Should I do an iol exchange for a toric?

[Adriennemk]

I had cataract surgery 2 weeks ago on my right eye. (I was a high myope, with repaired retinal tears). 5 years earlier, I had the left eye done and fixed for distance.This one was to be set for mini monovision. I knew to expect my distance vision to be lacking...
Now, neither distance, nor near is better than it was before surgery. I requested a blue blocking lens, was told I could have it but my near might not be as great, and we could always change it out. Well, I want to change it,
Today I was told that i have a slight (1.23, I think he said) astigmatism. If he exchanged, he suggested the toris lens, set for distance, but I don't want both set for distance. So...
1. Debating whether to just try my luck with the clear lens, as opposed to the yellow tinted one I have
2. Does a toric work as well for near or intermediate vision as it would for distance?
3. SInce I've already had a replacement lens in there, will a toric lens be more likely to move around?

I'm going to ask for the exchange. I want to keep mini mono,  I guess I just want to know if the toric would be worth it?

Thank you in advance

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

First of all I do not believe you are no better after the surgery. Before the surgery you indicate you were highly myopic and had cataracts. That means without glasses you saw terrible and with glasses you did not see normal because of the cataracts.  Now your cataract is gone which should make you better and your vision without glasses should be much better also.   Maybe not what you were hoping for since most people want to have vision like they had when they were 12 or 13. That is called unrealistic expectation.

Start by reading this:   http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You        ; Toric lens provided they are proper power and properly inserted makes the vision without the glasses better in people with more than about 0.75 diopters of astigmatism.    Assuming a spherical IOL is in the eye whether it is yellow tinted, blue blocking or other type of filter does not affect the visual acuity which is determined by residual refractive error.   If you are highly myopic you are are increased risk of retinal detachment. After cataract surgery the risk goes up substantially. More surgery will further increase the risk.  BE SURE YOU KNOW WHAT YOU ARE GETTING INTO BEFORE YOU SIGN UP FOR MORE SURGERY AND MORE MONEY.

[Adriennemk]

Thank you for your answer.

I should clarify. I am no better after this than I was before with contact lenses. My distance is worse than 20/50 and I still need to use reading glasses. I’d need distance glassses for things like night driving as well. I’d have to carry 2 pairs of glasses, and be miserable because I can’t see very clearly at any distance at all.
With such a small astigmatism, I don’t know that the risk of a Toric would be worth it. I’m only 40 though, and this vision will be my vision for a long time, I don’t want it o risk retinal detachment.  But I don’t want unclear vision either.  Not picking. But I feel that what I’ve given up in distance is not proportional at all to what I gained in near. Should things be crisp somewhere, anywhere?

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

If you want me to help you you need to do this:  1.  provide your pre surgery glasses RX and your best corrected vision WITH those glasses (since you had cataracts it should have been worse than 20/20)     Provide me with your post operative glasses RX and your vision with them.    (if your surgery was uncomplicated and your retina normal it should be 20/20)  REMEMBER I NEED TO KNOW YOUR VISION WITH GLASSES NOT WITHOUT.

[NightHawkGuy]

I doubt the blue filter in that model IOL would be an issue.
How long ago did you have cataract surgery with the monofocal where you apparently have some residual astigmatism?  If its less than a couple months, the cornea is still healing so the astigmatism may change as the eye heals over months. My own right eye vision varied a lot for the first couple months after surgery and didn't become more stable until I was finished taking the Rx eyedrops that were used for about 6 weeks.
If your eye vision is stable, you might get a refraction eye exam and find out if your eye can be corrected to 20/20 or better with eyeglasses first. Remember, there are no guarantees from cataract surgery since can how the eye ends up after healing can vary, so its not possible to be certain you will end up with better vision after the risks involved with an IOL exchange. So I would think very carefully about that, if you only have slight astigmatism.

[Adriennemk]

It’s only been 2 weeks. The rx drops I took were only for 2 weeks post op, so those are done. Glasses can correct but at this point, I’d need glasses for real reading-not just skimming or checking phone, and I’d also need separate glasses, if I wanted to see distance clearly with both eyes.
At this point, I’m wondering if I should set both for distance and just always have reading glasses.
My distance vision is awful and I can’t read well either.
I don’t think I want the toric though because he did tell me they like to put the toric lens in a “virgin bag” that hasn’t already had an oil, because placement needs to be so precise.
I don’t know what to do. I don’t want to wait so long that a swap becomes riskier if I need it.

[NightHawkGuy]

Are you considering a monofocal toric IOL? That would give good focus at one range like distance, intermediate, or near depending on what power its set for. Toric IOLs are for astigmatism cylinder of about 1.25D or greater usually, my right eye had almost 3D cylinder so I went for a monofocal toric in that eye recently. It cost me about $1300 extra compared to a non-toric monofocal IOL, it was worth the extra cost for me but you have to decide if having the chance for reduced eyeglasses use is worth it - there are no guarantees it will give you good eyeglasses free vision however.

There is also the Symfony extended focus toric IOL that could provide distance and intermediate plus as close as 18" or so if targeted for good distance vision. But with the Symfony IOL you would have night vision artifacts around lights, so not very good if you do a lot of night driving.

A toric IOL must not rotate or it will not reduce astigmatism as well, that can happen in the first month or so after surgery in a few percent of cases.  I got a Tecnics monofocal toric IOL in my right eye almost 6 months ago and it doesn't appear to have rotated since most days I'm getting 20/20 to 20/25 or so distance vision with it. When my left eye in the future requires cataract surgery (probably not for a few more years) I would consider mini-monovision with the same monofocal toric IOL set for a little nearsighted for intermediate vision, or perhaps a Symfony toric IOL to get a wider focus range in one eye.

[Adriennemk]

Thank you so much for your answer! I appreciate your time

We are looking at monofocal, yes. Set for a little nearsighted, as this current lens is.

Doc says it could be because of the yellow tint, or the astigmatism, that I am not really seeing clearly at any distance, and am getting a lot of ghosting. I can make out words to read a little bit, but it takes too much work to read anything other than a quick text. We are not looking at extended focus, just monofocal.

Does it sound like the yellow tint could be causing these issues? Is it worth the 1500 to go topic with such a slight astigmatism?