Are these Lenstar measurements suitable for Toric mini-monofocal?

[zepeye]

I've read about increased risks according to eye length and pupil size.  I"m not sure how I measure up in this regard.  But I'm interested in the mini-monofocal  lens to hone in on being able to do computer programming  without glasses more than I am concerned with having to use readers for closer distances.  So, somewhere in 20"-30" range is preferred over 10"-20" range.  

Do any of my numbers unusual enough that I should avoid a Toric lens?
(one doctor offers Tecnis and the other Alcon)

LENSTAR

Left (non-dominant ) eye

Measuring mode : Phakic  (default mode)

* Axial eye length 25.52mm  
* Cornea thickness   492 μm
* Aqueous depth 3.54 mm
* Lens thickness 3.99 mm
* Retina thickness 200  μm
* Flat meridian  43.91 @ 179
* Steep meridian 45.96@89
* Astigmatism in plus (default) 2.05 D @89
* Keratometric index  1.3375
* White to white   13.03mm
* Iris barycenter  ICX 0.24    ICY  0.24
* Pupil diameter 4.49mm
* Pupil barycenter   PCX -0.08   PCY 0.02

My right dominant eye shows very similar readings, but only has faint indication of a cataract at this time. But the refraction measurement of my left eye has grown much worse than the right due to the cataract.  (throughout my life typically measured within 0.25 of my right eye ).

most recent Jan 2019 refraction for glasses:
OD: Sph -5.50 Cyl +1.50 Axis  048  VA - Dist: 20/20-1   ADD: 2.25
OS: Sph -7.00 Cyl +2.50 Axis  090  VA - Dist: 20/60-   ADD: 2.25

May 2017
OD: Sph -6.00 Cyl +1.50 Axis  056  VA - Dist: 20/20   ADD: 2.00
OS: Sph -6.50 Cyl +2.25 Axis  095  VA - Dist: 20/25-1   ADD: 2.00

[zepeye]

PS:  Jan 2018, I also had some scan using Nidek OPD Scan II for whatever it is worth.   But I notice that on that particular diagnostic printout there is a glaring difference in the refraction showing between my right and left eye under a panel titled ODP.

My right eye shows :
Sph -5.00 Cyl +1.25 Axis  043  VD 13.75

My left reads:
Sph -11.25 Cyl +2.50 Axis  100  VD 13.75

Not sure why the difference in Sph is so much different from the other refractions.

[JohnHaganMD]

If you LE has a clinical significant cataract and your RE doesn't then you are going to have a monster problem using the two eyes together unless both are operated on  or if the RE no have surgery and they don't work together as is likely your Re would need LASIK or SMILE procedure to balance the two eyes.  The last -11.25 you posted is either an error or a huge amount of pseudo(false) myopia due to the cataract.   There is nothing in your readings that would preclude a toric IOL in the LE but again, they are not going to work together post op.

[zepeye]

Just to be clear, are you saying I will have a monster problem based on the -11.25,  or is there some other factor that poses the concern even if the -11.25 were an error or psuedo myopia?

Thanks!

[JohnHaganMD]

No I am saying you will have big problems with the eyes working together if only one ye is fixed. Cataract induced pseudomyopia could easily cause the recently -11.25 D

[zepeye]

Wouldn't cataract induced psuedomyopia also factor into the subjective refraction that conducted with the doctor, explaining the higher difference between the left and right eye which historically for me have been within a half diopter of each other?

OD: Sph -5.50 Cyl +1.50 Axis  048  VA - Dist: 20/20-1   ADD: 2.25
OS: Sph -7.00 Cyl +2.50 Axis  090  VA - Dist: 20/60-   ADD: 2.25

Thanks

[zepeye]

It occurred to me why you say it will be a problem.  I had for some reason thought of the corrected left eye,  as being no longer a part of the equation in terms of diopters difference with the right.  Not sure why I overlooked this.  

But I guess if I understand you correctly, if my left eye requires no glasses or contacts correction after surgery (IOL)  to provide the intermediate mini-monvision vision I may target, then it will be at zero diopters of correction compared with my right eye, which may need -5.50 diopters of glasses correction to see 20/20.    But I take it your saying my right eye wouldn't tolerate more than -1.5 diopters of glasses correction once the left has the IOL?

[JohnHaganMD]

If you target your LE to have no glasses at distance (20 ft or further) the RX will be 0.00 you will not be able to see intermediate distance unless you go with a mutifocial or accommodating type IOL  a  monofocal or a monofocal/toric will not give intermediate or near clarity if set for distance. Even if you were totally happy with a multifocal IOL and could see far/intermediate/near your eyes will not work together at all because your glasses Rx will be   LE 0.00 and RE -5.50 +1.50 Axis 48 and you will not be able to tolerate that.  Anytime the numbers are more than 1.5 most people cannot adjust. the problem is called aneisometrophia.

