I have a astigmatism and my script has prism in it. My prescription is CYL -175 & -225 AX-030 & 120. I'm a -625 & -500 with +2.50 add and Prism 5 up 5 down. I was told I'm going to most likely need glasses after surgery anyways at least to deal with the prism and really don't mind. I been wearing them so long I wouldn't feel right without them. The only part of my vision right now that works great without glasses is about the first 10 inches and I hate to loose it after surgery the +2.50 add for reading is not working well for me I wind up having to take off my glasses to see small print. Considering I'm going to be wearing glasses anyways what would be a smart lens choice for me that will allow me to see all 3 zones with 1 pair of glasses? Any suggestions ?
markee - I will assume you are having cataract surgery due to cataracts being bad enough that you can’t see well enough to drive (20/40) or worse.
Your list of what you want won’t come in one IOL and that is why doing as much reading and research as you can prior to a consult with a surgeon is advisable. There is no perfect lens and trade offs and compromises to make. The younger you are the more compromises there are. Someone of normal cataract age has list their near vision and wear glasses for reading years ago. I was able to see and read well without glasses when I was diagnosed with cataracts and that was unsettling to me and did factor into my decision however I was well aware that the IOLs I chose may not guarantee glasses free and I would be compromising my night vision.
Once you have read up on the pros and cons of the IOLs get several consults. Some surgeons will not even tell you about lens options. In Canada as our medicate system covers 100% of the surgery they assume monofocal lenses and don’t discuss premium lenses unless you ask. Some have their go to lens they are comfortable with so you could get differing opinions. You may not even be a good candidate for premium lenses so to some degree listen to their advice. Even if you aren’t there ate strategies with monofocal lenses like mini monovision where one eye is targeted for distance and the other eye is slightly nearer so that you have more range of vision. Unless very used to monovision with contact lenses already hopefully surgeon wouldn’t aim for more than a diopter difference (1.25 at most) between the eyes.
Wishing you well on this journey.
First, I have no understanding of your prescription and what this means for cataract surgery and the likely need for glasses.
With your preference for not loosing the ability so see up close without glasses there is one standout configuration. This would be premium lenses in both eyes configured for reading combined with progressive glasses. These glasses will handle the intermediate and far distances along with any correction for astigmatism or prism issues.
Other alternatives are mini monovision or multifocals but if you are going to need glasses anyway then those are not really the best solution.
Incidentally, the very basic IOL has a spherical shape. It is covered by most government medical plans. Premium lens are aspheric and provide much better vision. I would not be comfortable with any surgeon who does not discuss premium lens as an option (unless it is a clear situation that the patient would not be able to afford them and it would cause some embarrassment).
Prism: I don’t know much about that issue other than having a friend that has prism in her prescription glasses, and recently had cataract surgery. She went with PanOptix trifocal IOLs and to my knowledge they have no correction for prism. She has issues with reading and has ended up using reading glasses to read finer print especially in dimmer light. No idea if the issues she is having is associated with the prism or not…
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** Astigmatism**: Most IOLs have a model that can correct for astigmatism if it is greater than 0.70 based on the cornea error. You will not really know whether or not you need astigmatism correction until after they have done the complete topographical measurements of your cornea. The astigmatism your eyeglasses correct for is the sum of the cornea and natural lens astigmatism error. They may be additive, or in some cases one may be offsetting the other. The natural lens is removed to put a IOL in place of it, so the lens error is gone. The IOL only has to correct for astigmatism error in the cornea. Whether or not you need toric IOL’s is something you should discuss with the surgeon after the topographical measurements are taken. Most agree it is best to correct astigmatism with an IOL if there is a suitable power available. However the other option if you are going to wear glasses anyway is to correct it with eyeglasses. Because the steps in powers for astigmatism in glasses are smaller, and the angle more exact, an eyeglass correction can be more accurate. And last astigmatism can be corrected with Lasik after IOL surgery.
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Type of IOL: Based on your comment that you want to read fine print close up without glasses, one option is to use a monofocal aspheric lens like the AcrySof IQ Aspheric Monofocal (Toric if necessary), but with the power chosen to let you read without eyeglasses. You will then need eyeglasses for sure as you will be left with a myopic vision of about -3.5. The best would be progressives so you can see at all distances, and the prism could be factored into the eyeglasses, as well as any correction for residual astigmatism. There are other options but that one strikes me as the cleanest given your priorities and willingness to wear glasses. The other straightforward clean, and more common option would be to correct both eyes for distance with a monofocal. However, that will require readers for close up, and possibly prescription progressives anyway for the prism, and you will not see close up without glasses. Monofocal lenses are associated with the least optical side effects, and are also the least expensive.
Hope that helps some,
On a quick search on correcting prism with IOLs, I found this information:
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"Can I get IOLs with prism correction?
AUG 16, 2019
Question:
I am 70 years old and have had prescription glasses with prisms for double vision for almost 50 years. I have very slight cataracts that do not require surgery now. However, could I have lens replacement surgery with lenses that have prisms?
Answer:
Unfortunately, there are no intraocular lenses (IOLs) that have prism in them. Depending on how much prism you have, eye muscle surgery can eliminate the need for prism in some cases.
Answered By: Aaron M Miller, MD, MBA"