I got a lot of good info out of this sight when researching IOL implants for cataract surgery and wanted to offer my experience so others might benefit. I'm adding some lifestyle info as well so it can give some perspective to why I chose what I did. It's a real struggle to determine if the drawbacks of the premium IOLs are really worth the risk. So here's some background. I'm a 55 year old male. Have been wearing contacts since I was 12 years old for being nearsighted. The correction was always the same in both eyes, starting out not so bad but has been in the -4.25 range for the better part of 30 years. I had EXTREMELY good closeup vision without contacts/glasses. I also had what I would call EXTREMELY good corrected vision. 20/15 if I kept my contacts fresh and clean. At age 48 if I wanted to see something up close while also wearing contacts I began to need readers. Otherwise, I was pretty happy with my corrected vision. I considered lasik when I was younger but just never got there. I like to hike, cycle, shoot sporting clays, build furniture, maintain my own home and autos. Vacations are typically trips to see natural wonders, so color, clarity, and contrast are extremely important to me....even though 90% of what I do is considered in the up-close to intermediate range. I developed a cataract in my left eye in late 2021. Literally went to bed seeing just fine and woke up the next morning with considerable blurring. The right eye was just fine. In January of this year I needed some retinal repair work done in both eyes with a laser by a retinal specialist. Once that process was complete I was cleared to go get cataract surgery. I agonized over my options. The cataract was aggressive and by late April my left eye was little more than a garnish on my face. My initial consult was 4/11 and I could have literally had surgery the next day if I'd wanted, but I scheduled it a month out to give myself time to fully grasp my options and their potential downsides. Since it was my eyesight, money wasn't even a factor. Vivity really stood out and seemed to be the best option since I was already wearing contacts that corrected some for presbyopia. But there was that nagging loss of contrast issue with Vivity that I couldn't wrap my arms around. I relaxed, took a vacation, took inventory of just how much up close/intermediate vision I engaged in. (a lot) I waffled at least 3 times before finally coming to the conclusion that I'd have to kick my own backside if I went with anything other than whatever gave me the best color, clarity, and contrast even if it means I have to wear readers for that 90% up close things I do. So I confidently went with the Alcon set for distance vision and made sure it was the Clareon version. So on 5/11 I got that left eye done and had 20/20 vision before 8hrs had passed. I also took note that I had pretty decent intermediate and functional close up vision, but up close was a little more comfortable with 1.25 readers (looking at my phone or reading a book). I went for a walk that afternoon and there was an unexpected depth perception issue between my right eye and my newly clear left even though both could see clearly. It felt as though judging rough terrain or throwing a ball could be more challenging that I was used to. Also, being able to compare, I realized my right eye was a little subpar compared to the newly fixed left. I went for a drive when the sun went down and there were no halos or starbursts. I could also see the dash just fine. The only thing I noticed apart from my natural lens was during the day, a little flickering at certain angles when light was coming from the side during eye movement. The doctors office called to check on me and based on my progress, offered to do the right eye as early as 2 days later. At that point I needed no convincing. 5/13, just like the previous surgery, within 8 hours I could see 20/20. The depth perception issue was also gone. I'm typing this with my naked eyes and can see just fine. Even though I was formerly wearing presbyopia correcting contact lenses I need readers less now than I did with those, really only in low light. I'm really super happy with my decision. I have great color, clarity, and contrast and I basically have what was promised with Vivity without the risk of contrast loss. But truthfully, even if I had to wear readers for all things intermediate and closeup, I wouldn't complain one bit. Glad I took the time to settle in my heart what was important and didn't knee-jerk react to what seemed best to me in the beginning.
Something I failed to mention that might be important to others... I went strictly binocular vision with these. (both are -13.5D). I love the idea of mono-vision....and even attempted it with contact lenses for a time. While I'm tempted to call that an "old dog new tricks" issue, when I really think about it I've always been really picky about both eyes seeing equally well at distance.
On another note, during the time between the formation of the cataract and the surgery, I learned something about how my brain works with regard to eyesight. I've always been right eye dominant, however, I noticed when my right eye gets even the slightest bit dry or a bit blurry because I need to blink, my brain will instantly switch to my left eye regardless of whether the left eye can see clearly or not. (Even if I'm wearing an eye patch over it) Which explains why a few of those sporting clays got away on occasion even though I knew I was on target.
