Long story short. I made an appointment with doc to do cataract surgey next week. I’m high myopic in both eyes, both around -10.D. Chose to take vivity, Left eye aimed at: -1.25D, right eye: -.5D. But I just got a call from the doc’s office said vivity can only correct my vision to -1.5D according to their calculation. So here are all possible choices:
- both eyes target to -1.5D with Vivity
- left -1.5D vivity right -0.5D with Eyehance
- Or consider AtLara(Never heard of it).
But they also warned me that Vivity has a yellow tint while Eyehance is clear, so some people may have difficulty to adpapt to the difference.
I have been torn between these choices since the call.
What do you guys think? Any suggestions?
Thank you so much.
Honestly I think Vivity isn't an option for you. A -1.5D target with Vivity doesn't make a lot of sense. You would have no useful distance vision at all in that eye and the extended depth would reach beyond what is needed for near vision. So you'd get all the contrast loss of Vivity with none of the extended depth benefits. I think you need to let go of the idea of getting the Vivity.
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Eyhance has a much great selection of powers so I'd go with that targeting your dominant eye for -0.25 and then see where you land before choosing a target for the second eye 6 weeks later. Or monovision with Clareon monofocals. In either case I think I'd just do one eye first and see how it turns out before deciding on the target for the second eye.
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Yes there would be a slight colour difference if you mixed an Alcon lens with a J&J lens. You wouldn't notice it with both eyes open but personally I wouldn't mix them. I'd choose between Eyhance in both eyes or Clareon Monofocal in both eyes,
Thanks for your reply.
I've been considering the lens choices for a while before I decide to go for vivity. So being told I can't achieve the targted diopter with Vivity threw me into disarray.
Do you think left -1.5D Eyehance right -0.75D with Eyehance will enable me to read my phone without glasses?
Indicatively, the average of ten Eyhance defocus curves, both binocular and monocular, shows 20/31 at 12.11" and 20/25 at both 14.31" and distance. Of course, hitting targets isn't guaranteed and biometric measurements fed into an IOL power calculator will determine what your surgeon can target. Also, the data I took from the defocus curves are all mean results. Even if the power calculation is spot on and your surgeon exactly hits the targets, you could end up with better or worse vision than the mean.
Apologies, I miscopied an data point. It should be 20/25 at 14.31" and 20/28 at distance.
You should read Karbonbee's experience with Eyhance. Search:
Definitely an Ey(en)hance for me!
Karbonee had eyhance put in both eyes and tells about the outcome.
I would not go with any of those options. The first thing you should do is ask the surgeon for a copy of the IOL Calculation sheet. IOLs come in fixed steps of 0.5 D for sphere power. Your IOL calculation sheet should show what your predicted outcome will be with each of those steps in the range of outcomes you are looking for. Almost always there will be a choice between two differenct powers and one is likely to be over what you want and the other under.
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1. Both Vivity lenses at -1.5 D is going to give you very good close vision but poor distance vision. It negates the advantage of a increased depth of focus lens like the Vivity.
2. Assuming your left eye is the non dominant there is some logic in going with a Vivity in the close eye in a mini-monovision configuration. I almost did it, but got cold feet after a discussion with the surgeon. However, if you do it, I would suggest a target of -1.5 D is too much for the Vivity eye. The Vivity provides an extra depth of focus of 0.5 D, and the ideal total target is -1.5 D. The optimum target for the Vivity eye would be -1.0 D. With the distance eye, I would not go with a Eyhance, but instead go with a Clareon monofocal. The Clareon will match the blue light filtering in the Vivity. I would also target close to -0.25 D in the distance eye, not -0.5 D. You will get better distance vision that way.
3. I don't know much about the ATLara, but I think it is a multifocal lens. I would stay away from it. The risk of optical side effects like halos and spiderwebs is too high for my tolerance of risk. That said some do accept the side effects of MF lenses like this or the PanOptix, or Synergy.
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All considered there is nothing wrong with doing mini-monovision with monofocal lenses only. I think that is the lowest risk option. That would mean a target of -1.5 D in your left eye, and I would also suggest using Clareon. The distance eye should be targeted to -0.25 D to give you the best distance vision.
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Last you do not mention it, but don't get both eyes done at the same time, or close together. I would do the distance eye (right?) first and be assured you get good distance vision, and wait 6 weeks minimum before doing the second eye. You can use this recovery time to simulate mini-monovision by using a contact in your left eye that leaves you at -1.5 D to ensure that you are OK with it. It also gives the surgeon an opportunity to refine the power calculation for the second eye based on the refraction outcome of the first eye.
