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Acrysof Toric IOL in one eye and Multifocal Contact lens on unoperated eye

I am scheduled for cataract surgery in my left eye.  My right eye does not need cataract surgery.   I have a lot of astigmatism in the left eye and the surgeon wants to implant the Acrysof Toric IOL.  My left eye is non-dominant.  He wants to correct the Toric IOL for intermediate distance vision.   I've seen the posts about mini-monovision but my question is:  would I be able to wear my multifocal contact lens in the unoperated (right eye)?  The current strength of the right eye multifocal lens is -4.75.
1 Responses
177275 tn?1511755244
First be sure you have read this carefully:  https://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

Second what is your present LE glasses RX?   Third "intermediate vision" tells me nothing. What is the exact post operative refractive error you surgeon is going to target? e.g.  -1.50    
24 Comments
Thank you for your prompt response.  My left eye multifocal lens Rx is -5.25.  I can post my eyeglass Rx this evening.  I have my pre-op appointment with the surgeon in 2 days and I intend to find out that information.  I also intend to bring up your points in the All the Options post.

I have read your post on All the Options and it sounds like I would need no greater than 1.50 diopter difference between both eyes but that even with a contact lens in the unoperated eye I would still need glasses (I'm one of those people that have worn contacts since the age of 16 and don't want to wear glasses at least at work).

I've been wearing multifocal contacts for about 3 years now, prior my vision was corrected with monovision using contacts so if the multifocal in the unoperated eye won't work I am hopeful that I will be able to do monovision or mini-monovision.
The IOL you plan on putting in your eye is a toric but not 'multifocal"   Thus if you wish to remain glasses free you would need to wear a contact in the operated eye.  But the toric corrects astigmatism in the eye not on the cornea and a spherical contact lens will not work well in the operated eye.   So yes if you want to use both eyes together you likely will need glasses or just wear the contact lens in the good eye and in the operated eye it will be out of focus except at the distance the post operative uncorrected refractive error is set.  i.e. for distance 20 feet  intermediate maybe 2-3 feet.
So what you are saying is that the only thing that will work for me without glasses is monovision?  Would mini-monovision work?
First of all you say your  LE is 'non-dominant' at one time could you see 20/20 in that eye? Or less than 20/20 and it also had amblyopia?  you say it has a 'lot' of astigmatism it may also have amblyopia and visual potential less than 20/20.   Nothing is going to work "without glasses"   Your RE does not need surgery and has -4.75  myopia. Without glasses it only will see clear about 6 inches away. Your RE even if it is not amblyopia and the astigmatism can be corrected and was set at 0.00  will not see 20/20 until you are 20 ft/ or 6 m away.  That is too big of a difference to manage without glasses.    
I do not have amblyopia (that is lazy eye, correct)?  At my last eye exam in December 2018, the vision in my left eye was measured at 20/25 with my glasses on.

My eyeglass Rx is:
   OD Sphere: -4.75 Add +2.50
   OS  Sphere: -5.75 Add +2.50
Cylinder and Axis for both eyes is blank on the glasses Rx.

I incorrectly had in my first post that the surgeon wants to use the Toric IOL for intermediate distance but I should have written intermediate reading since the left eye is the non-dominant eye.  In that case, if I wore a contact lens in my right un-operated eye that is what I was hoping would work either just for distance so I would have monovision or (and I'm assuming this is not possible but correct me if I am wrong) that I  could wear my -4.75 multifocal contact lens in the un operated eye.

I am seeing the surgeon on Thursday and I will find out what refractive error he is targeting.

Thank you for the information you have been providing!
Your glasses RX has NO astigmatism in it (cylinder and axis)   It is possible in rare cases to have corneal astigmatism but not glasses astigmatism but not often.   If you wear a contact lens in your RE -4.75 and that eye does not have a significant cataract and your LE is left about -2.00  you would have monovision  just wearing a contact lens in  RE only.   With no glasses or contacts you LE should be able to read regular size print in good light.    Glasses may be a problem though.
Hmm..that is interesting that my glasses Rx indicates no astigmatism cause I know I have it in my left eye;  based on what you are saying that I could be a rare case maybe I will be able to just use my multifocal contact lens in the right eye which does not have a significant cataract.

I will re-post tomorrow after I see the surgeon with more information!

Thanks again!
You are welcome.  Your glasses RX has no astigmatism in either eye. Ask your surgeon if you have CORNEAL astigmatism.
Will do!
=
Hi Dr. Hagan,

During my pre-op today the surgeon  confirmed that I do have corneal astigmatism.   I also asked him what post operative refractive error he was targeting as you suggested and he said -1.50.  He also feels that I will be OK wearing my multifocal contact lens in my un-operated eye. He said the intermediate vision with the implant and the multifocal contact lens  should work as mono vision for me.

