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.

Fuzzy Lens Implant Vision

Question: My cataract surgeon misunderstood what kind of vision I wished to have and my toric lens implant has reduced my distance vision in my left eye so that it is fuzzy. It was my good distance eye and I was functioning quite well seeing inside and out. Now all I see is fuzziness until I put on glasses which I was trying to avoid for most of my activities. Can this be corrected or am I stuck with this situation?


Answer: From what you describe it sounds as if your left eye may have been calculated to help you see at intermediate or near range rather than at distance. In light of the fact that you do not wish to wear glasses there are really two options to discuss with your Cataract Surgeon. If your eye health is otherwise normal and the primary Cataract Surgery and Lens Implant procedure that you had was basically uneventful, then it may possible to have a Lens Exchange, whereby the Lens Implant is removed and exchanged for one with a more appropriate power so as to correct your distance vision. Another alternative is possibly to seek the advice of a LASIK Surgeon who can tell you if it would be possible to correct the vision with a LASIK Surgery procedure so that your distance vision was crisper and clearer for you.

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 & Prostate Medication Tamsulosin

Question: I am about to have cataract surgery and concerned about complications with Tamsulosin. I lost the sight in my left eye years ago and now have a cataract on my right eye. I have a slight astigmatism and take .4mg Tamsulosin daily. What should I be aware of to discuss with my cataract surgeon prior to surgery?


Answer: The use of Tamsulosin-a selective alpha antagonist or blocker-to treat prostate enlargement or benign prostate hyperplasia (BPH) and urinary symptoms has been closely linked to complications during Cataract Surgery. Patients taking tamsulosin are prone to a complication known as Intraoperative Floppy Iris Syndrome (IFIS) during Cataract Surgery. Adverse outcomes of the Cataract operation are greatly reduced by your Cataract Surgeon’s prior knowledge that you take this drug and thus having the option of alternative techniques. With alternative procedures and techniques, the complications can be managed and greatly reduces. PLEASE ADVISE YOUR CATARACT SURGEON THAT YOU ARE TAKING TAMSULOSIN ASAP.

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.

NY Cataract & Eye Care Mobile Web Site

Seeta Eye Centers, a leading NY Cataract and Ophthalmology practice is pleased to announce the launch of its new cataract and eye care mobile web site. Patients who use an iPhone, Android or any mobile smartphone or computer tablet like an iPad and wish to learn more about cataracts, cataract surgery or lens implants, or who want to schedule an eye exam for a cataract and lens implant consultation can simply search Seeta Eye Center and click through to get information and dial the practice directly with the touch of a finger.

If you are at a desktop computer and want to use a regular phone to schedule an appointment reach us at 845-454-1025 or for greater detail and more in depth information visit Seeta Eye Center or to just be social come see us at facebook.com/seetaeyecenters

Crystalens® Lens Implant for Cataracts after LASIK

Question: I am 65 and had LASIK surgery 12 years ago. I am 65 now and will have cataract surgery in October on the right eye. Can I use the Crystalens® Lens Implant? After my LASIK surgery, my far vision improved to 20-20, but I had to wear reading glasses.


Answer: It may or may not be advisable for you to have a Crystalens® Accommodating Lens Implant after Cataract Surgery if you have had previous LASIK Surgery. Once you have had LASIK, the precision with which your Cataract Surgeon can measure and calculate the IOL power is somewhat diminished in certain instances. IF, you have the preoperative measurements from your LASIK procedure it will be very helpful to your Cataract Surgeon in this determination. Crystalens® Accommodating Lens Implants can actually be a bit unpredictable in their visual results for some patients even without previous LASIK, so the decision will also depend on the comfort level and consistency of results the surgeon has experienced with this IOL. Should this not be a good option then you may wish to consider Monovision Lens Implants which would also help with near vision correction.

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.

