First I have thank everyone that posted. Each experience,diagram, suggestion has been far superior to any information from Dr. I had no idea I choose type of lens and subcategory brand of lens. Without everyones help here no doubt I would have been given Drs choice. I learned about Eyhance from this forum recently diagnosed overnight with cataracts myopic my whole life contacts work excellent just learned have astigatism i think 1 diopeter The Dr is awesome skilled and I trust his judgement at pre op I about Eyhance and luckily he does offer it. He seemed against Eyhance preferring the other Technis zcb00 and even that im not sure of. My question is does anyone have either Eyhance or Zcb00 and some advice as to basic and general vision after surgery? Is one a little better ? Does one have better outcome? Also if I have 1 diopeter astigatism is it necessary to get laser vs manual cataract surgery. Stay safe and thank you forum for guiding me Procedure is Nov 1
I have Tecnis but neither one of those. The Tecnis monofocal is by far the safest and the true and tested option. Many doctors only do Monofocal IOLs.
Tecnis Eyhance is a newer IOL in the category of Enhanced Monofocal in that they are Refractive IOLs that provide some EDOF. Well Eyhance's EDOF is so slight it might not even count as an EDOF IOL . Vivity and RayOne EMV would also fall into this category.
From what I have read Tecnis Eyhance is probably the least risky of any of the Refractive EDOF IOL. In fact I think if it pans out long term it could become the new Monofocal. Only time will tell.
Now this part is important. Eyhance only give you the slightest improvement in close vision. I doubt you even gain a line. Unless you are a statistical rarity, you are not getting "Great" close vision with this IOL. But having said that if you get the same results of a monofocal in the areas of Contrast Sensitivity, no light splitting, and dysphotopsias and gain almost a line, then well worth it.
So it all comes down to what is important to you and how much risk you are willing to take. For me I am going high risk and planning on gettting the defractive Synergy IOL.
If you are leaning towards Eyhance, I would suggest you also look at monovision. Maybe doing micro /mini monovision of -1.0D in your non dominate eye. Most people will do fine with that amount of monovision and it will at least give you some close up vision.
wow rwbill thank you for being out there and answering. Is Synergy a multifocal? How is your vision current without cataract and what made you decide a multifocal
The Tecnis ZCB00 is the basic monofocal IOL from Johnson & Johnson. It will give you very good distance vision but will require reading glasses for sure, and intermediate vision varies from individual to individual. The Eyhance is also from J&J, but offers a little closer vision. The best way to compare lenses is with a defocus curve. It will tell you about what distance vision will be good. The vertical scale is called LogMAR, and a value of 0.2 is considered good vision. The horizontal scale is harder to read, and is in Defocus Diopters. You divide 1 meter by the diopters to get the distance you could see at. If you google the link below you will find an article that has the defocus curves for both the standard Tecnis and the Eyhance. The way I read it the standard lens intersects with the LogMAR of 0.2 at about 1.0 D. That means vision should be good down to 1 meter. For the Eyhance the intersection is 1.5 D, so vision is good down to 1 meter/1.5 or 0.67 meters. So approximately 3 feet for the standard lens and 2 feet for the Eyhance. . Review of Ophthalmology 15 APRIL 2021 IOL Review: 2021 Newcomers . You will also see the lenses from the competition which is Alcon. Their standard lens is the AcrySof SN60WF, and their extended focus lens is the Vivity. Their graphs are not directly comparable to the Tecnis ones because they are based on binocular vision vs the monocular that Tecnis used. But approximately, the Vivity provides an extra 1.0 D of closer focus vs the 0.5 of the Eyhance. At LogMAR of 0.2 it indicates 2.0 of defocus, so the close vision range goes to 1/2 or 1/2 a meter or about 18". The risk of optical side effects is likely higher with the Vivity though. . These extended focus range lenses probably come at a premium price, which may be a consideration. I was really interested in the Vivity but eventually dismissed it in favour of monovision with standard monofocal lenses. Later I have seen some here posting what I would consider as really high prices for the Vivity, like $4,000 a lens extra. For that price, I really don't think the benefits are worth it, especially compared to monovision. Keep in mind that you probably will still need reading glasses with Eyhance, and probably with Vivity too. . On astigmatism a value of 1.0 D if that is what the surgeon measured on the cornea (not the eyeglass prescription) is worthy of a toric lens to correct it. The basic Tecnis lens is available in a toric, and I read that the Eyhance is too, but you best check to be sure. One question to ask the surgeon is whether or not the astigmatism is symmetrical or irregular. A toric lens will correct symmetrical astigmatism well because the correction is symmetrical. If the astigmatism is irregular the toric lens will not correct well, and may make it worse instead of better. i.e. wasted money on the extra cost of a toric lens. . On the laser surgery, my conclusion in reading the research on it is that it is not worth it. The thinking at some clinics is that if you spend lots of money on a "premium" lens then you should also spend more money on a premium laser surgery. I don't buy it based on what I have read about it. I believe the outcomes depend more on the skill and experience of the surgeon. In other words a skilled surgeon using the manual method is likely to do better than a less skilled surgeon using laser...
