Toric Intraocular Lenses

Toric IOL for astigmatism

Astigmatism Blurs Your Vision

A Toric intraocular lens is a great way to correct your astigmatism at the time of cataract surgery.

Astigmatism is very common. It can cause blurry vision and may be corrected a variety of ways; glasses, contacts, laser eye surgery or by a toric intraocular lens at the time of cataract surgery.

Astigmatism

If you have astigmatism it means that your eye that is shaped more like and egg than perfectly round like a ball.  This irregular shape makes your vision blurry and needs to be corrected for your ideal vision.

Your cataract surgeon will need to measure the shape of your cornea to know how much astigmatism you have.  If you have enough astigmatism to make your vision blurry, you may be a good candidate for toric intraocular lenses often called toric intraocular lens.

Some patients do not have astigmatism or have so little that no astigmatism correction is needed at the time of cataract surgery.  These patients do not need toric intraocular lenses and are better served with a standard IOL.

Toric Intraocular lens vs. Glasses

Just like a pair of glasses can have astigmatism correction in the lens, an intraocular lens can also have the astigmatism correction built right into it.  A lens implant that correct astigmatism is called a toric intraocular lens.

Recently I was able to help a friend I will call Wendy.  She had been near sighted with a lot of astigmatism since she was young.  She adapted well to her visual problems throughout her life, but when it was time for her cataract removal procedure she jumped at the chance to have her astigmatism corrected with  a toric intraocular lens.  She reflected on how hard it had been to get good glasses prescriptions and to keep her glasses adjusted correctly over the years.

A toric intraocular lens definitely was the right choice for her and she is elated with her vision.  While I cannot promise that you would share her same enthusiasm, her results are typical for many with moderate and high levels of astigmatism.  Patients that have suffered with astigmatism throughout their lives that choose a toric intraocular lens tend to be the happiest of all my cataract removal patients.

The toric intraocular lens generally gives better optical quality than glasses because the intraocular lens corrects the vision inside the eye so you are always looking through the center of the lens and it can’t move. The toric intraocular lens locks into place shortly after cataract surgery, making it very stable over the course of your life.

Glasses, on the other hand, sit out away from your eyes so they can slip out of place as you move your head, be out of adjustment, or dirty. Even if you are planning to wear glasses full time after cataract surgery, fixing the astigmatism with a toric IOL usually makes your glasses thinner, lighter, and easier to keep in adjustment.  If you choose a toric intraocular lens,  it is very likely that you will not need glasses for distance vision.  In case you can’t tell, I love these toric intraocular lenses for my patients.

Types of Toric Intraocular Lenses

Acrysoft Toric Lens Implant for astigmatism

Acrysoft Toric Lens Implant

The Acrysoft toric IOL is the only toric intraocular lens implant that has both uv protection and high energy blue protection, which protects the retina from the sun and decreases night glare.  It has a long track record of success.

The Technis Toric IOL and the enVista Toric intraocular lens were recently FDA approved and both have UV protection and good clinical data for safety and vision correction.  The Acrysoft, Technis, and enVista are all single vision intraocular lenses.

The Crystalens Trulign is a toric intraocular lens with some unique features.  This toric IOL has astigmatism correction built into an implant that can accommodate for different distances to decrease your need for glasses for computer and reading.

The clinical data for the multifocal ReSTOR Toric intraocular lens has been submitted to the FDA.  When it is approved, it will be the first toric multifocal lens for both distance and near vision without glasses in the U.S.

The Cost of Toric Intraocular lenses

Surgical cataracts are considered medically necessary so standard IOLs are covered by most insurance companies. Correcting astigmatism is not considered medically necessary since you could choose to wear glasses instead.  For this reason, the toric intraocular lens is considered an advanced technology upgrade.

Insurance companies cover the medically necessary part of cataract removal, but if a toric intraocular lens are used, there is some additional charge that you pay out-of pocket for the upgrade to the better IOL.  The additional monies cover the expenses to purchase the higher priced toric intraocular lens and for the extra testing done to prepare for the astigmatism surgery.

Side Effects of the Toric Intraocular Lens

The main risk for a toric intraocular lens is that we correct most, but not quite all of your astigmatism. Prior to your surgery, a series of measurements are performed to determine how much astigmatism needs to be treated.  We measure your astigmatism using several different machines to increase our accuracy.  This process is important, but not perfect.  As a result, there could still be some amount of astigmatism remaining.

If your eye surgeon uses the ORA alignment system during surgery, the accuracy of astigmatism correction is greatly improved.

If you have enough astigmatism left over to affect your vision, there are options to further decrease the astigmatism.  These include glasses, contact lenses, limbal relaxing incisions, or laser vision correction.

A second category of risk is that the toric intraocular lens moves out of position before permanently locking in.  This is rare and could require a quick return to the operating room to reposition the IOL.

There are other potential complications that can occur with IOLs that are not specific to the toric intraocular lens.

If you have further questions about toric lenses, please schedule an appointment to meet with me or post a question in the comment sections below.

Gary J.L. Foster, MD
Board Certified Ophthalmologist
Cataract and Refractive Surgery
Fort Collins, Colorado 80525

Comments

  1. Sheryl. Bacon says:

    I had the multifocal toric lenses put in February; the YAG procedure in APril and I still have blurry vision. I was nearsighted, some astigmatism and glaucoma. Is there any help to clear up my eyes? I have been told I should never have had this lense put in and is too much of a risk to try to remove them due to the Yag procedure. ???????
    What now?

    • Sheryl: We do not have a toric multifocal FDA approved yet in the United States.
      The most common reason for blurry vision after a multifocal IOL is a small target miss, meaning that you are still a bit near/far sighted or have some untreated astigmatism. I have had occasions where no astigmatism was detected by normal methods but it was only detected using a wavefront analyzer like the Visx Wavescan or Tracey Technology iTrace machine. Once the residual astigmatism was identified, a plan for improving vision could be made. If this is the case then you could speak with your doctor about options and the safest way to decrease your target error.
      Another common reason for blurry vision after a multifocal IOL is dysfunctional tear syndrome often called dry eye syndrome. If this is why your vision is still blurry then your eye doctor could work with you to improve your tear film function.
      There are other potential considerations, but focusing on your target error and tear film solve most of the blurred vision problems so I would start there first.
      I hope this helps you find your best vision.

  2. Hi,
    I had toric implants back in june due to cataracts and astigmitism. before surgery my site was
    RX,sphere, cylinder,axis
    OD,+6.00,-2.50,165
    OS,-8.00,-1.50,008
    After the lens implant and now its November i just had my eyes checked and am getting glasses because everything is still blurry:
    OD,+0.25,-.2.00,100
    OS,0.55,-1.75,120
    My question is I still have astigmatism. My surgeon has told me its nothing, so i went to an eye doctor to get glasses because its too hard to see to drive. Can I do anything to correct the astigmatism? It seems just as bad as when I started.
    thanks

    • Judy: There are several options to fine tune residual astigmatism when it occurs. You will need to see an eye doctor in your area to find out which option will be the best route for you. First, you can wear glasses or contact lenses as you are currently doing. Second, the IOLs could be exchanged or rotated. Third, limbal relaxing incisions could be performed to make the corneas more round and decrease the astigmatism. Forth, you could have LASIK or PRK to decrease the astigmatism.

