Toric decision
Posted , 4 users are following.
I am planning to target -2.0 D (near) or -1.75 D (near/intermediate) with Clareon monofocals and have been asked if I want to add toric correction. Apparently toric lenses would be required if I was targeting distance but as I am not, it is optional. I was told adding toric would improve my distance vision by 15%. Is there a downside to adding toric correction to the IOLs? I was told the only downside would be cost, but what about the possibility of rotation? Would be safer to have the astigmatism managed with my eyeglasses? Many thanks.
0 likes, 12 replies
RonAKA judith93585
Edited
With those near targets you will need prescription glasses for distance. The eyeglasses will correct any astigmatism you have more accurately than toric IOLs will. Toric IOLs will only have value when you are not wearing glasses, so they would really only help with near vision. Whether they are worth it or not for near vision would depend on how bad you astigmatism is. Normally torics are only used when the cylinder is predicted to be more than -0.75 to -1.0 D.
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My near eye has -0.75 D of cylinder and it is of the irregular type. It gives me a bit of a drop shadow on letters, and I think to some degree inhibits my reading speed. I see the letters well, but I think it impacts my speed of reading. My other eye has a similar amount of astigmatism and I don't notice the drop shadow images, so the impact may be due to the fact it is irregular rather than symmetrical.
judith93585 RonAKA
Posted
Is my astigmatism +1.00 for RE and +1.25 for LE?
I'll be wearing glasses for distance and the doc told me toric would improve my vision by 15%, does that make sense?
Sphere Cylinder Axis Dist VA Add
Right -4.75 +1.00 007 20/25 +3.00
Left -5.00 +1.25 170 20/25 +3.00
RonAKA judith93585
Posted
Are those eyeglass prescriptions? If so then the 1.00 and 1.25 D are cylinder which is astigmatism. However, if this is for eyeglasses then it does not necessarily mean that you will have that much astigmatism after cataract surgery. You need to ask the surgeon what the residual astigmatism is predicted to be if you do not get torics. In cataract surgery the astigmatism in your natural lenses is removed, so they have to estimate what will be left in your cornea. It most likely will be less than what you have in your eyeglasses. You can't really make a decision on a toric or not until they tell you what your residual cylinder will be.
judith93585 RonAKA
Posted
Yes, this is my prescription for my eyeglasses.
Thanks for letting me know to ask about residual astigmatism.
I'll do that!
Back to what the doc said about torics. They would improve vision by 15% for distance. Does that make sense?
RonAKA judith93585
Edited
"Back to what the doc said about torics. They would improve vision by 15% for distance. Does that make sense?"
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You will need prescription glasses for distance. They will correct 100% of your astigmatism even if you do not get toric lenses. So, no that does not make any sense.
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Torics will only help when you are not wearing glasses, and only if your astigmatism is high enough to justify the minimum power of cylinder power. The lowest cylinder power IOL I know of is the ArySof IQ and it will correct 0.75 D of cylinder. The Clareon is more and I believe it corrects down to 1.0 D. You may very well not have enough cylinder to make it worthwhile to correct with a toric.
judith93585 RonAKA
Posted
Many thanks for the clarification!
RonAKA judith93585
Edited
I didn't mention it but if you do get a toric, it will not likely make a perfect correction for astigmatism, but for distance with glasses the eyeglass prescription will make the correction for that error as well.
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However, from your eyeglass prescription, I'm doubting that you really need a toric. You need the prediction from your surgeon to be sure. If it is less than 1.0 D of cylinder I would question the need for it, considering you will wear glasses for distance anyway. Where I am the extra cost for a toric is $1,100 per eye.
Lynda111 judith93585
Posted
I would also add to what Ron said by saying I had a lot of pre-operative astigmatism, (2D), but I didn't want to correct it with a toric, because I wanted my surgeon to get in and out of my eyes with a plain jane monofocal. I wanted to make my surgery as quick and easy for her and me as possible. A toric IOL was just something else that could possibly go wrong, or at least complicate my surgery. As it was, I got lucky (or blessed) and didn't need eyeglasses to correct my astigmatism. But I would have been willing to wear them, and with eyeglasses, if they aren't right, you can get another pair quite easily.
judith93585
Posted
Thanks Linda! I was thinking the same. That he toric might rotate...
I'm not sure I understand your last sentence: But "I would have been willing to wear them, and with eyeglasses, if they aren't right, you can get another pair quite easily".
What does them refer to in "willing to wear them"?
Many thanks!
judith93585
Edited
Linda, I forgot to ask... Is it more difficult to implant a toric lens than regular monofocal? One thing I can think of is the need to get the angle correctly placed.
RonAKA judith93585
Edited
Yes, it is more difficult for the surgeon to do a toric implant. They have to mark your eye with the correct angle before the cataract surgery. Then during surgery they have to rotate the lens into the correct angular position. If the lens does not stay in the correct angular position based on the 24 hour post surgery exam they may have to go back in and adjust the angle to where it is supposed to be. My wife had torics in both eyes, and she did not say there was anything extra about it other than the position marking step.
Lynda111 judith93585
Posted
Yes. With a toric you have get your eyes marked and then when the toric is inserted it must be set to the right angle.
With my regular monofocal I assumed I would wear eyeglasses afterwards and had no problem with that. But fortunately I only need readers for sustained reading.
And it's easier to replace eyeglasses than to fix a toric. surgically.