“How is your vision current without cataract”
I wish. I have the Tecnis low-add MF in my left eye and my right eye cataract is so bad I cannot even see 20/200. I got the MF about 5 years ago, shortly after it was approved and available in the US. Based on my research it was the best defractive IOL available at that time. IMHO the IOL material was better than Restor and it did not have as much dim light issues.
Fast Forward, I am now looking at implanting the Tecnis Synergy IOL in my right eye, which is a combination of EDOF and MF, which “supposedly” give the best Vision throughout the defocus curve. It is also supposed to do well for a light splitting IOL in dim light. Synergy is the latest and greatest defractive IOL from Tecnis. Well I guess there is also the Symfony plus, but good luck in getting information on that one.
“what made you decide a multifocal”
A variety of reasons. When I started to get presbyopia, I hated having to carry readers with me everywhere. No matter how many pairs I had I still never had one when I needed it. And I am a bit of health nut that reads the labels on canned goods.
With the MF I got functional close vision which is what I was shooting for, which means I can find the sweet spot and read a label or a menu at a restaurant. But to do serious reading like read a book I need readers and good light.
Of course with all defractive IOL, comes more dysphotopsias than a monofocal. And that is the scary part as everyone is different and you just don’t know how bad or not bad it will be until after you get the IOL. I KNOW, DAMN SAD!!!! But that is the way it is.
My dysphotopsias are not horrible and I am fine with them for the close vision tradeoff. What bothers me more is just how dark things are in low light. I am hoping the Synergy allows more light through. That reminds me of something I recently hear a doctor mention on that subject. He was talking about how even minor PCO can be worse for someone with PanOptics, due to the light splitting. I guess he is saying minor PCO can affect light getting through and if that light is already reduced ……
Bottom line there is no Perfect IOL. All come with tradeoffs. It is your job to understand these tradeoffs as best as you can and decide what is most important to your lifestyle.
Gosh, one last bit of advice, if you can still correct your vision to be “Decent” enough, my advice is procrastinate as long as possible. There are some new revolutionary IOL in the making like the adaptive Juvene IOL.
I have ZCB00 put in 1 eye, second eye scheduled for next week. Today, 5 weeks after the first surgery, I still have some variable blurriness, but it seems to be related to the drops (another week to go for the prescription drops) and dryness. When I saw my optometrist a week after surgery, he said things look good but my cornea was dry. He gave me a sample of OTC lubricating drops to use, and I'm still needing drops for dry eyes, so I"m hoping my vision will improve slightly when the prescription drops end and the dryness settles down. I have another appointment tomorrow and may have more information to share then. Overall I'd say I'm quite happy with the lens. My target was -0.5. A week after surgery the optometrist said I was between -0.5 and -0.25.I have a Snellen chart taped to the wall--tonight I can just make out the 20/20 line, although I might miss a few letters. At about 27-28 inches in good light the Jaegar chart is in focus, but a lot of the text is too small to read. At 14" I can read line 9 and larger (although not clearly.) This is probably the closest I've been able to focus yet--it's actually improved somewhat over the last couple days. I have a little bit of glare when I look directly at exposed light bulbs, but light fixtures don't have glare. When I look on lights on neighbors' houses at night, I don't see any halos or glare; I haven't been driving at night to see how that will work.
