Aa
toric lens or not
I have 1.53 degrees of astigmatism in LE (dominant eye) scheduled for cataract surgery. Doctor suggest a toric lens for crisp vision. He uses the ORA in the operating room. LE will be set for distance - hopefully plano will be met. He says few people have complications, but he does sometimes need to rotate the lens after surgery which scares me. I need to make sure that I get the correct IOL Power so that I have the best chance of adapting to the modified monovision since the difference in both eyes will be 1.5 diopters away from each other. Will trying to correct the astigmatism affect getting the correct IOL Power?
The astigmatism may go down to 1.25 in the LE after the cataract surgery. I should have 20/20 vision in that eye after surgery.. Do you think that vision will be okay if I don't get the toric lens to correct the astigmatism? Most of the posts here on toric lens are older. Are the lens and technology better now in 2016?
RE has already had cataract surgery set for modified monovision at -1.5. This eye had .75 degrees of astigmatism before surgery, and after surgery went down to .5.
The astigmatism may go down to 1.25 in the LE after the cataract surgery. I should have 20/20 vision in that eye after surgery.. Do you think that vision will be okay if I don't get the toric lens to correct the astigmatism? Most of the posts here on toric lens are older. Are the lens and technology better now in 2016?
RE has already had cataract surgery set for modified monovision at -1.5. This eye had .75 degrees of astigmatism before surgery, and after surgery went down to .5.
That is a bug in their software and I've told them about it. Happens often to me. If you are sure you hit post a comment and you don't see it then make another post and just put any single letter or symbol. It will post the original post and the single symbol post below it. So its there it just doesn't show up until you make another post.
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Sorry for almost duplicate posts, there was either a bug in the software or somehow a post got sent to moderation so I didn't see the first post appear so I thought it hadn't gone through, and composed it again.
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Thank you from the bottom of my heart! That is what I needed to hear.
I'll let you know how the surgery goes at the end of the month with the toric lens.
I'll let you know how the surgery goes at the end of the month with the toric lens.
Our practice uses toric lens with a high degree of success and patient satisfaction. Rotation are unusual but the procedure is relatively minor and usually makes patient and surgeon happy. In the last 5 years none of the patients that I've managed or consulted on have had to have the IOL removed and exchanged for a aspheric monofocal IOL. Its important to put risks into context. Virtually nothing in life is risk free. We take risks everytime we get into a plane or automobile or on a bicycle (really risky). The risk benefit ratio on toric IOLs is good and the optics excellent. If I needed surgery I would strongly consider them as I have about 1.5 D of astigmatism. I would still not have a multifocal IOL but I've worn glasses for so long I do not find them objectionable.
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Dr. Hagan, thank you for posting your experience regarding your success over 5+ years with toric IOLs, that helps us with high astigmatism feel more secure with choosing a toric IOL.
When you refer to having 1.5D of astigmatism yourself, is that an eyeglasses prescription or the corneal cylinder?
What eyeglasses cylinder values are considered moderate vs high astigmatism for reference?
My eyeglasses Rx cylinder is -2.0 in the left eye and -2.75 in the right eye, I just hope that the right eye isn't too high for the highest cylinder toric monofocal IOL models (about 4D in the corneal plane).
When you refer to having 1.5D of astigmatism yourself, is that an eyeglasses prescription or the corneal cylinder?
What eyeglasses cylinder values are considered moderate vs high astigmatism for reference?
My eyeglasses Rx cylinder is -2.0 in the left eye and -2.75 in the right eye, I just hope that the right eye isn't too high for the highest cylinder toric monofocal IOL models (about 4D in the corneal plane).
Corneal astigmatism is the most important and usually the same or nearly the same as glasses astigmatism. Mine is both cornea and glasses. 2 to 2.75 would be moderate High would be about 4 or >
Very interesting, thanks Dr. Hagan. I had assumed corneal cylinder would be significantly higher than the eyeglasses Rx cylinder. So if my corneal cylinder turns out to be close to my eyeglasses Rx, thats not as bad as I feared. There are more options with toric IOLs if I have cornea cylinder in the 2-3D range.
At my first cataract consultation last week they did the cornea measurements with a machine that takes dozens of photos of the cornea, however due to dry eye they wanted me to come back in a couple weeks after using Refresh lube drops 4times/day for 2 weeks before to get better cornea measurements. I hope then I'll know more precisely my cornea cylinder and other values to help narrow down my IOL options.
At my first cataract consultation last week they did the cornea measurements with a machine that takes dozens of photos of the cornea, however due to dry eye they wanted me to come back in a couple weeks after using Refresh lube drops 4times/day for 2 weeks before to get better cornea measurements. I hope then I'll know more precisely my cornea cylinder and other values to help narrow down my IOL options.
Very few people have put as much time and effort in studying their options
Dr. Hagan, would your best suggestion for my eyes be toric monofocals for both eyes (e.g. Tecnics Toric IOLs)?
Perhaps with a slight -0.5 to -0.75D (slightly nearsighted) for the left eye since that eye gets me better than 20/15 corrected distance vision, so I could still probably get 20/20-25 and decent distance depth perception.
