Saturday, March 17, 2012

Monovision with Toric Lens Implant

Question: In August 2011, I had Limbal Relaxing Incisions (LRI) with a multifocal lens implant in my left eye. While the clarity of vision is pretty good, the halos and glare make it truly untenable. My cataract surgeon assured me at the time that he could remove it up to a year later if it didn't work out, which it hasn't. So, his plan is to give me mini-monovision. I've tried mini-mono with contacts and seem to do okay. He plans to explant the multifocal lens in my left eye, a Tecnis® Multifocal, and exchange it with an Alcon AcrySof® ReSTOR® Toric Astigmatism correcting lens implant to deal with the slight astigmatism remaining in that eye post Limbal Relaxing Incisions. The left eye prescription will be -1.75 to give me some nearsightedness. His plan for the right eye is to use an Alcon AcrySof® ReSTOR® Toric Astigmatism correcting lens implant for distance at Plano. My goal is to have as crisp vision as possible with as little glare as possible. I don't know if it makes a difference, but I'm a red-haired, green-eyed woman whose always had some (not huge) sensitivity to light. Also, I have moderate-to-very dry eye.

I don't mind the idea of readers as long as I can read a little with good light if the font's not tiny. My preference would be to have intermediate and distance is sharp.

So, here are my questions:

~ Is this a true mini-monovision corrective package?
~ Would you say these are the best lens choices to achieve crisp vision with as little glare as possible?
~What do you see as the pros and cons re: having the astigmatic lens in my right eye or having Limbal Relaxing Incisions in that eye also?

Answer: What you are describing is a well planned and thought out approach to your vision correction needs and goals. The optical solution of using monovision is sound in light of your intolerance to the complex optical design of the multifocal lens implant. The optical quality and thus the vision results of astigmatism correcting toric lens implants is really quite good and predictable. The level of monovision at 1.75 D selected is pretty much in the "sweet spot" of monovision success and the fact that you have a clinical trial with contact lenses translates into a very high success rate. While LRI's are common and provide good results for many patients they can be a bit unpredictable and unstable and CAN induce dry eye symptoms-thus avoid another LRI would be our suggestion. On that note the only word of caution is absolutely make sure that your tear film is healthy and is of the maximum quantity it can be through whatever dry eye treatments your Cataract Surgeon feels would be most effective.

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