Residual astigmatism with toric IOL, pain from cataract surgery
Posted , 5 users are following.
Is residual astigmatism of .50, .75 after toric IOL's a cause for concern?
Did any of you have at the incision site(s), pain? Did it go on for months and months, eventually to fade away? Or do you still feel discomfort where the incisions were made? My left eye does not feel normal or 'seated', like my operated right eye does. It has felt that way from Day 1, 5 months ago. My optometrist says this is because the incision is larger.
Thanks for your input and experience. I know I need to get a 2nd specialist opinion.
0 likes, 11 replies
rwbil hilary13182
Edited
What is your Optomologist saying?
My only recommendation is also get a 2nd opinion from a Top Rated Opthmalogist.
As I have said in the past I like Opthamalogis that do the clinical trials and write papers. You can also look at Castle Connelly Top Rated Doctors.
I give you one more resource. This is a famous Doctor in my area that does a lot of complicated surgeries. I see him on the local news with people that flew in from all around the world to see him.
Full disclosure I have never been to him, but I have seen him talk about Astigmatism and his methods in that regard which is why I bring him up and it seems he responds to people that comment on his page, so you might email him, especially if you live anywhere near him.
You can go to you tube and enter, "Dr. Gulani Explains Astigmatism" and then watch his other videos.
RonAKA hilary13182
Edited
Based on what I know the problem with a toric lens for smaller amount of astigmatism is that the minimum cylinder correction is 1.5 D. So for example if you have a needed correction of 0.75 D and you put this minimum toric lens in all it will do is reverse the angle of the astigmatism. You will still have 0.75 D but reversed in angle, and have not gained anything for your additional outlay of cash for a toric. As your astigmatism goes up above 0.75 then a toric lens starts to have more impact. Ideally if you have 1.5 D of astigmatism you could theoretically correct it all. But they come in steps so most likely there is going to be a residual, unless you get really lucky.
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My non toric lens left me with 0.0 D Spherical and 0.75 D Cylinder (astigmatism). The surgeon was estimating it to be less than 0.5 D with a non toric, so there must have been some addition of astigmatism due to the incision made to do the surgery. I understand there is an option to use limbal relaxing incisions (LRI) to reduce small amounts of astigmatism that can't be corrected with the available steps of toric lenses. However, a small amount of astigmatism stretches out your point of focus and can actually help you read better with a monofocal lens. For that reason some leave it, while others may refine the distance vision further with LRI. I have a bit better than 20/20 vision with my IOL eye even with the 0.75 astigmatism. When corrected with progressive eyeglasses that reduce the astigmatism I see a touch better, but not much. Not sure what the cost of LRI surgery is, so I kind of have it on the back burner, until I find out more about it. If there is a significant cost, I probably will pass on it, as it seems I would not gain much from it, and perhaps lose a bit of reading ability.
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As far as a toric lens requiring a bigger incision, I am not sure. The lenses look essentially identical to monofocal lenses in any picture of them that I have seen. Perhaps they need a bigger incision to manipulate the toric lens into the correct angular position? Don't know....
hilary13182 RonAKA
Posted
Hi. My pre-surgery astigmatism was -1.25 in the R, -2.50 in the L. So why did the Toric lens leave me with R-.75, L-.50? (The surgeon's optometrist said I didn't have any astigmatism a month ago (one month post op for the R, but when I went to get glasses, and was tested at the shop, my regular optometrist said I had the above....).
soks hilary13182
Edited
what ronaka said is correct. you probaly have surgery induced astigmatism which is the residual astigmatism. LRI can correct it but it will make near a little worse and also LRI makes the eye structurally a little bit weaker.
RonAKA hilary13182
Edited
There are some complications to consider. First you have to be careful when discussing pre-op astigmatism. There is the eyeglass astigmatism and somewhat independently there is the corneal astigmatism. Eyeglass pre-op includes both the astigmatism in the lens plus that in the cornea. They of course only try to correct the corneal astigmatism because the lens will be gone after surgery. What you have to ask about is the corneal astigmatism only. Then of course there is the issue of the IOL insertion incision. It can change the corneal astigmatism. And the last complicating factor is that the power at the IOL position is not the same as the power at the eyeglass location.
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The thing you have to keep in mind is that astigmatism as a rule of thumb has about half the impact on vision as Spherical error has. I.e. 0.5 D astigmatism has about the impact of 0.25 D of Spherical error. That is kind of at the insignificant level. If you were left with 2.5 D of astigmatism, that is significant to vision. 0.75 D not so much.
hilary13182 RonAKA
Posted
Hi. So you are saying the cataract surgery itself can cause astigmatism, irregardless of Toric IOL's? Above, I was comparing my eyeglasses Rx years ago to the post operated Rx.-
Would astigmatism cause straight lines, like the corner of walls to slightly bend? Thanks so much for your reply....
I'm confused. Btw, I have a J&J Toric -3D in my LE, operated 5 1/2 months ago, -2D in my RE,1 1/2 months ago. Post-op my glasses Rx is LE-2.50, -.50 astigmatism, RE -1.75, -.75. As you can see, the refraction changed. The shop optometrist says this because the IOL moves closer to posterior bag part as it heals. In retrospect, I should've opted for more of a middle range, but I didn't know at the time- I'm an artist. My LE has been a painful, distorted nightmare from day 1, but the surgeon's docs said the surgery went well (!!!). I also have developed major PCO, noticeably in the LE.
soks hilary13182
Posted
what are your symptoms of PCO?
RonAKA hilary13182
Posted
Yes, the incision to do the IOL lens implant can change the amount of astigmatism. I believe some surgeons claim they can locate the incision to reduce astigmatism. In my case that did not happen. My corneal astigmatism increased slightly.
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It is not possible to compare eyeglass astigmatism to corneal astigmatism. Your pre-op eyeglass astigmatism included the astigmatism in the natural lens as well as the corneal astigmatism. To my knowledge astigmatism does not cause straight lines to bend. Macular degeneration however can have that effect. There is a macular degeneration Amsler grid chart of straight lines that is used to detect AMD.
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After your surgery is done an eyeglass prescription should be a good measure of your residual astigmatism.
hilary13182 soks
Posted
Hi. Thanks for asking. Blurry, filmy vision, lots of tiny transparent floaters, night time glare rays from lights.....I'm not getting a YAG until my other issues clear-up, and then, I'll go to the most advanced university where they would have the latest equipment. I'm not sure the biometric measurements were accurate in the 1st place...(small city in Washington State, USA.)
julielyn hilary13182
Edited
i did have incision pain for a while after surgery, but i found that if i used OTC eye drops ( systane perservative free vials) more frequently, things improved. to me, the incision area felt tight...lubrication was the key.
i still use these drops daily, years later.
dry eye is a common result from surgeries 😦
hope you find a remedy
hilary13182 julielyn
Posted
OK, I agree... Is the dry eye symptom permanent, or do eyes return back to normal eventually? Thanks...