Perhaps with a slight -0.5 to -0.75D (slightly nearsighted) for the left eye since that eye gets me better than 20/15 corrected distance vision, so I could still probably get 20/20-25 and decent distance depth perception.
That combo would be similar to what I had 10 years ago with RGP contact lenses.
The rules of MedHelp.org prohibit us from doing anything that might be construed as practicing medicine. So I cannot tell you specifically what type to get.You've put a ton of time into this and got consultations. Ultimately its between you and the surgeon you choose
I understand, however from your previous posts about what you would choose for yourself and in your blog I think I can guess. :)
I see as my current possible options (considering my right eye limitations):
1. Toric monofocal IOLs (preferably Tecnis) in both eyes.
2. Toric monofocal IOL (Tecnis) in right eye and Symfony toric IOL in left eye with slight nearsighted offset (<= -0.50D)
3. Trulign (toric) accomodating IOL in both eyes, if my right eye corneal astigmatism is not too high for that lens.
Those are what I will be exploring at my next consultations.
I see as my current possible options (considering my right eye limitations):
1. Toric monofocal IOLs (preferably Tecnis) in both eyes.
2. Toric monofocal IOL (Tecnis) in right eye and Symfony toric IOL in left eye with slight nearsighted offset (<= -0.50D)
3. Trulign (toric) accomodating IOL in both eyes, if my right eye corneal astigmatism is not too high for that lens.
Those are what I will be exploring at my next consultations.
I would chose for myself a toric monofocal with target a mini-monofocal near bias.
The surgeon that will do the surgery and his assistant say that they have few rotations to go back to surgery by using the ORA. However, he does have one scheduled to do tomorrow! The surgeon I'm going to use does a lot of cataract surgeries. I'm told that a lot of patients get the toric lens in their practice and do fine. My vision before the cataract was 20/20 so I expect that it should be that also. However, without the astigmatism corrected, I'm told it may not be that optimal. Also, with the modified monovision in my other eye, I'll have only the one eye for distance so it seems it needs to be the best it can be. I've seen three surgeons. Two say the risk of using a toric lens are small. One says he thinks I'll wear glasses anyway, and he said sometimes if the lens has to be rotated twice, then it has to be removed. That really scares me. I do want the best outcome, of course, but I don't want any big complications. If all it meant was to have to go back to surgery once that wouldn't be so bad. If it were you would you opt to get the toric lens or not?
If you see a flaw in a comment i'd suggest posting a specific critique. For many months there wasn't a doctor posting on this forum, this is actually not one of the forums setup for doctors to post to but was for users to help each other, so I'm not sure what your problem is. Dr. Hagan is kind enough to post here on this forum even though its not one of the forums meant for doctor comments, though he sometimes seems to only have time for short comments.
If I'm uncertain about a topic then I tend to try to post a caveat regarding my level of knowledge. Otherwise the topics I post on here are things I've had reason to research, or which I read about while researching other topics. Many topics aren't arcane "rocket science" requiring years of schooling, but can be grasped by educated laypeople with a general science background. I originally intended to go into physics, before switching to computer science (artificial intelligence initially) and likely have more optics background (even if rusty) than most MDs, which is related to some of the topics.
Those in rapidly developing fields often get used to teaching ourselves new things out of necessity, especially those who apply our technology to different intellectual domains, have started our own businesses,, etc. If I get something wrong, I welcome others pointing it out to learn from.
If I'm uncertain about a topic then I tend to try to post a caveat regarding my level of knowledge. Otherwise the topics I post on here are things I've had reason to research, or which I read about while researching other topics. Many topics aren't arcane "rocket science" requiring years of schooling, but can be grasped by educated laypeople with a general science background. I originally intended to go into physics, before switching to computer science (artificial intelligence initially) and likely have more optics background (even if rusty) than most MDs, which is related to some of the topics.
Those in rapidly developing fields often get used to teaching ourselves new things out of necessity, especially those who apply our technology to different intellectual domains, have started our own businesses,, etc. If I get something wrong, I welcome others pointing it out to learn from.
If you find any actual fault with particular details within a post then I'd suggest providing critique of it, rather than the unjustified leap to a conclusion that because someone isn't a surgeon that they can't possibly have anything useful to say on the topic. For many months there was no doctor posting on this site, and Dr. Hagan often seems to only have time for short posts.
If I'm unsure about a topic, I tend to be careful to attach a caveat about my level of certainty to a comment.
The topics I post about on this site aren't some sort of arcane "rocket science" that a layperson couldn't possibly comprehend without years of study, its information that is easy to learn for someone with a general scientific background who is used to researching new topics. In rapidly changing fields like computer science (and artificial intelligence, one of my specialities) many people learn to teach ourselves because we have to because the field changes all the time, and we apply those skills to other topics. Many of us have needed to learn about various intellectual disciplines to some degree in order to develop software for them. I originally studied physics before switching to computer science. I probably have more optics background (even if rusty) than most MDs. Those with backgrounds in topics like physics learn to evaluate evidence and studies and papers.
