Cataract in one eye and mild astigmatism

[cdoc]

Hi Everyone - I've found this forum and the archives to be extremely useful as I researched options for a cataract in my right eye.  Now that I've had a couple of medical opinions I thought I would offer my specifics situation and questions.

I'm 44, with -5.00 in both eyes and .75 astigmatism in my right eye.  My right eye has a cataract, which I'm told is probably due to a case of uveitis that we beat a while ago.  I've been given the following options.

Doctor A: Toric monofocal lens in right eye to plano, and then where a contact in my left eye (or eventually get Lasik).

Doctor B: recommends monofocal lens to -2.5 in my right eye so that I could continue to wear glasses.  Suggests no astigmatism correction because it is a small amount.  His other options are a monofocal lens to plano in my right eye (again, not toric) and wearing a contact or having Lasik in my left.

I'm inclined to take the added cost of correcting my left eye with LASIK, something I've long considered, and then just dealing with reading glasses.  I need those now anyway when I'm wearing contact lenses.

My real question is on the astigmatism.  Is .75 not enough to be concerned about?  Would a toric lens really overcorrect for this amount?  Neither doctor mentioned Limbal relaxing incisions, which I've since read about here and elsewhere.

Any experience or input is welcomed, including other options folks have chosen.  Thank you to everyone who keeps these boards active and informative.

[Michael J Kutryb, MD]

You are correct about the basic options with the left eye.  Just wear a contact, continue to wear glasses (requires the right eye to be left significantly nearsighted) or have lasik.  I generally don't use toric IOL's unless the corneal astigmatism is greater or equal to 2.0 or 2.5 diopters.  Less that that I usually use LRI's.  If you truly have 0.75 then nothing needs to be done regarding the astigmatism at all.  I usually leave less that 1.0 diopters alone.  Now you just meantioned your glasses reading for astigmatism but what you really need to know is the actual corneal astigmatism readings or k-readings.  That is what we treat and it can be more or less than your glasses prescription.  Remember some of the astigmatism may be in your cloudy lens and that will be removed during the cataract surgery.

MJK MD

[londonbridge]

Glad all went well for you. I think you will be happy with the blended vision. That is what I have only my IOL is slightly underpowered and my contact is my far distance. My eyes also see things in slightly different tints, one being natural with a slight cataract and the other my new Torric IOL by Acrysof.  I rarely notice this a year later.
If you find you need glasses for a break from the contact but have difficulty adjusting to the large diopter difference between your eyes you could try getting a pair of glasses made with a fogged out lens.
I went to Pearle Vision and they had something called a mirage anti-reflective coating. It blurs out one eye to eliminate distractions and is barely noticable to people looking at your glasses. It is a good backup for when I am not wearing the contact, but I can't drive with it.
I will not consider lasik because I already have a small cataract in that eye.
Good luck.
londonbridge

[cdoc]

Just a follow-up for others to refer to as they consider options.  First off, I went with Doctor B, above, mostly because of his experience and how willing he was to spend time to answer all my questions, help me think through options, etc.

Second, it turns out that when we really measured things my corneal astigmatism was greater than what my glasses would suggest.  We discussed LRI's and other options, but ultimately with with the Acrysoft Toric lens for my right eye.  I'm really grateful to the community here for helping give me the information I needed to have a meaningful discussion with my Dr. about my options.

It is my dominant eye and I opted to get it corrected for distance.  We did the surgery yesterday morning  and my eye tested 20/20 today, although it is still just a little foggy and sore.  Honestly, I'm stunned at how good my distance vision is with my right eye, and my surgeon tells me everything is looking good.  

In my left eye I'm wearing a contact lens which is slightly underpowered, which allows me to read fine print at 12 inches or less even under poor lighting.  I'll test drive this kind of monovision for a couple of weeks, evaluate it, and maybe try other options for how much correction we should go for in that eye, either by contacts or later through lasik.

I have noticed a slightly yellow-ish tint to everything from the acrysoft lens, which is something I've read here that others have experienced.  But since I'm still on the post-surgical drops I'll have to wait and see if it is a long-run issue.  In any case, it's not a major detraction

Thanks again for those who responded to this thread and via messages.  I'll update again later.

[cdoc]

Thanks for the response and the information.  I did go back and read about your experience with Restor - what a nightmare!  I'm very glad that it ended well with your new monofocal.

You mentioned that the toric didn't seem to help with the astigmatism.  Why is that?

Based on the responses here and further reading, I'm more convinced than ever that the Dr. who was thinking non-Toric was probably on the right track.  I'm seeing him again in a couple of weeks for full eye measurements and a complete discussion of options.  I've discovered since that he would use the Acrysof IQ lens for my eye, and I'm inclined to defer to his judgment on Acrysof vs. Tecnis.

I'll need to think about what to do with my non-cataract eye: contacts or Lasik or. . . something.  The sort of blended vision or mini-monovision I've been reading about seems most attractive.

Thanks again.

[londonbridge]

Dear cdoc I am not a physician, only a patient such as yourself but I have a similar situation.  I originally planned to have two Restor lenses implanted for cataracts, which turned out to be fairly minor. I had the Restor explanted a year ago  due to multiple problems (see my thread on this forum). The bottom line is I had a torric monofocal implanted in my left, non dominant eye set for mid distance. I had a minor astigmatism, which I don't believe was helped by the torric after all. I wear a contact lens in my right eye for distance. This gives me good intermediate to distance vision and I wear progressive reading glasses when needed. This works pretty well except that I have no glasses option to fall back on since my eyes are very different with my right contact eye being  -7.5.  
I will eventually get an IOL set for plano for that eye. At my age, 55 I don't think lasik would be good since i still need  readers.
Bottom line is I think you don't need the torric. You would probably be happy with either plano for IOL and a contact or mid distance correction. I would probably not choose an IOL based on my current glasses requirements because those could change with age.
Good luck
londonbridge

[cdoc]

And my apologies for misspelling your name in the post above!

[cdoc]

This is very useful information, Dr., particularly about the distinction between my glasses prescription and the corneal astigmatism.  Once I have more information on that I can better consider my options.

Thank you very much.