How to solve residual astigmatism after IOL surgery?
Posted , 5 users are following.
Three months ago I received two trifocal IOLs (Zeiss Lisa). My non-dominant eye (LE) came out of the surgery with induced astigmatism - 0,5. My dominant right eye (RE) had lens rotation. In a second surgery the lens was rerotated and is still 10° off causing an astigmatism of - 0,75.
I received glasses with the following prescription:
R: 0,00 Sph; - 0,75 Cyl; 45 A
L: - 0,25 Sph; - 0,50 Cyl; 75 A
With these glasses I have perfect distance vision but they cause problems during driving inside my car (dashboard and navigation are blurry) or while I'm shopping (pricetags, small print on the products are blurred). They are not suitable for reading in front of my laptop and for the intermediate range (desk, table). I need smooth reading within 40-90 cm (15-35 inches) for my work. Therefore I received a second pair of glasses:
R: + 0,75 Sph; - 0,75 Cyl; 45 A
L: + 0,50 Sph; - 0,50 Cyl; 75 A
They don't help during driving and only work sitting in front of my laptop . The surgeon advised me to work in front of my laptop with the far specs only to get the focus points for intermediate range. I tried hard for several weeks but with no real improvement. I often had to put on 1.0 readers in front of the glasses to manage my work. With this piggyback I can read wonderfully sharp with crisp letters. Without I can't distinguish between fullstop and comma. In addition to my residual astigmatism in both eyes the intermediate vision obviously doesn't work as it should with the trifocal IOLs and as it was promised by the surgeons before surgery.
My question is: How to solve best the residual astigmatism in both eyes and my problems with the intermediate range? Will neuroadaption solve the problems or is that too much for the brain? Without the far specs I don't feel comfortable and secure outside because I can't read street signs and everything is not clear. It is worth trying without glasses? Same question while working in front of my laptop: Should I try to force neuroadaption without glasses or trying with my far specs with fully corrected astigmatism? The piggyback with the 1.0 readers on top is still the best solution for clear reading but this is not a solution for the rest of my lifetime. I can't go on swapping three pairs of glasses and putting one on top of the other. I was told I won't need any glasses or contact lenses after surgery. In fact I never had glasses since my childhood. I was happy with rigid gas permeable lenses for decades. And now I'm coming out of this surgery with three pairs of glasses! I went to an optometrist/optician for varifocals to solve this issue but unfortunately he got confused about the strange measurements he received. Varifocals seem to be problematic with trifocal IOLs. I think I will have the same problem if I see a specialist for contact lenses to get multifocal rgps.
The surgeon suggested an ADD-ON in the ciliary sulcus to solve my residual astigmatism. But this is another invasive surgery. New incisions have to be made I guess. My eyedoctor (she is not the surgeon) said the sulcus is not a good place for a lens. There might be rotation, movement, irritation. Anybody who can help with that? Maybe with experience receiving this kind of lens in the sulcus or dual-lens-procedure with one lens in the bag and the other in the sulcus?
Referring to LASIK the surgeon mentioned he can't fully correct. Is that worth the risks? I do suffer from floaters and severe dysphotopsia as well. My eyes were healthy before surgery. I wasn't told of the bunch of negative outcomes that are possible after this procedure. On the contrary: Everything should be fine, esp. if you choose a premium up-to-date lens like the Zeiss Lisa. Therefore I'm reluctant to undergo further invasive procedures that will not solve my issue to restore clear sight in all directions or causing new problems assiociated with LASIK.
I very much appreciate your answers, knowledge and experience. I'm thankful for this forum. Thank you for reading this long post and for your help!
0 likes, 11 replies
RonAKA assia99778
Edited
I can only offer a couple of comments. Keep in mind that astigmatism is not all bad, and uncorrected it can actually improve your reading ability. The impact of - 0.5 D of astigmatism on distance vision is about equal to -0.25 D of spherical or not much. My thoughts would be that your vision for reading would be better without the correction provided by that first pair of glasses that you listed, and the impact on distance should be close to negligible. I am surprised you cannot see the dash as I can see the dash in my car with a plain monofocal set for distance. My residual error in this eye is 0.0 D spherical and 0.75 D cylinder. I can start to read with it at about 20 inches.
.
If you are not against wearing a contact you may want to try a contact in your non dominant eye that leaves you with about -1.25 under correction, and perhaps not correct the astimatism. For example if your left eye is the non dominant one, try a +1.0 contact in that eye. The idea would be to leave the right eye for distance and the left eye to assist in reading.
.
This all said, my thoughts would be that your vision should be pretty good all around without any correction with a contact or eyeglasses. Perhaps it will just take some time to adapt.
assia99778
Posted
Thank you RonAKA for your encourageing reply!
Unfortunately multifocal IOLs are less forgiving in case of residual astigmatism and aberrations than monofocal IOLs which you received. Residual astigmatism 0.5 and above has to be corrected. It's not possible to drive longer distances or in unknown areas without correction, esp. during darkness with additional halos and glare (huge spiderwebs and concentric rings around point light sources, headlights etc.). I can't see numberplates or street signs on a motorway until they get very near.
