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Surgical correction of astigmatism at the time of Cataract Surgery.

Astigmatism explained

Surgical correction of astigmatism at the time of cataract surgery



 Astigmatism is a problem that comes from either the cornea or lens of your eye not being a perfect sphere. If you have astigmatism it makes your vision less clear at all distances unless it is corrected.

 

Should I worry about astigmatism?

 

The majority of people with astigmatism have it originating from the cornea.  When there is astigmatism in the cornea the shape of the cornea is not perfectly round.  In a perfectly round cornea, the cornea would appear like what a basketball would look like if you cut it in half.  A cornea with astigmatism looks like what a football would look like if you cut it in half. There is one side that is steeper while the other side is flatter (see the photo above.

 
Astigmatism is routinely dealt with by glasses or contact lenses.  It can also be corrected by laser vision correction (either LASIK or PRK). 

 
You now also have the availability of technology that can correct your astigmatism at the same time you are having cataract surgery.

 
If you have astigmatism and a cataract there are three ways that astigmatism can be addressed at the time of your cataract surgery.

 

Astigmatic Keratotomy

Astigmatic Keratotomy involves make incisions in your cornea to help round out the corneas shape. These incisions can either be made with a diamond blade by your surgeon or can be made with a femtosecond laser guided by your surgeon.  Astigmatic keratotomy is good at correcting low to moderate amounts of astigmatism. I will general consider using astigmatic keratotomy for astigmatism that is between about .75 to 1.5 Diopters (diopters is a power measure we used to gauge degrees of astigmatism, near-sightedness and far-sightedness).

 

Toric implants

Toric implants are similar to the regular implants that we insert during cataract surgery only they have astigmatism correction built into them in a similar manner to which your glasses have astigmatism correction in them.  Once a toric lens is inserted in your eye during your cataract surgery it then needs to be rotated to the correct axis to match up with your pre-existing astigmatism.  I find that correction of astigmatism with an implant inside your eye provides better overall vision than correcting it with glasses in front of your eye.  The implant is more stable in its positioning than your glasses are.  If you have a high degree of astigmatism you probably have realized if your glasses get the least bit tilted your vision gets much blurrier.  That is not something you need to worry about with your toric implant.

 

Combination Surgery

There are limits to how much astigmatism can be corrected with either astigmatic keratotomy or a toric implant.  There are times where I have encountered people whose astigmatism is so high that neither procedure alone can correct the full amount of the astigmatism.  In those cases, you can combine both procedures to achieve full correction of the astigmatism.  It is fairly rare to encounter anyone who can’t be fixed by a combination approach.

 

Summary

Astigmatism correction at the time of cataract surgery is an excellent approach to trying to give you the best vision possible after your cataract surgery.  There is one issue though - most health insurance plans do not cover the astigmatism correction portion of your cataract surgery; it is an out of pocket expense to the patient but having the opportunity to get your vision clear is well worth the consideration of having to pay out of pocket for it.  For more on “non-covered” portions of cataract surgery please see our three-part series below.

 

Why would I have to pay out of pocket for Cataract Surgery?

Should I pay out of pocket for Cataract Surgery?

How much should I pay out of pocket for Cataract Surgery?
How to care for your eye after Cataract Surgery
What kind of correction do I need for Sports?

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Thursday, 20 June 2019

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