Results with the Alcon Toric Lens Implant for Astigmatism

By Scott Grealish MD
EyeHealth Northwest Lasik Specialist
Portland, Oregon

The Problem: Astigmatism

toric iolI can still remember being told as a teenager that I needed glasses because of my astigmatism and nearsightedness.  Nearsightedness made sense to me; I knew I was OK seeing things near to me but not very good far away. Astigmatism was a mystery. When my doctor told me my eye was more football than basketball shaped, I was left thinking what I now believe many of my own patients believe; Astigmatism sure sounds like a bigger problem than nearsightedness. In fact, to an eye surgeon currently astigmatism is a pretty straightforward problem with some very sophisticated solutions that work very well to create better vision at any distance.

Warped Corneas= Warped Vision

I think the easiest way for a layperson to grasp the concept of astigmatism is to visualize the thin clear covering of the eye, which we call the cornea. We place contact lenses on our corneas, and in fact LASIK surgery is performed entirely on the cornea (an amazing feat involving only 1/10th of a millimeter of the entire ½ millimeter thick cornea). Now it’s easy to imagine that our corneas are built in different sizes and shapes, just like the rest of our bodies but with surprisingly little variation (basketball players don’t necessarily have bigger corneas than the rest of us). One thing that does vary is the roundness of the cornea. While it’s not true that anyone has a truly round (like a basketball) cornea, it is true that some are less round, or more warped it you will (if you can imagine a football being a warped basketball). If your cornea is more warped, we say you have astigmatism. It is fairly intuitive that since the cornea is the first lens of the eye (the cataract is clouding and yellowing of the second internal lens), a cornea with astigmatism gives a less clear image than one without astigmatism. This holds true at any distance from reading fine print to looking at the stars.

A "Fixable" Problem

Now that we have an idea of astigmatism, we can better understand the need to correct it with glasses, contact lenses or surgery. If we don’t, everything will look a little bit blurry, doubled, or ghosted around the edges. For patients undergoing cataract surgery, the “standard” lens implants that surgeons have used for decades are perfectly acceptable for the roughly 60% who are lucky enough to have naturally more round shaped corneas, in other words, very little or no astigmatism. If you happen to fall into the 40% who have significant astigmatism, (something your surgeon can easily measure before surgery), then you will not end up with truly clear vision after surgery without resorting to wearing new glasses after surgery. Surgeons have used special techniques to correct astigmatism for many years, but they have only become commonplace in recent years due to advancements in technology.

An Older Method

The oldest surgical method to correct astigmatism is to create specially placed incisions in the cornea at the same time as the cataract surgery. In its current form this is now called a “Limbal Relaxing Incision” or LRI for short. LRI’s are very effective and easy for patients since they only add a few extra minutes to the cataract procedure and healing time is minimal. The drawbacks however are their relative inaccuracy compared to more recent options, and the small risk entailed by creating the extra incisions.

A Newer Method

Since 1995 surgeons have routinely used LASIK surgery to correct astigmatism. Our current laser technology is so good that even large amounts of astigmatism can be corrected with extremely high precision. Although this is the most accurate technique, its two main drawbacks, high cost and the need to perform the laser surgery weeks or months after the initial cataract surgery, make LASIK a less attractive option for many patients with astigmatism.

The Best Method

Since 2005 there has been a better option for surgically correcting astigmatism called a Toric Lens Implant. The concept is simple; cataract surgery is essentially the removal of the cloudy, yellow natural lens of the eye followed by replacement with a plastic lens implant. It stands to reason that if only a custom lens made to fit the prescription of each patient and their astigmatism could be made, then surgeons could simply order the exactly correct lens implant for each patient. In reality, it took the worlds largest lens implant company, Alcon, many years to perfect the manufacturing process and get FDA approval. I was amongst the first surgeons in the Northwest to use the Alcon Toric Lens Implant back in 2005, but its popularity soon spread due to its effectiveness and ease of use. The Alcon Toric is nearly as accurate as LASIK, just as convenient as LRI’s, and safer than both since no extra surgical incisions or lasers are involved.

A Good Investment

In my experience, now having implanted hundreds of Alcon Toric Implants, there is really only one drawback to this great technology: cost. Back in 2004 the government and private insurers began a policy of allowing surgeons and lens manufacturers to bill patients directly for the extra costs associated with this new technology. This sounds like another bad government decision, but in fact it has been largely positive. In reality the budget simply doesn’t allow coverage for an ever-increasing amount of new and expensive lens implant technology to be routinely covered by insurance. At the same time, I applaud Alcon for investing in the research to solve the astigmatism problem and I support their decision to price the Toric Lens Implant to profit from that research. I know they are likely to produce even better technology going forward which will benefit my patients in the long run. I don’t see this model of charging extra for a better lens implant changing any time in the foreseeable future. In the meantime, those with cataract, astigmatism, and the means to pay about $1000 extra for the Alcon Toric Lens Implant are wise to do so in my experience. There have simply been great results with no side effects to date except the cost.

To learn more about my results with the Alcon Toric Lens Implant for Astigmatism click here.