Michael J Kutryb, MD
Michael J Kutryb, MD
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
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Jan 28, 2011 - 4 comments
Of all the new "Premium IOLs" for cataract surgery it has been the Acrysoft Toric IOL that has been the most widely accepted and praised by cataract surgeons like myself. I personally have been very pleased with this IOL, because it delivers better results for patients with significant levels of astigmatism and with very little downside. Also, the cost for the patient is less that half of the cost for a multifocal IOL.
Patients who are good candidates are those with:
1. Amounts of astigmatism in the 1.50 to 4.00 diopter range.
2. Regular astigmatism that measures the same on a consistant basis.
3. Patients with minimal other eye problems such as macular degeneration, retinal disease, or corneal diseases.
4. Patients with an understanding that glasses may still be needed for the very best possible vision
Going forward, it is very important to talk about the patients that are not good toric IOL candidates. These include:
1. Keratoconus patients, since their astigmatism is usually quite irregular. Results are generally disappointing.
2. Patients with signifincant map dot fingerprint dystrophy - again they often have irregular astigmatism.
3. Previous radial keratotomy patients.
4. Some patients with previous lasik - these cases can go either way but they are not optimum cases in general.
Finally, regarding toric IOLs, there is an expectation from patients that they will see fairly well without glasses, so it is of the utmost importance for the surgeon to get excellent measurments of the eye before surgery. This means using an IOL Master or Lenstar unit, and multiple manual and automated readings of the corneal astigmatism making sure that the reading are clear and consistant. A corneal topography reading is also needed. Using Holladay IOL Consultant software and personally adjusted A-constants are very helpful as well.
If you have any specific questions about toric IOL's, don't hesitate to ask. A very common question is when are limbal relaxing incisions (LRI's) a better choice? We can get into that next time, but in general, LRI's may be better for lesser levels of astigmatism in the 1.00 to 1.50 diopter range as long as the patients don't have corneal surface problems like bad dry eyes.
Patients who are good candidates are those with:
1. Amounts of astigmatism in the 1.50 to 4.00 diopter range.
2. Regular astigmatism that measures the same on a consistant basis.
3. Patients with minimal other eye problems such as macular degeneration, retinal disease, or corneal diseases.
4. Patients with an understanding that glasses may still be needed for the very best possible vision
Going forward, it is very important to talk about the patients that are not good toric IOL candidates. These include:
1. Keratoconus patients, since their astigmatism is usually quite irregular. Results are generally disappointing.
2. Patients with signifincant map dot fingerprint dystrophy - again they often have irregular astigmatism.
3. Previous radial keratotomy patients.
4. Some patients with previous lasik - these cases can go either way but they are not optimum cases in general.
Finally, regarding toric IOLs, there is an expectation from patients that they will see fairly well without glasses, so it is of the utmost importance for the surgeon to get excellent measurments of the eye before surgery. This means using an IOL Master or Lenstar unit, and multiple manual and automated readings of the corneal astigmatism making sure that the reading are clear and consistant. A corneal topography reading is also needed. Using Holladay IOL Consultant software and personally adjusted A-constants are very helpful as well.
If you have any specific questions about toric IOL's, don't hesitate to ask. A very common question is when are limbal relaxing incisions (LRI's) a better choice? We can get into that next time, but in general, LRI's may be better for lesser levels of astigmatism in the 1.00 to 1.50 diopter range as long as the patients don't have corneal surface problems like bad dry eyes.
Dear Dr. Michael,
I read another post of yours about monovision, and find it very usefull. But this post interested me even more.
I am a 43 year old Brazilian who had a IOL implanted on my RE last friday night (02/18), less than a week.
So far I am very satisfied wih the results. My RE vision is crystal clear, and my Dr. told me it will get even better.
A primary evaluation on satudary morning showed that my RE already was at 20/40, eve with my pupil still very dilated.
I will need a reading right lens, but I already known that. I had presbyopia, so it is not a big deal.
My both eyes was measured by IOL Master.
IOL Master reports 13.0 (REF -0.18) and -0.05 D @20º on RE.
The IOL implanted was a AcrySof IQ SN60WF monofocol 13.0 D non toric.
So basically we are expecting near 0 myopia on RE with negligible astigmatism.
Ok. maybe it will not get plano, but even so if I get a little myopia on my RE, it is still much better than that terrible multiple images (4 or 5 images) I was viewing with cataract.
At night the streets seemed a Christmas Tree, and I was avoinding drive ate night because of that.
I am a IT professional, so I work all day with computers, it was a nightmare.
But ... Yes, there is always a "but".
My LE, which does not have cataract, and so does not need surgery, has a glass prescription of -3.75 (myopia) and -2.0 of astigmatism @79.
When I put my backup glasses (yes, I put a plano lens on the right), the images are great, but I can`t use it more than a few minutes.