[zepeye]

Thanks.  My confusion at first was that I was thinking the IOL diopters factored into the balance, but it is the diopters of the correction by glasses that matter.

I saw another doctor that came up with a similar glasses refraction, and a similar automated ODP refraction (although with pseudomyopia of cataract still worsening at -12.25).    I did mention that I will want to get the right eye done, and I mentioned that I had heard of the  issue with the 1.50  disparity between eyes being the common threshold.  He said it was a problem with glasses because the correction is made away from the face, but that with a contact lens in the right eye it shouldn't be a problem.     Not sure if you agree with that.  But if assuming its true I even have some lower power contacts, -4.50 and -3.00 that I could wear on the right eye to at least reduce the problem somewhat, until I get the right eye done.  I'm so used to walking around with blurred vision in one eye that, psychologically at least, maybe I can tolerate it more than others in the interim.    

Is it best to wait until the left eye has healed for a couple of months?

[JohnHaganMD]

If we are going to do surgery on both eyes we don't do second eye until person wildly happy with first eye for most people that is 3-4 weeks.   I thought you said the RE did not have a cataract. If it does and both eyes need surgery different animal.

[zepeye]

I have a cataract in the right eye as well, but it is not as far along and doesn't seem to be problematic for me (perhaps that is in comparison to the left eye).  I'm going back to see my first doctor Thursday to discuss the lens I want to use and I'll clarify with him then about the right eye.  Originally the impression he gave me was the right eye was in early stages.  I've not experienced the same rate of deterioration in my right eye vision as with my left, and I didn't think it was going to factor into things right now.  But that was before I knew about this issue with 1.50 diopters difference in eye refractions.  

I have another appointment with  a third doctor next week (he  uses the femtosecond laser I think).

[JohnHaganMD]

Good luck

[zepeye]

I ended up canceling the appointment with the femosecond laser doc, because using the first doc moves the process along and after speaking with him again, I have enough confidence in him.

Anyway, the Dr I'm using has chosen a 15.5 diopter Alcon Toric IOL with a target of -1.50 (I may have that wrong with the + or - ).  I told him I preferred a target focus of  21-24 inches.   I haven't talked with him since he ran the algorithms, but will be in touch.  

When you target a range out 21-24 inches, how many inches usable depth of focus can you expect?    If he managed to nail somewhere in that range, and I got a 6 inch depth of focus for instance, that would work fine.  Not sure what is reasonable to expect.  

Thanks.

[JohnHaganMD]

the number is minus    almost never do we target a hyperopic (farsighted) uncorrected refractive error after surgery.   -1.50 would generally give good computer vision and in good light probably good reading vision except for very small print.   Depth of focus cannot be calculated since it depends greatly on the size and mobility of the pupil.  The smaller the pupil the greater the depth of focus and vice versa (like cameras).   Optically the focal length of a 1.5 D lens is about 26 inches

[zepeye]

Thanks.   Before I read this I spoke with someone over the phone again and did confirm -1.50 as you say, although the IOL is actually to be 15.0, not 15.5.   Not sure how I heard that wrong the first time, unless maybe he changed his mind since I last checked.    But I'm going to meet with him again Tuesday ahead of the surgery on Thursday.    

My pupil measurements are:
* Iris barycenter  ICX 0.24    ICY  0.24
* Pupil diameter 4.49mm
* Pupil barycenter   PCX -0.08   PCY 0.02

I don't know what is normal, but if I have normal mobility of the pupil, with the IOL correction targets a focal point at 26 inches, is a depth of focus of 20 to 32 inches unheard of?    I'm not sure what is even in the realm of reality.  

I'll ask him what he thinks the difference in focal point would be between a 14.5, 15, and 15.5 diopter IOLs.     I was told they only come in units of half diopters.

[JohnHaganMD]

You are asking for reassurances and precision I cannot furnish.   The IOL power says nothing really. Implanted into eyes with different lengths it will yield different post operative refractive errors.

[zepeye]

Actually, I guess when you say " -1.50 would generally give good computer vision and in good light probably good reading vision except for very small print.  " that  does indicate that a depth of focus of 20 to 32 inches is reasonable.  I always forget that when most people say "reading vision" they are generally talking about a much closer range than I think of.  For a book, I suppose I might occasionally lean over a book with head in my hands, elbows on the desk , which might put me 15" away, but usually I'm around 18" away and could just as easily go 20.  Computer is more important to me.