Overall I'd say I think I will be quite happy with the lens. My eyes have a fair amount of damage due to diabetic retinopathy, so monofocals were the only option recommended for me.
thank you rwbill. i can sympathize with how dark things are in low light. funny i thought my whole life everyone vision is like that. Props for self responsibility in understanding trade off. This forum clarifies choices and procedures. Wow I was thinking of holding off right eye due to new future iol. I fully onboard with self responsibility but Dr is not really communicating much. I think astigatism diopeter is 1 and was told i have alot and should use femtosecond. but real life stories on this forum say 1 diopeter is average its not affecting me
Ron aka need a whole pack of cigs to polish off that info above. Your good i read alot of your posts and they were like the opening guide to cataract surgery will start on your knowledge asap
lucy thank you for real life experience. How was your vision before cataract ? Did you choose the zcb00 or did dr think it was best for your eyes? Blessings on continued recovery. does a target of 0.5 mean you have some myopia or are you closer to plano
symmetrical or irregular. dr didnt even tell me diopeter i had whisper question of diopeter to assistant on the sly. it was a previous post of yours that introduced me diopeter of astigmatism. i had no clue. for forty years im getting fitted with contacts not one optician ever said i had astigmatism and as for cataracts Ron had yearly eye exam Nov then March had tiny accident scratch with long nail eyeball. Optician never saw cataracts till July specialist appt due to left eye started seeing blurry can they grow that quick? And yes reading research I see that opthamologist generally agree that laser is not worth it and outcome based more on skill and experience. Learning from this forum last week I saw pre op appt and said i wanted Eyhance. Dr gave me no information about my choice when the last day of choice for iol is or contact him for my choice. He only said he does Eyhance but also does the other JJ iol mono and he likes that one
rwbill what does refractive iol mean with edof to vision or the way we see thing
"So approximately 3 feet for the standard lens and 2 feet for the Eyhance." Ron does that mean that Eyhance does not see distance as well as standard lens and that is trade off for better intermediate distance? Or does that mean that Eyhance sees better close up than other iol Excuse my not yet learned basic questions thanks for your patience and wealth of knowledge
sorry other technis monofocal i think the iol that Lucy has
Keep in mind that astigmatism is the result of astigmatism in the natural lens in the eye plus the astigmatism in the cornea of the eye. An eyeglass correction has to correct for both errors in the natural eye. Once you have the natural lens removed in the cataract surgery, the IOL then only has to correct for astigmatism in the cornea. It is possible that your natural lens astigmatism was correcting for astigmatism in your cornea. So, when the natural lens is removed there is more astigmatism to correct for. That may be why your eyeglass prescription has not astigmatism (cylinder), but your IOL may need to have it. The option of course is not to correct for astigmatism with the IOL and do it with eyeglasses.
The advantage of the Eyhance is that it should give you both good distance vision, and intermediate vision down to about 2 feet.
Diffractive Optics uses diffraction of the light waves to distribute light. For example, in case of Multifocal it creates 2 focal points and in case of trifocal it splits the light 3 ways allocating 50% to distance, 25% to intermediate and 25% to close.
I think the confusion comes in with these new generation “Enhanced” IOLs that do not use diffraction, but instead use Optic Trickery (stolen from Ron) to create a minimum EDOF effect. In the case of Vivity, from what I read at the cost of Contrast Sensitivity.
In general there is no free lunch and EDOF, even slight, comes at a cost. What makes the Tecnis Eyhance interesting is it calls itself an Enhanced Monofocal and "Supposedly" provides a little bit of EDOF without sacrifice. Only time will tell as more data is collected.
