lens implant in cataract surgery

[timmie]

  I am due for catract surgery on my left eye soon. My eyes are -5.75. I would like to remain shortsighted and wonder if it is OK to target -3.00 in the left eye and remain -5.75 in my right eye for anything between 6 months and a year. My right eye also has a cataract but I am not in a hurry to do it yet as I can still see well with it but the doctor told me that eventually I will have to do it. Do you think I can cope with one eye at -3.00 and one at -5.75? - a difference of 2.75
   I am told that the power of the lens is not an exact science and I can end up with something different. Can I end up with less than -3.00 even though the surgeon will aim for -3.00. Because if that can happen then the difference may be even more than 2.75. (I guess IIcan always get my better eye operated on earlier.)
   I look forward to your advice.  My surgery is on Jan 14. many thanks.

[JodieJ]

The charge of $500 per toric lens is pretty standard, I think.  If you don't want to pay it, consider getting standard aspheric IOLs and having limbal relaxing incisions to reduce/eliminate your astigmatism.  Many surgeons do not charge an additional fee for this procedure, which takes only a minute or two.  (Unless you are highly myopic, the Alcon Toric lens probably does come in the right power for you.)

[texas2step]

Thanks Jodie...The total bill for the Toric IOL is 1,000.00.  Methodist Hospital charges 500.00 for the extra five minutes the eye doctor places it in.  The Eye surgeon charges 500.00 just the lens. You would think that the extra five minutes would be nil for the hospital as they are getting quite a bit of $$$ for the cataract surgery.  I can understand the 500.00 charge that the surgeon has to pay for the lens but I am applaled at the hospital charging another 500.00 and not covered by any insurance UNLESS it is medically nescessary to see and all insurances compaines state that a person can wear glasses to see. Period!  It is hell too get old!!!  LOL

Another concern is that someone wrote that they had problems with the Toric IOL and having a hard time finding someone to help her.  (Louisiana Poster)  Just how long has this Toric IOL been on the market?  I have Drug eluting heart stents that came out in late 2003.  Everyone thought they were next to God...Well, they are not and these drug coated heart stetns are causing a lot of probloems for some heart patients and cannot be removed.   I am scard and cautious right now.  I just wish my surgeon was more forthcoming with information.  I would rather hear things from him that his tech.

Jodie, I have no idea what my numbers are.  No one told me. I feel like cancelling my surgery and live with the cataracts.  Bummer..

Thanks for responding.  Hope you are doing better.

[JodieJ]

I was in the same situation that you are facing.  Without some type of astigmatism correction, you will not see clearly at any distance without glasses or contacts, if this is a concern for you.   According to the results of the clinical trials, the Alcon toric IOL did a better job of correcting astigmatism than limbal relaxing incisions at the time of surgery.  I would have paid the $500 to get the toric lens, but it did not come in the power I needed to correct my high myopia.  So I got aspheric IOLs and had limbal relaxing incisions at the time of my surgery, with excellent results.  (My surgeon did not charge extra for the limbal relaxing incisions, although some surgeons do.)

[texas2step]

I have been reading these posts with great interest.  I am scheduled for right eye cataract surgery in 2 weeks. This eye has a stigmatism...(mild to moderate)  Left eye will have cataract removed one month after right eye.  Left eye has no stigmatism.  Like other posters here, I do not know what all these numbers are that they are posting.  All I know is my vision is poor and I cannot see squat.
I was given a piece of paper discribing the TORIC IOL lense for the right eye.  They are telling me that I will see sooo much better if we add this to the cataract surgery.  This lense is 500.00 Physican's charge and an added 500.00 for the hospital charge for the extra five minutes it takes to put in.  NO insurance will cover this, I was told.

I am thinking of declining this as I have very limited information and also the cost involved.  If it were such a needed thing, insurance would cover this but they don't..  Doctor, what is your take on the need for this Toric IOL?  Thanks so much for your help.
Nana in Houston

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

Today I went to the first of a two day conference on modern cataract surgery with emphasis on multifocal IOLs.  They presented papers that with the new aspheric IOLs like Tecnis (the clear winner at this time) that the IOL power for reading is quite a bit less than spherical IOLs where -2.00 to -3.00 has been used.

The research indicated that -0.25 for distance and -1.25 or -1.50 for near works nicely.

It is very important in my opinion for you to use the best aspheric IOL on the market and right now nothing is close to as good as the Technis IOL.  This lens also allows the increased focus at near (disclaimer I have no financial ties to any IOL or equipment manufacturer).

If you have your reading eye left -1.50 at near you will have a lot of problems with the other eye being -5.75    

I believe that  you are likely to be so happy with surgery on the "near" eye that you will want the other eye done within 3-6 weeks of the first eye.

THIS IS IMPORTANT:  A large series of cataract surgeries done with the most exact equipment available and the best trained staff shows that the average error after surgery is +/- 0.50 diopter BUT 1 in 15 cases will have an error of up to +/- 1.50 diopters

JCH III MD

[JodieJ]

I know that this is a very difficult decision for you, and I'm a little hesistant about posting this comment so close to your surgery date.  I think that it is an open question as to whether you will be able to cope with the results of surgery with a -3.00D target for your left eye (without continuous use of a contact lens.)  Why take the risk?

I was in a situation very similar to yours about a year ago.  In your place, I would definitely choose a less myopic target than -3.00D for my left eye.  I would plan to have the surgery on my right eye 2-3 weeks after the first procedure, given that all went well.  If my surgeon was uncomfortable about billing my second eye as "cataract surgery" (rather than "refractive lens exchange," which is not covered by insurance or Medicare), then I would find a different surgeon.  Trust me, many excellent surgeons would go along with advancing the date of the second surgery in your case.

[TessTx]

I had surgery on my right eye two days ago.  It was -9 and my left eye is -7.  A contact in my left eye is really the only solution for me and eventually I will need surgery on it too, as there is a smaller cataract there.  One thing I recommend that I did not do, is get as much information about the specific lens your surgeon plans to use.  Google as much as you can about it before hand.  I've some color perception issues and as an artist, it was alarming to me.  More research after the fact has alieved my fears that eventually this will go away, but it has been an emotional roller coaster that could have been avoided had I been more proactive and not relied on being given all the information.