AcrySof Toric Monofocal Experience
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Hi. This is for anyone who might be weighing IOL choices prior to surgery and wants to know more about the toric monofocal specifically. Some really lovely people (for whom I am so grateful) have really helped me on this site, and I would like to pay it forward.
To start, I am 48 and have a genetic predisposition for early-onset cataracts. I have had no eye injuries and no eye disease. I do have astigmatism. I only had a cataract in my right eye, which gave me 20/400 vision uncorrected, and 20/200 vision corrected, so I was legally blind in that eye, and surgery needed to be done. The doctor said he saw the beginning of a cataract in my left eye and anticipates lens replacement in approximately 3 years.
I am a SAH, home schooling mom. My favorite activities are reading, writing, and crafting, so I do a lot of close work. Even so, I chose a monofocal lens set for distance. I didn't choose a multifocal for 3 reasons (in order of importance):
- higher risk of light aberrations at night (halos, spiderwebs, glare, etc.)
- drops in field of vision
- the possibility of still needing glasses after the possible night vision compromise and added expense
I am odd in that I did not really want to stop wearing glasses, because, frankly, I look better in glasses. I could have chosen the non-toric monofocal but, ultimately, I felt that (for me) vanity was a poor reason to sacrifice the convenience of not wearing glasses full time and the chance to see God's natural world again without frames in my peripheral vision and with proper depth restoration. (They have filmed several movies in my area due to the rare and beautiful environment, and I really want to gaze upon it again with unimpeded vision.) I could have gone with the non-toric monofocal that insurance covers and then worn contact lenses, but I have never worn a contact, and I did not want to go through the trouble of IOL implantation and then place another synthetic lens on the external surface of my eye. For me, "enough is enough," so I killed 2 birds with one stone and opted for toric. I will still require reading glasses, so I joke that I will look better half the time. I realize that requiring reading glasses qualifies as a pretty big "drop" in my field of vision (see number 2 above), however, it does not come with a statistically high risk of night vision disturbances, so it's a compromise. I also realize that the same risk of needing to wear glasses anyway (number 3 above) applies, but I won't resent it as much as I would have if I had paid for it with my night vision and $6,000 for both eyes, eventually, in multifocals. I did what, for me, felt like a good balance. I did not "go for it" with a multifocal, and I did not "settle" for uncorrected astigmatism. I took what was, for me, a moderate approach that fits with my situation and certain aspects my personality.
A couple things to note:
Having astigmatism means that my reading glasses are also prescription. If I lose them or leave them at a restaurant or friend's house, I can't read until I get them back from wherever I left them or have a new pair made. Having a toric implant means I will likely get to wear non-prescription readers which are cheap, widely available, and don't pose any risk to my night vision. I should add that, for all my concern about night vision, I don't drive at night or have a night-related career. I do drive at night occasionally, and I do walk at night, and there are streetlights which I did not want to look at and see halos or webs, etc. I mainly wanted to reduce the risk of permanent visual disturbances period.
Regarding the surgery, I had dropless (no post-surgery eye drops) and ORA, because my regular optometrist (not my eye surgeon) strongly recommended it and because:
"For the first time in medical history, cataract surgeons have the on-demand ability to measure outcomes, correct astigmatism and verify lens implant calculations in real time during cataract surgery with the introduction of Optiwave Refractive Analysis (ORA). This technology is one of the most dramatic breakthroughs in intraoperative cataract care in the past two decades."
For a week I need to wear an eye shield when I sleep, but that's it..
I just had the surgery yesterday morning. It took 30 minutes and was a fun and interesting experience.. Fun because, let's face it, legitimate narcotics are relaxing, and it was interesting, because I could see what I assume to be the broken pieces of my lens swirling around in the light in my eye. I made a remark during surgery and was told not to talk, so make note of that-- no conversations during eye surgery when they are trying to keep your head as still as possible. That should have been obvious, but, yanno...drugs.