      The way I make these decisions with my patients is to first understand their desire. Some are fine with glasses and do not want any further surgery. Others desire a more accurate end target and are willing to consider an additional procedure to reach their goal.

      For these patient I dilate the pupil to notice the exact position of the toric lens and compare it to the preoperative goal. If, for example, I placed the toric lens at 75 degree but it rotated before it locked into place to 165 degrees, then sometimes the best option is to go back and rotate it back to 90 degrees to get rid of the astigmatism.

      If your cornea is of normal strength and your astigmatism is regular, often I will propose and LRI or laser procedure like LASIK or PRK to correct the astigmatism.

      If testing shows that your cornea is not strong enough for LRIs, LASIK, or PRK, then I give consideration to exchanging the toric lens for a different power.

      In all of these there needs to be a careful consideration of the potential benefits compared to the potential risks and alternative.

      Please let me know what you end up doing or if I can be of any further help.

  3. Jacqueline Booth says:

    Hello,
    A had a toric lens put in during cataract surgery to correct my astigmatism October 23, 2013. For 3 weeks, I had 20/20 vision in that left eye. The 4th week to the day since surgery, things were blurry. I was told the vision is now 20/25. I had a check up & it turns out, I had the perfect surgery as it is centered properly & has not rotated. There is no after cataract film. My doctor is perplexed & can’t help me. He said the Yag would not correct anything. I also have what is called “negative dysphotopsias, a dark arc in my perepheral vision & it seems to also be under my eye giving the sensation of a fat cheek. It is very annoying. Plus I see light beams on car headlights when driving or watching TV. I’m so disappointed that I had this done. I was advised to see my optometrist for glasses. My optometrist told me that my cataract is barely there in my right eye & that I do not need a toric lens in that eye. Also, I’m at least a year and a half of needing cataract surgery. He wondered if I was bad enough to have cataract surgery at all since my exam 2 years ago showed very little cataracts & an astigmatism of .75 in the left eye. I went to an opthamologist because I had a vitrious detachment which led to these events. When they did the exam for the cataracts I was asked if I see halos around lights, or blurry vision with glasses on & I said no. I asked the doctor if I really needed the surgery & he said it was close & he recommended it due to the astigmatism. He also scheduled me for the right eye 3 weeks after the 1st surgery. I decided to put it off due to the dark arc or shadow in my peripheral vision. I’ wondering if he did unnecessary surgery. He certainly doesn’t want to deal with me right now. He went on about how great the toric lens is & did not elaborate much on the risks, only saying it works in most people & the majority are very happy with it & the risks are low. So I’m in the minority with blurred vision as well as the dark shadow & light beams. Do you have any explanations for this or any advice on what I can do. Is it possible it could clear up? I should add that I have moderate blepharitis & mild to moderate dry eye. I asked if that could be a problem for cataract surgery & was told no. But now I wonder.
    Thank you, Jacqueline

    • Jacqueline:
      Most patients have a very good experience with the toric lens. I am sorry you are not. You raise three important issues: 1. Vision changes, 2. Negative dysphotopsias, 3. Surgery for your other eye.

      1. You had good vision for four weeks that became blurry.
      A couple of potential issues can arise at the one month mark. As the capsule contracts around the intraolcular lens, it locks the implant into place, but occationally will also slightly change the position of the lens or even cause it to tilt a bit. This could make you a bit near or farsighted or cause some astigmatism. An eye doctor can determine your prescription and determine the postioning of the lens. I like to use a diagnotic machine called the Tracie Analyzer to help me determine the positioning of the lens. Options to correct these types of issues include glasses, contact lenses, IOL exchange, or laser vision correction.
      Another problem that can occur at the four week mark is cystoid macular edema (CME). This occurs if swelling develops in the center of the retina. There is a test called an “OCT” that helps decide if there is any macular edema. There are medical treatments available for CME.
      Dry eye and blepharitis can blur vision. Treating these can improve vision and could decrease the lights you see from headlights at night.
      2. Negative Dysphotopsia
      Some patients will notice this during the healing phase after after cataract removal. Fortunately, it goes away for most by six months after surgery. It would be unusual for it to last longer than that for you. There is some controversy amount eye doctors about how to treat this if it persists and is problematice. Potential treatments include eye drops at night, positioning of your implant or placing a second implant over the top of the IOL. Again, it is most likely that this will improve for you over time with no intervention.
      3. Your Second Eye.
      You don’t have to have your second eye done until it bothers you.
      All the Best,
      Gary

      • Jacqueline Booth says:

        Hello Dr. Foster,
        I thank you very much for taking the time to answer my questions. You have brought up some possibilities that no one else has on the issues I’m having. My optometrist is referring me to a cataract specialist if things don’t change in a few months. At that time, I’d like to give them your response as a consideration to the problems. Again, I appreciate your comments.
        Have a Merry Christmas,
        Jacqueline

  4. Nina Lyons says:

    I have had retinal tears in the past and I have only a very mild astigmatism. I have been told that the Toric is a more risky than the standard lens in my situtation. Is this true?

    • Nina: Having had a retinal tear in the past would not disqualify a patient in and of itself in my opinion. There may be some other specific risk factors that your eye doctor has not clearly communicated that have added to that recommendation.
      You mentioned that you have a low amount of astigmatism. The amount of astigmatism could lead a doctor to recommend a toric lens, laser cataract surgery, or both.
      Some doctors are more committed to decreasing astigmatism than others. It is the same with patients. Some really desire to have it corrected at the time of surgery while others could care less. What matters most is do you want it improved and does the surgeon think he/she can safely help you with your goal.

  5. Low, Moderate, High Astigmatism. What are the guidelines? Glare and Starbursts are becoming more noticeable because of my cataracts. 74 y/o male.
    I’m thinking that the Crystalens and the toric version, Trulign, would give me the kind of vision I want.
    My last exam, and pretty much all my eye prescriptions for the last 10 years or so, show me farsighted +2.50 and +2.75 Spherical Diopters and -1.25 and -1.00 Cylinder for astigmatism.
    Would Toric Lenses be preferred?

  6. nuray bamanie says:

    My case is rather complex. I already did lasik for my two eyes ten years ago then underwent enhancement last year because my eye vision regressed. My problem now is not the lasik operation at all. My doctor about 6 months ago removed KAMRA implant for reading from my left eye because unfortunately it has damaged my first flap layer used for surgery causing sedementation and a hole in the flap. Then he gave me vexol which improved it to some point as the scar lessened on the cornea but I cannot see well with this eye because irregularities occurred and high astigmatisma. The doctor cannot go beyond this and suggested I wear contact lens for the left eye as my refraction is so huge now. I am saddened with this and I am looking for other options. So I want your advice and how I should move from here on.

    • Nuray:

      I am sorry you having so much trouble. The Kamra lens is not yet FDA approved, though I was in the U.S. FDA trial for the Kamra implant and have had a good experience with the implant. The company is preparing the data for submission to the FDA in the near future.

