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.

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 www.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 of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.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 for 87 Year Old?

Question: My 87 year old father will be having his 2nd eye cataract removal soon. He had the first cataract done 5 years ago with another cataract surgeon. This time the surgeon recommended a toric lens. This cataract specialist's nurse told my dad he had an astigmatism and they would need to use the toric lens. My Dad agreed, but now is wondering at his age, if this toric lens is absolutely necessary. When he had the first cataract surgery, they didn't use a special lens. We are willing to go ahead with the procedure, but would like your input as to the necessity of the special toric lens. Thanks for your help!


Answer: There first thing you should know is that toric lens implants to correct astigmatism weren’t available as an option 5 years ago when your father’s first cataract was removed and this may be the reason a conventional monofocal lens implant was used. Or, it could have been possible that even if they were available, your father didn’t have astigmatism in the first eye. People who have preexisting astigmatism-astigmatism before cataract surgery-will need to have their astigmatism corrected by one of three methods in order to see as well as they should after cataract surgery. People with astigmatism can wear eyeglasses after cataract surgery, have a second surgery to correct astigmatism called Limbal Relaxing Incisions (LRI) or have an astigmatism correcting toric lens implant (IOL) as part of the cataract surgery. The astigmatism needs to be corrected by one of these methods so that your father can see his best.

As we get older, the need to see clearly remains quite important, not only for our daily activities but also for our mobility and safety. You and your father have to decide which of the three ways is best for your finances, lifestyle and safety. Being dependent on eyeglasses to get out of bed in the dark or dim illumination can be a big deal-one missed step, one stumble on a rug can be a disaster-thus unless there is some compelling reason otherwise, seeking “glasses free” correction through the LRI or toric lens is a better option at 87 years old. ALL three options have cost-some greater than others, and only you and your father can decide.

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 www.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 of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.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 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.

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 www.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 of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.