Hello everyone, I would like to know your opinion, maybe get an idea how my second operation should proceed. March 2020 I received the Vivity in the remote dominant eye. Now the right eye is on. In good light I can read from about 35 centimeters. From 50 centimeters I can read well. However, mainly use fonts with good contrast, such as .B smartphone. Newspapers, fonts with poor contrast, are difficult even in good light. I would very much like to get a few centimeters more closeness. My 3 main focuses for the 2nd operation: 1. No strong optical phenomena, no risk of a failed neuroadaption. (which means that multifocal lenses are excreted) 2. The widest possible range and thus freedom from glasses. 3. The best possible visual acuity. I realize that either way it's a compriss. I am looking for the most suitable, best possible compromise for me. I am seriously considering 2 options so far, possibly a third party. Do you have a more suitable idea? 1. Vivity on emmotropy. - This should not cause me any optical disturbances and allow an almost perfect visual acuity from about 50 centimeters to Far (as it succeeded in the 1st eye) 2. Vivity with -0.5 diopters - This should give me a few centimeters more closeness without losing binocular appreciably distant. With only -0.5 diopters, neuroaddaption should not be difficult and I should get a uniform picture. Or what do you think? - On the other hand, I have the (small) concern that this mini-monovision will lead to further loss of contrast. And a few centimeters more closeness won't do me any good if the contrast nearby is so bad that I still can't read well nearby.... (these thoughts are pretty much my biggest question) 2b. Eyhance to -1.0 - Should give me less loss of contrast. However, the mini-monovision would be larger, so probably the binocular image would be more difficult and I would lose some distance - therefore probably not an option for me. 3. A bifocal lens, focal points near and far. - This is where I know the least. Is there a bifocal lens with wavefront technology? All other technologies provide halos and co., right? What would make for less interference and the larger range and the better overall picture: mini-monovision with the Vivity or a bifocal lens? I am very curious about your opinions and experiences, thank you very much! And all the best to you!
- This is a safe option if you are happy with the Vivity you have. Not going to significantly improve close vision though. Alcon claims this improves the contrast sensitivity compared to a single Vivity though.
- My choice would be a Vivity at -0.5 to -0.75 D, and ideally closer to -0.75. You have to be realistic and target a range. For the Eyhance a range of -0.75 to -1.0 D should work and give similar reading. I doubt there would be a significant difference in contrast sensitivity compared to the second Vivity option. The Eyhance option likely reduces distance vision some compared to the Vivity mini-monovision.
- This would be the highest risk for optical aberrations. Symphony may be the lowest risk option, but you should expect some issues with halos and flare especially at night.
- get panoptix.
My 3 main focuses for the 2nd operation: 1. No strong optical phenomena, no risk of a failed neuroadaption. (which means that multifocal lenses are excreted)
bifocal lens will have photic phenomenon and they will be as bad as trifocal. however the vivity in the other eye will cancel a lot of it.
Thank you RonAKA for your assessments!
The crucial question is: How do I gain more closeness? Either the 2nd Vivity on emmotropy and due to the better contrast Binocular a little more closeness - or a Minimonovision, which makes the 2nd eye a little more short-sighted, but gives a worse contrast overall....?
In good light, I am satisfied with the operated eye. Can shave me well etc, from 30cm distance. But in weaker light, the view within about 60cm is e.B. when cooking, taking medication, etc exhausting... and the view of ads bad.
If the 2nd Vivity on emmotropy slightly improves binocular vision nearby through better contrast, my choice is clear...
Thank you!
Is there not a single bifocal lens with as little/no phenomena as Vivity?
I think the binocular gain is quite small, and you will gain much more near vision by under correcting. The improvement in contrast sensitivity is a more minor effect than simply under correcting. The Vivity gives you a gain of 0.75 D nearer vision when set for emmetropia. If you under correct by 0.75 as well then the near vision gain is 1.5 D. The Eyhance has an emmetropia gain of about 0.5 D, so it needs a bit more under correction of about -1.0 D. The distance vision loss of the Eyhance will be a bit more than for the Vivity, as it has to be offset more. . Also keep in mind that contrast sensitivity is maximum at the optimum focus for the lens, and drops off quite rapidly as you focus closer. Offsetting the power moves the best contrast sensitivity closer. If you look at the Vivity Package Insert PDF you can see the defocus curves as well as the Contrast Sensitivity MTF curves.
without rings they cannot give you near and far on the same lens. and if u r getting rings then might as well get the trifocal.
Thank you! Now I understand this detail!
Okay many thanks! If you are interested, my surgeon's report on my case has been described in an international journal, including my defocus curve after the operation: Google: unilateral implantation curschmann steinert
If necessary, last question :): Is there another Edof that has the same or larger range as the Vivity, with just as few optical phenomena? So an alternaive I should consider?
I looked at that report and you got unusually good close vision with a -2.0 D at a logMAR of 0.2. Notice that if that lens is under corrected by 0.75 D the logMar of 0.2 will be extended out to -2.75 D. And the distance vision logMAR will remain above 0.2 and will be close to 0.1 which is excellent about 20/25 or so. That is based on your second eye behaving like your first eye, which is a reasonable assumption. With your first eye better than 20/20, your binocular distance vision should easily be 20/20. And your close vision at logMAR 0.2 will be good down to 1 foot or so.
I think the mildest lens after the Vivity would be the Symphony. There is a Su-An here that I recall has it in one eye and reports fairly mild optical effects like halo and flare at night. You should look at the defocus curve for the Symphony to see if it offers much over the Vivity. I suspect a Vivity with a 0.75 offset will likely do just as well, while maintaining excellent distance vision.
