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Toric IOL

Those over fifty years old are at an increased risk of developing a cataract in one or both eyes, especially if they have diabetes (of either type), take steroid medications or smoke. Prior to about 1980, those having cataracts removed had to wear very thick glasses to make up for the fact that they had no lenses within their own eyes. That is now a thing of the past. Today, synthetic replacement lenses, called intraocular lenses (IOLs) are put in place of the old, cataract-filled lens.

In the past ten to fifteen years in particular, so-called “premium” IOLs have been developed that not only replace a cataract with a clear lens, but that address other existing vision problems such as near or far-sightedness and astigmatism. Traditional IOLs were “mono-focal,” meaning they were set for one type of vision, near or far, and a person wore glasses or contact lenses for the range not covered by the IOL, or for their astigmatism.

Now there are premium IOLs that can correct astigmatism, called toric IOLs. They adapt the same technique to IOLs that has been used for decades in toric eyeglasses or contact lenses: These have two powers in them, made by curvatures at different angles and perpendicular to each other, one for astigmatism, the other for hyperopia or myopia. In both toric contact lenses and toric IOLs, it is important that the lenses not rotate in the eye, something that doesn’t matter for simpler lenses. To accomplish this, the IOLs (or contacts) are weighted at the bottom; this bit of “ballast” naturally stays on the bottom from simple gravity.

A torus is the proper term for the shape of a classic donut. One of the two curvatures used in a toric lens is that of a small portion cut off from the outer part of the donut, not cutting through the middle. The resulting “cap” piece is flat on the bottom – where the cut was made into the donut - and rounded on top, the existing outside curvature of the donut. The other shape is usually a simple spherical one. Together they make the best of both worlds for the person with astigmatism.

One thing to consider with the several varieties of ‘premium’ IOLs is that they are more expensive than simpler, monofocal lenses – and that extra expense is usually not covered, or covered very well, by insurance companies. Although premium IOLs correct both cataracts and other vision problems at the same time, most insurance companies do not see the need for corrective lenses with monofocal IOLs as causing a significant loss to ones quality of life. In other words, they don’t see the correction of astigmatism along with a cataract to be vital, but as a luxury – given that eyeglasses or contact lenses are easily obtained and used.

Insurance companies will typically reimburse up to the amount charged for monofocal IOLs, with the patient making up the difference. One can also request the eye surgeon reduce some portion of the difference in payment, which runs in the neighborhood of two thousand dollars. It is also possible, in a minority of cases, that the toric IOL still leaves a bit of blurriness to be corrected with eyeglasses or contact lenses. If this occurs at all, it is typical that a person needs the corrective lenses to a much smaller extent than they would have with simpler monofocal IOLs. In the majority of cases, whatever the details, new intraocular lenses mean greatly improved vision and quality of life for the patient.

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