It sounds like you had a very good outcome. I also got reasonably good closer vision with a monofocal set for distance. There seems to be a considerable variation in what people get for intermediate vision. My distance eye is perfect for reading the dash in my car or truck, but focus starts to suffer at about 18" or so. I could read a computer monitor but it would be a struggle. And reading my iPhone would not be possible with my distance eye. . One article I read suggested that those who are myopic (long eye) prior to surgery and have smaller pupil tend to get better closer vision with a monofocal. . I did go with monovision and with astigmatism I am at about -1.5 in my left eye. This had let be be essentially eyeglasses and contacts free since I had the surgery on my second eye back in February. No regrets but I am looking at the possibility of a touch up in the close eye with Lasik to deal with the astigmatism. Not sure I will actually go ahead with that though.
The fix seems easy enough for the astigmatism and you have more than one option and a clear path forward (I read your other post). Your chances seem really high to be able to get to where you want to be. I appreciate all the contributions you've made to the cataract thread over time. Was nice to see someone else's research and conclusions came very close to my own.
On another note....I just got back from my 1 week checkup. (even though one eye is only 5 days in) I could see the 2015 line all day with both eyes. I could easily make out 3 of the 5 letters on the 2010 line and could see one of them well enough to solidly guess it was an E, the last one "S" looked like a dot. So I'm declaring my eyesight at 2012 :)
The presbyopia test yielded easy 2050 but could read most the words on the 2040 line. 1.25 readers makes the closeup golden until about 7 inches from my face. My computer monitors are positioned about 24" from my face and I don't require any reading glasses for them. Starts to blur up at 20" and closing.
Great result. Just goes to show that your mileage may vary… a lot. For all the research we do you just never know. I certainly don't think one should go into surgery expecting to get any near vision with a monofocal set for distance but… you never know! My Dad was the same. He got monofocals both set for distance and his near vision is great. So many variables.
are you saying you got both eyes monofocal set for disatance and still have some good nearer vision without the contrast loss you would have had if you went with vivity.were both eyes distance or was one adjusted to intermediate sort of mini monovision? lm in the situation where l am having sugery in a few months and still deciding to go with vivity or monofocal, if l have both eyes set for distance monofocal will l still have arms lenght , or dashboard reading ability
Yes, I got both eyes set for distance with the monofocal lenses. No mini-monovision. Only had the one cataract so I was able to compare my natural corrected vision with the IOL corrected vision. I would go as far as to say I gained contrast with the IOL . (perhaps not if I were 25 years old, however) Color was spot on.
By decent near vision I mean I can get by without glasses when reading text or email on my phone, well lit menu, or book. It's not what I would call clear, but I can read it in most cases. If asked to look at a photo or video I would opt to see it with reading glasses. 1.25 reading glasses makes it all perfectly clear...text and photo/video.
There's very little chance you will know what your outcome will be. As Ron says above, he read an article indicating "that those who are myopic (long eye) prior to surgery and have smaller pupil tend to get better closer vision with a monofocal." This actually describes my situation. I also had read something along those same lines but went into it knowing my outcome wasn't defined.
My ophthalmologist was blown away by my results, but from what I've gathered they aren't typical. (I'm chalking it up to my wife's prayers for me before each surgery.) I couldn't get anyone to tell me how much of a loss of contrast I was going to experience or what that would even look like. But Alcon's own literature says it is significant. I know it has to be perfectly centered or your vision will be terrible. Those were the two biggest concerns I had. There seemed to be very few issues with the monovision....and based on that I'd made up my mind.....then my wife's ophthalmologist threw a wrench in the machine by saying he wouldn't hesitate to get them. So off I went on the Vivity wagon again for awhile.
I know I said a lot in these posts....trying to help people come to a decision just like I was 2 weeks ago. In doing so I likely muddied my message so I'll break down what I was trying to get across. Each one is a roll of the dice in that your outcome isn't set and it may require more correction before you reach your goal. Having said that: 1. If having the best possible contrast, color, and clarity is what matters most to you, go with the monovision and live with the need for readers.I've always thought my corrected vision was amazing and when I was honest with myself I couldn't knowingly risk making it less than amazing...i.e. loss of contrast 2. If being completely independent from correction is what matters most and you feel you can live with the potential side effects they create, pick one. You live in a time where there are some great options. So even if you rob a little from Peter to pay Paul I don't think you're going to go wrong.
