Avatar universal

IOL exchange and complications

I hqve just exchanged IOL from Monofocal Toric IOL to Trifocal Toric IOL since March 24, after that I have a lot of Astigmatism on my Left and my right eyes.

Left Eye : 425 Astigmatism and 100 Farsightedness
Right Eye : 350 Astigmatism and 50 Farsightedness

My doctor has let me wait for a month to see what happens, I am so worried my vision. Does anyone has any ideas on this issue? Your Concerns & Comments are highly appreciated.

15 Responses
Avatar universal
That much of a difference makes me wonder if they put in the wrong IOLs and are giving themselves time to try to figure out how to admit it. An IOL rotated the wrong way can cause the correction to be off, but it seems unlikely to be off that much, unless I guess the IOLs  have a lot of cylinder and are very far out of position. I don't know if there is any  post-surgery issue like swelling that might still be resolving that they saw that would explain the refraction being so far off, I haven't heard of any (perhaps someone else might post with one). They should explain clearly to you what they think it is and  why you should wait a month to "see what happens".
I'd suggest getting them to explain right away what reason they wish you to wait (via phone or email perhaps rather than waiting on an appointment), and what explanation they give for this. You might consider getting another surgeon to check on it if they don't have a satisfactory answer (or perhaps to confirm their answer makes sense).
Avatar universal
An important issue to sort out is how real and how accurate this refraction really is. Consider
How is your vision like normally (without glasses) and how did it change when they put lenses of such power above in front of your eyes?

If your unaided vision is pretty blurry and when they put the corrective lenses in front of your eyes things got a lot clearer, then the power is probably real.

If the number you put down above is just an autorefraction, and your vision is not too bad, then I wouldn't worry too much because autorefraction may not be accurate with multifocal lenses in the eye.

Now if the power is real, and your corneas have settled down (it is now about 3 weeks out from surgery), one possible explanation is that the toric IOL is placed in the wrong position. If so, they should be rotated back into the best position, and the earlier this is done, the better, before the lens gets too stuck in position.
Avatar universal
Thank you very much for your concerns, after one week of implanting of Trifocal Toric IOL, I checked the Toric Axix in another hospital in Thailand, it seemed that my left eye rotated out to 62 degree, in stead of the proper degree which is 79 .

I will check with a doctor again on April 27 , when my corneal is settled down from the operation, my doctor will let me know how to fix my eyes.

PS: now i use cylinder glasses , power 250 in both eyes , this glasses really make me headache
Avatar universal
Thank you very much for your concerns, actually the doctor said that there are wounds in my eyes that make the improper refraction.

My previous Monofocal Toric IOL was quite good in terms of collecting astigmatism which my left eye remained only 25 astigmatism and my right eye remained 50 astigmatism.

and I just wonder that could my regular astigmatism change to irregular astigmatism after explanting to Trifocal Toric IOL?

It seems that my doctor mention about that and if so the trifocal toric iol can not collect the irregular one.

What should I do later? Anything can improve my vision?
Thank you very much,

Avatar universal
You mention consulting another hospital, which seems a good choice to confirm what your surgeon is saying (since surgeons are human and can be fallible and some might not like admitting an issue). However it sounds like the doctor didn't fully explain the nature of the problem with your eye and how well it might heal, and  what the treatment options are assuming it won't heal entirely. You might consider trying to get more information from them (or your original doctor).

It is difficult to figure out what to suggest without more information, other than contacts or glasses. Perhaps wanlien3 might offer more informed suggestions, but since he doesn't always keep up with posts here,  I'm not sure if there are toric   piggy back IOLs that might be inserted, or if an implantable contact lens is available to correct astigmatism. There  are laser approaches to treating astigmatism, as well as yet another  lens exchange (which might still be an option depending on the condition of your capsular bag).

re: "it seemed that my left eye rotated out to 62 degree, in stead of the proper degree which is 79 . "

That rotation would impact residual astigmatism, though as I said it seems unlikely to be enough to account for more than a small fraction of the level of residual astigmatism you have. You mention "wounds in my eyes that make the improper refraction". Sometimes they use incisions that are meant to correct astigmatism (even if they are inserting a toric lens to correct most of it), and the result can take a while to settle down. However I'm skeptical the that accurate incisions would temporarily (while healing) cause a result that far off  (though I'm merely another cataract patient who researched things so its possible I just hadn't heard of it). I don't know if they did the wrong incisions (perhaps a chart showing what was meant for someone else?) or if there was some surgical reason another incision was required which caused the problem.
Avatar universal
An IOL that is out by 17 degrees is going to lose quite a bit of its astigmatic correcting effect. Although the correlation is not completely linear, 10 degrees out means about 30% of the magnitude of the astigmatism will be uncorrected (with a swing in the axis), and 30 degrees out means there is no change in the magnitude of the astigmatism from pre-op. How much of your current astigmatism could be corrected by rotating the lens (assuming no further changes to your corneal shape) can be calculated with things like the Berdahl-Hardten calculator.

