Rk and Toric Iol

[delgad9]

After 2 surgeries for correcting astigmatism  the results are very-very disappointing:
NO CORRECTON AT ALLl.

I wonder what would be the source of error:
  
   a) Defective IOL
   b) IOL misplaced
   c)  Toric iol not good idea for  RK patient

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

I note that you live in Arizona. One of the world's experts on IOL powers, astigmatism and correction of same is Warren Hill MD of Mesa AZ. I did a research paper with him some time back on use of hyaluronidase in local anesthetics.

He would be a good consult on the toric.

Then I would see a glaucoma specialist. I don't think his practice has a glaucoma specialist. I'm sure Dr. Hill could refer you to one

JCH MD

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

When you're digging a hole the first thing you do is stop shoveling.  I would suggest that you get a second or third opinion about your eyes one of whom is a glaucoma specialist. Find one near you at www.aao.org

Your biggest problem is not the toric IOL but the glaucoma.

A good goal for you is acceptable to good vision with glasses and your IOP under control

And take excellent care of the other eye.

JCH MD

[delgad9]

Can't sleep... Try to recall how I got to this point:  Two surgeries for correcting vision plus a trabeculotomy (glaucoma surgery). 3 surgeries in total. Glaucoma surgery because first surgery raise eye pressure to 50. Right eye marinated with zymar, forte, acular and lotemax, many-many follow-up appointments.
The outcome can be more disappointed: Zero correction in astigmatism, my eye pressure is 24-30 after 3rd surgery, my insurance money taken away plus had to pay for an expensive toric lens because is premium and the insurance donot pay for it.
My Dr recommended me the toric lens as a solution for my astigmatism He didn't mentioned that  because the RK the end result could be ended as exactly is right now.

Any comments on above matter highly appreciated

[delgad9]

Can't sleep... Try to recall how I get to this point:

[delgad9]

U R out of this world. Fantastic. Really-really awesome!.

Thank you very much.

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

You plug the numbers in the formula and run with it. Even if glasses RX is the same in both eyes it doesn't mean each eye will need the same IOL power. Variables are: type of IOL, length of eye, radius of curvature of cornea, anterior chamber depth.

JCH MD

[delgad9]

After first surgery  there was no correction on vision. I was able to see with same prescription before surgery. For 2nd surgery they change from the lens 20.5 D to 24.5 D
and sphere change +7.5 to +4.5 as mentioned cyl no change. I wonder why they didn't use some more diopter from the iol. Alcon AcrySoft :SN6AT5 gets to 30 diopters.

Any idea why?

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

NO not unless they are willing to accept the fact that they don't work nearly as well on a scarred RK cornea than a clean pristine cornea.

JCH MD

[delgad9]

Would you recommend  toric IOL to an RK patient.

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

IOLs are simply not defective in developed companies.
Yes the IOL could be torqued or misplaced or rotated.
If you have had RK all bets are off: IOP powers, toric IOLs, multifocal IOLs give uncertain results when inserted behind the scarred and misshaped cornea

JCHMD