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Given that you have high myopia, you may want to consider an optional process called Alcon ORA if your surgeon offers it. It is claimed to be more accurate in determining the final power to be used when the eye requires an extreme correction. @Karbonbee here had good success with it, while some others have not.
Regardless of the lens you choose, your dominant eye should be set for best possible distance. I think -0.75 is too myopic for your distance eye. Results can vary but I'd target the distance eye for closer to -0.25 and then offset the near eye accordingly for your phone. I would also do one eye at a time not both at the same time.
Choosing refractive targets is complicated, even leaving aside whatever constraints on your choice result from running your biometric measurements through your an IOL power calculation formula.
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If you stick to monofocals--"pure" like the Clareon and Tecnis 1, or "plus" like the Eyhance--then you need to decide whether to prioritize distance, with a possible reach into intermediate via mini-monovision, or near/intermediate, also with the possibility of mini-monovision.
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Asking your surgeon to target the first available minus refraction makes sense if you're prioritizing distance. But some of us, especially those of us who have lived with significant myopia, decide to stay somewhat myopic, prioritizing near and intermediate vision. In that case, it may make sense, as my surgeon is suggesting for me, to begin with the non-dominant eye, see where you end up, and if satisfied with that result aim for 0.75 - 1.25 D less myopia in your dominant eye. This strategy may result in your needing glasses to drive or watch TV/movies. Different strokes for different folks.
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And even if you're prioritizing distance, you may want to target the second minus, both to make sure you don't end up hyperoptic and to give a titch more depth of focus. This is what my wife's surgeon did with the Eyhance, and she's very happy with the result. She sees well without glasses for distance and intermediate. She currently uses readers for close vision. To avoid having put them on and take them off when working at her computer, she soon will get "computer" glasses. Both the Shamir Workspace and Shamir Computer are very good; her surgeon and I both wear the Workspace. Hoya and Zeiss both make well-regarded versions of their own.
I would suggest delaying your decision on IOLs past next week. You should investigate the options much more carefully before jumping in. An IOL decision should be a once in a lifetime decision, and should not be rushed. As I suggested in my first post you should ask for the IOL calculation print outs for the IOLs you are considering. And you should spend a bit of time learning how to read them. Then you can have a good discussion with the surgeon as to what target and power is the best choice for you. To be frank, the options you have been given are "all over the map" and require significant refinement to get to something reasonable. Google this for a pdf on what the numbers on the IOL calculation sheet mean. See page 5 and 6 for non toric IOL examples. I would also insist on seeing how well the predictions match for at least a couple of the most recent and accurate formulas; Barrett Universal II, and the Hill-RBF version 3.0. With your high myopia you want to be sure the best methods are used to get the most accurate prediction of the correct power.
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IOLMaster 700 Quick Guide Printing Functions EN PDF
20/31 at 12.11" and 20/25 at both 14.31" and distance
Did you mean Eyhance is expected to give one this vision when set to plano?
I've been myopic since grade school so I guess it's what I am used to. That's why I would like to be a little myopic after the cataract. My expecation is: I can read my phone and computer without glasses, and put on glasses for driving, movies, and so on.
What I really want to avoid is: having to switch between two pairs of glasses, one for near, and another for distant. That would be a total disaster to me.
Am reading it, Karbonee and I are both high myopic(since high mypia may elongate eyeballs, so a sllight extended depth of focus is expected). His case would be very valuable to me.
Thanks for metioning it.
Lurking on this forum for a while, learned a lot from your replies. Thanks dude.
Will try to ask for a calculation sheet from the clinic, don't know if they will provide one.
You made a good guess, my dominant eye is right eye.
I agree with your comments on atLARA, haven't seen many real experience about it on this forum or anywhere, definitely gonna avoid it.
I'm inclining to do both eyes at the same time, because:
1. high mypoic
2. I'm taking vitrectomy to remove massive floaters in my eyes, so I'm gonna get general anesthesia for my surgery.
Don't know if they got Alcon ORA here but will check with them, thanks for that.
Definitely. I will contact the clinic tomorrow see if they would give me that calculation sheet.
Also one confusion I've got is:
I contacted Alcon in the US years ago, they literally replied they have the range of lens extend to -10D(exactly my prescription). But the clinic said every one's eyes are differently, base on their calculation, vivity can only get me to -1.5D at the best. Do you think it's possible?
Not plano. I should have said explicitly that I was responding to your mentioning targets of -1.50 D and -0.75 D. I also shouldn't have responded hastily while eating breakfast. I see now that I copied from the wrong set of data points. With additional apologies, let me start over, more slowly and more carefully.
