Treating Residual Astigmatism after Restor IOL

[fidoprincess]

Two weeks ago, I had cataract surgery with a Restor implant done. I went for a follow up today and I can't see well. It turns out that I have .75 astigmatism now which is why I can't see. I started with 1.5 and had the limbal relaxing incisions done at time of surgery but the correction wasn't enough. I can't read the computer without readers, can't see far either and most everything is blurry but "almost" there as if I am wearing an old pair of glasses, but I can tell it's so close.

My doctor says "live with it" and explains that it's so slight that it's not worth correcting and any additional surgery comes with risk that outweighs the problem. It's not slight to me because I can't see! I was supposed to have my other eye done next week but delayed it for obvious reasons. My uncorrected eye is at -6 so they won't work together and I don't know what to do. He said no one would "fault him" or "touch me" for such a slight problem and just told me to come back in 3 months.

All of the literature that I've read said that .75 astigmatism with a multifocal is unacceptable. When he put the correct prescription on the black thing that you look through in the office, it was AMAZING. I could see perfectly and want it fixed. My "fee" was supposed to include touch ups but he's unwilling to do anything so now I need some advice. Thanks in advance for any replies!

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

Read this twice:

http://www.medhelp.org/posts/Eye-Care/Double-vision-only-when-looking-out-both-eyes/show/1983083

JCH MD

[fidoprincess]

Thanks for your reply but I don't understand how it applies to my question.

If I came to your office, would you fix my .75 astigmatism? How would you do it? Additional Limbal Relaxing Incisions? Lasek? What should I even be asking for? Thanks again.

[etrader]

Hi, I am almost exactly the same as you.

I was -6.5 in both eyes. My astigmatism in my right eye was 2 and now it is 0.9 following IOL surgery.

Yes vision is slighty off and it is annoying.

But that is the state of things, unfortunately surgeons cannot hit the bullseye with IOL surgery surgery. 0.75 is pretty close, as you have just had surgery definitely wait 6-12months to let everything heal to see where you are.

I am at the 9 month point, I could have Lasek surgery but again my surgeon correctly points out that the downsides of additional surgery might outweigh the benefits.

Also in my view Laser eye surgery is like IOL surgery - they cannot guarantee the final result in both our cases our astigmatism is less than 1.0 - there is only one outcome from surgery which would be acceptable to justify the costs/risks and than is zero astigmatism - and that is very unlikely to be achieved - the final result might be plus or minus 0.25 at the very best.

[fidoprincess]

Thanks etrader, for your reply. I guess your first eye had a better outcome? Otherwise, how could you ever proceed and get the second one done? Can you see your computer? Do you wear glasses to see far and then readers for up close?

I am shocked that this small amount of astigmatism is causing me such problems. Maybe you consider it "slightly" off because your other eye works? Distance is better but I can't read street signs until I'm right on top of them. Near/intermediate is awful, I can't see my computer without readers, can't see to cook or even see food on my plate. I can't even see someone's face sitting across from me at the dinner table. Certainly without doing the second eye, my eyes won't work together and I can't function now because I also have no depth perception so basically I am just using my one eye that didn't have the surgery.

If this happened on my second eye, I guess I would just learn to live with it but geez, it's hard to fathom intentionally doing this to myself when I could see a lot better with my glasses and contacts before I had the surgery.  Right now I still have my unoperated eye to depend on and I'm reluctant to have that eye done if this is the best of what I can expect. It's maddening because it's so close and I could see so clearly when the correction was made in the office.

Did you ever go for a second opinion? Every article that I've read says that in order for me to see well, it would have to be corrected and that this is the standard of care for Multifocal IOLs. Correct as low as ... "0.75 D of residual refractive error in some cases.... If you didn’t have a multifocal lens, you wouldn’t correct most of these patients. But when you have a multifocal lens, a small amount of spherical refractive error can cause problems." and it goes on to say "the smaller the residual refractive error, the longer you should wait to do a touch-up" so I guess there is still hope for me that things will change as you've said in your post. Here is one article that discusses the options: http://www.revophth.com/content/i/2298/c/39243/

To me, it's very disappointing that my "package" spelled out that "touch ups" would be included in the price but he won't do the additional step. It actually listed lasik, LRIs, PKR and even lens exchange in extreme circumstances so I thought that I was covered for all outcomes. These other surgeons in the article seem to take it in stride and that it's a "given" that touch ups are done. I was shocked that my surgeon was so angry and insulted that I wasn't thrilled with my vision. He was so dismissive and even more angry when I wouldn't schedule having the other eye done and then tells me just to come back in 3 months. Really? Would anyone come back after that attitude?

So now I am left with having to find someone to do my other eye and pay more out of pocket for touch ups to this eye. I already paid $3000 but thought it was worth it because everything, including touch ups, was included. If I could get my right eye done, even if it turned out like this, then I could wear glasses to see I think. Heck, I don't even know if that's true? I think I'd have to have bifocals with a reader in the bottom and then the astigmatism correction in the top.

Thank you for anymore information regarding your situation especially if that is just one eye or you wear glasses or well, anything at all. Did your vision change much in the 9 months? Did you have both eyes done in a short period of time? Did you ever get a second opinion?

[fidoprincess]

Now that I've read every post I can find on here, I realize that what I have is called ghosting/double vision with the new IOL when trying to see up close and the astigmatism is most likely the culprit. It's keeping me from seeing clearly at any distance. It has to be fixed some way and now I read that even .5 can interfere with the Restor lens. Do I have to hurry or will any doctor make me wait at least 3 months to fix this?

How does one go about getting a second opinion? What do I say on the phone to the doctor's office and how do I pick a new doctor? I'm worried now that my doctor says no other doctor will touch me for such a small amount of astigmatism!

I have HMO Insurance.  Will insurance pay for the visit since they paid for the cataract surgery or does the astigmatism rule out any coverage for a premium lens complication that I paid for out of pocket? Do I ask the first doctor for a referral and get him to cover the cost? He did offer to send me to "his friend" for a second opinion but that didn't sound like a good choice because why would his friend be objective? If you have any experience with this, please let me know.

Thanks in advance! So worried and desperate not being able to see...

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

Your first surgeon is not going to pay for a second opinion.  You can go to www.geteyesmart.org and find an cataract/refractive surgeon near your. When you call you explain that your want a second opinion about problems you are having with a Restor IOL. Some surgeons will not do this type of complications especially if they do not insert ReStor IOLs in their practice.

You insurance will likely cover the exam but you should check with them to be sure.

JCH MD