risk of doing Toric IOL implant

[uxuh]

My left eye need cataract surgery, it also has astigmatism, my ophthalmologist suggested using Toric IOL to implant. As far as I know doctor needs to figure out the astigmatic axis and align IOL to it. There are advanced equipments can do the measurement, But patient has no way to fit it before implantation. I wander how much is the margin of error?  After axis is identified, Doctor needs to mark the Toric axis on the cornea then position the IOL on to the axis during the surgery. What is the margin of error at this step? If there is a deviation after patients open their eyes, can it be corrected easily and how?

[Harold14370]

I think there are laws that say they have to tell you your prescription. I've always gotten it when I asked for it.

[LynneAV]

Thank you very much, Harold. I think you're right, it appears that I need to start over with a second opinion. I was very pleased with my doctor and the staff while I went through all the uveitis treatments and had so many emergency requirements -- and a successful treatment. This makes me sad. But I am also alarmed because this decision will affect me the rest of my life and the recommendations do not make sense to me. And I cannot believe I was informed that I may not know my own prescription. Thanks again.

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

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[Harold14370]

I know a guy with IOL in one eye, who has "monovision" as he calls it - nearsighted in one eye, far vision in the other. He loves it, doesn't wear glasses at all. He uses one eye for reading, the other for distance. Lots of people wouldn't be able to get used to that, though.

Like you I was nearsighted before the cataract operation and got very accustomed to being able to take off my glasses and look at things real close up. I kind of miss that. I don't think it would be a bad idea at all to get an IOL to match your nearsighted eye.

In between cataract operations, I had one eye far sighted (the one that was operated on) and popped the lens out of that eye. The other eye was nearsighted with corrective lens. That did not work well AT ALL. The two images did not match up. Double vision. It was a nightmare for 10 days until I got the other eye done. So, I too would be wary of what they want to do. Maybe you should get another opinion.

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

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[LynneAV]

Me again, still agonizing over which IOL to request. I just had another phone conversation with the consultant at my eye center. I am nearsighted in both eyes, but I only have a cataract in my left eye (from uveitis and steroids to treat the uveitis.) The consultant is sure that distance correction for the one eye, and a toric lens ($1200 for me to pay out of pocket, yikes) for astigmatism, is what is best for me. I can tell she thinks I am stupid for not jumping at this.

When I ask about the problem of being unbalanced -- with one eye farsighted and one eye nearsighted, she says I will still have to wear glasses anyway, so I would just get new progressive bifocals with one eye corrected for far and the other corrected for near. Then I wonder, what is the advantage of spending $1200 and also having to wear glasses ALL the time -- if I just stay the way I am (nearsighted in both eyes), I only have to wear glasses for distance and have super-duper near vision without any glasses and can read and put on make-up, and don't have the off-balance feeling I will probably have with half and half vision if I'm not wearing glasses?  I'm not used to having to wear glasses taking a shower, putting on makeup, or using the computer and reading ... I'm afraid of messing with success.

I guess I need somebody to  explain what I am missing, because obviously I am missing the advantage to having one eye far sighted. I think there is some advantage so obvious that the consultant didn't mention it to me because it is just too obvious -- but I'm not getting it.

(She refused to tell me my current prescription because she is not a doctor.)

Can anybody shed any light on this?

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

I would also be sure he/she (eye MD) is Board Certified by the American Board of Ophthalmology, and a member of the American Academy of Ophthalmology (www.aao.org).  You can on line see if the Eye MD has published medical papers generally Eye MDs that do clinical research and publish peer reviewed medical research are "better than average". Find out if they teach at a medical school or are on the faculty. Are they a Fellow in the American College of surgeons? www.acs.org  

As said above ask around friends, neighbors.  Ask how many procedures like the one you're having done they have done. You can even ask to speak to people that have had the surgery although expect to get a list of the "happiest ever".

Be sure the surgeon does the post operative care and does not farm it out to your optometrist if you have one (co-management a legal form of fee splitting), has a 24 hr/day answering service.

Be sure you feel comfortable with the surgeon and that he/she explains things and you feel is being honest rather than a salesperson.

Don't be pushed into a higher priced "premium" IOL. You can listen to the sales pitch and if you say "NO THANKS, I want a monofocal" don't put up with badgering to "upgrade" (code for spend more)

JCH MD

[cornczech]

The best way to tell who is a good ophthalmologist/surgeon is to ask around. Go online and see if there is anything written about that particular MD. Doctors who practice at University and/or teaching hospitals are normally pretty good. However, you can find a bad apple anywhere, including one that might do a lot of advertising in your area, (I once worked for an ophthalmologist like that. Did a LOT of surgery thanks to his advertising, but he was a lousy surgeon!) and you can find gems in small practices in small towns.

Good luck!

[uxuh]

How do I know who is the good eye surgeon? I am a member of Kaiser Permaente.

Thanks

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

The new toric IOLs in the hands of a good surgeon give good results, better than limbal relaxing incisions LRIs

JCH MD