acrysof iq toric lens implants not working as expected

[dmh479]

Hi I am a 39 year old female recovering from cataract removal and toric lens implants.  My dr had stated this would give me distance vision but may require continued use of reading glasses.  That sounded great to me.  Instead I have good reading vision and poor distance vision.  At my follow up I asked my dr about posts I read that I should have been asked to remove my contacts 2-3 weeks prior to measuring my eyes for surgery, no one told me that, they handed me a case and said take out your contacts.  Dr denies this contributes to the problem.  My dr blames my sclera (?) buckle for miscaluculations in vision --in both eyes despite only having it in right eye.  My doctor prior to surgery told me I am not a candidate for lasik and now he is suggesting it to correct the miscalculations and suggesting I pay for it, I already paid 900 per lens and can see little results.  I understand this is not a guareenteed service but I think there should be some minimum of progress considering the price for a premium lens. So A) lasik to correct miscalculation, safe on a person with family history of retinal detachments, one detachment in right eye myself 20 years ago and B) shouldn't or is it common for dr's to make some sort of effort to correct a large miscalculation---he agreed we were far from where he hoped we would be.  Thank you for any feedback

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

There may be some theoretical benefits to PRK over lasik but there is not hard scientific studies to verify that. PRK and lasik will both work better if you are just correcting spherical overcorrection and not spherical AND astigmatic.

I don't know about the contact lens.

It is true that there is generally longer healing with PRK and more discomfort but many people have little or no pain and rapid return to usual activities.

JCH MD

[dmh479]

I am updating my earlier concern about the toric lens implant.  My Dr suggessted PRK to correct the miscalculation.  I have been reading posts from other reporting really long recovery periods, unable to drive or return to work, this really frightens me as a single woman on my own.  I know there are worst case scenarios but what has been your experience with patients?  typical recovery, vision, return to work?  I am trying to weigh my options and make the best choice to attain distance vision without too much risk. Please advise, thanks

[dmh479]

My Dr clarified this morning he meant PRK ?  Do you feel the same about that as Lasik, he reports it puts less pressure on the retina.  My vision after surgery is left eye --1.75 right eye --2.75 more than the margin of error you suggested, right? My Dr did not suggest 3-7 days without contacts, do you think that made a big difference?  Thanks for your input, I'm starting to feel better about the situation, including the reduced fee PRK.

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

Generally on hard contact lens we ask our patients to leave their contacts out for 3 weeks before we do the K readings that are part of the IOL calculation. We do a set then repeat in one week. If same great, if different we repeat weekly until stable. For soft contacts probably 3-7 days would be sufficient.

Yes previous scleral buckle can create a big problem and is likely to lead to a situation like you have where the IOL is too strong and the person is left myopic. Obviously if you have not had a buckle on both eyes it would not be a factor on the unbuckled eye.

Risks of retinal tears, holes or detachments due to LASIK is controversial and the literature is not conclusive. It would probably be fine to have LASIK after your retina Eye MD looks at your eye and signs off on it.


IOL power calculations is not an exact science and the margin of error is about plus or minus 0.50 diopters although in very long, very short eyes, eyes with previous RK, lasik, scleral buckles the error rate can be as high as plus or minus one diopter.

It is not customary to do lasik for free after a problem like yours however most MDs would agree to a generous discount of their regular lasik fee.

JCH MD