Just relax and figure out what is most important to you. There isn't a choice that gives you it all. But there are choices that give you what's most important to you.
True. Your Dad and I are fortunate. For those inevitable occasions when I'm out running around, cycling, hiking, or needing to read a label in a store and just can't make something out I wear a necklace with a monocle around my neck tucked in my shirt.
Hi John20510 - it is really an unknown and a prediction cannot be made as to who will end up with better intermediate and functional near vision. It is super if you get that. I often wondered if I would have if I had chosen monofocals vs Symfony
I think kip3314 mafe his decision based on best clarity and least contrast loss and wanted both eyes equal ( no monovision). And got a bonus.
Important to narrow your decision to what the iol does deliver to fit your lifestyle and criteria.. If you get more it's all gravy.
From your other posts I can see that you are having a hard time deciding between a monofocal and a Vivity. I really think you should take the time to google "Vivity Package Insert PDF" and look at that document. It not only has the data on the Vivity but also how it compares to the monofocal. Based on the defocus curves in that document the monofocal give good vision down to 3 feet (1 meter), and the Vivity down to 2 feet (.66 meter). However that is an average. Some people like @kip33412 and myself get better than that, while I expect others would get worse. . The other thing you can find in that document is the comparison of contrast sensitivity or MTF. What you will see is that at distance (0 defocus) the monofocal is significantly better than the Vivity. However as your viewing distance gets closer the monofocal and Vivity become about equal for MTF at the 0.5 defocus position (1 meter divided by 0.5 = 2 meters or about 6 feet). Closer than that the Vivity has superior contrast sensitivity or higher MTF. Many think that the Vivity compromises contrast sensitivity at all distance. It doesn't, and is significantly superior to a monofocal at close distances. . I think I have given you this advice before, but given your objectives I would consider this approach. Think about the surgery as a two step process. First identify your dominant eye, and have it done with a monofocal like the Clareon set for full distance. Then wait for 6 weeks to see what you get for distance and intermediate vision, before you decide on the second eye. If you get lucky like @kip33412 and myself and are happy with your intermediate vision, then get the Clareon again in your second eye. If you do not get enough close vision, then get a Vivity in the second eye. The upside of having the Vivity in the non dominant eye is that contrast sensitivity will actually be higher at closer distances.
Closer than that the Vivity has superior contrast sensitivity or higher MTF.
. True. But Vivity is designed for glasses-free intermediate / functional near. Monofocals are not. Vivity spreads the light out across a greater range of focus (as you know). So of course Vivity has more light (better contrast) at intermediate / near without glasses (by definition… as an EDOF). But few people use Monofocals in intermediate / near without glasses. In other words a monofocal with glasses outperforms a Vivity without glasses (for intermediate / near). . I think what it may boil down to in the real world is Vivity has enough contrast for most situations but might struggle with distance viewing (driving or indoor sports) in low light / low vis conditions (as the patient info sheet warns). And there's not much you can do about that (maybe put a light bar on your Honda Civic… LOL). It also might struggle with near viewing in low light (menu in a dark restaurant) but that's easily solved with a light or readers… same as a Monofocal but there's a much better chance your will not need to do that with Vivity. . As someone that is heavily involved with backcountry activities (often at night in very thick woods) such as camping and overnight search and rescue operations, that was a concern for me with Vivity. I want to retain the best possible long distance night vision.
A monocle eh? Hmm. That's actually kind of badass! I love it. LOL.
I believe the large majority of people that get monofocals set for distance (like my wife) do not use glasses most of the time. They go eyeglasses free and when necessary wear over the counter reading glasses to see close. Close usually means 2 feet or less, or more practically when they can't read something. In other words they are seeing with less contrast sensitivity than someone with a Vivity from 2 feet to 6 feet most of the time, while thinking that they have better contrast sensitivity. They don't. . My thoughts remain that the best way to take advantage of the Vivity lens is to only use it in your non dominant eye, while using a monofocal set for distance in the dominant eye. Then you get the best of both worlds - closer vision with higher contrast sensitivity as well as better distance vision with higher contrast sensitivity. . I would have gone with Vivity in my closer vision eye, but there were complications for me. I have irregular astigmatism to deal with, and I had higher expectations for close vision than Vivity could deliver without an offset. Because of this I could not get the support of my surgeon. . But it seems to me that for someone going for both lenses targeted for full distance, it makes a lot more sense going with only the Vivity in the non dominant eye. That is better than a Vivity targeted for distance in both eyes.
