The hormonal changes associated with pregnancy and nursing can cause significant changes in your visual acuity. About three months after you stop nursing your eyes will be back to normal. If you have any refractive surgery of any kind while you are pregnant or nursing you will be getting a permanent correction for the WRONG refractive error.
There is only one phakic intraocular lens (P-IOL) available in the US. It is positioned in front of the iris, just underneath the back side of your cornea. It is vitally important that there be enough room in this anterior chamber of the eye for the P-IOL to not interfere with the endothelial cells on the back of your cornea. A detailed measurement of your anterior chamber depth needs to be completed before a P-IOL can be recommended.
The P-IOL currently available has a history of causing disruption with the endothelial cells. An endothelial cell count needs to be completed to determine if your density of cells is great enough that even with expected cell loss you will continue to have a healthy cornea.
Because of the large amount of refractive error correction you require, the size of the optics of the P-IOL will be limited. It will be very important that your pupil when naturally dilated in a low light environment is equal to or smaller than the size of the P-IOL optic. If your naturally dilated pupil is larger than the size of the optics, you are very likely to have vision problems including glare and halos around light sources at night. These light disturbances may be only a minor nuisance, or can be debilitating enough to keep you from driving or performing similar nighttime tasks.
All P-IOLs will need to be removed at some point in the future. They may need to be removed due to too much endothelial cell loss (probably several years), because of the natural formation of cataracts (probably after age 65ish), or if there is some dysfunction. While P-IOLs may provide excellent correction for a long, long time, do understand that they are temporary.
No US approved P-IOL is able to correct astigmatism. To correct both your high refractive error and corneal astigmatism, it would be necessary to have two surgeries: a lens-based P-IOL plus cornea-based LASIK, PRK, or similar. It will be very, very important that you use only the services of a surgeon who is highly qualified in both disciplines, or two surgeons who co-manage.
Glenn Hagele
http://www.USAEyes.org
I am not a doctor.
