Question: I have a question about Keratoconus and cataract surgery and not wearing glasses or contact lenses. I am 73 years old and am active outdoors. I have worn rigid contact lenses since 1958 and was diagnosed with Keratoconus in 1970. I have worn contact lenses of decreasing size until recently when we tried a Scleral contact lens for greater vault and pollen protection. They are no longer comfortable. I have cataracts and would like to have the cataracts removed and replaced with a lens implant, that would correct my vision, including astigmatism caused by the Keratoconus and eliminate the need for contacts or glasses. Is this possible? Thanks for the advice.
Answer: Your situation of requiring Cataract Surgery and Lens Implants, when you have Keratoconus for which you are becoming contact lens intolerant, is indeed a complex surgical challenge. The single most important factor is that you have realistic expectations regarding the expected outcome which is NOT likely to eliminate the need for glasses or contact lenses. Here is what you need to know and carefully discuss with a Cataract Surgeon, who is also a Corneal Specialist, who can guide you on the possibility of combined procedure of a Cataract extraction, Lens Implant and Corneal Transplant, if that, in the opinion of the Corneal Surgeon, the best option.
First, anyone who has been wearing rigid contact lenses for as many years as you have, adds significant complexity to the measurement and calculation of the Lens Implant power. Further, anyone who has Keratoconus has UNSTABLE and most likely IRREGULAR astigmatism-BOTH of which markedly decrease the precision and accuracy with which an astigmatism correcting Toric Lens Implant can be calculated if at all.
Finally, you will still require glasses for reading, as it is also unlikely that you are a good candidate for a Multifocal Lens Implant. Now, one remote possibility is that you could find a Cornea Specialist that is performing Corneal Cross Linking for Keratoconus. Corneal Cross Linking might just act to stabilize the Keratoconus enough that it would make the precision and accuracy of the measurements and computations for the Lens Implant considerably better-AND if some level of stable and regular astigmatism could be achieved on the cornea, there is a REMOTE possibility that a Toric Lens Implant MIGHT be of some benefit. This might just eliminate the need for a Corneal Transplant and greatly simplify the ultimate final optical correction that you will require in contacts or glasses. These are all hypothetical considerations dependent on a thorough examination by a Corneal Specialist and Cataract Surgeon.
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