I discovered (well, my Dr. had told me that maybe I will not want to were my glasses after surgery), that this is "anisometrophia".
I can see a big difference on images sizes from RE (bigger) to LE (smaller).
Now I know that I already had it before surgery, but the power difference was smaller (2.25), so it didn`t bother me too much, but I remembered seeing double images for example.
Maybe it explains some mysterious headaches I had before.
Well, I did`t discussed it with my doctor yet, but I found that there are two solutions: implant a IOL lens on LE (even without cataract) or use contact lens.
I don`t know if I will feel comfortable with contacts, but it is easy to do a "test drive" with it before decide to implant a IOL.
Contact lens is a reversible solution, implanting a IOL is not.
My doubt is regarding toric IOLs.
IOL Master measures of my LE: Cyl.: -0.79@83º. For Alcon SN60WF IOL Master suggestions are (beside others) 15.0 D (REF -0.28), 15,5 (REF -0.62), 14.5 (REF 0.05).
If I understand it right, a good choice for better distance vision would be 15.0 D.
What is your opinion ? A toric IOL like AcrySoft IQ Toric would be a good option ? I know that there is a risk of rotation.
I would need glasses for astigmatism correction if I decide to go with a monofocal IOL like SN60WF, right ?
For me it is ok. I don`t mind to using glasses, I prefer a safer solution.
I forget to mention, I also have glaucoma under control with no visual lost.
I learned that implanting a IOL could help keep IOP under control, right ?
Thanks in advance for any help,
Luis Bravo
I read another post of yours about monovision, and find it very usefull. But this post interested me even more.
I am a 43 year old Brazilian who had a IOL implanted on my RE last friday night (02/18), less than a week.
So far I am very satisfied wih the results. My RE vision is crystal clear, and my Dr. told me it will get even better.
A primary evaluation on satudary morning showed that my RE already was at 20/40, eve with my pupil still very dilated.
I will need a reading right lens, but I already known that. I had presbyopia, so it is not a big deal.
My both eyes was measured by IOL Master.
IOL Master reports 13.0 (REF -0.18) and -0.05 D @20º on RE.
The IOL implanted was a AcrySof IQ SN60WF monofocol 13.0 D non toric.
So basically we are expecting near 0 myopia on RE with negligible astigmatism.
Ok. maybe it will not get plano, but even so if I get a little myopia on my RE, it is still much better than that terrible multiple images (4 or 5 images) I was viewing with cataract.
At night the streets seemed a Christmas Tree, and I was avoinding drive ate night because of that.
I am a IT professional, so I work all day with computers, it was a nightmare.
But ... Yes, there is always a "but".
My LE, which does not have cataract, and so does not need surgery, has a glass prescription of -3.75 (myopia) and -2.0 of astigmatism @79.
When I put my backup glasses (yes, I put a plano lens on the right), the images are great, but I can`t use it more than a few minutes.
I discovered (well, my Dr. had told me that maybe I will not want to were my glasses after surgery), that this is "anisometrophia".
I can see a big difference on images sizes from RE (bigger) to LE (smaller).
Now I know that I already had it before surgery, but the power difference was smaller (2.25), so it didn`t bother me too much, but I remembered seeing double images for example.
Maybe it explains some mysterious headaches I had before.
Well, I did`t discussed it with my doctor yet, but I found that there are two solutions: implant a IOL lens on LE (even without cataract) or use contact lens.
I don`t know if I will feel comfortable with contacts, but it is easy to do a "test drive" with it before decide to implant a IOL.
Contact lens is a reversible solution, implanting a IOL is not.
My doubt is regarding toric IOLs.
IOL Master measures of my LE: Cyl.: -0.79@83º. For Alcon SN60WF IOL Master suggestions are (beside others) 15.0 D (REF -0.28), 15,5 (REF -0.62), 14.5 (REF 0.05).
If I understand it right, a good choice for better distance vision would be 15.0 D.
What is your opinion ? A toric IOL like AcrySoft IQ Toric would be a good option ? I know that there is a risk of rotation.
I would need glasses for astigmatism correction if I decide to go with a monofocal IOL like SN60WF, right ?
For me it is ok. I don`t mind to using glasses, I prefer a safer solution.
I forget to mention, I also have glaucoma under control with no visual lost.
I learned that implanting a IOL could help keep IOP under control, right ?
Thanks in advance for any help,
Luis Bravo
Looks like about -0.79 diopter of astigmatism at 83 degrees. That is not enough to treat with a toric IOL according to that measurement which I don't necessarily trust. You HAVE to have a corneal topography and MANUEL keratometry readings and even autorefractor readings to see exactly how much CORNEAL astigmatism you have. The corneal astigmatism is what will be treated with a toric IOL. In the meantime your best option is to wear a toric contact lens unless you cannot tolerate it then you will need to probably have cataract surgery but quite likely without a toric IOL. I can't pick your implant power for you - there are too many variables and I have to see how reliable and accurate the measurements are. You are assuming the measurements are accurate. 90% of the time if there is an inacurrate reading it involves the corneal power readings.