      The KAMRA corneal implant needs to be implanted deep in the cornea with plenty of overlying corneal tissue to avoid the corneal melting you described.

      All potential solutions to high refractive error and corneal trouble involve some risk. The biggest issue in determining the next step is the state of the cornea. If the cornea has regular astigmatism and you see well with glasses, then a toric intraocular lens is a possibility once the cornea has totally healed. If the natural lens is removed and a toric lens is placed, it would be possible to treat up to 4 diopters of astigmatism along with the near or farsightedness at the same time. This would not correct presbyopia so reading glasses would be needed unless monovision is selected.

      If the astigmatism is irregular and not well corrected by glasses, then topo-guided PRK with our without crosslinking and with or without a toric intraocular implant is a possibility that could be discussed with your eye surgeon, though caution, a gas perm contact lens, and time for further healing and better technology to become available may be the best course for now.
      God Bless with your decisions
      Gary

  7. Jacqueline says:

    Hello,
    I have dry eye & blepharitis. I had the Lipiflow procedure done about 6 weeks ago. It was $1,500 and made the blepharitis worse. I’m so disappointed & upset that I can’t seem to get this blepharitis under control & spent all that money for nothing, only to make things worse. I use warm compresses 2 to 3 times daily, ocusoft lid scrubs & TheraTears presevative free drops. I also use MGD Retaine eyedrops. I do blinking exercises many times daily. I’ve been on antibiotic oin tments, nothing works. When I went for a post lipiflow check up, I was told my eyes were very dry (worse after lipiflow) & the doctor put in punctual plugs. Not a big help. He won’t agree with me that the blepharitis & dry eye is worse after Lipiflow. I’ve read about using castor oil (organic, hexane free & cold pressed). and honey.
    The following is what I read as “self help for blepharitis” when all else fails.
    •Castor oil: (fresh and from the health food store) – place a small bit on a q-tip and apply to the inner lower lid margin.
    •Honey: same application as with castor oil. Thin with sterile spring water to reduce stinging. Honey is antibiotic, anti-fungal, and antiviral.

    I realize most doctors would think this is hogwash but I want to know if it is safe to use in or on eyelids? Also, your opinion on this type of treatment.
    Thank you,
    Jacqueline

    • Jacqueline:

      I am sorry you are having so much trouble with your blepharitis. It is important to understand what part of eyelid troubles are from blepharitis vs. meibomitis since the treatments are different. Many patients have both. Some have demodex also, which could require a different treatment strategy.

      Lid scrubs, steroids, and general antibiotics are intended to help blepharitis.

      Azasite, doxycycline, steroids, warm compresses, lid massage, fish oil by mouth, meibomian gland probing, and the lipiflow treatment are aimed at meibomitis problems.

      Results with the lipiflow treatment vary depending on the state of the meibomian glands. Those with mild to moderate meibomitis can have extended relief. Those with significant meibomian gland scarring will often have minimal relief.

      I have chosen to wait until there is more scientific data before purchasing the lipiflow machine specifically because the results vary so much between patients and the cost to the patient is high. There is no question that it is life altering for many while others are nonplused by the experience.

      I would personally look into some of the other treatments listed above with your doctor before using honey or castor oil given the paucity of scientific and safety data available.

      I have attached links to a couple of articles about honey as an antibiotic and an anti-inflammatory.

      Phytother Res. 2012 Apr;26(4):613-6. doi: 10.1002/ptr.3606. Epub 2011 Oct 6.
      Honey prophylaxis reduces the risk of endophthalmitis during perioperative period of eye surgery.
      Cernak M1, Majtanova N, Cernak A, Majtan J.

      Evid Based Complement Alternat Med. 2014;2014:287540. doi: 10.1155/2014/287540. Epub 2014 Feb 24.
      A double blind clinical trial on the efficacy of honey drop in vernal keratoconjunctivitis.
      Salehi A1, Jabarzare S2, Neurmohamadi M2, Kheiri S3, Rafieian-Kopaei M2.

      I hope this helps
      Gary

      • Jacqueline says:

        Dr. Foster,
        Again, I thank you for taking the time to answer my email.

        My doctor’s office had me answer questions & did a Lipiview test before doing the Lipiflow. I was told I do have meibomian gland disfunction as well as blepharitis. Also ,that I don’t blink all the way when they did the test. Out of 8 blinks, 6 were not complete on one eye & 5 out of 8 on the other eye were not complete. It showed blocked glands but not sure how bad that was. I was told I was a good candidate for Lipiflow. The doctor checked my glands after the treatment & said things were flowing nicely.

        On my follow up appointment after the Lipiflow treatment, I asked if I have Demodex Mites & the doctor said no in a tone that he thought it was a ridiculous question. If he did check me for demodex mites, I read it takes a slit lamp. It seems he would have told me if he was checking for that. I don’t understand why Lipiflow would make my symptoms worse & was not given an answer to that question. What he said was “most people say things did not improve & he never heard of it getting worse”. Of course the downside of Lipiflow is in a paper that I had to sign which states, it may not improve & symptoms could get worse. I was advised to use Lotemax & that was it. I feel the doctor should have explained in more detail that the success of Lipiflow would depend on the severity of gland disfuntion. Can the Lipiview test show this? I’d like to think the doctor was trying to help. All I know is my symptoms have increased such as more crusting even shortly after the warm compresses, a constant feeling of heavyness on my eyelids,light sensitivity which I did not have before and increased dryness. I was better able to treat it before Lipiview.

        Do you think my symptoms will let up somewhat doing the Lotemax gel & will they return after stopping the Lotemax? My eyelids are drooping more & more as time goes on. Using the warm compresses is giving me more wrinkles & bags under the eyes that were not there before all this heat which I’ve been doing for nearly 2 years now. Is there anything I can do to protect the skin around my eyes from the warm compresses? Anything you can suggest would be much appreciated.

        I can certainly understand you wanting to wait for more data on this Lipiflow machine before purchasing . It shows your concern for patients. I wish I lived closer to you.

        I will check out those websites you sent to me concerning the honey. I don’t want to do anything to make matters worse. Thank you very much for that information.

        Jacqueline

  8. deb mohler says:

    I paid for toric lens with ORA but have found out through a second opinion that only one is a toric the other an premium IOL .this surgery left me with reading vision 3 times worse and intermediate vision ( that I never had problems with) not good. I also had a retinal tear after this and am dealing still with this also. they did lazer and know said I may need more surgery to remove fulid if it doesn’t go away.
    what a nightmare I should never of had this done. they took my money and told me I didn’t need to come back to them any more .
    do you need to have the same kind of lens in both eyes to make them work correctly and do they cost the same?

