When RayOne EMV first got FDA approved I read articles that came out comparing it to Eyhance and Vivity and putting it in the same category.
I have no interest in Ray One EMV so I have not done any real research o it.
But if they are comparing bilateral implementation of Eyhance and Vivity set to plano to a Ray One EMS set to monovision (whether it be -1 D or -1.5 D) that is IMHO a meaningless comparison.
A more meaningful comparison would be to compare the Ray One EMV to other monofocals set to the same amount of monovision, it order to show it has some superior monovision than other monofocals.
Again in full disclosure I know very little about Ray One EMV and don’t see many doctors in the US using or discussing that IOL.
Hopefully someone that know a lot about this IOL can shed some light on the subject.
The initial idea (by Graham Barrett) behind that lens is to use an aspheric lens for the dominant eye set to plano, and a lens with positive spherical aberration set to ca. -1.5D in the non-dominant. He didn’t intend to use two identical lenses in a monovision setup.
You can look up Graham Barrett’s Patent if you search for Patent WO2013018379A1 which explains the concept.
I find the defocus curves that Rayner issued confusing. The one on their website lets an 2xEMV monovision look inferior to an 2xAspheric monovision.
For what it’s worth… My understanding and from everything I’ve read and seen in various articles and videos involving several high profile surgeons is that the Rayner EMV lens has a unique design that adds some spherical aberration to the lens, perhaps amongst other things, to eek out that extra depth of focus. I don’t think the Rayner defocus curves involve a mono-vision set up as a comparison to what we know as a standard defocus curve involving one lens.It has been mentioned in some cases patients have gained full functional vision from implantations targeting plano whereas this virtually never, or very rarely, happens with standard monofocal lenses when at plano. Surgeons are finding the offset with the Rayner lens in a monovision scenario is on the order of -0.50 to -1.00 diopter. This, in effect, achieves reasonable reading vision whilst maintaining a strong degree of steropsis with no dysphotopsias as far as I know. To achieve this with standard monofocals, you’d generally need at least a -1.25 to -1.50 offset. My surgeon in the UK has gone almost exclusively to the Rayner EMV lens when faced with a decision to use a monofocal lens. Not saying he might not have a relationship with Rayner, but I’m confident he’s finding value in utilising the lens.
I hope it goes really well for you and that you get a great result. The following image from "Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses " should give a rough idea of what to expect and hopefully it turns out even better.
I presume that sliding the 1D offset column up would give an idea what 0.5D offset would be like.
I am not sure how accurately the Binocular Quadratic Summation simulates what one sees with monovision. With my 1.5 D offset monovision with monofocal lenses I get 20/20+ vision with my distance eye only. If I open my close -1.5 D eye, vision does not deteriorate to somewhere between the two eyes alone. If anything it seems to even improve a touch with both eyes open. It would improve more of course with the binocular effect if both eyes were distance plano and I would probably be a full 20/15. But, my point is that at least in my case the -1.5 D eye does not make the binocular view worse. I think that is due to the brain selecting the image it sees best and ignores to some degree the poorer image. Closer in at say TV distance of about 8’ the -1.5 D eye actually helps by a more noticeable amount. The picture sharpness is certainly not worse with both eyes open compared to just the distance eye.
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This could of course vary from person to person as to how the brain deals with the two images. I’ve been doing monovision in one form or another for about 2 years now.
I agree Ron. I’d expect binocular vision to be at least as good as the plano eye is for distance and at least as good as the offset eye is for the near vision. I think that the other two columns are more useful. The image is pretty good at 26" (1.5D) with only a 1D offset and maybe/probably good enough down to 20" (2D).
Thanks and apologies for the slow reply. My surgeon has got back to me with some additional information as I had wanted to know specifically his targeted value. He says he’s targeting a -0.88 D offset to my plano eye. Not sure how he gets to that specific value. He said additionally that I should get around an extra 1.50D depth of focus from the Rayner EMV lens in this scenario. He knows another goal of mine isn’t to go too far with mono-vision (i.e. where I might lose a considerable amount of binocular vision). His recommendation makes sense to me in this context. We’ll see how it goes.
Your testing probably resulted with target predictions of +0.14D, -0.20D, -0.54D, -0.88D & -1.22D (approx 0.34D steps) and your surgeon would know and factor in the first eye result along with what you want from the second eye’s IOL when choosing the -0.88D target as being the most suitable to reach your goal.