Post surgery my eye hurt. I was told it would be mild pain. No. It was downright painful. It felt like my eyeball had a bad sunburn and like I had something in the middle of my actual, internal eyeball. I can't describe it other than to say it felt like an acrylic lens was implanted in my eye. I still have the sensation of that "fullness" in my eye. It's novel, but not too creepy or bothersome. Instead of taking an ibuprofen I went out for lunch with my husband and then took an all-day nap. 19 hours later my eye is slightly sealed from the excretion response to the trauma of surgery and sleeping so long. I am not forcing it open, because it feels better shut, and I am not anxious to see out of the eye, because I know my post-op vision is jacked up and it's way too soon to tell. I am not in as much pain.
Current emotional impressions:
I saw some light aberrations while traveling to the restaurant. Bright sun glinting off cars, headlights, and that sort of thing produced starbursts and halos. The restaurant was dark and had recessed lighting and white Christmas lights too. There were halos around points of light, and the recessed lighting looked like big white "snowballs" with halos around them. Because of this site, I knew to expect all this and that it will most likely go away in time. Thus it did not bother or frighten me one bit. But after seeing these aberrations I am kind of second-guessing myself thinking I could have dealt with spiderwebs/halos, etc. and probably been OK with a multifocal. Still, my husband saw about 5 friends he knew while waiting for me to come out of surgery. One of them, said he got the multifocal implant 9 years ago but now needs glasses again. So then I also started second-guessing myself about even getting the toric monofocal, thinking maybe I shouldn't have spent any money if I'm just going to need to again wear glasses for everything in the future. So I'm kind of all over the place right now. Hopefully at some point I will settle in and be confident about the choice I made. It's hard to really know, since there are so many variables, and we can't try each option out before we decide. At any rate, I am grateful that ANY options exist to help with cataracts. I have lots of experience with health conditions that have no available treatment, so the fact that anything can be done for a cataract is a wonderful gift.
4 likes, 44 replies
jeff72055 AshMac
Posted
I had my surgery one month ago. I got intermediate monofocal so I would have some near and intermediate vision. My lens was the Acrysof Model SN60WF. So far my vision for near and intermediate have been great I can see my phone at 14" as well as my computer. All my car gauges are clear and crisp and colors are bright. I have good focus about 6 - 8 feet out before I start to lose sharp focus in that eye. But that's what I wanted since I was near sighted in that eye and I wanted to still have the close up vision . Driving at night is fine. I can drive through dark tunnels and still see well. My natural RE is 20/40 at my last exam and both eye are working well together. I still have issues with artifical bright lights and I have edge glare or Negative Dysphotopsias but I'm getting more used to it. Hopefully my brain will completely adjust to it so I won't need a second surgery.
AshMac jeff72055
Posted
Thanks for sharing your experience.
AshMac
Posted
UPDATE:
I have discovered that although things get blurry at a distance (definitely cannot see individual leaves on trees) with my right, IOL eye and I see distance much better with my left, non-IOL eye in glasses, I see things that are between 3-4 feet away very well in my IOL eye (without glasses)--better than my non-IOL eye (with glasses) .
Is vision at between 3 and 4 feet defined as the intermediate range?
I know my IOL eye (right eye) was set for distance. It was great for 4 days. My intermediate was bad but now I see crisply at that 3-4 ft range. My near was and is shot. I think the lens shifted (the doctor doesn't think so)--what else could it be? Despite being told I am still healing and that in the process my distance vision could improve, I don't believe it will. Again, it was great for 4 days, then my field of vision shifted and has remained right where it is for 8 days now. I am convinced this is as good as it gets.
So when I have the left eye done in a few years my plan is to get a toric monofocal again and again set it for distance. Hopefully it won't fail. If it stays put then perhaps that will put me at mini monovision.
I am no longer bummed that I did not get toric multifocals. If had had spent $3,000 and ended up where I am now: needing to wear glasses for all ranges except for things at 3-4 feet, I think I would be VERY disappointed. That's a whole lot of moolah for such a small range of crisp vision. I am still glad I got the toric, because even though something obviously went awry and I lost my crisp distance vision, I have blurry but passable distance when I wake up. I can function at home without distance glasses unless I want to watch TV (if I want the image to be crisp).
SO while I'm bummed that I didn't get what I expected (especially after I had great distance for 4 days) it may end up working for me in the end (if I am correct that what I have now in that eye is "intermediate" vision and can achieve a true distance vision in the left eye). I am cross dominant (even before cataracts), and my left eye was dominant with distance vision, while my right eye was near. I was worried, before the surgery, that if I achieved distance with the IOL in my right eye and intermediate in my left eye after a future IOL surgery, it might cause some issues with neuro adaptation. So maybe this is all ultimately a good thing.
