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Iol exchange

Hi!
I underwent cataract surgery with multifocals last fall and I am scheduled for an exchange with two monofocals into minimonovision in late June. I have big pupils and dyspothopsia. I now have two toric iols ( regular astigatism), but unfortunately the surgeon told me that he would not make an replacement with new toric iols  due to possible tilt. (No problems with tilt with present lenses) He also warned me against laser toric treatment afterwards. The exact replacement lenses are not decided on yet.  I might get the BIL bag in the lens( Morcher) or a sulcus lens. I do not want lenses with higher index of reflection than 1.46, beacuse of bad experience with my eyes that lights up under certain light conditions and possible contribute to dyspothopsia. It feels bad to go back to 1.60 astigatism. So I am just wondering if anyone has any advice?. Could I for instance do relaxing limbal incission before the exchange or under the exchange or maybe after? Or could I eventually use the new technlogy Resight refactive index shaping if it gets FDA approval? If the bag tears my surgeon must use sulcus lenses. Is there any toric sulcus lenses or how could I adress this without contacts or glasses? Are there any sulcus lenses with lower refractive index than 14.7?. In addition to less glare and strabursts I want my eyes to look as normal as possible. It would be nice to adress the astigatism whether I receive an ordinary monofocal; the BIL lens or a sulcus lens. (I think refractive index shaping technology) only can be used on hydrophobic and hydrophilic iols, including sulcus lenses? My optician suggested that I also could look into Ortho K contact lenses after my eyes have healed.  I want to have the best relationship with my surgeon. He is very hard to get hold of though. At the same time I think it is important to adress my concerns, but fefore I contact him I would be very happy if anyone has some insight to offer.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
FIRST READ THIS CAREFULLY: https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You--2019-2020-Update      ; I would say right off that I do not think any IOL or any surgeon will meet your expectations which are unrealistically high. I agree that a toric should not be used for the exchange. Rotation is not important in spherical IOLs like you had. Another important factor MOST IOL surgeons have access to only a limited number of IOLs. at their outpatient surgicenter or hospital.  Any the surgeon is familiar with these. You do not want to use an IOL that the surgeon has no experience with. What ever you decide I would get a second opinion from a highly experienced IOL surgeon.  You have already had trouble with one IOL, to expect another IOL to meet all the expectations you put on the table, is in my opion unrealistic.
Helpful - 1
2 Comments
Thank you for your answer! May I ask why a toric lens should not be exchanged for another toric?
At the original operation there were no scars and a normal cataract lens. Afte the IOL has been in place scars and adhesions develop "the capsular bag closes" and the accuracy of putting a toric IOL in a untouched cornea is generally not acceptable.  So on the second procedure accurate placement is much more difficult and rotion risk much higher.

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