irregular astigmatism and toric IOL

[naoye]

As posted before, after cataract surgery in April, my right eye went from -8.5 to -1.0 with 20/40 vision (great, considering ERM and corneal HSV scar).  After 3 or 4 days, vision dropped to 20/70 and monocular diplopia appeared.  

The toric lens is perfectly centred but its cylinder power of 2.25 D corrected only .7 D of my astigmatism which is now 1.5 D.  Before the surgery, the cataract surgeon knew of the corneal scar astigmatism, but because of its "benign appearance", he apparently didn't take into account that it was "irregular astigmatism" which can't be corrected by a toric lens.  

Glasses bring the doubled letters closer but not close enough for reading.  The cataract surgeon said that an RGP contact lens would be better (still too early after the surgery to try this).  However, the reason for the cataract surgery was that I was no longer able to wear RGP lenses for any length of time.  A laser surgeon said he can't remove the corneal scar.  He cannot even see the problem clearly because the light is bent by the ERM, the corneal scar and now the toric lens.  He recommends no further surgery, not even cataract surgery for the left eye which is -12.0, because of the risk of retinal detachment or breaking of the capsule of my only good eye.  

Is it likely that my vision was good for 3 or 4 days because the corneal scar didn't interfere with the vision though the toric lens?  Then perhaps it did interfere as the incision started to heal, like shrink-wrapping an object.

If the corneal scar is the problem, why would the monocular diplopia and general poor vision be uniform, rather than affecting only the scarred area?

Do you think it would be too risky to have the left eye cataract surgery?  I haven't been able to return to work and my quality of life is pretty bad right now.  

Thank-you so much for taking the time to consider my questions.  I really appreciate it.

[naoye]

Thank- you very much for your responses!

Dr. Feldman, my vision has unfortunately been stable since the drop in vision 3 or 4 days after the cataract surgery which is now almost 3 months ago.  I also saw a retinal surgeon who said that my ERM was not causing the diplopia and the laser/corneal surgeon who recommended no further surgery.

Dr. Kutryb, you mentioned in response to a previous post that I might have a "higher order aberration" - if glasses don't fully correct the monocular diplopia - which they don't seem to do.   If so, is this a very difficult matter to correct?  Is removing an Acrysof Toric lens harder than removing other lenses, because of the sticky arms?

Jodie, thank-you for the information. I will look for the website you mentioned and perhaps eventually for those contact lenses.  The lens in my right eye is an Acrysof Toric and I'm told that it is postioned perfectly, so it seems the problem is likely the interaction between the corneal scar (causing irregular astigmatism) and the irregular curvature of the toric lens.

Thank-you again to all of you.

[JodieJ]

I'm SO sorry to learn about the problems that you've had recently.  Do you know which toric IOL you have?  I suspect it might be the Staar toric.  It's been reported in the medical literature that this lens tends to rotate in the eye during the days following surgery, thereby negating the astigmatism correction.  This might account for the deterioration of your previously excellent outcome.  (If this were the case, the right contacts would probably restore your vision.)

I believe that there are new (and unfortunately very pricey) contact lenses available that might work for you.  You might try doing some online research yourself, or find the very best optometrist in your area.  You could also try posting on the google newsgroup sci.med.vision.  Some of the eye care professionals who respond to posts are quite knowledgeable.

Please keep us posted on your progress.  Best wishes.  

[Sandy Feldman, MD, MS]

Dear Naoye,

It is important for your eye to heal from the surgery.  There are many causes to the difficulties you are experiencing and it is best to seek  an opinion from a few different eyeMD’s, a corneal specialist as well as retinal specialist.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California