Acrysoft Toric vs. Crystallens HD IOL

[Eatright]

I am in the decision making phase of the implant of choice: Acrsoft Toric vs Crystallens HD. The surgeon is stating she can achieve spectable independence with the Acrysoft but wants to aim it for intermediate vision. Needless to say with the Crystallens HD , I will need a contact for astigamtism correction which is 2.75. I currently have an the old Array multifocal in my right eye which gives fair vision results but I wear a corrective lense for my astigmastism . I am burdened with the night driving star bursts and halos also.I don't want to lose my night driving capability since I am only 49.
Additionally both implants will have the out of pocket costs of $2000.
Any and all opinions are welcome with having to make a decision within the next week.

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

A premium multifocal IOL is generally contraindicated with that much astigmatism and that's on the high side of what might be corrected with LRI.  Also what a hassle to wear contacts over IOL.

Your choice but I would not put a multifocal IOL in an eye with that much astigmasm.

JCH MD

[peakhope]

It sounds like your surgeon is proposing spectacle independence through blended monovision, where your right eye would take care of distance, your left would handle intermediate, and I guess your right would handle near. Some people have trouble adjusting to that, but it's fine for many.

There may be alternatives to wearing contacts for the astigmatism. Laser surgery is one, and LRI's are the other. LRI's might not be able to correct all of your astigmatism, they might bring it down to a point where it is minor enough that you could live with it. Only choose LRI's if your doctor is very experienced with them.

An alternative to the Toric IOL would be to combine a regular IOL with laser surgery to fix the astigmatism. I'm not sure there are advantages to that route, but thought I would mention it, since the total cost might end up about the same.

I am happy with my Crystalens HD's, but they are not the right choice for everyone. It is critical to have a doctor who has done many CL implants and is up-to-date with the latest research.

By the way, $2k out of pocket is probably the lowest number I have heard. Hopefully you're just getting a great deal, and not sacrificing quality of care.