Today I've seen a specialist for contact lenses. My left eye changed a little and got 0.75 Cyl. like the right one, the axis is now 50. They can't help me with multi- or bifocal contacts because they won't work well with the implanted trifocals and the errors left. I can try with soft lenses to correct far vision to get rid of the specs during outdoor activities and sports like swimming. The result is still that I do need several correction glasses or contacts with glasses for far and intermediate vision.
I tried your suggestion with + 1.0 in my non-dominant eye but that didn't work. My question is:
Did anybody correct small residual astigmatism in combination with trifocal or multifocal IOLs with LASIK or AddOns? Maybe limbal relaxing incision?
According to my information it is much more difficult to correct with LASIK if trifocal or multifocal IOLs are implanted because of the presence of several foci. There is a better outcome with LASIK after monofocal IOL implantation.
RonAKA assia99778
Posted
I agree that MF contacts are probably not a good idea. There are toric contacts of course that would correct astigmatism. I would recommend the J&J Acuvue Oasys Daily ones. However, as I mentioned this may make your reading worse rather than better. Astigmatism extends the depth of focus, at a price of some reduced sharpness in the image. I have residual astigmatism in both my eyes currently, but have 20/20 vision and read quite easily except for very small print with my contact lens monovision. I have done some investigation of LRI and but have not discussed it with my surgeon. He did say in the initial consult that it was an option. The other thing you should investigate is whether or not your astigmatism is regular or irregular. Irregular astigmatism is hard to correct for, and may be best left alone, although I don't think it is out of the question for LRI. My limited research on making a correction was that LRI may be a little bit more uncomfortable to get done, but with a skilled surgeon may have better outcomes than Lasik.
.
Here is the title of an article that I found helpful on astigmatism.
.
Review of Ophthalmology Astigmatism: How Low Can You Go?
.
And another article about LRI:
.
Review of Ophthalmology Is There Still a Place For Manual LRIs?
assia99778 RonAKA
Posted
Thank you for the articles! They are very interesting though residual astigmatism seems to be quite complex. What I have learnt: LRI even done manually by an experienced and skilled surgeon should help me to come down to 0.25 Cyl. The thing is: I'm not living in the United States but in Western Europe. You can't find experts on that.
I will have another consult in a few weeks. I have choosen an university eyeclinic with reputation in eye surgery. I'm curious what they will suggest.
assia99778 RonAKA
Posted
Just an update to my previous reply: The whole thing is an emontional roller-coaster. I thought LRI might help me but than reading about LRI-treatment after IOL-surgery to eliminate residual astigmatism I found this: "Incisional (e.g. astigmatic keratotomy and relaxing limbal incisions) are the easiest and most economically viable ways to address low amounts of residual astigmatism following monofocal IOL implantation. They can be very useful in older patients with dry eye disease. However, they should be avoided in MIOL cases because of poor predictability and regression."
It's depressing: Varifocals and multifocal contacts are no longer an option because of the trifocal/multifocal optic. LASIK works better with monofocal IOL. And regarding LRI it's the same problem. Your first article already mentioned this problem.
hilary13182 assia99778
Edited
Hi. I was wondering if the residual astigmatism was made apparent by seeing curved, convex, concave lines where there should be straight ones? Thanks.
assia99778 hilary13182
Edited
Hello hilary, I can't tell you. How can you make it apparent? One of the IOLs had rotated twice. After rerotation in a second surgery the IOL is still 10 degree out off axis. 1° causes 3,33 % astigmatism. Therefore I'm more than 30 % off. That's the cause in my dominante eye. It's not the cornea. Correction is difficult in my case but I still hope that there will be a solution. Probably my halos are worse because of this.
The other eye wasn't reexamined yet. It's probably induced astigmatism caused during surgery.
Can you explain the matter with curved, convex and concave lines?
hilary13182 assia99778
Posted
I have two toric IOL's installed, LE- 5 1/2 and RE- 2 months ago. When I look at what should be straight lines, corners of walls, telephone poles, hallways, etc...the line is slightly curved to my nose in both the eyes. I've had ongoing sore ache at the 8-10 o'clock position with the left eye. And the same floater rolling across it. I'm waiting on new ins. referral to see my ophthalmologist. I feel like the docs are missing something- like a haptic rubbing against one of my eye structures.
assia99778 hilary13182
Edited
I understand. The position of your IOLs must be checked. It seems to me that there is something wrong due to tilt, decentration or dislocation. Maybe a second opinion will help but your doctors are responsible and they should be able to find out the cause for your vision problems: They can see it. Try with your surgeon first. The opthalmologist needs special equipment to look inside your eye that usually is not available at that level (a normal slitlamp is not sufficient).
Best wishes and please let me know, assia
hilary13182 assia99778
Posted
Hi. So you are saying a normal slitlamp magnifier will not see a tilt, or haptics dislocation? Very interesting. Could problems be overlooked because of this? My problem left eye has never felt normal, or 'seated', and has the same dull sore ache in one area- 8-10 o'clock. I feel like I'm walking on a boat. And of course I have major PCO in that eye only.
assia99778 hilary13182
Posted
My eyedoctor wasn't able to figure out the rotation of the IOL in my dominant eye because her slitlamp couldn't make it visible. Only refractive eye-surgeons use sufficient diagnostics. That's at least the situation in my country which is in Western Europe.
Your PCO must be treated as well with Nd:YAG-Laser to make you happy again. There is a way to leave the boat, walking on steady ground again without pain in your eye. I'm sure. Be confident! assia