Friday, April 12, 2024

Cataract Surgery With Toric Lens

What Lens Options In Cataract Surgery Are Best For Me

Cataract Surgery with a Toric Lens

Now that weve discussed the different lens options that are available in cataract surgery, youre probably trying to decide which is best for you.

There are many different brands and models of lens implants, and there are different techniques for the surgery, such as cataract surgery with laser assistance.

The most important thing to consider is how youd like your vision to look after surgery, and have a discussion with your surgeon about your vision goals, lifestyle, and vision needs.

An active golfer or tennis player who still works as an attorney or accountant will have very different vision needs than a less active 95-year-old who doesnt drive at nighttime any longer.

Having a personalized discussion with your surgeon is the best way to achieve the customized outcome that will be best for you. If you need to find a cataract surgeon in your area search our doctor finder here

What Is The Acrysof Toric Iol

The AcrySof® Toric lens is a foldable, single piece lens that is implanted during cataract surgery or a refractive lens exchange surgery to replace the clouded lens. The unique design of the AcrySof® Toric IOL makes it possible to reduce or eliminate corneal astigmatism and significantly improve uncorrected distance vision. AcrySof® Toric lenses provide QUALITY distance vision, independent of eyeglasses and contact lenses. The AcrySof® Toric lens is made of the same biocompatible lens material already successfully implanted in more than 25 million eyes since 1991.

Toric IOL technology uses biocompatible materials that have been successfully used in contact lenses and proven safe for the eye. There is an additional cost for this lens implant. If you are seeking astigmatism correction in Arizona or New Mexico, please feel free to contact us to schedule an eye exam. We have locations in Deming and Las Cruces, New Mexico, as well as Phoenix, Tucson, Flagstaff and throughout Arizona.

Clear Corneal Incision On The Steepest Meridian

How it works

The main surgical incision is aligned with the steep axis of cornea leading to a decrease in the astigmatism.

Historically, a single incision along the steep axis had the potential to correct a small, but clinically significant amount of astigmatism: 0.5 D according to Eyerounds and 1.0 D according to Kaufmann et al. In recent years, as cataract surgery has evolved, phaco incisions have gotten progressively smaller, from 3.2 mm to 2.4 and even as small as 1.4mm. In a study comparing 2.2 mm and 3.0 mm on axis incisions, researchers found that the mean change in astigmatism between the two were significantly different, with the 2.2 mm incision inducing only 0.10 +/- 0.08 D and the 3.0 mm incision producing 0.32 +/- 0.20 D. While microincisions are good for patients with little to no preexisting astigmatism, as they reduce the amount of surgically induced astigmatism, their usefulness as a technique to reduce astigmatism is also minimized.

A second phaco incision can be placed on the opposite side of the same axis increasing the astigmatic effect, up to 1.5 D. Extending the width of the incision may provide greater astigmatic results, although this may necessitate suturing of the wound.

Advantages

CCIs are technically less complex and less calculations compared to toric IOLs and LRIs . For single incisions no additional surgical manipulation of the corneal tissue is required. CCIs are the least expensive option for astigmatism correction.

Disadvantages

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Your Prescription Changes After Cataract Surgery

That lens inside your eye that became a cataract? Well, that lens took part in your eye prescription.

About two-thirds of light that enters the eye is focused by the front clear part of the eye called the cornea. The rest is focused by the lens. Where the cornea and the lens focus this light determines your prescription .

Which Lens Is Best

Toric IOL implant surgery

With the diversity of lens choices available, it can be difficult to figure out which lens is best for your eyes and vision after cataract surgery. There is no one lens that rules them all. Fortunately, you donât to make this decision alone your cataract surgeon will also help guide you to the best option for your eyes.

  • If you are looking for the least amount of glasses possible and your eyes are healthy, then using a trifocal lens is the way to go.
  • If you are a long-time user and well adjusted to monovision contact lenses, than having micro monovision with extended depth of focus lenses or monovision with light adjustable or toric lenses provides the most seemless transition after cataract surgery to glasses independence.
  • Using extended depth of focus lenses with or without micro monovision is also the best bet if your eyes arenât healthy enough for trifocal lenses and you desire as much glasses independence as possible.
  • If you prefer the sharpest distance vision possible and donât care about computer or reading glasses, than using light adjustable lenses or toric lenses are your best bet.
  • If you don’t mind glasses and want what your insurance is going to cover, than having a monofocal lens is a perfectly suitable choice.

And many of these lenses can even be mixed-and-matched, such as combining a trifocal lens with an extended depth of focus lens, to really customize your vision after cataract surgery.

Allowing you to get your best vision after cataract surgery

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Ce: Lets Say It Has Been Determined That An Iol Likely Requires Rotation Whats The Best Way Of Explaining This To The Patient

Dr. Berdahl: Its best to be direct. Explain that the surgeon might not have gotten rid of all of the astigmatism and thats why the patients vision is a little blurrier than we would like. Also point out that this is no cause for concern, that it happens sometimes, and that its a fixable issue. Let the patient know that you plan to contact his or her surgeon to come up with a plan for addressing the issue and that it may involve rotating the lens or even laser vision correction.

