Hi! I am trying to choose between these 3 lenses. I understand the differences conceptually and that there is no perfect lens. Just want to hear first hand experiences with these lenses. Thanks!
In terms of personal experience, I can speak to my wife's experience with both her eyes at -0.50 D and my experience with my first, nondominant eye probably somewhere between -2.00 D and -2.50 D on a spherical equivalent basis and my dominant eye scheduled for surgery in nine days. (I say "probably somewhere" because I have an appointment this week with an optometrist to refract my first eye so that my surgeon and I can make a final decision regarding the target for my second eye based on wanting to avoid more than a 1.50 D difference between the two eyes.) . For background. Both my wife and I are 73. She only began wearing glasses relatively late in life; I've worn glasses for a fair degree of myopia since third grade. . My wife is a happy camper. She doesn't need glasses for driving and other distance vision activities or for intermediate ones, principally working with her MacBook Air computer. These are the results for which she hoped; she puts up with needing readers for near vision. For her work, she may get Essilor Computer or Shamir Workspace or Computer (or similar) progressive glasses so that she doesn't need to keep putting on and taking off her readers. . I'm very pleased with the result from my first eye. I have J1 near vision (the analog to 20/20) and can read normal-sized text on my desktop computer monitor (a 27" Asus ProArt monitor displaying at the recommended 2560 x 1440). I'm wearing a contact lens in my unoperated eye undercorrected to -0.75 D. (These lenses are left over from my pre-surgery trial of mini-monovision with contact lenses in both eyes.) If my post-surgery vision is close to what I experience now, I'll be legal to drive without glasses, but would want them anyway for driving at night or in difficult conditions and for watching movies. For me, the two-eye package would be an excellent result. And given my priorities, I'm okay if I end up needing glasses for all driving. As it is, I take my morning walk around the neighborhood without putting in the contact lens in my unoperated eye and it's just fine. . I have more information about the Eyhance, especially if you're interested in mini-monovision. But this is what I can tell you now from personal experience.
I used the Tecnis 1, which is made by same company that makes the Eyhance. It has been around for about a decade. I preferred something with a track record. I had good results with it. But the Eyhance is an excellent lens. So is the Clareon, made by Alcon. Personally, I would stay with a monofocal.
But it is really a personal choice. What is more important is that you find a skilled and experienced cataract surgeon whom you trust and feel comfortable with. Someone who will take time to listen to you, Also, you want to get really good eye measurements. No two eyes are the same, and results with same lens and even with the same surgeon may vary from person to person.
thank you. did both of you use eyhance? not sure how i feel about mini monovision since i have not tried it. i wear progressive eyeglasses now but take it off when i read or on the computer. wonder how i'll feel about needing glasses for intermediate or can i get distance and intermediate with eyhance? also if you are in the US, did you find it hard to find a doctor that offers it?
thank you. how is your near and intermediate distance with monofocal? do you use progressives but take it off for distance? did you get monovision?
Aspen I didn't go with monovision. I asked my cataract surgeon to target intermediate vision for both eyes, and the result surprised me and her. My distant and intermediate vision are excellent. I use readers for sustained close reading. On rare occasions, if I am driving on a country road late at night, I will use Rx eyeglasses for distant vision. I have had no halos, glares or any other unwanted visual phenomena.
thanks for taking the time to reply. why did you target intermediate? i'm confused what to target. i am nearsighted so i dont use glasses for the computer or my phone but wear glasses all day for everything else. if i target intermediate, will i have 2 glasses - one for walking and driving, one for reading?
I targeted intermediate in both eyes because I work with a computer everyday and it was important for me that I be able to see at intermediate distance. My cataract surgeon said, " You have been nearsighted all your life, so you should stay that way. After cataract surgery, you will still need glasses for distance, but they won't be as thick as what you have now." But as I am basically glasses free. My surgeon said it was because of where "the axis fell." My case was an unusual one. It doesn't normally work out like that.