Ron gave a link to an article that reviews this new IOL category.
I guess if I had to pick one of these New IOLs I would probably go with Vivity and do -.75 d of monovision in my non-dominate eye giving me a total of -1.25 d.But I have not really researched the 3 FDA approved IOLs that fall into this category so that is just based on mild reading about these IOLs.
I would add if you have any eye condition, other than cataracts and maybe minor astigmatism, I would avoid a Diffractive IOL, especially one like Synergy.
Though I am probably the only one to say this, dysphotopsias can sometimes be cool. I was driving home tonight in the dark and there was a cop car with its red and blue lights blazing and at such an angle that I saw this large circular halo that looked like a multiple color force shield covering the entire front of the police car. I thought that is cool! P.S. if that sounds horrible to you, again don't get a diffractive IOL.
Do you mean vision before the cataract, or before the surgery? Before the surgery my vision was very bad due to the cataracts. I couldn't even make out the top line on a Snellen chart and could not drive, even with glasses. Before the cataracts, I was mildly myopic-- prescriptions on the right eye (the one that's had surgery) of -0.25 when I first started wearing glasses, going up to about -0.5 about 12 years ago, then getting much worse as the cataract developed. I wasn't really given a choice of lens. Due to my retinopathy, monofocal lenses were considered the only/safest way to go. The doctor had originally told me that he would be using Acrysof (I think that's his go-to lens) but went with the Tecnis in my case. It seems like it was a slightly more conservative approach. I agree with the decisions this doctor has made, so I haven't fussed about his selections. That said, he was my 3rd option for a surgeon because I was really unhappy with Drs 1 & 2, and I went to him with the targets I wanted in hand--thanks to this forum and defocus curves. There is some myopia with the -0.5 lens, but it's what I've been used to. I will probably get glasses to drive because it will give my vision a little boost, but I can drive without them. My tv is about 12' away from where I sit and I can see almost everything except very small/small and low contrast print clearly (like the drug information they flash on the screen at the end of a commercial that they really don't want you to read--no loss not reading that.) I look out into the yard and can clearly see branches and leaves on the trees near the house, although I've still got a little blurriness from the drops/dryness that I'm hoping will go away when the drops stop. I didn't go for plano because I am a voracious reader and want more near vision, and I don't want to wear glasses to cook and have them steam up at critical points. The doctor nailed the -0.5 target and I'm pleased with it. There is some softening of vision at distance (I can't really read the whole number on the house across the street, but I can make out some of the numbers), but I think for around the house and puttering around in the yard it's going to be just what I was looking for. I did have a little more distance vision right after the lens was put in, and I can see why people love it, but for my lifestyle it wasn't the right choice.
If you search "cataract coach eyhance" there's a good video by Dr. Uday Devgan that compares the Eyhance and ZCB00. It's not very long and might give you some information.
i get that cool effect. i think now that im aware of dysphotopsias due to this forum as a life long myopic i have had them forever and i thought everyone else saw that too. With your help I understand Eyhance now. I cant choose which distance like traditional monofocal? and is that why its inbetween mono and multi? By reading this forum I think i understand what is really important now . RW is -1 diopeter enough for leaving myopia after surgery? And i love contacts im myopic and see perfect with them i want to continue wearing after surgery will i be able to wear as pre surgery?
thank you so much for the irregular and symmetrical suggestion. The Dr did not say much at all. I agree with laser not worth it due to same reading. How is your vision near with mono? Were you myopic before surgery? Can you correct with contacts instead of glasses? i do not know how to message Dr with questions. there is a disconnect so thank you
Ron great point about iol has only correct astigmatism cornea and natural lens correcting. Never saw that point. wow natural lens removed more to account for thank you put alot in perspective about post surgery astigmatism decisions Wish Dr would have advised me i will message him and ask for advice based on pre and post astigmatism solutions.