    • Deb: Sorry you are having problems. It would be helpful to know what kind of premium IOL you have in the non-toric eye so I can better answer you question.
      Gary Foster

  9. Luciana Vieira says:

    Dr. Foster,
    Is there any toric multifocal IOL FDA approved in the United States?
    Thank you
    Luciana

    • Luciana: Not yet, but we hope that the ReSTOR toric will be FDA approved by the end of this year. The Trulign is the toric version of the Crystalens that has FDA approval for a limited range of implant powers in the U.S.
      God Bless,
      Gary Foster

  10. Dear Doctor:
    I recently received a toric lense implant in my left eye during cataract removal surgery. The astigmatism in both eyes are severe due to corneal transplants – particularly my left eye.
    I now am wearing newly prescribed eye glasses but I suffer from severe eye strain and headaches.
    My eye doctor told me that this is due to the two eyes competing for vision.

    My question is: As is will I ever be able to wear prescription glasses without experiencing eye strain?

    Thank you for your time.

    • Carlos: Sorry you are having problems. Your previous corneal transplants make the surgery more complicated. What is your glasses prescription for each eye?
      Gary Foster

  11. I was told I was a candidate for a toric lens for my right eye when my cataract is removed but not for my left eye because it was 3.1 (?) which is right outside of the range. After much concern of having a Toric in one eye and a regular lens in the other because of cosmetic eye glass appearance, the Eye Clinic now tells me I can have a toric in both eyes. I don’t understand how I am now a candidate for toric in both eyes. Will I have to wear glasses for distance with a toric in both eyes? I know I would if I had one standard and one toric. Thanks for any information you can provide.

    • Bobby: If I understand your information correctly, you have 3.1 of astigmatism in your left eye. The alcon torics in the U.S. can correct up to 4.0 diopters of astigmatism. It may be that they more commonly use a different brand but have decided to now use the Alcon toric, which has a broader range of approval. If I have not understood the facts clearly, please clarify and I will re-answer.
      God Bless,
      Gary Foster

      • I didn’t know exactly how to explain the measurements but after reading your response, I should have stated that my right eye is below the 5.0 diopter but my left eye is 5.1 which is outside the range. I am trying to understand how this will affect my final vision and if glasses for distance is still required, will my lens difference be noticeable? I am confused as to how I can now be a candidate for two toric lens when at first I was told I wasn’t a candidate for a toric in my left eye. Thank you.

  12. I was diagnosed several years ago with cataracts but haven’t been told they are ready for surgery. I have glare problems and night driving difficulty. Small print is a problem also. I have an appointment with an Ophthalmologist next month. My question, do cataracts have to get to a certain point before having surgery or can you have surgery any time after being diagnosed? If surgery can be done before vision gets really bad, are there potential problems with the surgery or in the future? Also, I have astigmatism in both eyes and one of the lens in my glasses is thicker than the other one..
    Thank you.

    • Betty: Cataract surgery can be done at any time after diagnosis, but insurance will only help pay if the cataract has become medically necessary based on your vision and a glare test called a “bat.”

      Having the surgery at an earlier stage prevents you from going through the stages of progressively blurry vision but you face whatever risks are involved in eye surgery at that earlier age. Postponing eye surgery forces you to put up with blurry vision, but also postpones any risks.

      The toric lens may be an option for your astigmatism. Your upcoming eye exam will help you answer these questions and help you decide if cataract surgery is right for you at this stage of symptoms.
      God Bless,
      Gary Foster

  13. I have cataracts, contemplating surgery. I have about .75D astigmatism in both eyes. My eyes are healthy, with hyperopia and presbyopia. Would toric iols be a good choice. Also, do the newer toric aspheric acrylic lens have more advantages over the toric silicone lens?
    Thank you.

    • Ruth: At 0.75D astigmatism you could either elect the toric lens or have a laser arcs to reduce the astigmatism. I usually use the laser at your amount. If you elect the toric, then I prefer the aspheric lenses like the Alcon toric.
      God Bless,
      Gary Foster

      • You are a dear for helping people the way you do. You have made my mind rest so much easier about the toric lens choice, (silicone vs. acrylic). My choice was the Tecnis. I do not want to go with the blue light blocking Alcon, although it is a very good iol and would have been my first choice if it were not for that feature. ( i do not want to mess up my circadian rhythm, LOL) Just one more thing, are you referring to LRI’s or a laser procedure, when you use the term, laser arcs. I don’t think I would be inclined towards the LRI’s, for the fact they may not last, and I would be a little apprehensive on the laser procedure. I hope the torics will work for me, and not cause an over correction with such a small amount of astigmatism.
        Thank you so much, and may God Bless You Too.

      • Dear Dr. Foster, I am 6 weeks and 3 weeks out since my cataract surgeries with the Tecnis ZCT150 toric. I mentioned in a previous post that my astigmatism was about .75, maybe a little lower. My first IOL rotated 30 degrees. I was extremely careful not to do anything to cause this myself. It was blurry from day two. The second has remained stable. My vision in both eyes are still blurry at all distances. The eye with the rotated lens and no toricity now is actually better than the eye that did not rotate. My distance vision is worse now without glasses than what it was before I had cataract surgery. With both eyes I can read most of what is on my 17″ computer monitor at arms length with only slight blurriness. I can drive, but with some blurriness, especially in the far off distance. I can not read a lot of the smaller signs when driving. Bigger signs I can read, but they are a little blurry. No night driving problems like halos, ect. Personally, I did not think I should have had torics at all, but my doctor thought I should have them. Here is my two problems now. First thing in the morning, my eyes are very clear, and I can see almost perfect. About midday, they start getting really blurry. There has been more bad days than good days, but I can not understand why I can see so well when first getting up, and then later it goes all to pot. I have not been diagnosed with dry eye or any other eye problem. Can you figure it out, and do you think it will ever get clear all the time, like it is in the mornings? I am 70 years old and still pretty active, so I would like to have half way good distance vision without glasses, like I had before the surgery, for some activities where I did not have to wear any. Problem two is, my surgeon said he could do one of the lasik procedures to help my problem at no charge. He said he would do YAG first, even if my eyes were not quite ready for that yet, before he would do any lasik correction. He was really not too keen on rotating or replacing the lens that had rotated. He did not say, but I had the feeling he thought it was more riskier than using a laser procedure. (P.S. I am hoping that his reasoning for not wanting to rotate or replace is because it would mean another facility fee and surgeon fee that would come out of the group of surgeons pockets, not mine.)) I just don’t know if it is worth the risk to have anything done to improve my vision, or just relinquish my self to the fact of having to wear glasses all of my waking hours. I don’t think I could handle any long term side effects I might incur from any laser procedures (except YAG), if I let him try to correct my vision further. It would be a big gamble, I could come out great or I could be much worse than I am now, Before I got cataracts, I hardly had to wear glasses for anything except sewing and small print reading. Any reassuring thoughts or advice would be greatly appreciated. Thank you for your time, and have a HAPPY THANKSGIVING. Ruth

  14. I forgot to mention one thing in the post I just made. I had the femtosecond laser assisted cataract surgery, which I requested on my own. I don’t know if that would have bearing on my problems or not. Thanks again, Ruth

  15. Helen Welter says:

    I had aacrsot toric IOL implanted in my right eye. It was successful with 20/20 vision and no side effects. Two weeks later, I had the same type of lense implanted in my left eye and while my vision is 20/20 I have a strobe light effect in the temporal eye under certain lighting conditions. It is very bothersome. I also have extreme glare and haloes from lights even during the day, but worse at night. This dysphotopsia is affecting my quality of life. What can be done to lessen the glare and stop the flasing?