Have a look at this article, if you have not seen it. . A guide to the latest presbyopia-correcting IOLs October 27, 2021 . It compares a few lenses including the Vivity and Symphony. I believe some suspect that the Vivity curve is overly optimistic, but it appears very close to what you achieved. And, it gives you nothing over what you got with the Vivity.
Congrats on your excellent outcome with the Vivity in your LE. Your LE monocular defocus curve came out better than that in Vivity/FDA clinical study. Which IOL formula did they use for power calculation? Your astigmatism had perfect mirror image symmetry (corneal astigmatism: -0.93Dx169◦ RE, -0.93 Dx11◦ LE), and nice to see that your cylinder dropped to -0.25D (and sphere to 0DS) post surgery! Your monocular VA of ~0.35 logmar at -2.5D/40cm is better than FDA report VA at that vergence, but it drops off steeply to ~0.72lm at -3D/33cm (FDA defocus curve stops at -2.5D, so no data there). The starbursts & spiderwebs & halos are somewhat worse than I expected (though tolerable) for the Vivity, though.
Please check what predicted refractions you get for your RE biometry & Vivity (using the same power formula as in LE), for IOL powers 21D (~emmetropic), 21.5D and 22D. The values shoud be (my guesstimate) approx. 0, -0.35D and -0.7D, respectively (are they?). Then, you can use your own LE defocus curve to see what monocular VAs you can expect in your RE, at those power values. For example, with 22D power Vivity in RE, if ~ -0.7D is the refraction, your monocular near vision could be: 0.175 lm @ 40cm & 0.275 lm @ 33cm (0.175 lm @ 40 cm is roughly 20/30 Snellen = Roman N5 = Jaeger J2). Binocularly, I'd expect close to N4 @ 40 cm (=0.1 lm) with this choice.
Please share your thoughts & questions, and correct me if I've made any errors in the above.
Thank you for your hints and the article. I will study this ;) In order to avoid the danger of halos and co, it is probably clear that only the Vivity is suitable for me.
Or have you heard of WELL FUSION™ Systems and the Mini WELL PROXA®? Seems to me to work like Vivity with the Wavefront technology. Shouldn't this be compatible with my left eye?
@Ronaka: You always write from -0.75D. Surely you get closer with it. But I want to keep the mini-monovision as small as possible. Disturbing vision would be much worse for me than gaining a few centimeters more close. If my right eye had the same conditions as the left eye, then not even -0.5D would have to bring me a profit. What do you mean? (The cataract is too large to be tested with contact lenses)
Simply WOW! Thank you very much for the deep input! However, this overwhelms my knowledge to a large extent. I read out that the result LE was excellent and nearby better than expected. Which in turn tells me that with the same conditions in the RE, for more proximity, the MiniMonovision can be low...? (Lower MiniMonovision = lower risk of vision problems/disturbances/loss of contrast... right?)
The starbursts & spiderwebs & halos are somewhat worse than I expected (though tolerable) for the Vivity, though.
I don't have starburst and halos at all... After 4-5 weeks only a small capsule algae has formed, so that since then I unfortunately see two diagonal stripes through lights/sun/moon... however, this does not really bother the vision at all. it looks like this character "/" by a "0"
The following should perhaps be noted:
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The eye test on which the results and the Defocus curve are based took place under perfect conditions: Brightly lit room, illuminated panel with black writing. Better contrast is not possible. Therefore, good results. However, these lighting conditions are extremely rare in reality. Therefore, the real result in everyday life is not as good as the test result.
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For the operation, I bought the femto-second laser. Thus, the calculations for the capsule cut are even more accurate.
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Unfortunately, I have had permanent vitreous opacity since the first Biontech vaccination. This permanently disturbs vision and concentration (through hundreds of dots and "floating mosquitoes" in front of the eyes)
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My eyes are extremely dry due to the Lagophtalmus. I drip 12x hylocomode gel into the eyes a day. Dry eyes increase the risk of refractive errors. In January, I have the measurements taken on 2 different days.
Thank you for your time and input! I appreciate this very much!
I am suggesting an under correction of 0.75 D so you get good reading ability. Yes, 0.5 D might do it, but 0.75 has less risk of falling short. Keep in mind that regardless of all the sophisticated measuring methods the IOL only comes in steps of 0.5 D spherical power. For that reason you are highly unlikely to hit -0.5 D exactly. It is more practical to specify a range. Once you have the measurements of your eye, the surgeon should be able to tell you what the lens choice options that the steps will result in. My thoughts would be to target closer to -0.75 D than to -0.5 D. . Also keep in mind that anisometropia of 0.75 D is quite small. Full monovision can use up to 2.0 D. I simulate 1.25 D anisometropia with a contact and do not find it an issue at all. When it comes to getting my cataract surgery though I will ask for closer to -1.5 D with a monofocal. I am still considering using a Vivity, but in that case I would go for -0.75. . When you look at the defocus curves moving the Vivity to -0.75 D costs very little on distance vision. If I go with a monofocal at -1.5 D I will lose significant distance vision from that eye, and will depend much more on my 20/20 IOL eye. . I think it comes down to how much do you want to risk needing reading glasses for a smart phone and text documents. I have some +1.25 readers that I use very occasionally. It is quite acceptable. However if I needed them all the time to read my iPhone I would not be happy at all. I think I would just wear progressives. That would not make me real happy either. I have gotten quite used to being eyeglass free virtually all the time.