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Medical Forum / General / Vision / November 2006Closing in on Cataract Surgery
Cataracts in both eyes. Nuclear in the left, subcapsular in the right. Eye doctor recently told me I'm losing more distance vision. Left eye seems to be my close up vision, right seems to be distance. Right eye was lazy as a child, corrected with a patch over the left one (if that makes any difference). I'm aware I have astigmatism, also hypothyroid (positive Tg and TPO antibodies). Tried hard contact lenses early 20's, couldn't tolerate them under florescent lighting. I'm 55 now, and can no longer be helped with new glasses. Eye doctor wrote down last set of numbers for me: sphere cylinder axis OD -6 -75 +200 92 OS -11 25 +225 82 Since I seem destined to have surgery, probably sooner than later, trying to get an idea of what would be best for me. I'm the kid you saw in kindergarten with the coke bottle glasses, so it's probably understandable that I'd really like to toss the glasses after surgery. I've found a few doctors who only do monovision, and 2 doctors who do Crystalens, ReStor, and ReZoom, but they seem to favor one over the other on their web sites. Would it be feasible to try soft contacts, one near, one distant, even with the cataract to see how a monovision IOL might work out without glasses afterwards? Do any of the multifocus lenses work with astigmatism? At all? Anything on the horizon I should look forward to? Never have been able to see really well, so not expecting miracles, but after 50+ years of wearing glasses would so like to toss the frames after surgery. Is there a tool, book, article, list of questions to ask, etc. where I can get a better handle on what would work best for me so I can make a more informed decision? I'd sincerely appreciate any help. Thanks. Gerri >Cataracts in both eyes. Nuclear in the left, subcapsular in the right. >Eye doctor recently told me I'm losing more distance vision. Left eye [quoted text clipped - 15 lines] >understandable that I'd really like to toss the glasses after >surgery. It's certainly understandable but probably an unrealistic goal, unless your prepared to accept some compromise in your visual acuity and visual comfort. >I've found a few doctors who only do monovision, and 2 >doctors who do Crystalens, ReStor, and ReZoom, but they seem to favor >one over the other on their web sites. Would it be feasible to try soft >contacts, one near, one distant, even with the cataract to see how a >monovision IOL might work out without glasses afterwards? You'll only get a rough idea due to the loss of vision and the type of cataract in the left eye. From my experience the short answer is that monovision can work reasonably well with emerging presbyopes, and not so well for advance presbyopes. >Do any of the >multifocus lenses work with astigmatism? Not if it's corneal astigmatism, although I believe there are toric IOLs. I've never seen anyone have one implanted though, probably because the vision is unsatisfactory. >At all? Only marginal success. >Anything on the >horizon I should look forward to? Nanotechnology? >Never have been able to see really >well, so not expecting miracles, but after 50+ years of wearing glasses >would so like to toss the frames after surgery. In general, the best that can be hoped for is a reduced reliance on eyeglasses. I would be looking for safety, quality of vision, and visual comfort. >Is there a tool, book, >article, list of questions to ask, etc. where I can get a better handle >on what would work best for me so I can make a more informed decision? There's a lot of good threads with useful info right here at sci.med.vision. >I'd sincerely appreciate any help. Thanks. > >Gerri Hope this helps, Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr > Cataracts in both eyes. Nuclear in the left, subcapsular in the right. > Eye doctor recently told me I'm losing more distance vision. Left eye [quoted text clipped - 29 lines] > > Gerri With your history of right eye amblyopia (ie. lazy eye) along with your moderate myopia and astigmatism, there ain't no way you're going to be totally free from a spectacle correction/contact lenses after cataract surgery. You're just asking too much for what the current IOL technology has to offer. I'd go for best distance correction (especially important since you are amblyopic), maybe consider a little undercorrection for your right eye (to help with reading) and be happy. frank You have significant astigmatism. Without some kind of astigmatism correction, you'll have blurry vision at all distances post-cataract surgery without glasses/contacts. You're best bet for correcting astigmatism at the time of surgery would probably be toric IOLs and/or limbal relaxing incisions. There's a new toric lens by AcrySof, but