Multifocal vs. Toric Lens Implant IOL?

Question: I’ll soon have cataract surgery, and would like to have any comments about my choices. It’s my left eye (SPH +0.75 CYL -0.75 Axis 107) and I would like to get the multifocal IOL (rather than toric). I’m 87, and have been comfortable with drugstore spheres (1.25 for distance, and 3.00 for reading). I feel that it would be more convenient to have a single pair of toric eyeglasses (if desired) for all distances when more acuity is needed, rather than reading glasses. A friend in a somewhat similar situation recently chose toric IOLs, and suggests that I too might be better off with torics. Any comments would be appreciated.


Answer: There is a diversity of opinion regarding your choices here. There many other considerations in choosing a Lens Implant than simply the prescription. First, you do not state-and may not know-whether the .75 D of astigmatism you have is due to the corneal shape and thus “corneal astigmatism” or whether it is in the crystalline lens and thus “lenticular astigmatism”. This may or may not impact the decision. Second, you do not state-and may not know-the length or the position of the incision to be made to remove the Cataract and insert the Lens Implant. This too can impact whether you actually need an astigmatism correcting toric lens. Next, you do not state-and may not know-what your best level of correctable vision is and whether you have any trace of Age Related Macular Degeneration (AMD) which would not be uncommon in the average 87 year old person. Even with relatively “normal” healthy maculae, it is not uncommon to have a reduction in contrast sensitivity at 87 years old. Patients with reduced

Macular function-even if slight-may not do so well with multifocal lens implants. You do not state-and may not know-when you will need and have cataract Surgery in your second eye. Multifocal Lens Implants (IOL)s work best when they are implanted in both eyes. So, there are many open questions that really should be discussed with your Cataract Surgeon.

That said, there are a lot of “ifs”. If you had multifocal lens implants in both eyes, and IF you had astigmatism in the left eye that needed correction, it could be corrected with a procedure called Limbal Relaxing Incisions (LRI) after your primary Cataract Surgery and Lens Implantation-and IF you have strong Macular function it is possible that you would be able to see well at distance, arm’s length and near-OR you still might need help with reading vision. If you needed and had a toric lens implant, you would in all likelihood need some near and intermediate eyeglass prescription. A lot of “ifs”. Your next step is to consult the best Cataract and Refractive Surgeon you can find in your area and have a thorough examination and consultation so you can make this decision together.

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