Yes, the IOLMaster Calculation sheet shows results in two way. One result is the emmetropia line. It shows the theoretical sphere and cylinder power to get the best possible vision even though those exact powers do not exist. It also displays the results of actual powers of lenses and suggests the best one. The actual predicted sphere and cylinder is displayed for each available lens in the range suitable.
Hi LoveAnimals ( I do too by the way),
Yes, my surgery was back in late September. Subjectively, I think my results have been excellent and have exceeded my expectations. I wound up at - 0.75D from my distance eye with the Rayner EMV lens (not quite the -0.88D target, but that’s okay) and am reading J1 at about 11 inches (20/20 equivalent reading) to beyond arm’s length. I didn’t expect to be able to read pill bottle level print but I certainly can. What’s surprising me most about the Rayner EMV at this offset is that my distance vision is A LOT better than I anticipated in that “near” eye. My distance (monofocal) eye gets 20/15, and from my testing I get 20/30 in my near eye indoors in a rather dim room.. During brighter daylight, my near eye seems to get a bit improved distance to me. I think maybe this is due to the “hyperopic bump” that theoretically aids distance vision with this lens. Hard to say for sure. All I know is I’m very satisfied with my outcome.
My vision was nearly non-existent in my near (Rayner EMV) eye previously. I had my left eye implanted with a monofocal distance lens 4 years ago and my right (near) eye got progressively worse until I could basically not see anymore. When I COULD see with the eye previously I think I might have been about - 2.25D or so in that near eye.
Hi G
Turns out my surgeon only did 2 EMV. He is old school and will not do any mini mono now and not sure if he ever will in future.
Difficult finding doctors by me using this Ray one emv lens. One guy who I didn’t meet with spoke briefly on phone . He was like if not happy then there is lens replacement but gave me feeling he does lots of them too easily. Not talking this lens specifically. Think he said something to effect results aren’t maybe as portrayed. I think he said if I remember maybe 26 inche with no offset and with a -1 ?? maybe see j3. .
Also one eye I think under 1 astig. 2nd eye 1 or little more and since no toric for emv not sure how it works because videos were saying they don’t put in eyes with 75 or one astig.
From all read , videos etc they really all stress this is distance lens with extension into intermediate and for people that don’t mind readers. If you get mono and would only be small under one if no experience with the monovison contacts the you get better near. I am trying to find out who is doing that around here.
I contacted one surgeon who was in a video and in another state -his office told me they don’t do mono with it-they use it as enhanced monofocal and no offset.
Unless I can find mini mono surgeon with this lens my choices are losing all my near vision if get EMV with no offset (my near which now is at 14 inches (& if want can move things closer) & see tiniest of print)
Not keen on multi’s and price and though don’t drive don’t want chance of light phenomena.
One surgeon I saw who does vivity doesn’t do mini mono. -He likes things binocular.
Vivity here with laser is astronomical.
My surgeon also did only few Eyhance and wasn’t happy. Think I read somewhere??? if do any myopia for distance eye not good with this lens. He does not too so many cataract surgeries as some of these guys who do so many in a day Another surgeon who does eyehance says hit or miss about how good intermediate. Have to see again his mini mono results . Also even with offset 1 I think many want you to have experience with mono contact lens set up. My surgeon does manual cut.
Originally when I first went in 2 years ago discussed near intermediate with -2 and -1,50 for near and computer. Technician said -2 would get moderate near They said either eye can be near or far if doing small difference. They would target 15 inches like I have now and the other eye can only be -1.50 for the formula to work whatever that means. Maybe it could be -1.25 if start with -2 and see if can handle that.
No offense, but your surgeons/consultants may be misinformed. The EMV by Rayner does come in a toric lens as of a few months ago, at least in the UK. Also, the fact that your surgeon doesn’t do monovision strategies tells me he’s not giving his patients their best possible outcomes. He’s playing things far too conservatively in my opinion. Old school as you said.
One thing to keep in mind is that there is nothing wrong with mini-monovision using basic true monofocals. The issues have been well studied, and I would suggest the default targets are -0.25 in the distance dominant eye (just for some margin to avoid going hyperopic), and -1.5 D in the near non dominant eye. These targets do not leave an intermediate section not covered. This leaves the choice of surgeons wide open with the most popular Tecnis 1 and Alcon Clareon or AcrySof IQ being quite suitable. If the surgeon does not want to do mini-monovision then they are way behind the times and should be avoided in any case.