    • Helen:
      I am sorry you are having these problems. It is curious that the same lens is having such different results in your two eyes. It is most likely that everything is ideal with the lens implant, but it would be interesting to find out if the implant is well centered and if the anterior capsule covers then entire edge of the optic of the implant. If there is some problem with the centration of the lens or if it is slightly tilted, then you could have a discussion with your surgeon about the risks, benefits, and alternative of re-centering the implant. A second consideration is that there could be some aberrant shape to the cornea in the troubled eye that is causing the problems. There is a machine called the “iTrace” that can measure your eye to see if there are problems with the cornea or the implant. I find this very helpful in sorting out these types of problems.
      If everything is fine with your cornea and the implant, then most observe for a period of time to see if the eye adjusts and the symptoms go away, which they do most of the time. I’ll say that again for clarity. These types of symptoms usually go away on their own over time. However, if they do not lessen or go away, then some consider changing the position of the implant or changing to a different style/material of implant.
      God Bless,
      Gary Foster

  16. i had gone through toric icl treatment and i see double lights even after 4 months of treatment sometime i even seat the shape of a lens. The positioning of the lens is correct and i see everything clearly but double lights and shape of a lens is a problem for me. Kindly help

    • Gagano:
      As you know, with a toric icl, the natural lens is left in place and the icl is place between the iris and the natural lens. With a toric IOL, the natural lens (cataract) is removed and the toric IOL is placed where the lens had originally been to replace the lens.

      One potential cause of double images after a toric icl is under correction of your astigmatism which could occur from having more astigmatism than the icl can treat, or if the icl has rotated out of the ideal position. Your eye doctor can measure the amount of astigmatism you have to let you know if this behind your troubles. Potential treatments would include rotating the icl, LRI, LASIK, glasses, or contact lenses.

      It is also possible that your pupil dilated to larger than the icl at night and you are seeing the edge of the icl. There are drops that can be used at night to minimize pupil dilation if this is a factor for you.
      God Bless,
      Gary Foster

  17. Hello. I recently had a Toric lens implanted in my right eye to correct my far-sight vision. The plan is to implant the lens in the other eye in a month or so once we see how the first eye is doing. However, after a couple of weeks, it appears that this lens has improved my near-vision and has actually worsened my far vision (slightly). My Dr. says that this can be corrected but why would this happen in the first place? A testing mistake possibly? Maybe the wrong lens was implanted? My Dr claims that sometimes the eye reacts a little differently than what was intended but an improvement to near vision as opposed to the intended improvement to far vision seems like an actual mistake was made. I know the info presented here is limited, but what are your thoughts? Thanks!

    • Rich:
      Sorry your vision is not exactly as targeted. It sounds like you targeted distance vision but have ended up somewhat nearsighted. Prior to your cataract surgery, the length of you eye is measured along with the shape of your cornea. These measurements are fed into a formula that calculates the predicted lens power to achieve your goal. These measurements are quite accurate under normal circumstances. The formulas have to estimate where the intraocular lens will end up in your eye (called the “effective lens position” based on where it ends up for the average person. This means you achieve the target if your eye anatomy is average. If the implant ends up settling a bit forwards or back from the average, even a tenth of a millimeter, you would end up near sighted or farsighted. There is no way with current technology to predict which patients will fall outside the norm. The more modern formulas use the diameter of the cornea and your glasses prescription to try to better predict the effective lens position. Others use the ORA to increase the accuracy. Even with all of these the better surgeons tend to be within .5 diopters of target around 80% of the time. Your surgeon is expressing the willingness and capacity to get closer to target if the risks benefits and alternatives warrant further intervention. This alone indicates a surgeon with a significantly above average commitment to excellence.
      Some patients actually prefer to have one eye nearsighted and the other for distance. This was not you goal, but you have the opportunity to trial it while you heal. It is not uncommon for patients to end up preferring this system. If not, you could explore the other options alluded to by your surgeon.
      God Bless,
      Gary Foster

  18. Dear Dr. Foster,

    About 12 years ago, I had LASIK eye surgery to correct my nearsightedness and astigmatism. I use the monovision correction method and was VERY satisfied with results. This year at 59 years old, I developed cataracts in both eyes. My cataract surgeon told me that the previous LASIC surgery could complicate the selection of the right correction for the IOL. He asked me to get my pre-LASIK surgery Eye measurements and corrections made to my eye during LASIK surgery. Unfortunately my LASIK surgeon had disposed of all of my medical information due to the length of time. My cataract surgeon told me that he felt comfortable that he could get pretty close to the proper correction, so we went forward with the operation. I decided to continue to use the mono vision approach, so we scheduled my dominant distant eye for the first surgery. He used a Acrysof IQ, SN60WF, 20.0 D., Length 13.0mm, Optic 6.0mm
    The day after surgery I noticed that my vision was good for objects that near, (1 – 2 feet away from my eye) but it was out of focus beyond that. Also I was seeing double at distance 8 feet and can barely read a freeway sign from right below it. At the one week follow up, there was very little change. My surgeon suggested continuing with the second eye surgery using Left & dominant eye for reading and correcting the right eye for distance. I told him I was uncomfortable going forward with another surgery. I wanted to focus on getting my left eye corrected to the original goal of being a 20/20 distant eye.
    He tested me for astigmatism and proceeded to put a corrective lenses in front of my eye which eliminate the doubling up of my vision and allowed me to see near 20/20.
    He asked me if I would like to wear glasses or contact lenses to correct my astigmatism. I said no that it didn’t fit my lifestyle needs. He suggested that LASIK could be a solution. I asked him if replacing the current lens with a toric lens with the aid of a ORA System could be a better solution. He stated that my previous LASIK surgery could make a toric lens problematic.
    I am now being referred to another in network cataract surgeon that also specializes in Lasic surgery. My appointment with the new Doctor will be at the four-week post surgery.
    I don’t know if they have a ORA system machine available in the network. If they don’t, I’m afraid they’re going to mess up on my correction again. If I choose the LASIK solution, Will I have to have it redone every 10 years or so? Then what do I do for my right eye.
    Your thoughts Please.
    Thank you.

    • David:
      I am sorry you are having these problems, but you do have a number of potential good options to get where you want to end up. I will not be able to advise you on which option would be the best, as I have not examined your eyes, but can speak toward general principles I use to help make these decisions with my patients.

      Your goal was distance vision in your left eye but you have achieved near vision. This decreased accuracy is possible with any cataract surgery, but more common in those that have had previous laser eye surgery. This miss does not represent surgeon error, but rather the current state of our scientific and technological limitations, even in the best hands. You are correct that the ORA system helps improve this accuracy, but it doesn’t deliver perfect accuracy. I am presenting a paper at the ASCRS meeting of our success percentages with the ORA vs. standard methods at the ASCRS meeting next month.

