PRK and Irregular astigmatism ?

[starman6600]

Today I went for a second opinion as to my tx options for my suspected cataracts. I am post RK both eyes (15 years ago), post LASIK  for myopia left eye only (8 years ago),  and have possible cataracts. My recent vision measurements are:

Obj    OD +1.25 -1.25 x 112    
          OS +2.00 -1.00 x 100

Rx      OD +1.75 -1.25 x111 w/25  +2.25
           OS +2.00 -0.50 x104  w/25

The Dr. provided the following  information:

I have a positive spherical aberration.  I am not hyperopic.   He believes that my vision problem is partly or largely due to an irregular astigmatism and he plans to have me wear hard contacts in the office at my next visit to learn more.  He said that this will help him determine the degree to which  my vision problem is due to a surface irregularity or due to cataracts.  He stated that PRK may be an appropriate tx to give me the best possible vision and that IOL implants may be helpful as well.  He says that I seem to be a candidate for either the Tecnis aspheric or the Crystalens.  

Here are my questions:

1.  I don’t understand, how I can have an Rx which is OD  +1.75 and OS +2.00 and not be “hyperopic.”  Additionally, my understanding has been that when you are post RK your cornea flattens and you become “hyperopic.”  Yet the Dr. is saying that I am NOT “hyperopic.”  I would appreciate any clarification on this.

2.  The other physician that I saw a few months ago cautioned me against having any further invasive tx being done on my eye.   Is PRK tx relatively safe in the long run (we have learned longitudinally that RK is not safe)?   Has there been any good research completed which shows that  the combination of PRK and IOL implants works is successful?

3.  Prior to this office visit, I  was hoping to have only an IOL and expecting that this would be all that I would need.  Would it be wise to wait awhile before proceeding with the PRK?  Is there a reasonably good chance that a new lens will be developed that will make it unnecessary to have PRK?

As always, any information which may shed some light on these issues will be greatly appreciated.  Thank you.


          

[starman6600]

Thank you Dr. O..  Your comments are very helpful.   I had 8 cuts in my left eye and 7 cuts in my right eye.

Frank

[Ray T Oyakawa, MD]

You rx looks hyperopic to me.  The amount of astigmatism you have is not very large.

How many cut RK did you have?  The hard contact lens over refraction is a good idea.  If you obtain good vision with this test, get a bat test to see how much your vision decreases with glare.

I would agree with a Tecnis or Crystalens.  DO NOT get a multifocal.  An RK eye is already multifocal and adding a multifocal IOL will cause problems.


It the cataract is a significant cause of decrease in vision, I would wait a few month after cataract surgery before PRK. RK eyes can take months for the cornea to become stable. This should be a wavefront guided PRK to minimize the irregular astigmatism if present.

PRK works with IOLs.


Dr. O.