Mature Cataract Risks

Question: My mother has a mature cataract in her left eye that needs to be removed the old fashion way rather than by laser. My mother is 81 and in excellent health. What is a mature cataract and is it a more difficult case with more risk of complications. Does she need an ordinary ophthalmologist or a cataract specialist?

Answer: A mature cataract is one that is quite dense. Waiting too long for cataract surgery can result is some unintended consequences and possible risks. As a cataract matures, it does become denser and somewhat more difficult to remove. This requires more energy and may lead to prolonged inflammation or even intraoperative complications. If a patient delays cataract surgery too long the cataract to become so dense, swollen and cloudy that it causes a type of glaucoma. Cataract Surgery for a mature cataract does require a somewhat greater skill and experience however most ophthalmologists who are Cataract Surgeons are quite capable of safely performing this type of procedure.

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.

Trifocals after Cataract Surgery

Question: I had cataract surgery three weeks ago and now I need trifocal glasses to get 20/25 vision. Before surgery my cataract surgeon said I might need glasses for reading. After surgery he said he was very happy with the outcome. I am very disappointed, what happened?

Answer: It is not clear from your description what your problem actually is. The visual acuity of 20/25 refers to distance vision. If you are saying that you need to wear eyeglasses to see clearly at distance this suggests that either the measurements of calculation of the Lens Implant power was not quite precise. However, it is only three weeks after your cataract operation and is entirely possible that the prescription will change further and improve your uncorrected distance vision. You need to discuss this with your Cataract Surgeon so that he can give you a timeframe after which your vision and prescription-if any-is stable.

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.

Retinal Tear before Cataract Surgery

Question: I had a small retinal tear which was treated by a laser procedure in the office of the retinal specialist. He says the procedure was successful. Can this affect the outcome of cataract surgery with the implant of a monovision lens and a toric lens?

Answer: Any type of previous retinal tear, detachment, hole or other pathology requires due but not excessive caution if the Retinal Specialist has provided clearance for Cataract Surgery to a Cataract Surgeon. A monovision toric lens implant offers no additional or exceptional risk or challenge to the outcome. Follow the advice of your Retinal Specialist and 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.

Type 1 Diabetes & Cataracts

Question: I am Type 1 Diabetic and my Optometrist told me that I had the start of very small cataracts in 2008. I have not had any problems with them. At the start of July 2012 I noticed all of a sudden a small amount of fogginess at the top of my vision in my right eye. I went and saw my Ophthalmologist and after numerous tests he told me that the cataracts were minor and that he could not see anything wrong with my eye and to go and buy some eye drops. 5 weeks later the fogginess has become much worse and the vision in the entire eye is cloudy. I had a prescription check at the Optometrist as I thought maybe that could be the problem and she said that it could not be the cataract as it is so small and she did not know what the problem was. I then went back to the Ophthalmologist and he said that I needed to have cataract surgery and booked me in and took measurements etc. I asked him if he was sure it was the cataract as he said that it wasn't a problem 5 weeks ago. He said it had to be as it wasn't anything else. So I am just wondering if cataracts can develop this fast, from normal vision to very very cloudy in just 6 weeks? I am very scared of this surgery as I think the fogginess will still be there after the operation and maybe I have been misdiagnosed.


Answer: Cataracts are an extremely common eye problem associated with Diabetes. Data from the Framingham and other eye studies indicate a three to four fold increased prevalence of cataract in patients with diabetes under the age of 65, and up to a twofold excess prevalence in patients above 65. The risk is increased in patients with longer duration of diabetes and in those with poor metabolic control. A special type of cataract—known as snowflake cataract—is seen predominantly in young type 1 diabetic patients and tends to progress rapidly. Another type of cataract called a posterior sub capsular cataract is also extremely rapid in its progression and tends to locate along the visual axis which decreases vision quite rapidly.

That said, you must be certain that your blood glucose is stable and that there is no evidence of Diabetic Macular Edema which would also cause a variable and quick drop in vision. These are things in all likelihood your Cataract Surgeon considered and ruled out prior to making the final diagnosis.

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.