Dr Michael,
Thank you for your help.
Today I went to my second post surgery review of my RE.
As I was expecting, based on my personal post surgery viewing experience, my RE results were perfect.
My surgery was last friday, and today, I could get a 20/20 on a preliminary acuity exam of my RE without difficulty.
Now I must choose if I will use contact lens, or if I will get a IOL implant.
Because of this anisometrophia I just can`t use my glasses.
For now I decided to try contact lens.
I will wait a full RE surgery recovery before thinking about LE surgery, so I thought contact lens could be a good ideia.
It also allows me to try monovision.
By the way, on your opinion, what power should I choose if I decide for monovision (or mini) ?
My doctor said a -1.0 on LE would be a safer choice.
Right now, with -3.75 on LE, I think I am experiencing a HUGE monovision, is this conclusion right ?
With -3.75 on LE, I can manage to do many activities without glasses, even drive, so with -1.0 on LE maybe I will not even notice monovision.
Regarding IOL choices (toric x non toric) my doctor advised me to choose a non toric.
He also thinks -0.79 is not enough to treat with a toric IOL.
I don`t mind wear glasses, so we could treat any astigmatism left behind with glasses.
The current astigmatism power of my glasses is -2.0 (LE) and 0.0 (RE).
But I will talk to him about these exams you suggested.
Once again, thank you.
Thank you for your help.
Today I went to my second post surgery review of my RE.
As I was expecting, based on my personal post surgery viewing experience, my RE results were perfect.
My surgery was last friday, and today, I could get a 20/20 on a preliminary acuity exam of my RE without difficulty.
Now I must choose if I will use contact lens, or if I will get a IOL implant.
Because of this anisometrophia I just can`t use my glasses.
For now I decided to try contact lens.
I will wait a full RE surgery recovery before thinking about LE surgery, so I thought contact lens could be a good ideia.
It also allows me to try monovision.
By the way, on your opinion, what power should I choose if I decide for monovision (or mini) ?
My doctor said a -1.0 on LE would be a safer choice.
Right now, with -3.75 on LE, I think I am experiencing a HUGE monovision, is this conclusion right ?
With -3.75 on LE, I can manage to do many activities without glasses, even drive, so with -1.0 on LE maybe I will not even notice monovision.
Regarding IOL choices (toric x non toric) my doctor advised me to choose a non toric.
He also thinks -0.79 is not enough to treat with a toric IOL.
I don`t mind wear glasses, so we could treat any astigmatism left behind with glasses.
The current astigmatism power of my glasses is -2.0 (LE) and 0.0 (RE).
But I will talk to him about these exams you suggested.
Once again, thank you.
My Father is going to go for cataract surgery and his numbers are as follows:
Glasses Right: OD-9 cylinder-0.75, axis:44 vn:0.5
Glasses Left: OS-7.75 cylinder -1.25, axis:133 vn:-
Autorefraction Right Eye: OD-7.25, cylinder -1.00, axis 39
Autorefraction Left Eye: OS-6.25, cylinder -1.25, axis 169
The Surgeon suggested to go for Acrysof IQ IOL in Right Eye, and Acrysof TORIC IOL in Left Eye.
I just wanted to know that is Toric IOL neccessarily required to correct Left Eye Cylinder of -1.25 or would you suggest getting normal Acrysof IQ IOL in the Left Eye also.
The Doctor said that they would be able to complete correct the distance vision with putting Acrysof IQ IOL in Right Eye and Acrysof TORIC IOL in Left Eye.
I would highly appreciate reply from the doctors on this forum at the earliest since my father's surgery is scheduled on thursday 24th march 2011 for the right eye and on monday 28th march 2011
Glasses Right: OD-9 cylinder-0.75, axis:44 vn:0.5
Glasses Left: OS-7.75 cylinder -1.25, axis:133 vn:-
Autorefraction Right Eye: OD-7.25, cylinder -1.00, axis 39
Autorefraction Left Eye: OS-6.25, cylinder -1.25, axis 169
The Surgeon suggested to go for Acrysof IQ IOL in Right Eye, and Acrysof TORIC IOL in Left Eye.
I just wanted to know that is Toric IOL neccessarily required to correct Left Eye Cylinder of -1.25 or would you suggest getting normal Acrysof IQ IOL in the Left Eye also.
The Doctor said that they would be able to complete correct the distance vision with putting Acrysof IQ IOL in Right Eye and Acrysof TORIC IOL in Left Eye.
I would highly appreciate reply from the doctors on this forum at the earliest since my father's surgery is scheduled on thursday 24th march 2011 for the right eye and on monday 28th march 2011
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