Toric Lens Implant or LRI for Astigmatism

Question: I have cataracts and astigmatism and have seen two cataract surgeons. One recommended LRI and one recommended toric lens implants with cataract surgery. Which is better to do?

Answer: Both Toric Lens Implants and Limbal Relaxing Incisions (LRI) can be used to correct astigmatism with Cataract Surgery. Depending on the amount of astigmatism, the health of the cornea, the quality and quantity of the tear film and a few other factors, there may be a preference in the hands of some Cataract Surgeons. The predictability, stability and precision of Toric Lens Implants is generally considered to be better by most eye surgeons.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Toric Lens Implant Option

Question: I had cataract surgery and a lens implant on my right eye. The cataract surgeon dilated my eyes before surgery and I do have a astigmatism. Shouldn't I have had the toric lens implant? 

Answer: The decision and necessity of having a Toric Lens Implant with Cataract Surgery really depends on more than simply having astigmatism. The appropriateness depends on the amount and direction of astigmatism in the prescription itself, the amount and direction of the astigmatism created by the shape of the cornea as well as the location of the surgical incision to be made for the Cataract Surgery itself. That said, if it were necessary to have a Toric Lens Implant it is highly likely that your cataract Surgeon would have suggested this option.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Lens Implant Choice Confusion

Question: I have cataracts and need cataract surgery but have been given three different opinions of the type of lens implant that I should have and am now confused.   Two cataract surgeons suggested not having Crystalens®, while one did.  One suggested a toric lens implant and the other a ReSTOR® IOL.  The eye surgeon who recommended the Crystalens® explained that my astigmatism is very small and may be corrected to a great degree by the natural lens removal.  The cataract surgeon who recommended the ReSTOR® IOL also would use LenSx® femtosecond laser to do the cataract removal and make any correction for the astigmatism.  The other two doctors do not feel laser use is necessary.  The ideal of a multifocal lens implant appeals to me, especially if I can obtain very good vision without glasses.  My current refraction is OD: -9.00-1.00 x 141 Axis and OS: -8.00-.075 x 048.  I do have a +2.25 add for both eyes for reading using progressive lens. The question is how does one determine what to choose? Do I continue to seek more suggestions?  I went to the 3^rd eye surgeon when I received two really different recommendations. Now I have three different options.

Answer: Indeed this can be confusing when there are multiple opinions on lens implants from the various Cataract Surgeons. First, let’s consider the astigmatism. It is not completely possible to tell from information provided without knowing the corneal topography measurements, but it is reasonable to think that the astigmatism is at least in part due to the changes in the crystalline lens itself and would be reduced or eliminated by the cataract surgery itself or could be quite well managed by the planned placement of the cataract surgery incision or a laser LRI if needed. Based on this one would believe that a toric lens implant is not necessary. Now, regarding the use of either an accommodating lens implant such as Crystalens® or a multifocal lens implants such as ReSTOR®, technically either of these could assist you with being less dependent or independent of glasses after cataract surgery for most activities. Generally, those patients who like to have crisper clear near reading vision do much better with ReSTOR®. In fact there is significant bias among the Cataract Surgeons we queried that suggested NOT opting for Crystalens® for a number of reasons. The use of the LenSx® femtosecond laser does appear to offer some advantages for some patients, but is really a decision made by the individual Cataract Surgeon.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Poor Near Vision after Cataract Surgery

Question: I had cataract surgery on both eyes two months ago and my near vision is now poor. Before surgery my close up vision was extraordinary. I could read the smallest lettering and see very fine detail. My distance vision was fair. I did not wear glasses for distance vision except at night, driving. I did explain to the cataract surgeon that I did not want to lose the close up vision because 80% of what I do requires excellent close up capability. Since my cataract surgery I cannot see anything smaller than a quarter inch in height and so essentially need glasses for everything I do.  My question is can the cataract surgery be reversed to give you your original sight back or am I stuck being so handicapped. Can additional surgery be performed to give me both distance and close up vision?

