Toric or Near Vision IOL-Which One Should I Have?

Question: I am 72 and have cataracts. I was scheduled for cataract surgery this month but changed my mind after a friend said I was making the wrong decision. I have always been nearsighted and have worn glasses since I was 13. I started wearing bifocals at 44. I have always had to wear glasses to drive.


I have double astigmatism and the Ophthalmologist said I would need Toric lenses and then Lasik to be able to see both distance and close. I am really afraid of the Lasik surgery. I told him I would prefer to have implants for CLOSE VISION instead of distance because I work on the computer a lot, read, play cards and sew. My friend said I should have the DISTANCE corrected with the implants and wear glasses for reading. The eye doctor said I could have one eye for reading and then later do the other eye for about 20 feet to see TV without glasses. But I tried contacts years ago for monovision, and it was always blurry.

In your practice with patients who opted to correct their close vision (instead of distance) and wear glasses for driving, would you say are happy with their decision? If I choose the distance correction, would that mean that everything would be blurry within a 20-30 foot range?

Answer: Your question is somewhat unclear which gives concern to whether you have been fully counseled by your Cataract Surgeon regarding the options for lens implants to correct vision after Cataract Surgery or perhaps you didn't understand what was presented to you. Let's see if we can organize the options that might be available to you. First, it is unclear what "double" astigmatism means. If it means that you have a moderate to high amount of astigmatism we understand this.

For people having Cataract Surgery who have preexisting astigmatism-before their Cataract operation-AND WHO WANT TO HAVE CLEAR VISION AT DISTANCE WITHOUT GLASSES-the Cataract Surgeon can implant an astigmatism correcting toric lens. Astigmatism correcting toric lens implants DO NOT CORRECT NEAR VISION-ONLY FAR VISION and thus you would need to wear reading glasses or bifocals to see the computer screen, play cards and sew-with two caveats. As a practical matter, Toric Lens Implants only correct up to approximately 2.5 D of astigmatism and thus if the amount of astigmatism exceeds this amount ("double astigmatism"?) you might indeed need a second astigmatism correcting procedure to see clearly at distance-thus the POSSIBLE need for LASIK.

For people who wear bifocals and are having Cataract Surgery who want to be able to see far, near and arm's length without being totally dependent on eyeglasses after Cataract Surgery, the Cataract Surgeon can implant a presbyopia near vision correcting lens implant-BUT-AT THIS POINT IN TIME IN THE UNITED STATES PRESBYOPIA NEAR VISION CORRECTING LENS IMPLANTS DO NOT CORRECT ASTIGMATISM AND YOU WOULD STILL NEED TO WEAR GLASSES TO SEE CLEARLY-UNLESS the astigmatism was corrected by a second procedure such as LASIK Surgery for Astigmatism.

Now, the notion of using a monovision lens implant correction after cataract Surgery should be removed from consideration as you did not adapt well to monovision contact lens correction.

SO:

1. You can be MOSTLY OR COMPLETELY corrected for distance using an astigmatism correcting toric IOL in which case you will need to wear eyeglasses-readers or bifocals-to see arm's length and near, OR

2. You can MOSTLY OR COMPLETELY corrected for distance AND near using a near vision presbyopia correcting IOL in COMBINATION WITH LASIK. You should not be afraid of LASIK. Worldwide patient satisfaction studies of LASIK demonstrate that patients are as happy if not more happy with LASIK Eye Surgery than they are with Cataract Surgery.

Typically patients who elect to correct their near vision with monofocal or toric lens implants end up not being terribly happy as compared to those who fully correct their distance vision-and have clear vision to within 4-5 feet, and then wear readers or bifocals. One way or the other, due to the complexity of your prescription and desired tasks you will either need to wear eyeglasses some or all of the time OR have LASIK if you wish to be relatively eyeglass "free". For certain, you should have a complete review and discussion of these options with an eye surgeon who is both a top Cataract Surgeon as well as being one of the top LASIK Surgeons in your area.

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