LRI

[sally987]

Do you think I would be a candidate for LRI after standard aspheric IOL.  I have been told I have thin corneas and early stage normal tension glaucoma (which is not being treated as yet).  Astigmatism cyl numbers are 1.00 and  1.50.   Do the axis numbers also refer to astigmatism.  My axis numbers are 102 and 088.

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

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[JodieJ]

Yes, your astigmatism numbers are 1.00 and 1.50--not very much.  BTW, my surgeon didn't charge me for doing LRIs.

[sally987]

Thanks.  I am still not clear on what my astigmatism diopter number is.  Would it be the 1.00 and 1.50 ?  (from the first post above)

This is really a great forum.  Thank you all for checking in so frequently.

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

Our practice has been very happy with the Alcon aspheric toric

JCH MD

[JodieJ]

There was a study several months ago comparing the results of Alcon's toric IOL and LRIs for correcting astigmatism.  The toric IOL did a significantly better job with higher astigmatism (especially above about 2 diopters).  Below 1 diopter of astigmatism, LRIs had a better outcome.  I've seen reports stating that there is some tendency toward regression with LRIs (i.e., return of some astigmatism) but not with a toric IOL.  Dr. Oyakawa has commented that the current popularity of toric IOLs may relate to the inability of many surgeons to perform LRIs, which apparently requires some experience.

I have Alcon's non-toric aspheric IOLs (AcrySof IQs) in my own eyes, and I have nothing but positive things to say about them.  The manufacturer claims that they provide enhanced night vision, and I believe that is true although the benefit is subtle.  (For more information about the benefits of an aspheric IOL, watch the patient education video at www tecnisiol com.  The comments actually apply to both Tecnis and Alcon aspheric monofocal IOLs, although the sponsor's product is the Tecnis.)  Aspheric IOLs have also been associated with reduced glare.

[sally987]

Have you heard any results on the new Alcon Aspheric Toric IOL?  The aspheric has been added.  

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

Bottom line torics are more predictable than LRI and can correct larger amounts of astigmatism but torics are not available in multifocal.

I'm am glad you are pleased with your result.

JCH MD

[peakhope]

I had not heard about an increasing preference for toric IOL's over LRI's. Is that because torics have improved?

LRI's are not perfect, and are not the best choice for everyone, but I decided to get LRI's because:

1. I wanted Crystalens HD's, which ruled out toric IOL's.
2. The thought of Lasik (cutting an eye flap) freaked me out, and PRK had longer/more painful recovery.
3. LRI's are very forgiving, not requiring highly precise cuts. The cuts can be lengthened later if the correction was not enough.
4. LRI's have basically no risk of increasing glare or causing other visual problems (because the cuts are outside the field of vision).
5. My doctor offered the LRI's for free as part of the implant procedure.

If I were considering a monofocal lens, I'm not sure if I would opt for torics or LRI's. And if I were less squeamish, Lasik would also be a serious candidate.

I had about 2 diopters of corneal astigmatism in each eye. After the LRI's, my left eye came out with zero astigmatism. My right eye hasn't been measured yet, because I still have stitches (due to a pressure problem during surgery). But it looks like any remaining astigmatism will be minor.

Regardless of the method used to correct astigmatism, I think it's really important for doctors to address it. My impression is that even somewhat minor astigmatism can increase glare and/or impair clear vision. I am not a doctor.

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

General belief now is that toric IOLs are better than LRI.  Yes the two numbers are the astigmatims (aspheric cornea) that's not a lot. Talk to your surgeon about putting the incision on the axis of the astigmatism, usuing a slighly larger incision than normal and a lot of topical steroids post op. He/she could reduce the amount of the cylinder as much as 0.5 to 0.75

and it would not add to the expense of the surgery as LRI or toric IOL would

JCH MD