There have been plenty of discussions about Vivity but it is hard to figure out if people are overall happy with their decision to go with it or not. If you had Vivity implanted, could you kindly share your satisfaction with the lens and if you would choose it again. Also, how good is the vision at night in terms of contrast loss and night time driving.
For now I have catract in one eye only and I am struggling with the decision to go with Vivity or a monofocal. Being able to see close up is very nice but I would probably not go with it if it means sacrificing distance vision clarity and night time contrast loss. Thank you.
I almost went with Vivity, but got cold feet. I would suggest you do some research on doing mini-monovision as an alternative to using the Vivity and expecting near vision.
I have two Vivity lenses, implanted about a year ago in a mini monovision setup, and I am very happy with the outcome. I have posted about this in a couple of other chats; you can find those posts by searching my name. And yes, I would do it again.
I am surprised at the number of people who are extremely concerned about contrast and night driving. My cataracts got pretty bad, and these IOLs are a huge improvement. I always read without glasses, but sometimes in a dimly lit pool hall I need to put on glasses to fill out a team score sheet, or I just go find a spot with more light. So what? I still would not trade my lenses. That said, it is very difficult for one person to understand exactly how another person sees or what is important to them.
For night driving, I do see a halo around bright point sources of light. The artifact is predictable and I am used to it. If I am in an unfamiliar area, I wear glasses to focus my near eye better. The halos are smaller when I wear glasses. I wore glasses all my life so I am fine with this. I would not trade anything about my daytime vision just to improve my nighttime vision...I spend way more time using my eyes during the day.
I'm also looking at Vivity IOL's and it seems from reading a lot of posts that a straight binocular set up (both eyes set to plano) provides the best results in acuity, but the need for readers. The contrast sensitivity loss for Vivity is real compared to IOL's like Eyhance or other classic monofocals. Some suggest using a straight monofocal in dominant eye for distance and contrast and a -.5 to 75 D Vivity in the other for near/intermediate. I'm also considering the Eyhance as an alternative option since it's not considered a premium lens.
The Vivity provides about 0.5 D of extension to the range of focus over a monofocal. A monofocal needs to be targeted to -1.5 D to provide good reading vision. This means a Vivity in the near eye can be targeted to -1.0 D to provide a similar reading acuity as a monofocal targeted to -1.5 D.
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An Eyhance provides about 0.3 D of extension over a monofocal. By the same math, an Eyhance needs to be targeted to -1.25 D to provide good reading vision.
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I think using a monofocal in the distance eye targeted to -0.25 D is a good idea. It will ensure good contrast sensitivity at distance and will compensate to some degree for the potential halos of the Vivity and to a lesser degree with an Eyhance.
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It is worthwhile to keep in mind that MTF or contrast sensitivity follows along with visual acuity. If you target a monofocal to distance the maximum MTF will be at distance. If targeted to -1.5 D, then maximum MTF or contrast sensitivity for that eye will be at 1/1.5 meters or about 2 feet. This gives peak contrast sensitivity for both near and far with the combined vision of the two eyes.
If you read the posts, some people report greater contrast loss with the Vivity in a mini-mono configuration and Alcon's own data shows that a binocular setup provided better optimal distance acuity compared to a straight monofocal configuration. The use of a straight monofocal lens in the dominant eye is to offset contrast loss and optimize distance acuity especially at night. Not everyone is simply interested in range of vision, but quality of vision potentially supported by glasses. Monovision (mini) has its own issues in patient ability to handle the image differences through neuroadaptation challenges and the creation of problems in contrast sensitivity, stereopsis, depth of field perception, and binocular visual acuity.
"If you read the posts, some people report greater contrast loss with the Vivity in a mini-mono configuration"
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If you look at the MTF curves for the Vivity compared to a monofocal you will see that the peak MTF is significantly reduced compared to a monofocal. However, at closer distance the MTF is actually better than a monofocal at those distances. Contrast sensitivity is spread out over a range of distances rather than at just one distance. If you use the Vivity in a mini-monovision configuration the contrast sensitivity will be spread out over the range of distances and will be significantly better at closer distances.
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"Alcon's own data shows that a binocular setup provided better optimal distance acuity compared to a straight monofocal configuration."
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Any lens used in a binocular configuration will be better than a single lens. The increase is measurable but small.
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"Monovision (mini) has its own issues in patient ability to handle the image differences through neuroadaptation challenges and the creation of problems in contrast sensitivity, stereopsis, depth of field perception, and binocular visual acuity."
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Those issues have been well studied and as long as you keep anisometropia at less than 1.5 D, the loss of stereopsis and depth of focus perception are very minimal. Contrast sensitivity is actually increased with monofocal lenses across the depth of focus. See this article as an example. Graphs are provided to quantify the impact of anisometropia.
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Optimal amount of anisometropia for pseudophakic monovision.
Ken Hayashi, Motoaki Yoshida, +1 author H. Hayashi Published 1 May 2011 Medicine Journal of refractive surgery
-Lab testing, clinical trials, and real-world results are not necessarily the same.
-The Vivity trials used monofocals as the comparator and thus demonstrated that better acuity was achieved in a binocular configuration. Monovision (mini) intentionally departs from that optimal visual acuity configuration.
-Please refer to ryan13242, david98963, fred23984, and others posts regarding Vivity real-world experience.
-Monovision (mini) is not a one size fits all model due to simple fact that no two patients or cases are the same. Like other IOL patient selection, equal attention is required for the proper selection of traditional monovision or mini-monovision candidates factoring the surgeon’s confidence & ability to achieve intended refractive goals based on patient corneal irregularities, ocular pathology, the aberration profile of the selected IOL and patient tolerance to neuroadaptive, depth of field, & visual acuity issues. Execution of mono or mini-monovision is not without its own risks despite your assertions.