Its helpful to add that the fix you have proposed is included in the fee for the original toric lens . Understanding your comanaging surgeons approach is helpful for this conversation, because some operate in a hospital and their hospital may not let a patient come back to the OR for free.

What Are Toric Iols

In the past, intraocular lenses were not capable of correcting astigmatism when used to replace the lens removed during cataract surgery. At this time, the surgeon may have made incisions into the cornea to reduce the severity of the astigmatism. Toric IOLs changed this completely and gave people a viable treatment option for astigmatism.

Toric IOLs have things in common with toric soft contacts for astigmatism. In different meridians on the lenses, there are different powers. This helps to improve the eyes asymmetric power, which occurs with astigmatism.

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Will I Still Need Eyeglasses With A Toric Lens Implant

The toric lens implant does NOT allow you to both read and see far away without eyeglasses. It may not necessarily correct 100% of your astigmatism either. However, compared to a conventional lens implant that does not correct astigmatism, the toric lens implant should improve how well you see without glasses, and any eyeglasses that you do require should be less strong and potentially more comfortable to wear.

Like contact lenses or eyeglasses, every artificial lens implant model is manufactured in more than 60 different powers. As with prescription eyeglasses or contact lenses, it is important to match the appropriate artificial lens implant power to your eye. To prescribe the correct spectacle or contact lens power, we utilize trial and error to preview various lens powers in front of your eye. When you are asked, which is better, one or two? during an eye exam, you are selecting the lens power that you see best with. However, because the artificial lens implant is only inserted inside the eye after your natural lens has been removed, it is impossible for you to preview or try out different powers during the middle of surgery. In the operating room, we obviously cannot insert more than one lens implant to let you select which one gives you the best distance focus. Nor can we switch to a different lens implant power later on as one could with contact lenses.

Toric Premium Lens Implant For Astigmatism

Correction of Astigmatism with Toric Intraocular Lens during cataract surgery- See Better!

Toric Premium Lens Implants are a type of lens implant for cataract patients that are designed to correct astigmatism, resulting in better uncorrected visual acuity.

For cataract patients who have a significant amount of astigmatism, and who do not wish to wear eyeglasses to see clearly at a distance, choosing a Toric Lens Implant can help them be independent of glasses for tasks such as driving, that require clear distance vision.

The Toric Lens Implant does not correct presbyopia, the inability to focus naturally from near to far distance. After cataract surgery, patients that receive the Toric Lens will still require reading glasses or bifocals to be able to comfortably perform near vision tasks such as reading and intermediate tasks such as computer work.

If you have a considerable amount of astigmatism, Mr. Srinivasan and staff will discuss Toric Lens Implants with you, as this type of premium lens implant may be a good option for providing you with the best possible vision without needing eyeglasses to see at distance after your cataract surgery.

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Speak With Your Ophthalmologist About Your Iol Options

Not all surgeons offer the options of toric or multifocal lenses, so its essential to bring this up with your ophthalmologist if youre considering cataract surgery in Vancouver.Want to skip the waitlist for cataract surgery? Are you looking to cure your cataracts and eliminate your need for glasses at the same time? Get a free cataract surgery consultation from BoydVision.

Ce: Is There Anything Else You Would Like To Add About Managing Patients Who Require Toric Iol Adjustments

Dr. Berdahl: When a patient is referred by an OD to an MD for cataract surgery, not only has that patient transferred his or her trust to the surgeon, but so has the optometrist. MDs know that, in many cases, the optometrist has spent many years cultivating a relationship with the patient, so when both parties put their trust in us, we dont take it lightly.

John P. Berdahl, MD

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Implanting A Toric Lens Implant

For higher levels of astigmatism, its more accurate and consistent to have the astigmatism correction built into the lens implant itself. Toric lens implants have been around for many years and the implantation, alignment, and positioning is routine for experienced surgeons. Toric implants can correct much higher levels of astigmatism compared to limbal relaxing incisions.

Toric lens implants work similarly to how a glasses lens fixes your astigmatism except for the convenience of having it implanted in your eye so that you dont have to rely on glasses or contacts to see clearly. All adult patients have a lens implant placed at the time of their surgery, so the only decision to make is whether you want a modern toric lens implant that fully corrects your vision, or a basic lens implant that does not fully correct your prescription.

What Are The Advantages And Disadvantages Of Toric Lens Implants

Cataract surgery Toric Lens

Toric lens implants are lenses that are implanted internally inside the eye to replace the natural lens as part of a cataract operation or as part of a refractive lens exchange operation. We use toric lens implants when a patient has astigmatism. It is very important to consider in the preoperative planning before the operation.

Many patients think that because they have astigmatism, they may not be suitable for a certain kind of lens implant or refractive lens exchange procedure. In most cases, thats not true.

