Sulcoflex for reducing photic phenomena?

[concentrico]

Hello, I have been implanted two multifocal toric iol 6 months ago, I have stable keratoconus treated with prk/cross-linking several years ago. I'm experiencing very debilitating photic phenomena like flashing, flickering, arcs and rings of light during the day and night. I will be implanted with sulcoflex toric to reduce the corneal astigmatism post-operation. I'm curious about how a second "monofocal" lens like the toric sulcoflex could reduce all those disturbing aberration.

[JohnHaganMD]

Answered elsewhere. K-conus is considered generally a contraindication to multifocal IOLs even if stable so its not surprising you have this problem.  Before you have the surgery I would suggest you consider a second opinion for a different cornea/IOL/refractive surgery. Since much of your problem likely comes from the cornea its not likely all your symptoms will be relieved. Question is why was that type of IOL put in in the first place.

[concentrico]

I had this surgery already...

[concentrico]

is there a solution now to correct such problems? sulcoflex? corneal surgery?

[JohnHaganMD]

Suggest you get second opinion cornea/IOL/refractive surgery.  The opinion is about your problem and the best way to approach it.  A toric IOL is not a monofocal IOL.

[concentrico]

Thank you. Why before the operation, with my natural lens, I didn't see those higher-order aberrations like flickering on the sides and multiple circles of light snapping all around my sight?

[concentrico]

Is sulcoflex toric aspherical?

[JohnHaganMD]

I have no experience with the sulcoflex. You will need to look on the manufacturer website.  Some people with perfect corneas have the problems you describe. However with K-conus it is so common most surgeons consider it a contraindication to multifocal IOLs. You didn't have problem because it comes from the IOL, made worse by your irregular astigmatism.

[concentrico]

Thank you doctor! I was put a multifocal because my young age, the surgeon thought I would see well. Do you think that wearing rigid contact lens could help with those cornea-related dysphotopsias?

[JohnHaganMD]

You can try it but usually not take care of the problem

[JohnHaganMD]

You can try it but usually not take care of the problem

[JohnHaganMD]

Keratoconus is generally considered a contraindication for insertion of multifocal IOLs even if it's 'stable" so your problems are expected. It's not likely that a toric IOL would solve them. I suggest you get a second opinion from a cornea/IOL/refractive specialist and another cornea topography.