"Like other IOL patient selection, equal attention is required for the proper selection of traditional monovision or mini-monovision candidates factoring the surgeon’s confidence & ability to achieve intended refractive goals based on patient corneal irregularities, ocular pathology, the aberration profile of the selected IOL and patient tolerance to neuroadaptive, depth of field, & visual acuity issues."
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Pure bafflegab! Where did you copy that from?
It's standard surgical management and academy of ophthalmology practice. Take a look at the following publication for your reference: Elizabeth Yeu , Matching the Patient to the Intraocular Lens: Preoperative Considerations to Optimize Surgical Outcomes, Ophthalmology, Volume 128, Issue 11, November 2021, Pages e132-e141. Healthcare providers almost always use some sort of assessment to determine patient appropriateness and potential outcomes regarding any medical intervention including IOL's.
It seems to be a physical fact that contrast sensitivity is harder to improve substantively through glasses or contacts (not saying it can't be improved at all), whereas acuity can be modified/optimized easily via readers or any sort of prescription glasses/etc. I'd much rather need glasses occasionally than permanently reduce my CS, though I might not even notice a CS reduction with Vivity lenses.
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Contrast sensitivity is also extremely important to some people personally / professionally - poor nighttime vision is the main issue I have with my cataracts, often in situations where I have no control over ambient light, AND I work in a visual occupation - but CS is also much harder to find useful, realistic data on compared with acuity. Most people don't even really have a vocabulary with which to talk about it clearly.
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For many of us, any IOL is an objective improvement over our cataract lenses when it comes to both acuity and CS, but it's a matter of determining what trade-offs one wants to make - ones that can be adjusted via glasses, or ones that are 'permanent'. Seems like a risk/reward sort of balance, but also combined with a ton of physiological and psychological factors that cannot be predicted.
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All that said, I'm really happy to hear the Vivity lenses are working so well for you! :) I'm planning on an Eyhance for distance in my first eye, but very well may go for a Vivity in my second eye once my first eye settles.
Well stated! All IOL's have trade-offs and unfortunately our own high expectations likely exceed the reality of potential surgical outcomes due to individual variability and a surgeon's ability to achieve intended refractive goals.
I too am looking at either a pure monofocal approach due to contrast sensitivity concerns or a possible hybrid combination using Eyhance or Vivity. My surgeon states that the 20-30% decrease in MTF is more associated improper patient selection. Vivity success appears to be very pupil diameter dependent. He states that he only sees a 12-15% decrease in his real-world experience. Night driving dysphotopsia is my second biggest concern in making my choices.
"All IOL's have trade-offs and unfortunately our own high expectations likely exceed the reality of potential surgical outcomes due to individual variability and a surgeon's ability to achieve intended refractive goals."
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Good point, although I think that the cataract clinics and surgeons kind of add to those "expectations" because they don't really tell the whole story when they discuss the options with you, or in the literature they give you. I know when I first left my first consult, I had no idea of the potential side effects of most of the lenses presented, and not a clue about using mono-vision with any of them in order to enhance the results of the surgery. It wasn't until I started researching on my own and questioning people who had had the surgery with a particular lens, that I started to realize that it wasn't going to be a simple and lovely as when first presented to me.
How does your surgeon measure MTF?
I would just point out that I am not a Vivity recipient… although I have, in the past, posted a LOT about it and about other people's real world experience with it. I have Eyhance in one eye. Second should be done this spring some time.
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It is a very very good point that range of vision is not everyone's goal. Ron is very helpful to a lot of people on here and he is clearly very happy with his monovision setup but it's important to remember that it is not for everyone.
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Also although a -1D offset for Vivity would theoretically give you full range of vision, from the hours of webinars I've watched (and even occasionally sat in on live, no one the wiser that I was not an ophthalmologist) and also academic studies, no one does a -1D offset with Vivity. The top surgeons from around the world from Toronto to the to the US to Australia simply never use Vivity that way in practice. The manufacturer recommends plano in both eyes and a HALF diopter offset is a VERY common "off label" practice for a slight functional near boost without strongly compromising distance and contrast… but not a full diopter.
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Yes maybe mix and match with a standard monofocal in the distance eye would be a strategy but I'm not sure how often that is done either (depends on the doctor… some are strongly against mix and match… others are fine with it)… but there is no data / studies on such a combo.
He doesn't because it's an optical bench lab test measure of an optical system of image resolution and contrast/modulation of the lens. I am willing to bet he and Alcon are extrapolating in-clinic contrast sensitivity testing as a potential guide of the IOL performance in real world compared to others. It's why you have to take any information with "a grain of salt" and seek second opinions from physicians not just aligned to one manufacturer. Additionally, it is my understanding that no study has found a significant correlation between bench optical image quality and clinical contrast sensitivity. This is why the MTF data in the product labeling has stated the same, yet a warning was later added regarding contrast sensitivity. A theoretical modulation transfer function (MTF) curve can be generated from the optical prescription of any lens and while helpful, it does not indicate the actual, real-world performance of the lens after accounting for manufacturing tolerances.
This article may be of interest.
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The Effect of Spectacle-Induced Low Myopia in the Non-Dominant Eye on the Binocular Defocus Curve with a Non-Diffractive Extended Vision Intraocular Lens
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"Conclusion: Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia."
You said " He states that he only sees a 12-15% decrease in his real-world experience."
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How would he know that if he does not measure MTF?
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The MTF and Visual acuity is well documented in the Vivity Package Insert if you want to see the data from Alcon.
Already speculated likely context of his statement to known fact in previous post.
Absolutely agree that opinion doesn't always match practice and that interventions need to be tailored to the patient, which no two are alike.