Cataract Surgery and Astigmatism Reduction

The surface of the eye (the cornea) normally has a spherical curve, like the shape of a basketball. This helps light rays passing through the cornea to be bent toward the center of the retina and be focused on one spot for clear vision.

If you have corneal astigmatism, the surface of the cornea is curved more like a football, with both flatter and steeper curves. When the surface of the cornea has an uneven curvature, vision becomes distorted. This common abnormality, called “corneal astigmatism” causes blurred or distorted vision because light rays are not focused at one spot to provide clear vision. If you have astigmatism, this is usually corrected by glasses with a special astigmatism lens to compensate for your abnormality in your cornea.

If you have a cataract and corneal astigmatism you will not regain high-quality uncorrected distance vision after microincision cataract surgery unless your astigmatism is also corrected. One option to correct your pre-existing astigmatism after your surgery is with eyeglasses with an astigmatism correction or a special toric contact lens. If you want to improve your uncorrected distance vision and minimize your dependence on corrective eyewear after cataract surgery there are surgical options for you to consider.

At the time of your microincision cataract surgery Drs. Solway and Rasansky can utilize a diamond knife and make cuts in the cornea called “limbal relaxing incisions”. These cuts are usually separate from the cataract incision and are oriented in such a way that the shape of the cornea becomes more spherical. Limbal relaxing incisions are an effective way to reduce astigmatism at the time of your microincision cataract surgery. However there are some significant drawbacks to limbal relaxing incisions. Some of the limitations of limbal relaxing incisions are the following:

  • Limbal relaxing incisions depend on wound healing which is variable from patient to patient. Therefore, it is not as predictable as we would like (sometimes you get less effect than predicted, sometimes more effect than desired).
  • The amount of astigmatism that can be corrected is limited by this method
  • There are some surgical risks with limbal relaxing incisions (inadvertent perforation, epithelial defects, wound gape and foreign body sensation).
  • The cornea is structurally weakened by these incisions which may leave it more susceptible to rupture if you suffer an injury.

Acrys of Toric Intraocular Lens Implants

The Acrys of Toric Intraocular Lens (IOL) is a recently FDA approved IOL that can be implanted at the time of your cataract surgery to replace your clouded lens. The unique design of the Acrysof Toric makes it possible to reduce or eliminate corneal astigmatism and significantly improve your uncorrected distance vision. This IOL is fixed focus and most patients will still need reading glasses at a minimum after surgery. It must be emphasized that Drs. Solway and Rasansky cannot guarantee you that your astigmatism will be eliminated. In FDA studies however, 97% of patients that had the Acrysof Toric IOL implanted bilaterally achieved spectacle freedom for distance vision after their surgery.

The Acrys of Toric IOL is custom ordered to correct your astigmatism as well as replace the function of your natural lens. Drs. Solway and Rasansky utilize special pre-operative tests and a computer program to determine the exact IOL that would be best for you. The Acrysof Toric IOL is considered a premium IOL and the expense of this IOL and additional procedure is NOT covered by your insurance. Prior to your procedure the office staff will review with you exactly what your additional out of pocket expense would be if you decide to have your astigmatism surgically addressed. If you have a very large amount of astigmatism it may be necessary to utilize the Acrysof Toric IOL combined with limbal relaxing incisions at the time of your surgery to give you the best post-operative results.

Drs. Solway and Rasansky and their staff are committed to offering all of their patients a complete range of options and to provide state-of-the-art microincision cataract surgery in a cost-effective and compassionate manner. Which IOL and procedure to utilize is an individualized decision and it is important that you be as informed as possible. Certainly there can be no guarantees regarding results, but Drs. Solway and Rasansky and their staff will do everything possible to make your microincision cataract surgery successful.