it comes in a limited range of powers which probably wouldn't include the correction that you'd need. There's also a toric IOL available by B&L that might work for you. A cataract surgeon who is experienced in astigmatism correction could probably give you close to 20/20 vision for distance post-surgery. Opinions about the multifocal IOLs vary. Some people are happy with them; others report absolute horror stories. There are lots of reports posted at Med Help International (Eye Care Forum), which I strongly suggest you check out before proceeding. If you do go this route, you'd undoubtedly need laser vision correction post-cataract surgery to address your astigmatism. Plan on spending several thousand dollars out of pocket. There's lots of into available online about cataract surgery options. It would certainly be worth your time doing some research before scheduling consultations with surgeons. But you can end up with the best vision you ever had in your life (at least for distance.) Hi Everyone, I did some reading about the toric IOL and wondering if a piggyback might work for my heavy duty astigmatism. Made an appointment with a surgeon based on his office stating he's working with the newer IOL's including the toric. Also that he and the facility are both in network. I'm unsure of the info given about the toric being an extra $500 per eye. Can that be right? I was really expecting that figure to be higher. Now I'm wondering if we're talking about the same thing. Does anyone know if this would be a usual/customery price for a toric IOL? Or maybe I'm justing getting nervous? :-) Thanks again! > You have significant astigmatism. Without some kind of astigmatism > correction, you'll have blurry vision at all distances post-cataract [quoted text clipped - 19 lines] > scheduling consultations with surgeons. But you can end up with the > best vision you ever had in your life (at least for distance.) You should opt for limbal relaxing incisions, providing your surgeon is good at it and offers it, as your 2.00 cyls are good for that procedure. I think it's a lot more predictable than toric iols. I'd recommend a moderate undercorrection (-1.00 or -1.50 target) on your left eye, and a very slight undercorrection on the right (-.50 target), which is accustomed to being less near sighted. Do not let them talk you into a multifocal or "focusing" type lens. w.stacy, o.d. >Hi Everyone, > [quoted text clipped - 38 lines] > > jerzger, The AcrySof toric IOL is technically not a "premium" lens like the multifocals However, my surgeon charged an extra $1000 for it. (I'm not sure whether that was per eye or for both eyes.) It is an excellent lens which proved to be more reliable at reducing astigmatism than limbal relaxing incisions in the clinical trials. However, it comes in only a limited range of powers. From the info you posted, it probably would not come in the power you'd need to correct your myopia. The Staar toric IOL is another possibility, although some surgeons have complained that it tends to rotate in the eye, thereby negating the astigmatism correction. Your surgeon should be able to recommend what would work best in your situation. > Cataracts in both eyes. > sphere cylinder axis > OD -6 -75 +200 92 [quoted text clipped - 17 lines] > > I'd sincerely appreciate any help. Thanks. With a current correction of -6 and -11, you certainly have the option of "tossing" your glasses. Those thick and heavy glasses will be but a painful memory. I ditched mine, and now I can get out of bed and do many things with no glasses. I can't read and I can't use the computers because I am heavily dependent on reading glasses. However, they are quite light and comfortable compared to my old glasses (I was -10 and -12 before cataract surgery). With a 5 diopter difference between your eyes, and based on what you posted, you may find that monovision is easier for you to get used to than for other people who are used to using both eyes together. I have never tried monovision, but people I've talked to like it if it works for them. I haven't heard much good about the multifocal IOLs. Be aware that although you may have some choices, you don't always get what you ask for. I was lucky, and both my eyes came in exactly as planned, but there is some variation beyond the control of the surgeon. You may still end up with glasses, although they will be much thinner, depending on the strength of the IOL. I would suggest going back through old posts on this group posted by people who have been through this. I also talked to people at work who had helpful stories. My OD was very helpful. Of course, the surgeon is the one who is the expert, but I found it helpful to talk to others also.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA |
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