      If the cataract is mild in your right eye you could have a temporary contact lens placed in the right eye to demonstrate distance vision with that eye. During that trial you would have reading in your left and distance in your right. If this worked great, then you could consider mono vision in that configuration as discussed by your surgeon. If you dislike it, or if your cataract is too advanced to conduct such a trial then there is risk that you would not find a mono vision configuration that you are not used to acceptable long term.

      The previous LASIK creates uncertainty of which lens should be placed before cataract surgery, but it doesn’t create uncertainty about which lens should have been placed once the cataract surgery has already been done. You can measure your residual glasses prescription and it is merely a matter of math to calculate, in retrospect, which lens would have given you distance vision, including what toric lens would have corrected your astigmatism.

      I have had occasion to put in a toric lens and found out the patient, in retrospect, didn’t need it and exchanged it for a standard lens and I have had the occasion of putting in a standard lens only to find they really needed a toric and exchanged the lens to achieve the correct outcome. These exchanges are not perfect, but there are far fewer variables on a re-do than the original case since you know the actual outcome and there is no cataract to remove the second time. This is true if the support structures in the eye are strong and there is no tilt to the intra ocular lens. I use a machine called the iTrace to let me know if the implant is flat or if it is slightly tilted.

      I find the ORA very helpful on the original cataract case but minimally helpful on an IOL exchange, again, since you know the outcome and can mathematically calculate what you really should have put in the first time. The mathematically calculated lens is usually more accurate than the ORA on a re-do.

      The most conservative option is to wear glasses or contact lenses to correct the nearsighted astigmatism of a refractive miss. If this is not acceptable after considering the risks, benefits, and alternatives there are some principles I use to advise patients.

      The first question is does your surgeon actually use the toric lens at all? If he/she doesn’t, then they will not view this as an option, but there may be others in network that do.

      In patients that have had a lot of previous LASIK, who are poorer candidates for any more corneal surgery (corneal irregularity/scaring/weakness, etc.) I tend to prefer to leave the cornea alone and do an IOL exchange. Inpatients that are great laser eye surgery candidates where I fear going back into the eye (for example someone with a greater risk for retinal swelling or the support structures are stable but weaker than normal, etc.), I tend to recommend staying outside of the eye and doing the laser eye surgery on the surface. I have a slight lean towards fixing myopic astigmatism with a laser and a slight lean toward fixing hyperopic astigmatism with an IOL exchange with all else being equal. In patients that are best served by laser eye surgery, I tend to do PRK rather than LASIK if their previous LASIK was a long time ago. In patients that are neither nearsighted or farsighted, but only have a small amount of astigmatism, I often do a small LRI ( incisions in the cornea to correct the astigmatism) in the office.

      The longer the IOL has been in place, the harder it is to exchange so with time, laser eye surgery becomes a more appealing option as the exchanges can be more difficult.

      There is one additional option called a piggyback lens. With this option, you place a second very thin IOL on top of the first one your surgeon placed. This would correct your near sightedness, but not your astigmatism which may be correctable with a limbal relaxing incision.

      There are risks with corneal-based enhancements (laser eye surgery) and there are different risks with intraocular surgery (IOL exchange). Which is best for you would require a careful discussion with your surgeon.
      God Bless,
      Gary Foster

  19. Ronald Moscatello says:

    I have since the age of 4 years old worn very thick glasses. A lot of astigmatism and my right eye is also lazy with a blind spot. I can see with it but words were always like looking at a jumble and not readable. Up until recently I was wearing Tri-focal’s which were very thick and always dirty and annoying. I even paid for the thinner lenses but even these were thick, heavy and annoying. I recently noticed problems with my vision and went to my eye doctor who told me I had cataracts in both eyes. I was looking at his charts on the wall and noticed the Acrysoft Toric IOL. He checked me out and suggested I only get the Toric IOL lens in the good left eye and a regular IOL in the bad right eye. I had the operation first in the right eye and was later told that he made incisions in my right eye to reduce the astigmatism. About three weeks later he placed the Toric IOL in my left eye. At first I had very good intermediate and distance vision and could also read from about a foot away. After a week I noticed that the distance vision was very blurry in the morning and improved as the day went along. In fact when the sun is out the distance vision is very good. I guess a smaller iris is causing more depth of field ? I now use #2 reading glasses and I’m able to see good enough to drive and do most everything. I guess what I am asking is if the lens will finally adjust to better distance vision ? Why is it blurry in the morning but improves as the day goes along. Is my eye trying to focus the lens ? As a side note I have very good distance vision if I look to the side. The blur is only when I look straight ahead. I told the doctor and he said it may be dry eyes causing this but I hate the eye drops. The Systane gives me eye pain and a headache and the Restasis makes me feel like I have crap in my eyes and also bothers my eyelids so I stopped using both. The distance blur is the same with or without that eye drop garbage. So is it possible to become slightly nearsighted with the Toric lens and will this go away or is the lens out of alignment ? I have perfect computer or I guess you would call intermediate vision. When I read the eye chart I can read 20/20 but the chart is only about 8 feet away. So please give me your professional opinion of what to do or what not to do ? Thanks in advance.

    • Ronald:
      Sorry for your troubles. It sounds like you had a distance goal, but have ended up about halfway between distance and intermediate vision. Your eye doctor could check your refraction and let you know your prescription. You are probably -.75 to -1.0. If you are already a couple of months postop then it is not likely to change much more on its own. You would have the option of glasses, contact lenses, laservision correction, iol exchange, or a piggyback lens to improve your distance vision if it is worth the hassles and risks involved. If the distance vision is improved, the intermediate vision would worsen without glasses. If you have residual astigmatism you would have similar options to improve that based on the impact in your life.

      The doctor probably didn’t recommend a toric lens in your right eye either because the amblyopia is profound enough that he/she didn’t think you would get your moneys worth or because there wasn’t enough astigmatism to warrant the toric.

      Distance vision worse in the AM may represent blepharitis. If this is the case your eye doctor could talk with you about treatment to decrease the impact of this. There are other eye drops, fish oil, punctal plugs, etc. that could be employed if the eye drops are not satisfactory. Your eye doctor could help you decide which approach would be the most ideal for you.
      God Bless,
      Gary Foster

  20. Michael Tontimonia says:

    Dear Dr. Foster,

    My name is Michael Tontimonia and I have a very severe case of astigmatism mixed with severe nearsightedness as well. My latest dubious Rx is -8.25 sphere in both eyes with -5.5 cylinder in OD and -6.0 cylinder in OS. From doing tons of research I have concluded that this is a very rare astigmatism. My dad is also suffering from Fuch’s Dystrophy, so I am almost positive I may be in the early stages of that disease as it is hereditary.

    Earlier in life I was relegated to the front row of the class, where I could still not see the chalk board. My parents spent thousands of dollars on glasses and eye exams only to be told that I was difficult to work with as a patient, or outright being accused of lying by some “Eye Doctors” during refraction. Finally out of exasperation my dad took me to Lenscrafters of all places and I received a pair of glasses that changed my world. The doctor took almost 90 minutes during refraction and he consulted with the staff Ophthalmologist. I could see detail that I have never experienced before in my life. I literally cried when I realized how poorly I had been treated by eye “doctors” who did not have the skill or patience to see a patient with my condition.