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I derived the following data by averaging ten Eyhance defocus curves, four binocular and six monocular. (I'm interested in mini-monovision and my working assumption is that the results for a difference between the eyes of 0.75 D - 1.25 D will be somewhere between the binocular and monocular defocus curves. So, I've just averaged them all together. I identified seven of the source studies for the data in a post yesterday in @Lynda111 's thread "Alcon Release New Study Comparing Eyhance monofocal with Clareon monofocal".)
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Assuming two Eyhance IOLs, one targeted to -0.75 D and the other targeted to -1.50 D, the average of the ten defocus curves for the better eye is:
12.11" 20/35
13.12" 20/31
14.31." 20/28
15.75" 20/25
4m 20/25
distance 20/28
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I don't know the distance from your eyes at which you hold your phone or what visual acuity you need to feel comfortable reading it. Bard tells me that, according to a University of Utah study, the average distance at which adults hold their smartphones is 10"-12" from their eyes. I tend to hold mine at a little over 14" from my eyes.
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Using Eyhance without monovision, the average of four binocular defocus curves indicates that having both IOLs at -1.50 D yields 20/30 at 12.11", 20/28 at 13.12", and 20/25 at 14.31". By the same token, they yield 20/35 at distance.
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If you try mini-monovision to get better distance vision, then you need more myopia in the "near" eye to get near vision results comparable to two -1.50 D IOLs. For example, the averages for -0.75 D and -1.75 D are: 20/31 at 12.11", 20/28 at 12.12", 20/25 at 14.31", and 20/28 at distance.
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It gets more complicated, however. You may not be able to ask your surgeon to target -0.25D and -0.25D, -0.75D and -1.75D, or any other pairing. As @RonAKA has mentioned, IOLs come in discrete powers, generally in increments of 0.5 D. Until your eyes are measured and the resulting biometric data run through an IOL power calculation formula using your surgeon's "a constant" for a particular IOL, you can't know what refractive result it is predicated to achieve (assuming also that your surgeon hits the target exactly). For example, it might turn out that the calculation tells you that, in your dominant eye, the relevant powers of the IOL allow targeting -0.25 D, -0.57D, -0.9 D, etc. That's great if you want to target -0.25 D; not so bad if you want -0.57 D; but less than fully satisfactory if you want to target -0.75 D.
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I'm still thinking my way through the process. Assuming monofocal IOLs and mini-monovision, I suggest deciding what range of vision you want to prioritize. For me it's near and intermediate. I'm willing to need glasses to drive under some or all conditions. Others may prioritize excellent distance vision. Whatever you decide, I suggest asking your surgeon to operate first on the eye that will be primarily responsible for the range of vision you're prioritizing. Indeed, my surgeon spontaneously proposed doing my "near" eye first because of my prioritization. Five or six weeks post-op, you and your surgeon should have a pretty good idea where the first eye ended up. At that point, also knowing how close the surgeon came to the target for the first eye, you can decide on the target for the second eye. All going well and depending on what you and your surgeon decide about your degree of mini-monovision, you could aim to be, say, -0.75 D to -1.25 D less myopic. But if your first eye ends up less myopic than you want, you might decide to try for more myopia in the second eye. @Bookwoman has written extensively about myopia in both eyes.
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Good luck.
The IOL lens powers have no direct relationship to eyeglass correction powers. If your eyeglasses are in the range of -10 D, then you will likely need an IOL power in the range of about +5 to +7D. The package insert information I have seen on the Vivity suggests it only goes down to +15 D. That is not even close to what you need. The more myopic you are, the lower the power of IOL you need. Even if they have extended the powers to +10 that is still not enough. I am basing this on @karbonbee measurements which are in the range you are at. However, you are very close the end of the range of powers needed, and you need to be sure they are not compromising the power selection due to available powers of the model of lens they are offering.
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I think you should demand to see a printout of the IOL Calculation Data Sheet. They have to give it to you. There has been a supreme court ruling in both the US and Canada that says medical data belongs to the patient, not the surgeon.
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The Clareon goes down to +6 D and may work, depending on your specific measurements. The Eyhance goes to +5 D and could also work. Another option would be the Tecnis 1 (+5 D minimum), or B+L enVista (+6).
Right but if you want a myopic result why do an offset? Just set both to -1.5. The -0.75 target paired with -1.5 target doesn't make a lot of snese to me. The -0,75 probably isn't myopic enough for really good near but it's also not plano enough for good distance. An Eyhance at first minus will already give you good intermediate.
Doing a vitrectomy at the same time is a major complication. So, it may be necessary to do the big bang all at once surgery. Risk is going to be high...
I agree with Ron but one important thing to point out is that Vivity doesn't come in a power that will allow the original poster to target -1D. The best they can do is -1.5D. The available powers of the Vivity is pretty narrow.