toric lens

[naoye]

I'm scheduled for cataract surgery next month and was very sorry and dismayed to read about the difficulties Laura4 has had after her surgery.

My cataract surgeon has recommended the acrysof toric lens to me as well.  I mentioned to him my apprehension after reading the posts by Laura4.  His opinion is that these difficulties unfortunately can occur with any type of IOL and are not more prone to occur with the toric lenses.  (He also mentioned that, if Laura4 was going to change the lens, she should try one from a different manufacturer because they all have different ways of making their lenses and a different method may be more suited to her eyes.)

Because my 1.5 D astigatism is on the borderline for the toric lens, I think he would be willing to use an aspheric lens with limbal relaxing incisions, although he says that the LRI are not very precise and sometimes grow back in.

I would really appreciate any futher thoughts regarding the toric lenses.  At this point, I'm leaning towards the aspheric lenses because being conservative seems less scary.  (The cataract surgery is being done mainly because pyterigia in both eyes have made it very uncomfortable to wear contact lenses and glasses don't correct my high myopia very well.  An ERM peel will probably be done on the right eye soon after the cataract surgery, so the cataract would have progressed quickly in any case.)

Thank-you very much.  This is a great forum - for the information given and shared and for encouraging people to keep looking for solutions.  

[naoye]

What you say makes a lot of sense, as usual.  Thank-you, Jodie.  I'll just try to think positive now.  

Do you mind if I ask whether you are finished now with medical procedures for your eyes?  Other than really missing monvision for near/intermediate vision, are you doing well with your eyes and your vision?  I sure hope so.

[JodieJ]

What type of vision correction would work best probably depends on lifestyle and what someone's used to having.  In all honesty, I don't think I'd be satisfied with any single focus.  Something like -1.0 to -1.25 would give you good intermediate vision and some reading ability.  But you'd need glasses for many activities, including driving, reading the overhead signs at the supermaket, seeing what they're ringing up on the register, etc.  Maybe your best bet would be to stagger the power slightly, as your doctor suggested.  But as I said before, even if your post-surgery vision isn't ideal, it's almost certainly going to be an improvement over what you have now.

[naoye]

Thank-you very much, Jodie.  I really would like to have monvision too.  From wearing monovision contacts, I know the power difference is ok for me but I'm sure you're right about the advantage of allowing my left eye to compensate for the right.  The cataract surgeon must have been thinking of the same thing when he said before that the most he would recommend would be to stagger the power slightly.

Do you think you would have found something like -1.0 or -1.5 in both eyes more satisfactory - for more near/intermediate vision?  

[JodieJ]

I hope that Dr. Hagan reads older threads--he's in a better position to address your questions than I am.

1)  Bulging eyes???  I've never heard of this, and I've never known (or noticed) anyone who had it.

2)  I think the issue of which correction would work best for you is something you should discuss with your cataract surgeon.  (It might help to get input from your retinal surgeon, too.)  My target for cataract surgery was -.5D, but I ended up plano.  Having both eyes plano is great for driving, watching movies in the theater, and spectator sports.  Otherwise, the loss of near/intermediate vision drives me crazy, and I almost always wear my progressive glasses or (sometimes) bifocal contacts. (I do have a friend who also has both eyes plano, and he wears his drug store readers less than 5% of the time.)  I don't think I'd be much happier with both eyes at .5D, though.  It's been three years now, but I still miss my monovision contacts.

3) I think that astigmatism between 1.5D to 2.0D would significantly affect your vision at all distances.  Your cataract surgeon can advise you about this.

4) One of the aspheric lens models--I think it's the Bausch & Lomb Sofport (sp?)--is supposed to work well even if its slightly off-center and/or tilted.  The patient education video at tecnisiol dot com suggests that aspheric IOLs are the best technical innovation since sliced bread.  However, the few independent studies that I could find comparing conventional vs. aspheric lenses told a different story.  Most people who had a different type lens in each eye couldn't tell the difference.  And among those who claimed they could perceive a difference in their vision, more people preferred the conventional lens!  I've heard that aspheric lenses are better at reducing glare, but who knows?  Your cataract surgeon will recommend what s/he feels would work best for you.

[naoye]

I really appreciate your encouragement, Jodie, and the information about compensation by a good eye.  It's very kind and generous of you to take the time to send me these messages.  As you probably can tell, I'm trying to be calm and logical but am feeling quite anxious and uncertain.  It must be the same for many of the people who post on this site. - trying to make decisions about such a small part of our anatomy, that affects our ability to function so much.  If you have any further thoughts at any time, I appreciate them more than you know.  

I feel that I shouldn't impose on you so much, but wondered if I could ask you some more questions.  If you don't have time to answer, or not right away, I understand completely.

1.  Do spherical lenses show in any way or make your eyes bulge out?  I know this is a funny question but an article I read said that aspheric lenses (which are flattened on the top I think) are better for cosmetic reasons.

2.  For compensation by the good eye to work, do you think I should ask the doctor about correcting both eyes to plano?  Or would correcting both to -.5 be a good goal as it would allow some intermediate vision as well as this compensation?  I know the amount of correction is not precisely predictable in any event - which might be another reason to aim for the same for both eyes - although I wouldn't want the poorer right eye to accidentally end up stronger.

3.  With spherical lenses, is it possible that I might not need LRI to correct astigmatism of -1.5 to -.2 D?  I think I recall Dr. Hagan saying that up to 1 D of astigmatism could be corrected just by the way the lens incision is made - which might leave me with quite a small amount.  Also, an article mentioned that, to get the benefit of aspheric lenses, astigmatism correction must be precise, from which I'm inferring that it doesn't need to be as precise for spherical lenses.  It would be nice to avoid LRI because another article mentioned that they can cause dryness which I already have from mild pterigia.  

4.  I'm also thinking that conventional spherical lenses might be better for me because they don't need to be centred and tilted quite as precisely as toric and aspheric lenses - so subsequent surgeries would be less likely to affect them.  Does this make sense to you?

Thanks so much, Jodie.  I'll talk about these things with the cataract surgeon of course but think it will help both him and me if I know a little more before I see him.

[JodieJ]

I have another thought about about your targeting a modified monovision correction with IOLs; then I promise to stop overwhelming you with additional information.  At this point in time, it's unknown what your vision will be like post retinal surgery.  (The literature says that vision generally improves by about two lines on the eye chart, although the affected eye may always have some residual distortion.)  By chosing (modified) monovision, you would not have the benefit of letting your "good" eye compensate for any impairment in vision in your affected eye.  (This ability to compensate is the advantage of having both eyes corrected to the same target.)  This is something that you might want to discuss with your doctors before making a decision.