Sincerely thank you for the detailed information !!!
I feel very lucky to have found this forum on time! The good and well-known doctors with private ophthalmology clinics in Greece are trained well but rarely spent the time to give you all this information. They are like stars, there are so many people waiting after you …
By the way vivity will be available in my country after March 16
Thank you very much for the informative answer.
Monofocal lens seems restrictive but a safe solution. What worries me is the absolute denial of all three doctors I have visited in the monofocal lens. Obviously I will see and other doctors.
I really do not see much wrong with using two different lenses especially if they are from the same manufacturer. A Vivity and a AcrySof IQ Monofocus are the same material from the same manufacturer. I have the AcrySof IQ Aspheric in one eye now and vision is excellent except for up close. I am considering either the same AcrySof lens but under corrected by -1.25 D, or alternately the Vivity under corrected by 0.75 D. In theory the Vivity would give me better distance vision with the second eye and about the same near vision.
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What you might want to consider is doing the non dominant eye with the Vivity at -0.75 D and see how you like it. If you like it then do the second eye with Vivity set for plano at distance. If you don’t like it then you could do the second eye with the AcrySof IQ Monofocal lens.
I don’t like to be cynical but I am sure they make a lot more money putting in a presbyopia lens than they do with a monofocal lens. My surgeon is kind of the opposite of the ones you have seen. My eye was done 4 months ago and the Vivity was not available then. However the PanOptix was, and my surgeon said that he would do it, but he really had trouble recommending it because he would not be prepared to have that lens in his own eyes. I found this article very helpful in deciding whether or not to consider monovision and how much under correction to use.
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Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD
The private clinic I will be going to if I get a premium lens told me the Acrysof monofocal costs $200 and the Vivity costs $1450 (just the cost of the lens in the quote, not the entire procedure). I would guess they are pocketing a fair bit of markup on the Vivity.
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Not to hijack the thread RonAKA but I was amazed to read that you say you have good vision down to 50cm with your Alcon IQ Acrysof monofocal? Is that right? it that eye under-corrected? That’s amazing.
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The more I read about people getting amazing close vision with monofocals (my Dad has Tecnis mono’s and says he can read his watch from 9 inches away) the more I wonder if maybe I should just forget about the premium lenses.
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I guess the point with the premium lenses is just that your chances of getting good close up with them are statistically MUCH higher than with a mono. It can happen with a mono but you have to be among the very lucky few. And it’s not meant to be a reversible surgery (it can be re-done but they don’t like to do it). So no matter what you do there’s some small risk that you won’t like the outcome.
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Regarding surgeon IOL preferences… in Canada we have surgeons that work through the hospital with public healthcare and surgeons that work in private eye clinics. If you go to a doctor that works in the hospital through public heath they are biased towards monofocals. I suspect that’s because that’s the only option available for free through public health. You could theoretically pay more for a premium lens but with probably 99% of their patients just getting a mono and likely not even KNOWING about premium lenses, those surgeons may have limited experience with them or may have outdated opinions on them based on early designs that were not that great.
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In Canada you really have to go to a private clinic if you’re interested in “premium” IOLs. Those surgeons will be more up-to-date with all the “latest and greatest” IOLs and have a lot more experience working with them. My point is, the differing opinions you get may just be due to their own biases, experience, public vs. private, etc. Ask 6 surgeons and I bet you’d get 6 different recommendations. Unless of course you have some kind of ocular pathology or you’re an airline pilot or something in which case almost all surgeons would likely agree on monofocal.
What worries me is the absolute denial of all three doctors I have visited in the monofocal lens.
That’s a bit weird to be honest. In Canada and the US most doctors tend to stick to the “tried and true” monofocals. And in Canada you have to go out of your way (to a private clinic) to get a premium lens. Maybe it’s a European thing? I think multifocal lenses are much more widely accepted there. Also they are probably considering that being so young you may end up very unhappy trying to adjust to the loss of accommodation (natural focus ability) that would come with a monofocal. But yes as far as image quality, sharpness, contrast, hitting the right refractive target, etc… monofocals are the lowest risk.