Hi there, Kip, John and others, I have worn contacts nearly all my life, for distance vision. My near vision was very good without contacts. My cataracts developed fairly quickly over a three-year period, and my eyesight, which had been improving significantly over time, began to revert. I had trouble driving at night, and began to have trouble walking or driving during the day under bright light conditions, which were blinding, and also having trouble with contrast vision. My contact prescription also could no longer make my vision clear. I spent some time on this forum (thanks everyone!) and thought about the Vivity and the Multifocal, but I am a perfectionist, everything in my world needs to be “even,” and I am very sensitive to changes in my environment. For all of these reasons, I opted for a basic Alcon lens in both eyes, set for distance. Clareon is not yet available in the practice I chose, but I did pick the Alcon lens that is aspheric and filters out blue light. I decided against Vivity due to the contrast issue. I also elected to pay for laser-assisted surgery, to fix a slight astigmatism in both eyes. I had my first surgery on my left eye 3 weeks ago and the second surgery on my right eye one week ago. Within 1 week, both eyes were seeing close to 20/20. I can read my phone (text or email) outside if the light is bright, but I am more comfortable using +150 readers to look at my computer, my phone, or a book. These are the same readers that I had to put over my contacts to see up close before my surgeries. I can see fine in my car, both the steering wheel and the dash. My eyes are pretty light sensitive, which can continue for a year I’ve heard. They are also quite dry, which I understand is likely to continue for 3-6 months, although eye drops help a lot. I was also not expecting that there initially would be shimmering as the new IOL moves around in the eye a bit, but that has already settled down. (I felt a bit like “Mad Eye Moody” from Harry Potter!). In between surgeries, colors seemed similar, but whites were definitely brighter in the eye without the cataract. It’s a little awkward between surgeries so I thought two weeks in between was a perfect amount of time for me. I can see all things in the distance very well, so I am very happy with my result, and even though I’ve lost my near vision, it’s still better than I was expecting and perhaps will continue to improve with time?
Vision is probably 95% there 3 weeks after surgery, and should be as good as it is going to get post 6 weeks. I think adaptation may take longer with multifocal lenses where the brain has to learn to ignore some of the optical side effects. . One article I read said that those who get better closer vision from a distance targeted monofocal are likely to be myopic before surgery, and have a smaller pupil size.
My point is simply that of course Vivity has more light (contrast) at intermediate / near… that's what it was designed to do. Monofocals even don't try to do that so I'm not sure its a fair comparison. Vivity still has less contrast overall at any focus point with or without glasses. But it gives you more independence from glasses. So ya. Not an easy decision. It's too bad there's no way to "try before you buy".
"Vivity still has less contrast overall at any focus point" . That seems to contradict your point that "Vivity has more light (contrast) at intermediate/near". . The MTF curve indicates to me that at less than 6 feet the Vivity has the most contrast sensitivity, while further than 6 feet the monofocal is best. That is why I think a Vivity in one eye and monofocal in the other is the best of both worlds. It is better than a monofocal in both eyes, and better than a Vivity in both eyes. This is with all lenses set for distance. There are other options of course with monovision.
Yup I understand your point. It's a good point too that although a monofocal with glasses will outperform Vivity (in terms of contrast, image quality, etc.), most people don't wear glasses (progressives) regularly after surgery. . As for the "contradiction", I mean that even at it's peak focus (which is what I meant by "at any focus point") Vivity underperforms a Monofocal (at peak focus). It's light is spread out so even at it's best it can't match the image quality of a Monofocal.
lm having surgery in a few months, my doctor said becasue l have healthy eyes the lower contrast from vivity wont be a problem, but my plan is to have vivity in one eye first and if l dont like the contrast l will get a monofocal set for distance in the other eye which should improve the overall contrast. But if l am happy with the vivity l will get another vivity in the second eye, what do you think of that idea
Understand now. I agree. But the real life issue is that we are not able to always view the world at the peak focus point.