    I have used these miracle glasses since 2007 until now. I lost my insurance in 2008 and I have been uninsured since that time. My driver license expired in August and when I went to renew I ran into the dreaded eye test machine. As you may guess it didn’t go well and I am not able to renew my license currently. I decided to go out of pocket at a standard optician right before school started in September and received the usual nonchalant dismissive attitude towards my condition. The nurse even had to recheck the prescription of my glasses because the first test was “Impossible” and even then she could not accurately read the Rx of my lenses. Eventually the young “Doctor” just gave up on refraction after around 20 minutes and told me I needed contact lenses and left me high and dry and 200 dollars lighter.

    I cannot begin to describe the anger and frustration I feel from this medical condition. It drives me crazy when the twits at the DMV act like i’m the only one in the world who cannot see the stupid letters on line 3, or for that matter have a machine judge your ability to see or not period. I would not be driving if I felt my vision was an issue. When you tell people how bad your eyes are they look at you like you are lying or making it up for sympathy. They only look at the world through their own lenses and they just don’t believe that someone’s vision can be that bad, or that there are only two labs in the world that can cut lenses as precise as I need them.

    Without my glasses I am legally blind, I cant even see the giant “E” on the eye chart. I realize now that I don’t need to see a glasses mill “Doctor” anymore. I need a straight up board certified real Doctor on my case. Could you give me your opinion or advice on any possible treatments. I really want my mobility and life back. Please help. I’m hoping to see Dr. Paul Hiss in my area as soon as I get my Medicaid card.

    Sincerely,

    Michael Tontimonia

    • Michael:
      Sorry for all you troubles. It would be great to get you driving again.
      I am an ophthalmologist that specialize more in surgery than the glasses part of eye care, but there are many optometrists that do specialize in glasses. You are hoping to find one that is ready for a challenge. It may be helpful to have the office that gave you the original helpful glasses and have them give you a copy of the prescription. This will give the other offices an accurate starting point. If your astigmatism is irregular and progressively becoming more irregular then some patients reach a point where they cannot see well with glasses and can only achieve acceptable vision with a gas perm contact lens. If your eye doctor has a topography machine he/she could do the simple test to see if you have keratoconus. If you have this medical condition it could make your visits medical and covered by medical insurance rather than requiring special eye coverage. On some occasions, it even makes the contact lenses medically necessary. I realize that you currently don’t have insurance. It is also possible that you have regular astigmatism but some amount of lazy eye that holds you back from drivers license vision. If this is the case, a gas per contact lens would often give a couple lines of better vision. This is because correcting the astigmatism closer to the eye does a better job than correcting it out away from your face as glasses do.
      God Bless,
      Gary Foster

      • Michael Tontimonia says:

        Dr. Gary,

        Thanks for the input and for caring so much for people out there on the Internet. I recall from my last Orbscan images that one eye was irregular astigmatism and one eye had the standard bow tie pattern astigmatism. I don’t know if it was ATR or WTR. Is this common? The doctor asked if I had suffered an injury to this eye which I have not as far as I know. The eye with the irregular pattern is definitely my weaker eye as well. As far as i know I have not been diagnosed with kerotoconus, but I don’t think these places have a vested interest in telling you that because you may want to leave and go see a real doctor at that point. When I complained about malpractice to the office manager at one of the chop shops she said they deal with people with kerotoconus all the time when I asked about experience with high astigmatism. I had to politely ask her to look at my chart and tell me if I had or not. When she saw I did not have it she really couldn’t argue against my malpractice claim and issued a refund right away. I wish these places would be banned by Congress. These places will tell you anything to get your money and I feel that no one besides a true doctor should be able to prescribe eyeglasses or look at someone’s eyes period. I am done with “optometrists” and will only deal with board certified doctors from now on. Any research I find on surgical options seems to only be related to another disease or condition like severe injury or cataracts.

        Also in my research i have found that most doctors concur with the RGP lens solution but I have not found a single contact manufacturer that claims in their literature that their lenses will correct astigmatism by more then 90 percent, even with the tear film forming a perfect lens behind the RGP. I don’t know about what you think but ten percent of my astigmatism is still clinically significant and I would have to wear glasses with a smaller cylindrical correction along with contacts still, which does not sound fun or cool AT ALL. I simply cannot afford this solution either. Could you get a Toric Phakic IOL payed for by insurance as medically necessary in my situation? I feel that the best solution out there for me right now is this one, but I only find studies where they implant the lens after cataract surgery or severe injury, but the results are spectacular. No insurance will cover glasses and RGP lenses together as medically necessary right? I really don’t think RGP lenses can help correct my vision completely. Would contact lenses speed up or aggravate the development of Fuchs Dystrophy? I don’t think having something on an already diseased cornea all day long even being permeable could be helpful. Please tell me i’m wrong, after all you are the DR.

        Also you didn’t mention any surgeries that may help me out either. As a surgeon is your opinion that my eyes just too bad to operate on at all? It is not my fault I have this condition, yet i’m looking at thousands of dollars out of pocket to treat it, so I want the absolute best solution possible. I have never been corrected to 20/30 let alone 20/20, so I have no baseline on what good vision is for me. I thought I was doing well still but a machine at the DMV says no. Also any studies that you may know of that I can participate in, I would be a very willing guinea pig. and I know most of you guys have only seen eyes as bad as mine in textbooks so I would be willing to let you poke and point all you want. Thank you again for your time.

        • Michael:
          If you are not able to obtain acceptable and functional vision with glasses, but do have good vision with a gas perm lens, some insurance companies will consider the contact lenses as medically necessary. This usually requires sever letters to the insurer and persistence to obtain. The toric phakic IOL’s are not currently FDA approved despite years of effort by Starr Surgical. The toric IOL’s would correct the regular parts of the astigmatism. Deciding to put a toric IOL in a patient with irregular astigmatism is not the norm, but can be a good decision in isolated cases depending on the needs of a patient and the probability of them ever wearing contact lenses in the future.

          There is a chance that the local Lions Club would help with contact lenses if you were in a tough spot prior to receiving Medicaid.

          God Bless,
          Gary Foster

  21. Dear Dr. Foster,
    Thank you for your responsed to my March 22, 2015 post. I was very distraught at the time due to my poor vision. You’re very valuable input has brought clarity to the situation and has guided me to the correct path forward. Thank you very much for the time and effort you provide all of us.

  22. On February 12 & 13 I had cataract surgery on my left and then right eye. As I had quite severe astigmatism I opted to have the toric lenses implanted. Since than vision I my left eye is at a slant and is not correcting itself. I was told the lense was sitting coeectly and everything looked fine, and theoretically this should correct itself. It has now been 2 1/2 months and my vision is no better and might possibly be worse. Could you please tell me what could be causing this and can it be corrected? Thank you so much

    • Shirley:
      I am sorry you have having troubles. These are rare after a toric lens for most. I assume you mean the your vision seems slanted rather than that you eye itself sits in a funny slanted position. Please write back if I have misunderstood.