Now, in your case, well, it depends on what you want your outcome to be after cataract surgery. If you want to be glasses-free or almost glasses free, then you would go with mini-monovision. @RonAKA here can advise you more about that. But if you want to stay nearsighted and not use glasses for the computer or your phone, you would target near/intermediate and wear glasses just for distance, as I thought I was going to do. @Bookwoman here has done that. Or you could target distance and wear glasses for intermediate/near. There are different ways to go about it
thank you. that's interesting. that may be a solution for me coz I am also working on the computer all day. might be better for me to target intermediate instead of distance.
"No two eyes are the same, and results with same lens and even with the same surgeon may vary from person to person."
If there is one thing I have learnt on this journey, it's this ^. There are many who love their Vivity lenses, but more me they're intolerable.
Lense choice really is a bit of a gamble. I think the safest choice is probably the proven monofocal lense.
If Bookwoman doesn't chime in, you can send her a Message and she can tell you more specifically what she had done.
Both my wife and I have Eyhance IOLs. . Regarding mini-monovision, while I'm a strong proponent I strongly encourage anyone considering it to trial it twice with contacts: once with contacts in both eyes before the first surgery; again with a contact in the unoperated eye between surgeries. That said, a 0.50 or 0.75 D refractive difference between the eyes, that is, micro-monovision, most likely safe for most everyone. . Like you, I wore progressive lenses for many years. I was myopic enough that without my glasses I couldn't see my computer monitor or read printed matter without holding it very close to my eyes. For computer work and reading I wore Shamir Workspace lenses, a modified form of progressive lenses with wider intermediate and near zones and a small, but for me very effective, distance zone at the top. Hoya and Zeiss, among others, make similar lenses. . My wife has both distance and intermediate with her Eyhance IOLs at -0.50 D. As has been said, however, we are each unique. That said, defocus curves can be useful in indicating mean results at different focal distances, recognizing that visual acuities make up a normal distribution so that one should regard reported results suggestive and that you could end up with better or worse vision than the curves, which graph the mean results. . Looking at the average of defocus curves from four studies I found online that show binocular results, the mean binocular visual acuities at distance and intermediate (66.67 cm / 26.25") are: . 0.0 refraction: distance, 20/19; intermediate, 20/28 -0.25 D refraction: distance, 20/21, intermediate, 20/25 -0.50 D refraction: distance, 20/22, intermediate, 20/23 . I'm in eastern Massachusetts. Without any difficulty, I found three surgeons who implant the Eyhance IOL. Of these, the surgeon with whom I've ended up uses it preferentially as his monofocal lens; another had started using and recommending it within the preceding six months or so; and a third used it but not preferentially (he was pushing the Light Adjustable. Bear in mind that many surgeons have relationships with, or at least strong preferences for, particular companies. Someone with ties to Alcon may not even offer the Eyhance, just as someone with ties to Johnson & Johnson, which makes the Eyhance, may not offer the Vivity. . If the particular IOL to be implanted in your eyes matters to you, I strongly suggest using a surgeon with considerable experience with that IOL. The primary reason is that the IOL power calculation formulas require both biometric data and what's called an "a constant." While each manufacturer recommends a constants for its lenses, best practice is for each surgeon to personalize the a constant for each IOL in light of their patients' results. Obviously, the more surgeries a surgeon does with a particular IOl the more data they have with which to personalize their a constant. For example, Johnson & Johnson recommends an Eyhance a constant of 119.3 for use with the Barrett Universal II formula (widely considered one of the best); my surgeon's personalized a constant is 119.4. (Ask, they should tell you, and then with your biometric data, which they also should give you, you can do your own power calculations online.)
Here I am. :-) I have -2 Acrysof IQ monofocals in both eyes. One eye wound up at -2.5, so I have mini (or micro depending on your definition) monovision. I wear progressive glasses when I go outside, but indoors only for watching TV. I don't need glasses at all for reading or computer use, or for doing 99% of things around the house. I've been severely nearsighted since I was a child, so I now see at all distances much better than I ever have. I didn't expect my vision to be as good as it is, so I've been delighted with the outcome.