I also found out that my axial length is 24.5.

That is a reasonable plan. Best of luck. Let us know how it turns out
I will and thank you for taking the time to respond and offer advice!
Happy to help.  Let us know how this turns out
Hi Dr. Hagan,

My surgery is scheduled for next week but I began to wonder, since my glasses Rx and my multifocal contact lens Rx do not correct my corneal astigmatism now, why would I require a Toric monofocal IOL in my LE?

If I just had a monofocal IOL and used my multifocal contact in the unoperated eye wouldn't that work?

I am thinking I may have difficulty getting used to the Toric IOL since my  corneal astigmatism  hasn't been corrected and I've been fine like that.

My contact lens Rx is (with no Cylinder or Axis:)
OS -4.75 /HGH  +250
OD -5.25 /HGH +250

My eyeglass Rx is:
   OD Sphere: -4.75 Add +2.50
   OS  Sphere: -5.75 Add +2.50
Cylinder and Axis for both eyes is blank on the glasses Rx.

Another question:  Since both my glasses and contact lens Rx for the RE are -4.75, does that make the RE plano?

Thanks in advance for information!
If you want to check this out further you would need to ask your surgeon for the "K" (keratometry) readings.   It would be rare but since you have no "cylinder"  in your glasses RX that means you have not net astigmatism. This is rare but it would mean you have corneal astimatism that is correct perfectly by "Lenticular" (your natural lens).  When the lens is removed the the cornea astitmatism would show up. THIS IS RARE.    That's really all I can tell you.   The K reading measure astigmatism on the cornea. There are 2 numbers 90 degree apart.  They should not be the same and the difference should be about the power of the toric lens the surgeon proposes to put in.  Second question NO..    When we talk about post operative desired UNCORRECTED refractive error.     SO plano = 0.00 WITHOUT glasses at distance.
OK, all I know is he said I have moderate to high astigmatism. Without the astigmatism being corrected it was 'good enough' for me to drive, work at the computer and watch TV.

The fact that my axial length is 24.5 which he said is considered long  and from what I have read that is true, but not much longer than normal, maybe that is why I was OK without the astigmatism correction.

I'll try to find out about the keratometry readings if possible.

Thanks again!

Share your concerns NOW.  Everyone is better off having these type of discussions BEFORE rather than after surgery.  If necessary you can get a second opinion or postpone surgery until you 'have a good feeling'.
I understand.  I did get a second opinion and the second surgeon also recommended the Toric IOL.  I did not feel comfortable though with him (I could tell he didn't like me asking so many questions) but I do feel comfortable with this surgeon.

I will follow up with him again.  Thank you!
Well at least they both are recommending the same thing.
Hi Dr. Hagan,

I had the surgery on my LE on Wednesday and it went fine with no complications.  I saw my surgeon yesterday for the 1 day post op appointment and he said the IOL is perfectly positioned.

The lens he implanted is the Acrysof Toric Model SA6AT3,  17.5 D,  1.50 Cylinder,  Length: 13mm,  Optic: 6mm.  This implant is the new one,  it is clear, not tinted yellow, and is UV absorbing.

So far I've noticed some "shimmering" vision and the "twinkle" in my pupil.  My pupil is not it normal size yet but it has been constricting some each day.

Today I put my -4.75 multifocal contact lens in my RE unoperated eye and it looks like this is going to work for me!  I'm still off from work but no issues reading or watching TV.  I will do some driving over the weekend to be sure that is going to be fine.

I see an amazing difference in the brightness of colors with the operated eye - I don't think my vision was ever this vibrant, its quite something!

I will post more observations as I begin living with my pseudophakic eye!

Thanks for all the information you share.  I hope my information is helpful to the community.
Thanks for posting. Hope all continues to go well. The shimmering is common, my wife had it for a couple of weeks. Generally its 'positive dysphotopsia" and comes from the cornea incision.  Acrylic IOLs can cause  'twinkles' that some people like some find objectionable.  More than a few positions about them.  Color improvement is usually dramatic especially when you compare operated eye with unoperated looking at something white.
Can't say I'm a fan of the "twinkle" but I was aware of it having seen YouTube videos of people with it and reading about it on this site, but if that is the worst problem I have from the surgery I'll can live with it.

My surgeon says the shimmering could take as long a 4 to 6 weeks to resolve, hope mine is quicker like your wife experienced!
Best of luck. Hope you end up in the "happy camper" catagory
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