Is my thinking convoluted?
Deb03 AshMac
Posted
I've seen varying definitions of near, intermediate, and distance vision. I think it may start closer in than 3 ft. If your lens rotated seems like that would cause blurriness at intermediate vision also. But I really don't know. I think I'd give it another week or so, to at least 3 weeks and go see your surgeon or regular eye dr to see where you are at that point. Didn't you say you could read 20/20 distance at your first follow-up? I don't understand that part. My distance has been pretty clear from the start and I was 20/25 at 1 week. In any event, if you aren't close to where you were supposed to be, the dr should make it right IMO. You paid extra so it should be reasonably close to the target.
AshMac Deb03
Posted
Do you have just the one eye done like me? Yep, I definitely need glasses for distance. Blurry and images spread (ghost?) faintly to the right. I'm going to see what my regular doctor says at the check up. If he tells me I should be seeing better I will go back to the surgeon. On a lark I had my eyes tested at WalMart. They said there is still .5 diopters of astigmatism in my toric IOL eye. Is that normal?
Night-Hawk AshMac
Posted
0.5 diopters max astigmatism is the target for a toric IOL, my surgeon told me like they like that better than 0 diopters since as the eye ages over the coming years it will tend to reduce that some. 0.5 diopters or less of cylinder should not affect the vision noticeable (less than one line on the eye test).
In my own case my right eye with a toric IOL ended up with about 1.0 diopter cylinder, though I believe it varies day to day since somedays I can see 20/20 or even better with that eye uncorrected, but most days its 20/25 to 20/30.
So 0.5 diopters cylinder or less is a great result!
Night-Hawk
Posted
Also I got a walmart eye doctor Rx after 4 weeks from surgery, but the eye still was changing so I got another Rx a couple months after that. So your Rx could change probably get better over the next month or two as well.
Hudsongrl AshMac
Posted
i had only my right eye done in Feb. I also had toric monofocal IOL implanted. I never had crisp vision with it. Had a refraction done in March and I am -.50 under corrected. i cannot wear glasses because my non surgical eye is -4.50 and it causes double vision. So, i have contact lenses both eyes. i was so disappointed that I still need a contact, but my optomotrist tells me this is common. He says better undercorrected than over. i had no further vision improvement after 1 month.
Hudsongrl Night-Hawk
Posted
while you are correct,it is not crisp, clear vision and for me personally drives me batty. I have been nearsighted my whole life and was hoping to finally see clearly. With contact lens in I am 20/20 and they did get my astigmatism right, so I don't need a toric lens anymore.
AshMac Night-Hawk
Posted
Thanks. Good to know. Maybe the problem is me. Maybe I was expecting too much. I really was expecting crisp vision. I can't read road signs with this eye alone. Not until I'm right up on them. But maybe this is normal for cataract surgery. I feel like 4' is my sweet spot. I definitely can't see very far well. I can't see individual leaves in trees, and I was looking fwd to that, because I'd seen someone else say that they could. Maybe this is closer to intermediate vision. And this was my near distance eye anyway. My left is still my God-given lens, and it's my far eye. When I get it done in a few years maybe it will work better for distance and I'll end up with kind of a mini monovision. That would be ideal.
AshMac Night-Hawk
Posted
When it changed did it get better or worse?
AshMac Hudsongrl
Posted
Thanks so much for letting me know your experience. What is a refraction? Is that another procedure on your eye or just a test to check your vision?
Do people who get the toric multifocals have these same issues? Do they still have to wear glasses? Or do they get crisp, clear vision at all distances and only suffer night vision issues?
Night-Hawk AshMac
Posted
For me the first few weeks my vision in my right eye varied a lot, some days worse >20/100 and other days near 20/20. After a month it started to stabilize though and has been around 20/25 uncorrected since then, though it can still vary some day to day but not very much - some days better than 20/20 and not worse than 20/30 or so.
I remember the first day after surgery the exam showed 20/40 so its gotten better over time, mainly more stable.
AshMac Hudsongrl
Posted
Yes, I notice that while I can't see distance clearly (and feel I need glasses same as always) I can now wear cheap dollar store readers, and they work perfectly in the IOL eye (horribly in the non-IOL eye).