Astigmatism does not preclude patients from having one of these procedures.

Patients with a significant degree of astigmatism often want to understand the implications for their vision after the surgery. They want to know what their vision will be like if they do not have astigmatism corrected, or if they do, and I often show patients the images in the video

Dont let post-COVID cataract queues delay you from getting the treatment you need. Save your spot now with a virtual appointment

Meet online or over the phone with surgeon Prof Muhtaseb, and get a clear answer on your cataract surgery options from the comfort of your home. Youll also discover the little known possibility of fixing your reading and/or distance vision at the same as you fix your cataracts. Click the button below now to book your video or telephone appointment.

ABOUT THE EXPERT

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How To Manage Toric Iol Rotation Postoperatively And Preventative Measures To Take Intraoperatively

The importance of a toric IOL being placedand remainingat the appropriate axis is critical for optimal performance. A frequently cited study describes how just 1 degree of misalignment results in 3.5% of residual cylinder 3 degrees of misalignment in 10.5% of residual cylinder and 30 degrees of misalignment in a total loss of the torics astigmatic correcting effect.1

How common is toric IOL rotation? Steven Safran, MD, New Jersey Surgery Center, Lawrenceville, New Jersey, said he thinks its not that uncommon to see 510 degrees of rotation with toric lenses.

Knowing methods to reduce the risk of IOL rotation in eyes more susceptible to it and how to manage residual astigmatism after rotation occurs is important. Still, the opinions on management of a rotated toric IOL vary.

Multifocal And Trifocal Lenses

Because science has yet to discover a way to make inflexible material behave exactly like the way our own natural lens does , different optical techniques have been developed in order to give simultaneous vision for distance, computer and reading vision.

These particular types of lenses take light that enters your eye and focuses it for distance vision, reading vision and computer vision all at the same time. Instead of a single focus, these lenses have multiple focus points . That way, no matter where you are looking, some of that light entering your eye will be in focus.

The current generation of these lenses can pretty much get you completely out of glasses. These are known as trifocal lenses because they focus for the three main distances that we look at: far away, up close and intermediate or computer distance.

There are two main trifocal lenses approved for use in the United States :

  • Panoptix by Alcon, approved in 2019
  • Synergy by Johnson & Johnson, approved in 2021

Because of the special optical properties of these lenses, it does take some adjustment to get fully adapted to this alternative way of seeing. These are the small compromises in order to be able to have full vision correction without glasses after cataract surgery.

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Cataract Surgery Toric Lens Complications

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Best Lenses For Astigmatism

Toric Lens Implants After Cataract Surgery

These lenses for astigmatism Toric IOLs provide the opportunity to correct corneal astigmatism. They offer patients with pre-existing astigmatism optimal distance vision without spectacles. Furthermore, the recent introduction of multifocal toric IOLs offers patients with pre-existent corneal astigmatism the opportunity to be spectacle-free for distance vision and near and intermediate vision. Toric IOLs can correct astigmatism because they have different powers in different lens meridians. They also have alignment markings on the peripheral part of the lens that enables the surgeon to adjust the orientation of the IOL inside the eye for optimal astigmatism correction. The difference in cataract or phaco surgery between the toric lens and a regular monofocal or multifocal lens is that before cataract surgery, the surgeon places temporary markings on the patient’s cornea that identify the location of the most curved meridian of the front of the eye. Then, when the toric IOL implant occurs during the cataract procedure, the surgeon rotates the IOL, so the markings on the IOL align with the markings on the cornea to ensure proper astigmatism correction. Because of this customized technology available to patients, the toric lens price in India is higher than monofocal lenses.

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Surgeons Share Strategies That Will Help Ensure The Best Possible Vision With A Toric Implant

Although toric intraocular lenses are considered a premium optionone that can have a profound impact on a patients visionthey involve far fewer potential visual tradeoffs than premium options such as multifocal IOLs. Nevertheless, they do require making some extra effort and managing the occasional pitfall. With that in mind, several surgeons with extensive experience implanting toric IOLs answer 11 key questions to help make sure you end up with happy toric IOL patients.

1. What should I use to determine toric power and orientation?

Y. Ralph Chu, MD, founder and medical director of Chu Vision Institute in Bloomington, Minnesota, and adjunct associate professor of ophthalmology at the University of Minnesota, says the most critical measurement when implanting a toric lens is topography. That not only defines the magnitude of corneal astigmatism on the anterior corneal surface, it also helps define the type of astigmatismregular or irregular, he says. When thinking about implanting a toric IOL, surgeons need to shift from looking at the astigmatism in the patients refraction to seeing what topography reveals.

George Waring IV, MD, FACS, founder and medical director of the Waring Vision Institute in Mount Pleasant, South Carolina, believes its essential to base your toric lens choice on at least two measurements. To measure magnitude and orientation, he says, you should use optical biometry and either tomography or placido-based topography.

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