Cataract Surgery with Astigmatism & Prism

Question: I will be having cataract surgery on both eyes in the next few months. I have significant myopia and prism - which I understand that the cataract surgery will not correct, so that I will still need corrective lenses after the surgery. I also have significant astigmatism. The cataract surgeon has suggested using toric implant lenses to correct the astigmatism but I am wondering whether basic monofocal implants might be a better choice since I will need to wear glasses after surgery anyway and the glasses can correct both the astigmatism and the prism.

The toric lenses would cost a total of $2400 more than the monofocal lensimplants which I can deal with so I am only concerned with making the best long-term choice. 

Answer: The goal of cataract surgery is to give you the best overall functional vision that you can achieve so that you can participate in whatever activities you wish in the most comfortable and safest manner. With modern cataract surgery and lens implants it is possible to correct your nearsightedness and astigmatism-but not the prism correction, upon removal of the cataract. This would be the best choice to consider-even though you will need eyeglasses for the prism correction as it will provide the greatest degree of clarity. Sure, you could have BOTH the astigmatism and the prism correction in the eyeglasses-but as you will likely find out, it is much more comfortable and convenient to see your best even without the glasses. Generally speaking, the less dependent you can be on eyeglasses, the better and safer the quality of life-have the toric lens implant if that’s what your cataract surgeon suggests.

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 Vision Blur & Sloping

Question:  My wife recently had cataract surgery with a toric lens implant for astigmatism in her right eye. 10 days after her operation the vision is fuzzy-out of focus-and horizontal surfaces seem to slope to the right, and despite several attempts the cataract surgeon was unable to find any external lens or combination that would give any clearer vision. She can see clearly through a pin-hole mask and the macula, retina, and pressure are all good, and the lens seems to be correctly placed. They say come back in 6 weeks - what do you recommend? 

Answer: There are many reasons that your wife may be experiencing blur that clears with a pinhole mask and also several others that might cause a sloping of her vision. Some of these are related to the healing process and should self limit in the next 6 weeks as your cataract surgeon suggests. Others may not clear and could represent complications that require more immediate attention and possibly intervention as they could involve the retina. While you state that the retina is normal, prudence suggests that a retina consultation is to be considered to rule out subtle swelling of the macula, fine epiretinal membrane formation and other subtle changes that might be contributing. A conservative approach would be to have the retina consultation now and then the waiting for six weeks will likely be a less anxious time.

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 Rotation Problem

Question: I have just had cataract surgery and a toric lens implant for astigmatism in my left eye done. My cataract surgeon told me the lens had "rotated" about 10 degrees-how serious is this?  Should I consider correcting this?  How soon?  I am doing my right eye next week. 

Answer: It is possible to have a primary misalignment during the cataract surgery itself or in the unusual case a secondary rotation of the toric lens implant after the surgery. This is extremely rare with the Alcon AcrySof® Toric Lens Implant but is known to occur with other brands. In any event, there is no need to be concerned or to actually do anything to adjust the rotation unless it causes a problem with vision. A small rotation of 10 degrees-unless it is a very significant amount of astigmatism-should not typically cause too much vision disturbance. The best course of action is to follow the recommendation of your 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.

Vision without Toric Lens Implant for Astigmatism

Question: I need cataract surgery and have significant astigmatism but can’t afford a toric lens implant to correct the astigmatism. How much less "good" vision I will have because of this?

Answer: Depending of the amount and the orientation of the astigmatism you could have somewhat distorted or blurred vision for far and near. If you do not have a toric lens implant it is possible that you could have Limbal Relaxing Incisions (LRI) or else you will likely have to wear glasses to see clearly. When making the decision not to have a toric lens implant to correct your astigmatism make sure that you take into account the recurring cost of buying glasses for the astigmatism correction over the course of multiple years.

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 Rotation

Question: I had cataract surgery and an astigmatism correcting toric lens implant for a moderate cataract almost 6 months ago. I complained that my vision was way off after cataract surgery and I could see better when I tilted my head a lot. My cataract surgeon found the toric implant to be and said it needed to be corrected, which lead to a second surgery on same eye. I have been complaining for the whole time since then to my eye doctor and my cataract surgeon that my vision became blurry and I am not able to focus both eyes together-my vision is terrible. Now, my Cataract Surgeon tells me the toric lens implant rotated again and he will not reposition it as a thick haze has developed which makes it difficult to read and see with that eye. They recommend I have a laser treatment in the surgeon's office to help get rid of the haze, but once I do that I cannot have the lens repositioned.  I am at a loss of what to do, as my vision is so terrible and I can no longer read.  I have asked my eye doctor to send me to another eye specialist and surgeon for second opinion and recommendation but he said I have to finish with my current Cataract Surgeon. Help - is there something that can be done to improve my vision since the second time toric lens rotated it is still off.

Answer: Most Cataract Surgeons would not go back yet again and reoperate to correct the rotation of the toric lens implant-too much surgery. A YAG Laser Capsulotomy would BE THE LAST STEP to be taken after all other options for correcting your vision have been explored. There may very well be posterior capsular opacification or a secondary cataract causing the haze-or there may be other problems with the lens capsule causing the haze. It needs to be carefully determined. Also, a very careful refraction and examination of the amount and direction of the astigmatism present on your cornea needs to be observed. Further, a careful and thorough examination of your retina, especially the macula, needs to be performed to be certain that there is no swelling causing the distortion of your vision. One would suspect that the initial toric lens implantation was performed “off axis” as these lenses do not typically rotate excessively as you describe-but it could happen. You should find the best Cataract Surgeon in your area and seek a second opinion.

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.