Whether you have regular or 'irregular' astigmatism is very simply distinguished by looking at your corneal topography.

My approach:
1 Check corneal topography (+/- biometry) and determine what your ideal lens would be (assuming your astigmatism is 'regular')
2 Check exactly what lens you have in your eye (model, spherical power, toric power) and exactly what its position is
3 Determine what would happen if I simply rotated your lens (the ideal solution)
4 If step 3 would result in significant residual astigmatism (1D or more), then you would have to consider the options of dealing with that, either with  glasses, soft contacts, or further surgery
Avatar universal
Since I didn't need to deal with astigmatism I didn't research it much. I guess my reaction was based on the thought that  if both lenses were only reducing his astigmatism by 50%, that would indicate that his initial astigmatism would have been 8.50D and 7D, which seems unusually high. It seemed like there were low odds that the astigmatism could be that high and that the lenses were off that much. But obviously with an unlikely result, one of a set of unlikely occurrences has to be the explanation.

In addition, he only mentioned the rotation on his left eye being 17 degrees off, I don't know if that means the right one just wasn't mentioned, or if it isn't that far off.

I suppose the issue may be that 17 degrees would be more than 50% off (As you say isn't linear so it could be off more than it seems,  I had just recalled  seeing figures of like 3% of so per degree, but even that yields 54%)
Avatar universal
Oh, and obviously as the expert wanlien3 explains above (by default his answers are the ones to go with), the first option is to rotate the lens of course. I guess I was assuming they planned on that (though I'm surprised at waiting to do it), then to figure out what to do with any remaining astigmatism.
Avatar universal
I am not sure how accurate the refraction mentioned is, actually. I agree that it is rather unusual for 17 degrees of malrotation to result in residual astigmatism of 425 degrees. It is also possible that some kind of incisional procedure was done.

Actually I need to add another step in my approach-get an accurate refraction done first of all.

That's why in these complicated cases, we usually work the case up right from the beginning...
Avatar universal
It’s very normal! There is nothing to be worried of. In my case I had 20-25 vision and I did a corrective laser eye surgery for my left eye from SEE By Intravision in Oakville ( http://seebyiv.com/lasik-services/laser-vision-correction/ ) . My right eye had normal vision. Vision bothered me for more than 2 weeks post surgery. My doc assured me that sometimes changes take time to come into effect. I remember my eyes going completely blurry at times. But now it is functioning perfect and far better than before. These occurrences are very common and may take time to evolve in for some. You need to worry only if it’s lasting blurry for more than 3 weeks time.
Avatar universal
Thank you very much for your comment, actually my vision has been blurry for a month; since my operation March 24 until today April 25, I use the glasses to correct my astigmatism, it's clearer but make me headache. The power of my Cylinder Glasses are : The left eye, 250 and the right eye 250

Tomorrow I will fly to Bkk in order to check my eyes, maybe a doctor might do something to improve my vision acuity.

Avatar universal
Actually my astigmatism before operation was round 150-175 in my left eye and 250-275 in my right eyes. Today, I go to see the optometrist and i come up with my current reflaction ;

Left eye : Astigmatism 425, Farsightedness 100
Right eye : Astigmatism 225 , Farsightedness 25

It is one month and a day already since March 24; the day that i exchanged the IOL, my refraction seems the same as the first week of operation.

Since I have a thin corneal, the lasik could not do in my case, What shall i do , please?
Avatar universal
Several Doctors said that my corneal has changes the shape after surgery , What should i do please?
Avatar universal
Since you say you are seeing a new doctor, the most important thing is to make sure he gives you enough information for you to understand the issues and your options. I'll suggest things to think about, which you can post here if you want feedback after you have talked to this new doctor.

Did they say if the corneal shape change is likely due to some temporary factor like swelling they expect to heal and stabilize soon, or is it permanent? Did they indicate how much of your astigmatism is now due to the cornea being reshaped, rather than the lens?

Assuming its at least in part due to the lens, as wanlien3 mentioned, the first step is for them to get the lens rotated. Did they give you cards with your lenses giving the lens powers, which might provide a clue as to how much of the issue could possibly be due to the lens rotation?  You only mentioned the rotation of one lens, is the other rotated as well?

After they rotate the lens, if there is only a small amount of residual astigmatism, they may be able to correct it with an incision that reshapes the eye, but first they need to be sure the eye has stabilized after surgery.

If rotation and incisions won't fix it, they may be able to consider a toric piggyback IOL or implantable contact lens if you would prefer not to wear glasses or contacts. Or of course worst case yet another IOL exchange, though they'd have to see what the status of your eye is to let you know if it could be for another trifocal (or a lens outside the capsular bag).

Avatar universal
Hi, yes, if there is some corneal shape change, then what you do does depend on whether this change is temporary or permanent.

If we assume that the cornea has settled down one month after surgery, and is unlikely to change thereafter, then there are several options to consider but which exactly you go for depends on a number of factors that can only be determined after a full examination and discussion with the doctor at the office.
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