Closing 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

jerzger wrote:
> 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

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

In article <(E-Mail Removed). com>,
"jerzger" <(E-Mail Removed)> wrote:

> Cataracts in both eyes.

> 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.


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.

--
Dan Abel
(E-Mail Removed)
Petaluma, California, USA

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!

Jane wrote:
> 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.)

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.

jerzger wrote:

>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!
>
>Jane wrote:
>
>
>>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.)
>>
>>
>
>
>

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.