IOL and asitgmatism

[jim538]

i am close to 60 and recently had Restor lens implanted (both eyts) for cataracts, glasses had become a PITA and am mostly happy.  my doctor metioned that it fixed an astigmatism i had also.

my son-in-law recently mentioned that his contact lenses were costing quite a bit per month for his astigmatism.  are there IOLs available to treat this, not necessarily cataracts.  if so, is an IOL for astigmatism classed as 'elective' surgery and an insurance company wouldnt pay for it?

thanks.

jim

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

Welcome JCH MD

[jim538]

thanks dr hagan.

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

$1200 per year for contacts is a LOT.  He should look into a less expensive replacement even over the internet. He can go to glasses. He can go to gas permeable contacts which last much longer. Vision after lasik is generally better than with glasses or contacts.

JCH III MD

[jim538]

thanks all for the comments.  a followup please, if vision is correctable by replaceable contacts then any surgery, even lasik, is then considered elective and therefore an/most insurance companies wont pay for it?  the cost to him is on the order of $100/mo (seems high to me, but..) i'm not sure what/if any portion his insurance company pays. but if they are paying, long-term wouldnt they be ahead, assuming lasik surgery, rather than the monthly $$ for contacts?  is his vision post lasik as good as currently using the contacts.  or is there some vision loss, offset by the conveniene of not contacts/glasses.  jim

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

Cheers, indeed.

JCH MD

[cdn_glenn]

you wrote:
BTW its not a spherical IOL that reduced astigmatism its the cataract incision which flattens the cornea in the meridian of the incision so the surgeon can move the incision and operate on the steepest aspheric part, the bigger the incision the flatter it makes the cornea.

Thanks!  Actually I'd been scratching my head all this time wondering how a non-Toric lens could be positioned to reduce astigmatism.  That's it: the meridian where the incision is made.  I've watched surgery for Limbal Relaxing Incision (LRI) on YouTube.  LRI incisions can be quite sizable.  This uses the same technique, but limits it to the incision used for IOL surgery.  It works!

Cheers,
Glenn

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

I do not recommend clear lens exchange or intraocular contact lens for most people too much risk for the benefit. BTW its not a spherical IOL that reduced astigmatism its the cataract incision which flattens the cornea in the meridian of the incision so the surgeon can move the incision and operate on the steepest aspheric part, the bigger the incision the flatter it makes the cornea.

JCH III MD

[cdn_glenn]

Apparently positioning the IOL on the correct meridian can reduce, even clear a small astigmatism.  After I had my lens exchange done my surgeon advised my astigmatism (previously .90 in each eye) had been eliminated in one eye and reduced to half in the other.  This was wonderful news.

If your son-in-law's vision is otherwise fine I wouldn't advise "clear lens exchange" to correct his astigmatism.  If his vision is fully-corrected with contact lenses then having a lens exchange would give unsatisfactory results.  Most noticeably he may not have clear vision either near, in his mid vision or for distance.  I gave up a zone (mid) to have better near and far vision.  Toric IOLs are used to correct astigmatism, but are single focus and can be set to one of the three zones.  I don't believe there are yet multifocal Toric IOLs available in North America.

As JodieJ described, there are other options.  Properly mapped Lasik can certainly reduce astigmatism.  Your son-in-law could follow-up by researching this option.

Regards,
Glenn

[AnnaE]

I am a community leader here, not a doctor. I am also an experienced eye patient. Welcome to our community.

I am so glad that Jodie could help you.

Write us anytime.

[JodieJ]

Yes, there are toric IOLs, and yes, it would be elective surgery.  But I suspect it would be really hard to find a surgeon willing to perform an invasive procedure to correct astigmatism.  Tell your son-in-law to stick with his toric contacts or consider a procedure like LASIK.