In order to understand Custom Astigmatic Surgery, it is important to have a good understanding of astigmatism. An eye without astigmatism is essentially round, like a basketball. Eyes with astigmatism have a shape more like the surface of a football or an egg. You can imagine that eyes with refracting surfaces shaped like footballs do not focus light very well!
If astigmatism is not corrected, even patients with clear lenses after cataract surgery will have blurred vision. Traditionally, astigmatism is corrected with eyeglasses or contact lenses. For those patients with cataracts and astigmatism who desire increased freedom from glasses, there are several surgical methods for correcting astigmatism:
Placement of a Toric (Astigmatism Correcting) Intraocular Lens: this procedure involves the use of a more expensive type of implant (a toric IOL) that corrects for astigmatism. Rarely, toric implants can rotate out of position after surgery, requiring surgical repositioning.
Limbal Relaxing Incisions (LRI): these are made at the time of cataract surgery with a diamond. As they heal, they flatten the steep part of the cornea and steepen the flat part of the cornea, thus making the cornea more round.
Excimer laser refractive surgery (PRK and LASIK): PRK and LASIK are the most precise methods for reducing astigmatism. Since most cases of astigmatism with cataracts can be easily managed with LRI’s and toric IOL’s, excimer laser refractive surgery is rarely necessary after cataract surgery.
Prior to surgery for astigmatism, a number of special measurements are taken, and extra care is needed in the planning for and execution of surgery. Custom Astigmatic Surgery will be used to target either distance vision in both eyes or monovision, depending upon your goals. Because astigmatism can otherwise be easily corrected for with eyeglasses, surgical correction of astigmatism is considered by Medicare and private insurance carriers to be a cosmetic or luxury procedure and is not covered by insurance.
With Custom Monovision, we aim for distance vision in the dominant eye. We aim for reading vision in the non-dominant eye by making it nearsighted. Having one eye set for distance and one eye set for near increases the number of things that you can do without glasses. This approach after cataract surgery or refractive lens exchange works best in patients who have previously had success wearing contact lenses for monovision.
The disadvantage with monovision is that both eyes may no longer work together for distance or near vision. Some patients, realizing the advantage of increased freedom from glasses and contacts, tolerate this disparity extremely well. Other patients are unable to tolerate the imbalance between the two eyes. The goal with Custom Monovision is to see well enough to pass a driver’s test and read a newspaper without glasses.
Our Custom Distance program involves the use of monofocal, aspheric intraocular lenses set for distance vision in each eye. Extra testing with our Refractive Services Packages helps us customize our choice of implant to your eye. By measuring your spherical aberration prior to surgery, aspheric lenses can often be used to reduce your aberration profile after surgery. The goal with Custom Distance is to see well enough with each eye to pass a driver’s license test without glasses.
In order to assess your suitability for Custom Cataract Surgery, a battery of tests is performed. We call these tests our Refractive Services Package, which involves screening tests not covered by insurance or Medicare. These screening tests include corneal topography with both the Atlas and Pentacam topographers, specular microscopy, and assessment of macular function with OCT. Although not covered by insurance, the cost of testing is similar to what you might spend on a good pair of eyeglasses.
There are four basic options we offer for our Custom Cataract Surgery patients: Custom Distance, Custom Monovision, Custom Astigmatic (Toric), and Custom Multifocal. Understand that special cases, especially those patients with a history of prior refractive surgery such as LASIK, PRK, or RK, may require the use of more than one technology or procedure in order to obtain the desired result. Dr. Schulze will work with you to help you make the best choice for you.
The goal of Custom Cataract Surgery is to reduce or eliminate your dependence on eyeglasses and contact lenses. Custom Cataract Surgery has as its basis the same procedures used in traditional cataract surgery, but involves extra testing, materials, and procedures to improve the patient’s chances of becoming less dependent on glasses. The additional procedures involved with Custom Cataract Surgery are considered to be in the category of luxury or cosmetic procedures, and hence are not covered by insurance.
