Hi. I had an Eyhance IOL implanted in my right eye (plus laser-assisted LRI) 1.5 years ago. The surgeon was targeting SPH 0 and CYL 0. I ended up with SPH +0.50 and CYL -1.00. (Prior to surgery it was -3.50 and -1.50). As a result, I don't see clearly near and intermediate, my more-or-less decent vision begins at about 6-7 ft out. Distance vision is about 20/40 without correction, so I can drive and hike without glasses. I'll be more deliberate with my left eye now in surgeon and IOL selection. I'm thinking that I should target my left eye to have good vision from reading distance to about 6 feet out. This way the left eye will kick in at 6 ft and closer where the right eye starts being blurry. Is there an IOL that would give me good vision in the left eye from reading to 6 feet out? I don't quite understand the defocus curves and how to translate it to the range of good vision. Any insight and advice is greatly appreciated. Thanks, Allen
Some additional info: my left eye currently is SPH -0.50, CYL -1.75. I can read with it (without glasses) but things start getting blurry farther than about 14 inches (due to astigmatism I guess?) So, what IOL and what target SPH would get me good vision up to 6 ft? I'm guessing it would have to be a toric IOL. But what kind (Monofocal? Multifocal? Accomodating?) I don't mind paying a little extra to get good near/intermediate vision. Thanks.
You are in a bit of a "pickle". It is not good to end up far sighted in the + zone. It hurts both your near vision and distance vision. And, the kicker is that based on my two consults with Lasik surgeons you cannot reliably bring your +0.5 D sphere back to 0.0, or I have not found one willing to try it. One option at this point would be for the surgeon to explant the Eyhance and put in one that is 1 D higher in power. It would leave you at about -0.2 D, which is ideal for distance. It could also be a toric to reduce the -1.0 D of astigmatism. Unfortunately 1.5 years since it was implanted is a complication and will make an exchange more difficult. It should have been done right away after surgery. The other option is a "piggy back" lens to make a correction. . There are other options for the other eye, but the simplest if you can get your first eye back to good distance, would be to just do a monofocal with that leaves you at -1.5 D. . Just my thoughts on how to get out of a difficult situation.
RonAK My prescription for the eye that has had surgery is +1.0 sphere and -1.0 cylinder. I am trying to figure out what this says about the vision in that eye. Does your answer above apply here such that my eye is now overly farsighted damaging both near and far vision? If so do you have any idea what to read to learn more about this?
Allen, is the 20/40 distance vision just an estimate?
I asked because it sounds like you choose to hike and drive without correction. If given a choice I think most people would choose sharper vision than 20/40 for hiking and driving.
Also, your Spherical Equivalent (SE) is 0.0D. The calculation is Sph plus half the Cyl so +0.5 plus (-0.5) equals zero. I would have expected you to test better than 20/40. Maybe a fuzzy 20/20 or at 20/25.
A few of choices for the other eye could be: 1. Improve distance and gain intermediate with another Eyhance, toric this time, targeted at no worse than -0.25 in my opinion because there will probably be a bit of residual astigmatism even with the toric. The goal would be to get the resulting SE at better than -0.5 in that eye. Targeting should be more accurate with the second eye because you have the result of the first eye. That could result in being able to see the car dashboard and the time on your watch etc.
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Try to get both better distance and some actual near vision with an EDOF or multifocal but with the possibility of side effects like halos.
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Target both intermediate and near with monovision if your distance vision in the other eye is OK for you. Make sure to understand what you can lose with monovision and are comfortable with that.
There's a good article on Healio titled "Should I choose distance vision in both eyes, monovision, EDOFs or multifocals?". It's easy to find through Google should help with the decision making.
I'm risk adverse myself so an explant would be far down the list of choices for me.
Ron, could -1.5D or so be an achievable LASIK target for Allen from what you've learned?
Freddi, how do you see out of that eye without glasses for reading and distance? Do you know what your measured acuity (e.g. 20/NN) is for that eye? How does your your surgeon explain why you got +1.00 and -1.00?