Answer: It is possible that as the cataracts progressed prior to your cataract surgery you became progressively more nearsighted enabling you to read and see clearly up close. Once the proper lens implant calculations were made and your surgery was performed you achieved the appropriate distance correction and thus were no longer nearsighted or able to see up close. This is unfortunate if most of your daily activities are requiring excellent near vision correction. There are a number of choices and options that can discuss with your Cataract Surgeon. First of course is that you can just wear glasses-which does not seem to be a good choice for you. Second, you can explore whether a monovision correction allowing one eye to be corrected for near, might be appropriate. This can be demonstrated by placing a contact lens in one eye to approximate the near vision. If it is satisfactory, then there are two possible ways to achieve the monovision correction with the lens implants. One way is to see if your Cataract Surgeon cans perform a lens implant exchange to adjust the power of the lens. The other is to have LASIK or some other Corneal Laser Eye Surgery to achieve the monovision correction in the non dominant eye. All of these options really depend on the results of a thorough consultation and examination to really determine exactly what is possible and with what potential result.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Lens Implants & Fluttering Vision after Cataract Surgery

Question: I had lens implants and cataract surgery 2 1/2 months ago. I am still experiencing consistent fluttering of the lens and shadows on the perimeter of the lens. Florescent lighting seems to intensify the symptoms.  What has happened?

Answer: It is not possible to determine the exact reason for the fluttering vision after your lens implant and cataract surgery, however one would suspect that what you are experiencing is due to reflections off the lens implant edges or other optical phenomenon related to the lens implants.

A type of optical side effect called “dysphotopsia” may in part be the cause as well as edge reflection. You should certainly discuss this with your Cataract Surgeon but rest assured that for the great majority of patients it does self limit albeit taking differing amounts and sometime longer timeframes for some patients.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Dizziness after Cataract Surgery

Question: I am a 59 1/2 year old woman who has cataracts and had cataract surgery on my left eye. I developed a secondary cataract so 3 months later I had laser surgery.  My vision is still blurry and getting worse. I used Acular, Pred Forte and Systane eye drops 4x/day. Within 2 days of starting these meds I experienced severe dizziness and was unable to stand up and walk without holding onto someone or something. I am no longer using the drops.  Are there other options for treatment?  It is very worrisome because my right eye also has a cataract.

Answer: What you are experiencing is not within the expectations of routine Cataract Surgery. It is not expected that the vision will get blurrier-especially after a YAG Laser capsulotomy to clear a secondary membrane or posterior capsular opacification (PCO). Further, the fact that you are experiencing dizziness is not normal and may not even be related to the Cataract operation. In discussion with your Cataract Surgeon you should inquire about a consultation with a Retinal Specialist to rule out maculopathy or macular edema or swelling which could be  related to the  Cataract Surgery or not. In addition, in discussion with your Cataract Surgeon you need to inquire as to whether the untreated right eye is also contributing by creating a significant optical imbalance between the two eyes-called anisometropia. Last, you must make sure with your internist or family physician that there are no other health issues contributing to the dizziness.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery Complication & Outcome Concern

Question: I am in need of cataract surgery and am concerned about possible complications as a result of several pre-existing conditions that could impact the outcome of a cataract operation. These concerns include that I am a well controlled Type 2 diabetic for more than 10 years, I have chronic idiopathic neutropenia and I have been diagnosed with a posterior vitreous detachment (PVD) within the last year. Will this impact the outcome of cataract surgery?

Answer: Assuming that the diabetes has not resulted in diabetic retinopathy-including diabetic macular edema-and the retina and retinal vasculature are otherwise healthy, the Type 2 diabetes should NOT be of concern. If there is some baseline retinopathy or macular edema, your Cataract Surgeon or a Retina Specialist might want you to have one or more intravitreal Lucentis® Injections to prevent and reverse the vascular effects and edema from the diabetes. This is quite manageable. Chronic idiopathic neutropenia only comes into the picture if there is an acute infection to fight-not a typical occurrence with all the intense antibiotic eye drop prophylaxis used today. As long as there is no evidence of retinal traction or operulated retinal tears or holes present, a posterior vitreous detachment (PVD) is not of any real concern. Some 50% or more of patients having Cataract Surgery experience a PVD anyway. Just be sensitive to any increase in flashes, floaters, the presence of “curtains” or “veils’ or “bowing”, distortion” or “bending” of the  vision as this could indicate a retinal problem after surgery.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.