Thanks Bookwoman! 😊
thanks for your reply. when I called the doctor they said that they typically do distance. did the doctor suggest you target near or did you have to insist on it? i just dont know if i have confidence in letting him do near if he does not do it regularly. also the doctor's office said they will only do mono if i have used it for contacts which i have not. have u tried it before u had the surgery? do you need glasses just walking in the office for example? if you dont, isnt it very blurry that you cannot recognize people?
thank you for the extensive reply. sounds like you did extensive research. how did you get comfortable with using eyhance given that it is relatively new? how long has your wife had her eyhance and did she experience any side effects? did both if you choose distance as target?
OK, let's take your questions in order. 1) My surgeon is also my ophthalmologist of many years, so he knows me well and knows that I spend much of my day reading or on the computer. He's the one who suggested near vision, as "it's what your brain is used to." 2) My mini-monovision wasn't targeted, it just turned out that way. In fact my doctor suggested it, but knowing that what goes in doesn't always come out (we're dealing with biology, not machines, so the target can be off once things have healed), I wanted to have the same lens put in both eyes. 3) The fact that I wound up with a .5 diopter discrepancy between my eyes has worked out very well for me, but it could have been even greater, and I didn't want to risk that. I had tried monovision years ago with contact lenses, and always felt a bit "off", but I imagine there was more of a discrepancy between the prescriptions than would be used now. 4) I don't have to wear glasses walking into an office, or out at a restaurant - I can certainly recognize people across a table, for example. But when I'm out of the house I always have them on, as I see perfectly at all distances with them. And at my age (65) I think they add something to my face: they're free eye makeup. :-)
Let me take your questions in order. First, I got comfortable with the Eyhance IOL for several reasons including its substantial similarity to the well-established Johnson & Johnson Tecnis 1 monofocal IOL; prior use outside the United States and peer-reviewed studies based on that usage; endorsement by the first surgeon my wife and I saw (with whom she stayed), who described himself as being neither the first nor the last to adopt new technologies; and its preferential use as a monofocal by the surgeon with whom I ended up. . My wife had her eyes done in late December and early January of 2022/2023. She was comfortable relying on the surgeon's recommendation after rejecting multifocal IOLs and the Vivity because she did not want to risk negative side effects and was willing to wear readers for close-in reading. . She has not experienced any side effects. . My wife accepted her surgeon's targeting recommendation of -0.50 D on the basis that these targets promised first class vision from distance through intermediate (computer), which in fact is what she has. IIRC, her distance vision is 20/25, which she experiences as excellent, not needing glasses to drive at night or in bad weather. She's also very comfortable working for long stretches at her MacBook Air laptop. But she does need readers for reading at near. . I have not chosen to target distance, a preference formed before meeting with my eventual surgeon. After having biometric measurements taken and discussing what I find important in living in the world visually, my surgeon recommended targeting my first, nondominant eye anywhere from c. -2.00 D to -2.50 D. I should learn tomorrow, five weeks after that surgery, where it's settled. This information will help decide the particular target for the (more distance-oriented, but not plano) dominant second eye.
Aspen, It's YOUR EYES., not your surgeon's eyes. A cataract surgeon should not care how you target your vision. It's a personal preference. I consulted with 3 surgeons. I remember one that I saw asked me, "How do want me to target your vision, near, intermediate or distance?" It should not be technically difficult to target near. If he can do distance, he can do near. It's all in how they make their calculations. Ron can address that in detail, if you like.
Some cataract surgeons (and some surgeons in general) tend to be "bossy." They all have their own personalities. Like I said initially, you want someone who is willing to listen to you and take time with you. Now, as far as monovision goes, all 3 surgeons I saw told me to try it with contacts first, but as it was, I decided to target intermediate in both eyes and it worked out well for me.
Unless your insurance plan or where you live has you "stuck" with your particular cataract surgeon, consult with others. Or maybe you and your cataract surgeon can come to a mutual agreement.
If you want near/intermediate vision, your cataract surgeon should follow your wishes. And if he can target distance, he can target near. It is not technically difficult. If you and your cataract surgeon can't come to a mutual agreement, then get other opinions. I consulted with three cataract surgeons.