Frustrated. Surgeon is pushing for me to have my Eyhance set to computer distance (66cm) in dominant eye and at near fie non-dominant. Concerned as I've not read anywhere of using Eyhance for near? She says it's better to keep near vision as i was myopic before. Says I'll be able to use computer and read but will need driving/distances glasses. I see so many of you on here saying your went with distance and can read and user computer. Is that a rare occurrence? How should i proceed?
I can't speak about. the Eyhance. monofocal. or mini- monovision but others here can.
My surgeon also told that since I was a lifelong myope I should stay that way and that I would still need glasses after surgery but they wouldn't be as thick as I what I was wearing. I didn't use Eyhance because I had lot of astigmatism that I planned to correct with glasses. I had read that the Eyhance might make that more difficult. After a lot of research here and elsewhere, I went with the Tecnis 1 piece set for intermediate vision in both eyes. Now I only wear glasses for reading and only sometimes.
I have 20/20 distant vision and excellent. intermediate vision. My surgeon was surprised at my outcome. Remember no two eyes are the same. What happened to me may not happen to others.
The advantage of Eyhance over standard monofocal lenses is less blurriness when an object is closer than optimal distance for the lens. In other words, when set to be sharpest at distance X, it is less blurry for distances closer than X than a standard lens would be at those distances. So, if the doc sets the near eye for, say, 30 cm, the vision with Eyhance will be sharper at 20 cm than a standard lens would be at 20 cm. But it's not going to be sharper at 40 cm or 50 cm than a standard lens would be at those distances.
I think that's still useful, even though the need for sharp vision at closer-than-book-reading distance is not very common for most people. I would nevertheless want it.
You seem to be asking if you can't get both eyes set to intermediate, or maybe one at intermediate and one at far, and still see near. The answer depends on how sharp you want the near vision to be. It will be sharper if one lens is set to near than if neither lens is set to near. But if you're not too fussy, it might be acceptable with neither lens set to near, given the little bit of extended depth of focus that Eyhance provides. How good do you want your near vision to be?
I haven't made a final decision on what I will do, but I'm leaning toward setting both eyes for near ( like maybe -2.00) because I want to be able to see near really well without glasses. I don't mind having glasses for far, because most of the time you want to see far. The glasses will be right there on my face, so I won't have to carry them around and perhaps lose them. But the need to see near comes up unexpectedly for short time periods throughout the day. I want that capability to be built into my eyeballs so that all I have to do is take off my glasses, not hunt for reading glasses.
Only one of my eyes is eligible for Eyhance, so that's likely to be my choice for that one. The other eye, due to extreme astigmatism, has to have a monofocal toric.
The glasses I get for far will probably be actually geared for intermediate, just to have that versatility. Those will be my general walking-around glasses. I can keep full-correction distance glasses in the car and by the TV if I want to be fussy. Right now I have glasses with full correction and glasses with 3/4 diopter under correction. I almost never wear the full correction ones.
I'm going for contact lenses tomorrow so that I can simulate various targeting strategies, with the contacts at various degrees of under correction and cheap ($20) prescription glasses from Zenni Optical for distance to wear over the contacts. I can't wear regular contacts, so these will be scleral contacts.
Only one of my eyes is eligible for Eyhance, so that's likely to be my choice for that one. The other eye, due to extreme astigmatism, has to have a monofocal toric.
I'm curious to learn how much is too much astigmatism for Eyhance to no longer be an option?
You are correct. The Eyhance was designed to give more depth of focus to the near side. So for example if you get a power for full distance correction it will give about 0.4 D more close vision. The extension is not to the distance side. So if you want near (66 cm or -1.5 D) and very close (33 cm or -3.0 D), I don't see any advantage in using a lens designed to give closer depth of focus. You may as well use monofocal lenses. Monofocals with glasses will give you better distance vision as they are a pure power, and are not compromised to give closer vision. . If you want to use Eyhance to get some closer vision I think a better strategy is to use a monofocal like the Tecnis 1 in the dominant distance eye targeted to -0.25 D, and an Eyhance in the non dominant eye targeted to -1.25 D. Your dominant eye will give very good distance vision, and the near eye will let you see quite well at computer distance and most reading of paper documents - all without glasses. . I think the targeting for near vision if you are myopic before surgery is a bit of a cookbook approach. Yes, those people will be used to being short sighted and wearing glasses for distance. But, when there is an opportunity why not try for eyeglasses free? Eyeglasses can always be used for a further correction if needed. Most will get away with just readers for very small print.
The Eyhance is available in IOL plane cylinder powers of up to 6.0 D. That equates to a corneal plane power of 4.11 D. If you google this you should find a specification sheet on the lens. . Tecnis Eyhance Toric II IOL spec sheet pdf
I feel like only patients that specifically want and ask for a near target should be considered for a near target. I think most people are happier with good distance vision. If you DO go with a near target though I think I'd use a regular monofocal. The point of Eyhance is to improve intermediate vision when people target distance.
I had my first eye (right/dominant) done with a toric Eyehance lens targeted for -.25 on Dec 8th.
