Let’s say that you have a patient who already had cataract surgery more than a year ago. At that time the patient elected to have a monofocal IOL and the patient decided not to treat the pre-existing astigmatism. The patient currently has a refraction of +0.75 -1.50 x 120 which gives 20/20 distance vision. Same in both eyes. But now the patient has decided that she would rather have a trifocal IOL in both eyes, just like her best friend recently received. Would you go back and perform an IOL exchange for this patient? Our guest surgeon agreed to do so, would you? I would probably not and here is why…
I would fix ast with ak then trivial in other eye. Give her 6 weeks and if unhappy give her trifocal exchange for monocular. She may really like having that distance monocular in dominant eye depending on her life style and neuro facility. Binocularity can adapt and create some great flexible vision. Nailing the astig on the distance eye can create a whole new positive visual experience. If this solves problem you have saved her an operation and cash.
great points — thank you!
Great point about comparing the before and after.Also,what if she changes her mind again and demand an exhange back to monofocal toric?