In Greece in Public Hospitals you can only have monofocals lens. Insurance also covers a part of the cost only for monofocals lens (about 1/3 of the total cost). For premium lenses you should go to private clinics where the cost is around 2000 euros
Agree with everyone here, do not do cataract surgery unless absolutely necessary. My right eye got bad really quick so I had that surgery in February 2016 and my left eye got worse slowly over time and I had that surgery 5 years later in January 2021 (delayed that as long as possible)
I am also young like you, had my right eye done when I was 27 with a Symfony IOL, could not stand the side effects (glare, halos, weird vision in low light etc) that I got a Tecnis monofocal in my left eye.
If I could go back in time, I would have got a monofocal in both eyes. I think that ophthalmologists oversell multifocals to make money and don’t really tell you about the negative side effects you will experience. If they do, they make them seem like they are nothing and won’t bother you. I also think the range of vision in a monofocal is actually quite good. I do have some side effects but I recently discovered I think it’s from my eyelid dropping a bit. I read that can happen after cataract surgery. My distance and intermediate vision (computer screen 2 feet from my face)is really good, I will get glasses for close up. You could also try monovision as Ron mentioned. Any questions feel free to ask 
Yes, I can see down to about 0.5 meters with my monofocal IOL eye, AcrySof IQ Aspheric. I can read the 20/20 line with it, and about half the 20/15 line. My eyeglass prescription for it is 0.0 D spherical, and -0.75 D cylinder. The astigmatism probably does help me read a bit closer. That is equivalent to about -0.35 D spherical.
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The surgeon I went to is a teaching professor at the University of Alberta. I suspect he is quite up on the latest lenses. He operates out of the Eye Clinic at the Royal Alex hospital. He does toric lenses, but I was not a suitable candidate for them. We never did get to the point of discussing price on the premium lenses. He does consulting work for Alcon, but was also willing to do a Tecnis monofocal if I wanted it. The price is apparently $100 more, but our healthcare system pays for either.
Is that 2 foot distance monocular with your new ZCBOO Tecnis monofocal or binocular with the mono + Symphony blended? I’m assuming the latter. And were both eyes targeted for distance (and not too far off)?
Yes, I can see down to about 0.5 meters with my monofocal IOL eye, AcrySof IQ Aspheric
This is very encouraging. I actually think “monofocal” may be a bit of a misnomer because today’s aspheric monofocals (Tecnis and Acrysof) both have a -.25D shift towards the centre. The Eyhance increases that to -.5D to give you an extra line. The point is, when I first started researching this I was under the impression that I’d be basically “blind” for anything within 6 feet! But it’s not nearly that bad. I think most mono patients can probably count on seeing clearly down to 3 feet / 1 metre. Add a touch of under-correction (since they always aim on the myopic side) and some corneal luck and you could do quite well. Especially with something like Eyhance (I’m a little too risk-averse for the Vivity… the contrast sensitivity warning label scares me). The other thing to remember is you can still read at 20/40. It just not super sharp. If your goal is just good enough intermediate to function for day-to-day stuff like aisle shopping without glasses, mono or mono-plus is probably fine.
I suspect there is a hair splitting difference between the Eyhance and Vivity. It does not seem possible for the Eyhance not to have some reduction in lower light contrast sensitivity.
I’ve read that Eyhance contrast sensitivity is essentially identical to the Tecnis ZCBOO but it is profoundly difficult to compare apples to apples. Every trial shows different charts with different criteria etc.
I believe the Eyhance uses variation in asphericity from the center of the lens to the edge to stretch the focus. Vivity appears to be doing the same thing, but with a very tiny step in the profile. Unfortunately when you stretch the focus I believe you lose contrast sensitivity. I suspect pretty much all presbyopia correcting lenses compromise contrast sensitivity to some degree.
Is the RxSIGHT light adjustable lens available to you?
This is the first time I have read about this light treatment. Unfortunately it is not available in Greece. Even the alcon vivity is considered something very new in my country and will be available after March 16, while I have read that in other countries it has been used for about a year!!!
David, what is the source of that graph?
The early reports of Vivity use I believe has been in Australia, Spain, and Italy. It was just recently approved in Canada.
David, what is the source of that graph?
Search on “Delivering intermediate vision the new tecnics eyhance monofocal iol” and open the PDF. I’m going to make a new thread so I can stop “thread jacking” this one from DG12345. I’ll post the link here if and when it gets approved by the moderators.