I can only tell you what I am experiencing today as others here have helped me to understand that it's far too early to draw any conclusions.
I'm typing this on my iPhone using only my Eyehance eye. The text could be sharper, but I can absolutely read it. Everything from arms length out like the dashboard and infotainment system in my car is crystal clear.
Some caveats. 1) The eye is still healing, so this can change. 2) I was told by my surgeon that I will need some sort of YAG procedure in a couple of months after the eye has officially healed. That should only improve my vision in theory, but it's another X-factor. (I hate X-factors! :-P), 3) Your mileage WILL vary. There's no way to truly predict your the outcome. (I hate that too! ;-)
After my one week follow-up on Friday morning, I should have some tangible numbers to share.
when considering a defocus curve, i'm wondering how many diopters of useable vision a monofocal can realistically provide?
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so when a monofocal lens is set to a near target (perhaps 15"), what is the usuable range? (10"-20"?)
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and why wouldn't it be better to go with Eyhance or another EDOF lens to increase that range?
I believe that if usable vision is defined as 20/30 or better than the usable defocus range of a standard aspheric monofocal is 1D. Eyhance extends that to at least 1.35D but there is some disagreement on that (I've seen as much as 1.45D mentioned). That extension is also more light dependant than the 1.5D range of Vivity (for example). So in dim light with Eyhance you won't get much benefit. . Not sure about the second question but if you look at a defocus curve you will see that the closer you get, the more diopters you need to see clearly. So the range you get when you target near focus is tighter. But if you set for distance you can be pretty well assured that everything from 3 feet to infinity will be good. . As for the third question, I haven't done the math but again I think the closer you get, the less range that EDOF effect is going to "buy" you. So personally I'd rather just go for the absolute best quality image and contrast with a classic monofocal. I'm sure Ron will have some thoughts though and maybe more specifics.
Ron Regarding your statement that monofocals with glasses will givethe clearest vision. Would you imagine that there would be a difference in the clarity of vision from glasses and two distance monofocals as compared to glasses with minimonovision? I am still considering what to do with my second eye, My first surgery was to be distance and is toric (both will be toric) and now has a prescription of +1. I want to be sure to have the very clearest distance vision with glasses, as I will still wear glasses at least for some things as the toric has not corrected all of my astigmatism. I knew that would be the case. Thanks for your input.
Have a look at the defocus curves in this article which compare the Alcon monofocal to the Vivity, and in another graph the J&J Tecnis 1 monofocal to the Eyhance. This is not a direct apples to apples comparison though as the Alcon graph is for both eyes together, while the J&J is monofocal. The Tecnis 1 provides LogMAR 0.2 (about 20/32) vision out to about -1.1 D. If you divide 1 meter by this number you get the distance in meters, or in this case about 91 cm. The Eyhance stretches this out to about -1.5 D or about 66 cm. To see the impact of targeting something other than plano you just slide the whole curve to the right by the amount you are targeting. At some point there will be no benefit in moving the offset too far to the right as it will give best vision at a point that is too close. And the idea is to move it as little as possible to preserve distance vision as much as possible. However, when you are in a monovision configuration distance is being provided by the other eye, so that is not as critical. . Review of Ophthalmology PUBLISHED 15 APRIL 2021 IOL Review: 2021 Newcomers .
Hey Ron. You mentioned monovision but I would point out that the original poster was talking about a surgeon recommendation to set one eye for intermediate and the other eye for near. Neither eye will be set for distance. This seems unusual to me. I'd just go for distance and then maybe a little monovision to improve near. . FWIW I have Eyhance in one eye which is now 3 months post-op. It was set for distance and we nailed the target but I got some residual astigmatism which isn't great. But with glasses to correct the astigmatism I see 20/20+ for distance and it's breathtakingly clear. The other eye hasn't been done yet. . For near, in super bright direct sunlight (so TONS of light) I can easily read J1 at 14 inches. But only in very bright direct sunlight. In normal room light, nope. The astigmatism is probably helping me achieve that result. I also have small pupils. Similarly my Dashboard looks amazing during the day but for night driving its not great. I can read it but it's not great.
No, based on my experience there should be no difference in corrected vision with both eyes corrected to distance compared to mini-monovision. In mini-monovision eye glass lens for the near eye will be slightly thicker at the edge than the eye corrected for distance. That is what I have and these glasses are the thinnest and lightest glasses I have every had, and they are not high index. With no glasses I am 20/20 or slightly better. With progressive glasses I am 20/15. If anything I think my left eye which is my closer eye with more astigmatism is possibly better than my right eye with the eyeglass correction. . The issue with correction of an Eyhance eye is that the power of that lens varies slightly from the center to the periphery of the IOL. There is no way of correcting that with an eyeglass lens that I am aware of. . And the issue with eyeglass correction is that the peripheral vision I find is reduced when driving compared to no glasses and depending on mini-monovision.
