With RP and Glaucoma in mind, should I take any extra steps when discussing surgery and lens choice? - I know that I should stick to monofocal IOLs and am at much higher risk of complications - Are LRIs a safer bet for me than Toric IOLs? - Toric IOLs can tilt and RP can cause zonular weakness, should I be worried in advance that I could develop it at some point in the future? - Are normal spherical IOLs safer in terms of lens shift and tilt than aspheric ones? - I also have the option to choose laser assisted surgery (FLACS) - does it matter when Retinitis Pigmentosa (and Glaucoma) is involved, is it less invasive or reduces any side effects significantly? - Does FLACS improve precision of LRIs significantly? For the longer story... I've had Retinitis Pigmentosa since childhood and basically only my central vision intact for as long as I can remember. I'm 40 now. Blind at night, tripping over obstacles if the lighting isn't optimal (and even then sometimes), but overall I make due - I can't drive, but am productive as a software programmer. I managed well, until I started to suffer from glare really badly, i.e. now even in good lighting conditions I am struggling - can't go outside without a cappy to shield my eyes and can only read in dark mode (white text on black background). It was diagnosed as mild cataracts in both eyes, "typical for RP", but as it is central and I only have that part of my vision, it impacts my vision significantly. At the same time, my doctor also diagnosed Glaucoma, though it is unclear if it already did any damage, as it would start in the peripheral parts which are already decimated by years of RP. My eye pressure was 17-19 (LE) and 18-23 (RE) at that time, 2.5 years ago. Managed with eyedrops I'm at 12-13 (LE) and 15-16 (RE) now. After two years of procrastination I'm going to have cataract surgery done in a couple of weeks and am trying to prepare myself for the consultation where choice of IOL will be discussed with my doctor. I'm very anxious about this, as I am a picky perfectionist who does spreadsheets for just anything, struggles with any decision and usually still ends up regrettful. One of my concerns: With RP it apparently is common to develop Zonular Weakness at some point in life and this could lead to decentration and tilt of the implanted IOL. One of my eyes has around -1D corneal astigmatism, the other one a bit more than -1.5D. Should I be worried that a Toric lens could shift at some point? Would LRIs be a better or even valid option instead? Similarly, I'm worried about just aspheric IOL vs spherical ones. If I was to get a non toric Tecnis IOL with 0.27 asphericity or a Clareon/AcrySof with 0.2, could this become an issue? Would I be better off choosing the simpler, spherical counterparts or seek a surgeon who uses something like an B+L enVista (neutral spherical aberration), or is this not really a big issue to worry about and I'm overthinking here? As someone with an impaired retina, will an aspheric lens even work beneficially for me, or is it similar as with any type of multifocal that isn't really a valid option for me either way? i.e. are aspheric monofocals a better choice, a worse one, or just about as good of an outcome as spherical ones? FLACS - reading through studies it would seem that there isn't a significantly better outcome than the regular method, though specifically in regards to RP and Glaucoma, I'm thinking maybe it could reduce some risk? Also, if I were to get LRIs instead of Toric lenses to fix astygmatism, would FLACS significantly improve the possible outcome in that regard? I'm sorry for the wall of text, I'm not good at this and probably should have broken it up in multiple topics. Thank you for reading if you made it this far ;)
Lens and Procedure choice as a RP Patient: Is FLACS worth it? Should I avoid Aspheric or Toric IOLs?
You are asking very technical and difficult questions to answer. I am not aware of the implications of RP and Glaucoma. And I am an engineer, not a doctor. But with these precautions, here are my thoughts.
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On the issue of correcting astigmatism, the advantage of a toric lens is that it is a one step solution. You get rid of the cataract, correct your sphere error, and largely correct the astigmatism. The disadvantage is that the toric lens can rotate over time. The Alcon lenses have a reputation of being more stable in the eye and resisting rotation though.
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The advantage of correcting it in the cornea is that it is the source of the error, and it can be done after the cataract surgery, which is most likely to induce some more astigmatism. My surgeon does not recommend LRI as he says it is hard to get predictable results. He recommends a laser method. We have not discussed in detail, but based on my research, I think all laser LASIK or PRK are the best two methods.
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On lens tilt, I believe all lenses can tilt and cause astigmatism, although the Alcon ones may be more stable. It probably does not matter if it is an aspheric or not. The aspheric lens is just going to give you a very slightly sharper focal point. That said lens movement and tilt is not likely to do good things to a toric lens.
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I have not seen any conclusive proof that laser surgery is necessary for the cataract incision. It may be convenient if other laser surgery is to be done at the same time. But in that case I think it is best to defer the laser surgery correction of astigmatism until after the eye is fully healed and stable.