If I'm unsure about a topic, I tend to be careful to attach a caveat about my level of certainty to a comment.
The topics I post about on this site aren't some sort of arcane "rocket science" that a layperson couldn't possibly comprehend without years of study, its information that is easy to learn for someone with a general scientific background who is used to researching new topics. In rapidly changing fields like computer science (and artificial intelligence, one of my specialities) many people learn to teach ourselves because we have to because the field changes all the time, and we apply those skills to other topics. Many of us have needed to learn about various intellectual disciplines to some degree in order to develop software for them. I originally studied physics before switching to computer science. I probably have more optics background (even if rusty) than most MDs. Those with backgrounds in topics like physics learn to evaluate evidence and studies and papers.
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Your very detailed information was excellent .It was along the lines of the clinical trial surgeons in europe israel and later in usa in regard to symfony lens positive outcomes.I have the lens and am thrilled.Thank you softwear.
You guys are often rhe smartest
You guys are often rhe smartest
I am sure that you are a well meaning person SoftwareDeveloper who is trying to help people but you appear to be a layperson who is not a cataract surgeon and as such not an expert and yet you are offering a whole paragraph of technical advice which you have no actual expertise to comment on - surely you should leave these sort of comments to John Hagan who is an actual bonafide expert?
I am not trying to be rude just pointing out that some people might read too much into your comments.
I am not trying to be rude just pointing out that some people might read too much into your comments.
It isn't clear how anyone can suggest in advance that they know that with 1.25D of astigmatism after surgery that you will have 20/20 vision since unfortunately people's visual acuity varies even with the same level of refractive error. With small levels like 0.25 they might make an educated guess that it'd leave you with still 20/20 vision, but my reading (as a layperson of course) suggests that seems a bit high to be sure to reach 20/20, if anything I would have bet against it. Its very possible it'll still be good enough for driving regardless, that I hadn't checked into.
The 1.25D after surgery without a lens is merely an estimate of course, an educated guess. They can't say exactly what it will be, but they do have statistics based on prior surgeries as to how the incisions they make during surgery will likely impact your astigmatism postop. Some surgeons will do extra incisions to correct even 1.5D of astigmatism surgically rather than with a toric lens, even if many prefer to use a toric lens. The result sometimes isn't as predictable as a toric lens since eyes heal differently, but there would likely be a large improvement even if the astigmatism doesn't hit 0.
ORA does give them an advantage with setting a toric lens to the right rotation, and rotating it afterwards does seem to be a minor thing. It is low risk that you'll have problems, though admittedly not 0 risk (few things in life are). Modern lenses are improved over older lenses, though I don't know how old you are referring to.
re: "Will trying to correct the astigmatism affect getting the correct IOL Power? "
The risk is low that it'll have much impact since the IOL is likely to be positioned correctly or at most only a little bit off. However it is the case that if an IOL rotates, it effects both parts of your refractive error, your sphere and cylinder. Essentially an astigmatic eye is shaped somewhat like an American football rather than a sphere, and the different lengths lead to a different lens power in one direction than another. The lens power in one direction is the spherical part of your correction. The "cylinder" part tells how much different the lens power is in the other direction. So a toric lens has different powers in one direction than another to try to compensate for that, and if it rotates, it impacts the correction for both angles.
The 1.25D after surgery without a lens is merely an estimate of course, an educated guess. They can't say exactly what it will be, but they do have statistics based on prior surgeries as to how the incisions they make during surgery will likely impact your astigmatism postop. Some surgeons will do extra incisions to correct even 1.5D of astigmatism surgically rather than with a toric lens, even if many prefer to use a toric lens. The result sometimes isn't as predictable as a toric lens since eyes heal differently, but there would likely be a large improvement even if the astigmatism doesn't hit 0.
ORA does give them an advantage with setting a toric lens to the right rotation, and rotating it afterwards does seem to be a minor thing. It is low risk that you'll have problems, though admittedly not 0 risk (few things in life are). Modern lenses are improved over older lenses, though I don't know how old you are referring to.
re: "Will trying to correct the astigmatism affect getting the correct IOL Power? "
The risk is low that it'll have much impact since the IOL is likely to be positioned correctly or at most only a little bit off. However it is the case that if an IOL rotates, it effects both parts of your refractive error, your sphere and cylinder. Essentially an astigmatic eye is shaped somewhat like an American football rather than a sphere, and the different lengths lead to a different lens power in one direction than another. The lens power in one direction is the spherical part of your correction. The "cylinder" part tells how much different the lens power is in the other direction. So a toric lens has different powers in one direction than another to try to compensate for that, and if it rotates, it impacts the correction for both angles.
There is no way any surgeon can tell you that you will not be the one that needs the toric IOL rotated. You can ask your surgeon what % need rotating and then make your decision. Rotating the IOL is generally a simple procedure. There is no way to predict how much your astigmatism will decrease or increase after cataract surgery with a spherical IOL nor your vision without glasses.
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