So in theory, targeting -.25 with an eyehance lens would get you to LogMAR 0.2 at around -1.75 = around 57.1 cm = around 22.5 in
Targeting -.50 with an eyehance lens would get you LogMAR 0.2 at around -2.0 = around 50 cm = around 19.7 in
Targeting -.75 with an eyehance lens would get you LogMAR 0.2 at around -2.25 = about 44.4 cm = about or 17.5 in.
Targeting -.1.0 with an eyehance lens would get you LogMAR 0.2 at around -2.50 = about 40 cm = about or 15.7 in.
Of course you're also degrading your distance vision every .25 D.
Is that more or less correct, or is it not that simple in practice?
I agree that targeting for that close is unusual. Based on the quoted distances the dominant eye is being targeted to -1.5 D (66 cm), and the near non dominant closer (possibly 33 cm, -3.0 D?).
Not sure what the logic is there. Does not seem to take advantage of the extended depth of focus of the lens. I think some surgeons are focused on not having to spend "extra chair time" with patients that are surprised with their outcome. For that reason they may want to keep a patient myopic if that is what they are used to. I look at differently and as an opportunity to improve vision from being myopic to something much better.
Yes, that is basically correct. The whole curve just moves linearly across as you offset the target. I have a monofocal with -1.0 D sphere, and -0.75 D cylinder, so about -1.375 D spherical equivalent. Not sure if it is LogMAR 0.2 but I can read a computer screen with normal print down to about 10-12". This is what makes me think that an extended depth of focus lens is not really necessary when doing mini-monovision. And on top of that, correcting the vision with eyeglasses for any residual error is simpler.
...because all you're really accomplishing by doing mini-monovision using two Eyehance lenses is achieving binocular vision over a very short range of distance that can basically be measured in inches in exchange for a slight decrease (but a decrease nonetheless) in visual acuity at a range of distance which can be measured in yards (and LOTS of them)?
This is a conversation I'm currently having with myself. What am I gaining in spectacle independence by going for mini-mono vision in my second eye with a toric Eyehance lens vs. sacrificing binocular vision from -..25 to -1.75 even if the low end of that range is at logMAR .2? Right now, it seems like I would only need readers for extended screen time at work and at home on my iPad. That doesn't seem like that big a deal. I was concerned with not being able to see my dashboard clearly, having to fumble for glasses to read and reply to a text or read a menu, and other everyday activities requiring some degree of intermediate vision. That doesn't seem like it will be an issue.
...which also leads back to Kelly and what level of spectacle independence (and what field of vision) is desired.
I believe I have good binocular vision from about 20" out to 6 feet or so, with two monofocals. The only time I have really missed binocular vision has been when pruning bushes in my yard at a distance closer than 20". I do occasionally miss the branch I am trying to cut. I see it well, but my distance judgement is not so good. The good news is that so far I have not cut any fingers off!
"...improve vision from being myopic to something much better."
I don't agree. In my value system, myopic vision is better than distance vision if I have to be presbyopic . I respect that others have different values and reach a different conclusion, but suggest that everyone should respect that some of us LIKE myopia.
I'm tired of emmetropia chauvinism. Emmetropia is great for the young. There is no advantage to myopia if your eyes have 10 diopters of accommodation. But if you have very little accommodation, and you do have money to buy glasses, myopia is superior to emmetropia.
Once you have presbyopia, you cannot avoid needing glasses for something, unless you want to accept the risks and drawbacks of a multifocal lens. So, it's just a question of at what distance do you want to use glasses for and at what distance do you want to see sharp without them. There is no objective better or worse answer to this question.
To me, if I have to carry around glasses, the most convenient place to carry them is on my face where they will always be handy and I won't lose them. I don't want them in my pocket, falling out, getting misplaced etc. Most of the time we need distance vision, so it's better for distance vision to require glasses, so the glasses will mostly be on my face where I won't lose them. The need for close vision is intermittent and comes up unexpectedly and frequently, so I want that built into my eyeballs, conveniently available just by peeking over my glasses or momentarily taking them off.
If I have a long session of needing close vision, I'm probably sitting down and can lay the glasses on the side table, and will put them back on when I get up. But if I have a long session of distance vision need, I'm probably active and susceptible to misplacing my glasses if they are not on my face.
I would hate to be dependent on glasses for close vision. Glasses in bed? Glasses when I've got my hands full of tools and parts and need to quickly see exactly if two little things I'm assembling are lining up? Glasses when I need to measure something precisely? No thank you!
But glasses to walk around, drive, socialize, do computer work -- no problem.
Also, most things that require eye protection are done with distance vision. I don't want to be tempted to skip the eye protection. I want it to be normally on my face when things are flying around that might damage my eyes. How many of you with glasses-free distance vision have skipped putting on eye protection to do something where eye protection is advisable, like hammering, sawing, some sports, certain types of yard work? I bet 100% of you at least 80% of the time.
As to whether to use Eyhance with a close target -- why not? They don't cost much more do they? And they have superior depth of focus, so less issue if there is a refractive miss and a bigger sweet spot for sharp vision wherever they are targeted, and they supposedly have superior contrast sensitivity to monofocals. Yes there is a portion of the defocus curve where they are a little less sharp than a monofocal, but I'll bet that's barely noticeable.