Ron, thanks for your comment. The option to replace my right eye IOL is not feasable, I had YAG 3 months after the implant, so the capsule is compromised. Plus, the IOL has been in too long now, and the risk of capsule damage and retina detachment during extraction is too great for my comfort. So, the best I can do at this point is to tune the upcoming IOL in my left eye for the most optimum monovision. I've tried monovision with glasses, and I'm comfortable with it. So, what's the best IOL and target SPH for my left eye for 1-6 ft range, any ideas anyone? I'd like to be better informed this time prior to a consult with the new surgeon. The last time I thought I could rely on the good judgement of my experienced surgeon for my right eye, and I ended up with sub-optimal results, despite his 20+ years of experience, his use of the Femtosecond laser and ORA technology; I paid close to $2,000 extra out of pocket for laser/ORA for poor quality results...
Have a look at this article: . Review of Ophthalmology PUBLISHED 15 APRIL 2021 IOL Review: 2021 Newcomers . In particular look at Figure 2 which shows the defocus curve for the Eyhance in orange colour. Without going down the rabbit hole too far the vertical scale is visual acuity. 0 is 20/20, -.1 is 20/15, and +0.2 is 20/32, or good but not perfect vision. . The horizontal axis is in diopters, but it can be converted to distance. 0.0 is infinity or long distance. -0.5 is about 6 feet, and -1.0 one meter or about 3 feet. You divide 1 meter by the diopter value to get distance. -3.0 is about 1 foot. . As you can see from the graph and comparison of the Eyhance to the monofocal, the Eyhance does not drop as fast as you get closer. That is what you are paying for when you buy it. It extends the distance you can see 20/32 (0.22 LogMar) out from 3 feet to 2 feet or about 0.5 D. . BUT, when you say your prescription requires a +0.5 D, that suggests the surgeon missed on the power required to get your peak vision at 0.0 D. Instead it is at +0.5 D on the left, and the whole orange curve shifts to the left by 0.5 D. That means you lost the closer vision you were supposed to get with the Eyhance. And to a lesser degree you distance vision at 0.0 D is reduced too. That is why you have compromised distance and closer vision. . The normal practice is to target -0.25 D or slightly to the right of the 0.0 position, or leave you slightly myopic, instead of far sighted. This reduces you distance vision by a very small amount, and actually increases your near vision, as the whole curve is shifted 0.25 D to the right. . Defocus curves are a bit hard to understand, but I hope that helps.
If you look at the defocus curve you can select the offset you want to get maximum vision in the 1 foot to 6 foot range. For example if you pick -1.5 D that is about 2 feet optimum, and about what I have. I can see quite well from 1 foot out to 6 feet, and even the TV at 8-10 feet is watchable at that distance. I have a monofocal. If you use the Eyhance you will get a little closer vision and you may want to offset it by a little less in the -1.0 to -1.25 range. You have to target a window as you now know that they do not have total control of where you end up.
Thanks Ron, I'll invest a bit of time to learn how to interpret these. My first surgeon never discussed with me any of the relevant facts, so I was clueless about precision, LRI not being an exact science, etc. Hopefully my next surgeon will actually talk to me, and deliver better results. As a side note, I've read that several teams (one in Utah, one in Boston I think) are testing the use of laser (Femtosecond?) to either re-shape the already implanted IOL to improve refractive errors, or change the implanted IOL's hydrophilic or hydrophobic property to add toricity or change it's refractive characteristics. That would be much better than the use of lasers to mess with our aging corneas... Hope it becomes available soon for us to benefit from it...
If you want to be more precise print out a copy of that defocus curve and shift it right by a couple of different amounts. Then look along the 0.2 LogMAR horizontal line to see where it intersects with the shifted curve. That will determine your near and farther limits of good vision.
Going into hyperopia is never good but a bit surprised +.5 would lead to such bad vision range. Before doing anything with 2nd eye, I would focus on first eye. You only mentioned uncorrected vision. I would first want to know exactly what the problem is. Have you tried to just correct for the residue Astigmatism with contacts or glasses. If you correct for Astigmatism error I would expect if your eyes are healthy, no other issue than cataracts, you should be able to see better than 20/40 distance with Eyhance, even if off +.5 on the refractive target. I am wondering if the IOL is not centered or there could be other issues.
If you are not getting answers from this doctor, I would suggest you get a 2nd opinion from one of the top Ophthalmologist in the US.
Depending on what you find there might be other options. For example let’s say when astigmatism is corrected you can see 20/25 distance and clearly down to 3 feet, which is more what I would expect. You then might be able to correct for Astigmatism.
