Recommendations for IOL

[RSeverns]

I am planning on having cataract surgery and would appreciate advice/opinions on the choices of IOL's. I am aware of and been diagnosed with a slight astigmatism (<1.0). I have had a meeting with the Ophthamologist, with (I am assuming) the standard tests. I explained to him that I desire the best distance vision because of my activities. The doctor recommended the toric IOL and when I met with the "Premuium Vision Counselor" the following day to answer  questions, she seemed intent on selling me on the toric IOL. The additional cost for the toric would be over $1500, so I started doing more research. With my mild astigmatism, and the fact that I have never felt hindered by it, I am strongly leaning away from that option. I have been reading a lot and wondered if the aspheric IOL might not be a better choice for me. I am planning on having just right eye done as the left shows very minimal evidence of a cataract. I am 58 yo and am in very good health.

[JodieJ]

Hopefully, you will not need an online forum to answer your questions--that's your surgeon's job.  I imagine that your surgeon will target good distance vision for you--maybe between plano and -.25 D.  (IOL calculations are not an exact science; your outcome may vary a little from the prediction.)  Your surgeon can probably eliminate most of your astigmatism at the time of surgery.  (Ask if this is on his/her agenda.)  I was told to leave my contacts out for 10 days before they did the eye measurements--but surgeons have different opinions about this.  (Follow your doc's instructions.)

[RSeverns]

I have spent the last hour reading related posts and have more questions. First, I should explain that my vision objective is excellent distance vision because I am very involved in smallbore rifle shooting competition. Before I started experiencing vision issues with my aiming eye (right) my contact correction was -2,75 in right and -2.50 in left. A couple of years ago I started having some issues and we experimented with toric contact lenses, but they did not seem to help and we determined that my head tilt while shooting was more than likely negating the toric. It seemed that almost overnight my vision was getting worse and I was worried to put it mildly. I have a great optometrist, who has spent a lot of time helping me, explain that a developing cataract was causing my issues. My correction for the right eye has jumped around from -3.75 to -4.50 since this cataract has developed. What IOL correction should I be expecting to obtain my objective, distance vision? Also, I will have gone without wearing soft contacts for a period of 4 1/2 days before my scheduled "eye measurement" for implant, should I wait longer?
This site is a God's sent and I know that it has eased a lot of my apprehension.
Thanks,
RS

[RSeverns]

I wanted to sincerely thank each and everyone that took the time to respond to my questions and concerns. I will also be thanking the person that directed me to this wonderful site.
My best to all of you,
RSeverns

[JodieJ]

I checked out the doctor locator at the Crystalens website, and some of the doctors I pulled up were not listed at www.aao.org.  I assume that this means that they are not board-certified.  All things considered, why chose a doctor who didn't pass his/her boards?  It might be a good idea to verify board certification (and how long the doc has been using the Crystalens) before setting up an appointment.  It would also be a big plus if a doctor was experienced with refractive procedures (LRIs, LASIK, etc.)

[Lerbea]

If your physician is a provider he may not be able to bill you for the excess over what the insurance will pay.  Be sure to personally talk with your carrier for your exact benefits. Mine tried to make me pay the extra. I did pay prior to surgery but I got it all refunded because he couldn't charge that because of the provider contract. Don't rely on what the doctors office tells you as being the truth.  Mine lied to me and they had to pay...

[londonbridge]

I agree that you should have a second or even third opinion in making such a critical decision.
I also had a cataract in one eye, my non-dominant. I had a Restor lens explanted and replaced with a torric Acrysof IQ lens. My astigmatism was about 1 diopter. I was not sure which way to go but ultimately found a doctor I trusted and went with his recommendation. This far I am very pleased. My lens is a vast improvement over the Restor and while I can't say I was bothered by astigmatism before, it is hard to judge because I always wore progressive glasses. I only paid $605.00 for my torric so I think $1500.00 sounds very high. Many people have posted that they are please with asperic monofocals as well with or without LRI. The newer torrics don't seem to have the problem with rotating in the eye. You probably will do well which ever way you go as long as you have a good, trustworthy surgeon who cares about your outcome.
Good luck!

[peakhope]

Note that your existing astigmatism is a mix of your current lens+cornea, so after your lens is removed the amount of remaining astigmatism could be higher or lower. I have no idea if LRI's would work for you or not.

I just had LRI's done at the same time as getting Crystalens HD's. The first eye had about 2 diopters of corneal astigmatism, and now has zero. The second eye had a similar amount, and it hasn't yet been measured officially, but my informal tests indicate that if any astigmatism remains, it is minimal.

When I first heard about LRI's, I thought "No way! That's 1980's technology!" The more research I did, the more I became convinced that they are an underrated and underused tool.

One advantage of LRI's is that you could choose to do them later, after deciding whether the IOL vision by itself was good enough. And after they are done, the doc can go back and tweak later as needed to fine-tune the results.

I can't imagine paying $1500 for a toric IOL in a case where LRI's would be an inexpensive solution. Some doctors even include LRI's for free with the IOL surgery.

[JodieJ]

I'd vote for getting another opinion from an experienced, board-certified cataract/refractive surgeon.  Personally speaking, I'd avoid any office that had a "Premium Vision Counselor" on site.

According to a recent study, LRIs got better results than a toric IOL in cases where there was less than a diopter of astigmatism.  Of course, it's presumed that the surgeon knows how to do LRIs, as Dr. Ayakawa points out above.

I had excellent results with aspheric monofocal IOLs--never a problem with glare, halos, ghosting,etc.  These lenses can be set for full or mini monovision to minimize your dependence on glasses.      

[Ray T Oyakawa, MD]

Many ophthalmologist are not happy with their LRI (Limbal relaxing incision-to reduce astimagmatism) results.  A vector analysis to plan for the resulting after the cataract surgery and appropriate LRI is effective if over 95% of cases.  Depending on the steep axis of your 1 diopter astigmatism-it can be reduced just the operating on this axis or near it.  Most surgeon use a fixed depth blade and do not do a vector analysis so their results are variable.

Aspheric IOLs are a very good choice.  However, they will not give you the same degree of near as a Crystalens.  Monovision with aspheric IOLs is a good option.  Of the premium IOL, I do less than 10% torics.

I would look on the crystalens website for an ophthalmologist in your area at a Center of Excellence.  Get a few options.  

You refractive error and the bat (glare test) of your other eye and lifestyle are important factors.