      The lens may be in exactly the position your doctor intended, but the question is do you have any left over astigmatism? If you have left over astigmatism it may be that the lens should be in a spot different from the preoperative planning or it could be that you need to have glasses, contact lenses, or an enhancement procedure (like and LRI) to get rid of the remaining astigmatism.

      If you still have a tilt to your vision even when you look through the eyeglasses machine at your doctors office then left over astigmatism is not the problem. Other potential causes include an IOL that is not centered or that has a slight tilt to it. I use an instrument called the iTrace to help me decide if one of these other more subtle issues are involved.

      Such issues would not usually indicate that something was done wrong but just how the implant is settling in your eye. There are potential interventions if these are at the root of your troubles.

      It is also possible that your brain will adjust with more time.

      God Bless,
      Gary Foster

  23. Camilla says:

    I had Staar Visian ICLs implanted in August 2013 (non-toric). In the past month, I’ve noted my vision in my left eye has been quite hazy, like looking through a fog, and the halos are worse compared to previous. I saw an optometrist last week who noted there is a peripheral cataract and worsening of my residual astigmatism (previously -0.75 in Oct 2014, now -1.5). She said the cataract was not encroaching on my pupillary region yet but was unsure if it might be contributing to some lenticular astigmatism. However, my understanding is that astigmatism, be it lenticular or corneal, should be correctable with lenses, and yet the rx she gave me has helped only somewhat. The haze and halos persist. I did mention to her during the refraction that nothing she did cleared up the haze. I’m a bit skeptical that the astigmatism has doubled in such a short time-frame or even that the astigmatism alone is the problem, especially since the rx she gave me has not resolved the issue.

    The peripheral cataract was present at my one year f/u visit with the surgeon last year but he did not feel it was an issue, nor did he think it would become an issue anytime soon. He also confirmed an adequate gap between my natural lens and the ICL, so did not think it was a complication of the procedure. I will be seeing the surgeon again later this week and would very much appreciate any insights you could provide regarding the possible underlying cause for my current hazy vision, and any questions/tests I should request when I see the surgeon. If the issue is indeed the cataract, what could be done to correct this at this time and what would be the risks?

    Many thanks for your help,
    Camilla

  24. Carol Ross says:

    I am 75 years old and had cataract surgery locally in October, 2014. I am nearsighted with some astigmatism and blepharitis. The blepharitis was relatively mild and only bothered me when I was very tired. I used hot compresses and washed my eyelid edges with Johnsons baby shampoo when it was bothering me.. I opted for an implant that would keep my near sightedness, and was extremely happy at first with the outcome. My visual acuity with my glasses was, and still is, really excellent. I can see individual leaves on trees across the street. Before the surgery the cataract caused lights to have a “smear” so, for instance, looking at a little reflector at the side of the road, or the stars, I saw something similar to a checkmark. After the surgery things were wonderful, until several months ago, I started getting problems with ghost images around bright objects and traffic lights, taillights, etc have many lines emanating in several directions. At night these glaring lines from headlights and traffic lights reach almost all the way across the road. The signs that used to be crystal clear and sharp now have ghost images on both sides. When I am in a building with fluorescent lights overhead, everything appears washed out like looking through a fog. It improves somewhat if I shade my eyes. I wasn’t given any lens options before the surgery, and never heard of the toric lens until a friend of mine had one implanted just recently at Wills Eye. Her vision is A-1 perfect. Could I switch to a toric lens at this point, or am I doomed to live with this, and maybe even having it get even worse? The blepharitis has gotten worse, but only in the eye that was operated on. ( I have nothing but peripheral vision in the other one because of a blood clot many years ago, so I didn’t bother getting both eyes done). I am seriously considering going to see the same doctor that did the surgery for my friend at Wills Eye. I would appreciate any insights or suggestions you might have for me.
    Sincerely,
    Carol Ross

    • Carol:
      If the vision was great earlier on, but started to worsen later, then it could be that you are developing posterior capsular opacity. I have a blog post on this that may be helpful. http://www.garyfostermd.com/seconday-cataract-surgery-for-yag-eye-laser-starburst-vision/

      About 20% of patients develop enough of this that they require a yag laser treatment to restore their original vision. Fortunately most patients count it as even easier than the original cataract surgery.

      A much rarer condition would occur if the capsule scars in an abnormal fashion and warps the intraocular lens. This can often be treated with a yag laser to loosen the scarring, but could require an IOL exchange.

      The IOL could be exchanged for a toric lens if your motivation rose above the potential risks of the exchange. Again, it is quite possible that there are other easier fixes to your visual problems. An eye exam would allow your doctor to quickly decide if PCO is the main issue.
      God Bless,
      Gary Foster

  25. Hey Doc,

    I had my right eye done last week with a Toric Lens (don’t know the brand) went back the next morning for follow up – eye pressure was 60 – he got it down to 30 and gave me 2 new drops to take for a while. I told him I was seeing a lot of floaters and he said that is normal and also said that part of the cataract was too strongly attached to the lens bag and he did not want to risk tearing it and said that in about 3 months it would require laser surgery to remove it…..

    About Me:
    1. T1 diabetic 45 years – currently 54 years old.
    2. Cataracts were first noticed about 7 years ago.
    3. Had retinopathy in both eyes and had laser treatment in 1997 and then a Vitrectomy in my left eye as there was some membrane.
    4. Have worn glasses and really had no issues with seeing ….

    I have moved many times and I annually see an ophthalmologist and a retina specialist. The retina guy has been saying it would be nicer if the cataracts were gone – he could do a better exam. So, this year I had some expensive things happen and i figured, “Hey, they all say this operation is simple and it will be completely covered (of course the Toric lenses cost $1,100 each; I figured lets go all the way!!”)

    My right eye is sore and I have been using Lotemax every 2 hours and one drop of Travatan a night. I still have floaters and it almost looks like a few air bubbles??? Is this normal after a week and my vision is maybe worse although he is saying it’s better … What’s the laser thing about and is it affecting my vision currently?

    Tomorrow I go in for my left eye and have been putting 3 drops of different types pre-op. I am a little concerned. I am not confident that I will be able to see clearly. I am currently using a contact in my left eye that he said I could use until tomorrow morning.

    Does this all sound “normal”

    Scott

    • Scott:

      It sounds like your posterior capsule had some scar tissue, perhaps from your previous eye surgery. Your surgeon is suggesting that he will perform a yag capsulotomy so you don’t have to look through the scar. It is common to wait until three months after surgery to perform that though there are circumstances where it is performed soon. I have a post on yag laser treatments http://www.garyfostermd.com/seconday-cataract-surgery-for-yag-eye-laser-starburst-vision/

      The most common cause for the floaters would be pre-existing floaters that have just moved to a more noticeable position, they could be a new posterior vitreous detachment (http://www.garyfostermd.com/posterior-vitreous-detachment-pvd-and-posterior-vitreous-separation/), or it could be blood from diabetic retinopathy. You will need to ask your provider which of these is the root cause of your floaters.

      You are using an above average amount of lotemax. This could be because you have above average inflammation causing eye ache or it could be your doctor being proactive to prevent inflammation because of your diabetes.

      God Bless with your second eye surgery
      Gary Foster

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