I tried my old distance glasses on, and honestly, there is not much difference in vision for my right IOL eye. It's pretty much just as fuzzy with the spectacle lens as without unless I am looking at text from a distance. Only then is it better just looking through my IOL. What does this mean?
Deb03 AshMac
Posted
Just the one. am scheduled for the second next week. Currently at the doctor asking about the iol flicker I'm still experiencing. Tech did not do a full vision test but I read the 20/30 line and then she added .5 diopter for astigmatism and I could read 20/20. But I can see leaves on trees and read road signs at a reasonable distance.
Deb03
Posted
Adding on, my optometrist said my astigmatism is oblique (kind that makes vision worse). She said if it bothers me down the road after my other eye is done, my doctor can fix it with a laser. She also said at this point my eye is pretty much healed (1 month out) as far as vision is concerned. Also gave me more Ilevro NSAID for inflammation. Do you have any eye pain or dryness Ash?
AshMac Deb03
Posted
Great that you can see leaves and signs. Can you achieve that with the IOL eye alone or do you need both eyes?
AshMac Deb03
Posted
No eye pain or dryness in the IOL eye. I actually feel that the eye is less dry than it used to be. When the left eye is dry, the IOL eye isn't. That's a welcome change. I had dropless. Never had a single drop. I heard they can irritate the eye and contribute to feelings of dryness.
AshMac Night-Hawk
Posted
My eye seemed to be great for 4 days, and then BOOM! I hasn't changed at all since then. Consistently fuzzy distance. It's ok until any kind of text is involved.
Deb03 AshMac
Posted
Just the IOL eye. My IOL eye can see slightly better than my non iol eye with glasses (lens out for IOL eye). When driving during the day, I am wearing nonprescription sunglasses so all of my vision is with my IOL eye. I read road signs fine. At night, I need my prescription in my non-iol eye. Did you say you have a follow-up with your regular eye doctor? I think that would be a good idea to get a second opinion. Also regarding the Ilevro, I also had the dropless, but some doctors still give NSAID for inflammation also. I only used it for 2 weeks, but today, she said I still had some inflammation and gave me more. If you aren't having any pain, you are probably fine!
Hudsongrl AshMac
Posted
Refraction is the eye exam where the eye doc says "better or worse, #1 or #2. i have no experience with toric multifocals. Maybe someone else can answer that question.
Hudsongrl AshMac
Posted
Sounds like something is off. I'd make an appt. and see your surgeon again. or you could see an optomotrist and they could see if a contact lens would improve your vision in your surgical eye.
Hudsongrl Deb03
Posted
note: i was told ILLEVRO can cause blurred vision. your vision might be better once off drops.
AshMac Deb03
Posted
"My IOL eye can see slightly better than my non iol eye with glasses (lens out for IOL eye)." Wow, that's awesome. I only get that at the 3-4' range. Can't read road signs with the IOL eye alone until I'm right up on it. My follow up with the regular dr. is on July 3. Yep, I never had any inflammation, and no pain after about 2 days. Healing like a dream. Sight isn't great though. At least, not what I expected.
Deb03 AshMac
Posted
My non-iol eye has a moderate cataract in it so my vision is off in that eye with glasses. But I do think my distance vision is good in my IOL eye. Although they measured 20/30 at the doctor's office yesterday, I have multiple charts at home and can read 20/25 just fine, and I personally think I am more in that range. Glad you have a follow-up with your regular doctor. Do you have an eye chart at home? I downloaded one from allaboutvision which seems comparable to the ones I purchased.
AshMac Deb03
Posted
No. I don't have an eye chart. If I printed one out I'm not sure I would even know how to use it. Thanks for letting me know where you got yours. Maybe I'll try it and see if I can figure it out! 😃
Night-Hawk AshMac
Posted
You can get regular wall eye charts from amazon for $10-15.
I got one and put it on a wall in a room where my couch is 20feet away, thats the distance to view the eye chart from for distance measurement. You can cover each eye to measure separately.
Hudsongrl Night-Hawk
Posted
Yes , i bought a chart on amazon and stand 20 ft. from it for periodic checks. hubby thinks i am nuts. lol