I don't have eyehance. I have J and J toric monofocal so there is no close vision to lose. I dont really think my distance vision is compromised except for the astigmatism that remains. this is my right eye. I still have not had surgery on the left eye which has very useful near vision but distance vision that is poor, even with progressives. Both eyes together have very very good distance vision and I can get by for a while longer with the near vision in the left eye. My doc has proposed -1.5 for the left eye with the same lense type as the right. I worry that this minimonovision will be hard to adjust to. I get dizzy sometimes now when using eye hand coordination and I think it is due to the big difference in the vision between both eyes and the fact that this is a monovision of sorts. So I know my doc's goal was 0. But ended up at +1for my prescription.
Yes, with correction (+0.50/-1.00 lens) my right eye can see better, about 20/25 distance, and with progressive lens (add +2.50) I have good vision at all ranges. I may not have stated it clearly, but my goal for the 2nd (left) eye IOL surgery is to have good uncorrected (without glasses) vision at all ranges, i.e left 1-6 ft, and right 6-infinity, that was the thrust of my initial question.
I think the reason that +0.50 SPH gives me such poor uncorrected vision is that I also have astigmatism in that (right) eye of -1.00, so between both SPH and CYL errors my right eye can only see 20/40 uncorrected.
I was utterly unhappy that I didn't get plano/plano results, until I read that IOL result errors of up to +/- 0.50 are common, I wonder if that's true????
Some friends who had IOL implants tell me they had 20/20 results...
One friend had an accomodating IOL implanted, and he has excellent vision at all ranges.
Allen, I replied earlier but it got stuck in the moderation queue. I had questions about your 20/40 also but please just ignore what I posted about that when that post shows up. I found out that you only correct to 20/25 or 20/30 which is unfortunate. This is the previous post of yours. https://patient.info/forums/discuss/why-isn-t-anyone-talking-about-technis-eyhance--710285?page=9#3840130 . Your right eye result is mystery for sure. It's needs some explanation from a surgeon so that you can be confident that it doesn't happen with the left eye. Maybe a referral to a Retinologist is needed.
Thanks Myope. I've been sent to several Ophthalmology specialists, including a Neuro-Ophthalmologist, and no one has a definitive answer of why my right eye vision isn't 20/20 even with best correction. One theory is I may have posterior corneal astigmatism (back surface of the cornea). Another theory my optic nerve is thin and twisted (vs. straight), and my optic disk is crowded, which result in less information transmitted to the brain from retina. In addition, I consistently fail the field-of-vision (peripheral vision) test in the upper-left quadrant, which I'm told also reduces the amount of data going to my brain. I'm now at peace with my imperfect vision in the right eye, just hoping the left eye IOL would compensate near/intermediate without glasses.. Thanks, Allen
Sorry, but I mixed my response to you in with the Eyhance lens that Allen has. You could look at the same Figure 2 from that article though. It also has the J&J Monofocal on it. Your vision in that eye would be a spherical equivalent (SE) of +0.5 D which is not that bad. SE is your sphere plus 50% of the cylinder. But, from experience the contribution you get from the astigmatism part is a little suspect. But, to your question going to +1.0 does hurt your distance and near vision. It is not a good place to end up. . What is your prescription for the non operated eye? . I think a -1.5 target in the second eye is a good choice if you were closer to 0.0 in the operated eye. Ignoring the cylinder if you go with a -1.5 that will give a total differential of -2.5 D which is a bit much. What you might want to do is try different power contacts in the non operated eye and see what you can tolerate and still get some closer vision.
Surgeons typically land within +/- 0.5 only about 75% of the time. It is a real risk.
" if you go with a -1.5 that will give a total differential of -2.5 D which is a bit much."
Not sure I understand. 1. If I go with -1.5, how did you get a diff of -2.5D? 2. And what's the nature of the -2.5 diff being a bit much?
Thx, Allen
*"Surgeons typically land within +/- 0.5 only about 75% of the time."
Hence the demand for light-adjustable lenses. My ophthalmologist has offered me that for my left eye, the one with low enough astigmatism to be corrected by toric lenses available in the U.S.If it's really important to you to hit the marks, get a LAL. However, there is no guarantee your vision won't change after the LAL has been locked, putting you back in the same glasses-dependent boat.