I got my right (dominant) eye surgery done a week back and I got J&J Eyhance (Plano distance) in my right eye. So far, my experience with this lens is good - especially if I look with right only. If I use both eyes (which I have to :-)), the experience is OK (it maybe due to brain switching/selecting b/w the eyes). Also, the cataract in my left is pretty bad, which is creating too much difference b/w the two eyes. Now, I feel I should get my left eye surgery soon.
Currently with my right(operated) eye, intermediate vision is fine, distant vision is excellent and the near vision (fine prints and smartphone use) is blurry.
I used this forum and learned lot about different lens options. In fact, I came up with the Eyhance idea from this forum and discussed it with doctor.
For left eye, my doctor was suggesting to go with a mini-monovision with an offset of 0.5D to give better near vision. I recently came across RayOne EMV option in this forum and I am wondering I should go with RayOne EMV with same offset or different to get better overall experience (better near vision and no/less sacrifice in intermediate & distant vision). I haven’t discussed the EMV option with my doctor yet, I have a follow up appointment next week.
Any expert suggestions for my situation? Should I simply go with Ehyance lens in my left eye as well or the EMV lens for better overall experience?
Hi Oscar,
I don’t consider myself an “expert” but rather an informed user of the Rayner EMV lens. It’s hard for me to say whether the Rayner lens would serve an advantage over, say, another Eyhance set “in” for mini mono-vision. I will say that the Rayner lens was indeed designed with mono-vision in mind. So to the extent you might implement that strategy it is certainly worth discussing with your doctor. I’m quite satisfied with the Rayner lens. Mine is set at a -0.75D offset to my other eye, a monofocal. For what it’s worth my doctor, a rather high profile surgeon, usually uses offsets anywhere from - 0.50 D to - 1.00D with the Rayner lens with very good results. It really depends on how you want to tweak it and what’s most important to you. I would say read up as much as you can, check some YouTube videos out about surgeon experiences, and discuss with your doctor if it is suitable in your specific case. Good luck to you.
Indy G
@oscar11025, ignore that post I made. I tried to get it deleted but it is still up. I had forgotten that this Rayner company engages in what I would describe as very deceptive and misleading advertising. As best as I can filter through it, while this looks like a single lens solution, it is really two lenses implanted in both eyes. The EMV stands for enhanced monovision. The lens itself appears to be just a plain old monofocal type with no extra extended focus like the Eyhance has. The extended range of focus comes from implanting it in both eyes with one eye set at -1.0 D I believe. Sorry about that. That extended range of 0.9 D is bogus. The lens itself appears to have none.
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In light of this my thoughts on your original question would be to stick with the Eyhance. Now that you have an Eyhance set for plano in one eye, you can accurately estimate what a monofocal configuration would be like with it set to -1.0 D by just buying some dollar store +1.0 D readers, and also +0.75 D if you can find them. Put them one and then determine how well you can read with the Eyhance eye. From my experience I think an offset of -0.5 D might leave you short of good reading, and an offset of -0.75 or -1.0 D may be better.
RonAKA,
I’d be interested in the source you’re utilising to come to the conclusion that the Rayner EMV lens is “just a plain old monofocal” lens. I would be quite surprised that a doctor of Barrett’s stature would put his name behind something so misleading as you’re suggesting. With a 70% rate of acquired reading vision with both eyes targeted at emmetropia suggests a range of focus larger than a typical monofocal. I’m open minded to considering your opinion, but I also think it’s highly unlikely my surgeon would abandon the Eyhance lens (which he had used previously) in favour of the Rayner EMV unless there was a compelling reason to do so.
Have a look at this report, and in particular Figure 2. It shows the defocus curves for some monofocal lenses plus the Eyhance ICB00. The Rayner lenses are shown at 0.0 and -1.0 D, a monovision configuration. The RayOne at 0.0 D is insignificantly better than the standard Tecnis 1 monofocal, ZCB00. You can see that the Eyhance has much better depth of focus than the RayOne and ZCB00.
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Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses Grzegorz Łabuz, Hyeck-Soo Son, Tadas Naujokaitis, Timur M. Yildirim, Ramin Khoramnia & Gerd U. Auffarth
Oscar,
I have no halo or glare issues. I’m not sure what RonAKA is talking about when he says the Rayner EMV lens is just like any plain monofocal lens. It does act much like a monofocal lens (no dysphotopsias for example) but my understanding is that there is positive spherical aberration built into it which gives an enhanced range of vision. The reason I chose it is because the offset required to gain functional reading vision was less than what is required from a standard monofocal, leading to better stereopsis. As I’ve mentioned my surgeon abandoned Eyhance and prefers the Rayner EMV over it. I’m very happy with my results.
Hi RonAKA,
From what I read of that study you posted it says the following: “An optical-metrology station was used in the assessment of IOLs’ optical quality in polychromatic light.”. I’m not sure exactly what an optical metrology station is but it seems to be machine-measured based and not based on patient experiences. From what I understand, when positive spherical aberration is introduced into a lens (as the Rayner lens is designed to do) the light rays form more of a small “disk” of light than a more “pinpoint” of light as a monofocal is designed to do. Although this creates a more diffuse light beam hitting the retina, the brain for the most part ignores the fainter image (because it’s so subtle) yet the subject gains more depth of focus as a result. Whilst the study you point out mentions they used a monovision scenario for the Rayner lens, I still don’t see how Rayner has misled anyone in their marketing materials. Check out the following video on YouTube (I don’t know if I can post the actual link so I’ll just give the search term). Search YouTube: “WEBINAR: RayOne EMV: A monofocal IOL providing extended range of vision to patients”. Clearly Dr. Barsam is making a point that, in practice, the lens has depth of focus benefits over a standard monofocal. I hope this helps.
Yes it is well known that correcting spherical aberration, partially correcting it, leaving it uncorrected, or even using a spherical non aspheric lens will impact the depth of focus. See this B+L graph showing the effect along with a comparison of the Tecnics 1 (full correction), AcrySof IQ (partial correction), and B+L enVista (neutral correction). Not shown would be the old spherical non aspheric lens that is not used much any longer. It would come in at about +0.37 SA, and provide even more depth of focus than the enVista.
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Now if you look at the Figure 2 from the link detail I gave you. Put Springer into the very beginning of the search for this phrase and you will get a more detailed report than the pubmed version. Here it is:
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As you can see there is very little difference between the RayOne 0 D curve and the Tecnis 1 curve. The RayOne is a touch better than the fully asphericity corrected Tecnis 1, but I would suggest it is insignificant compared to the EDOF provided by the Eyhance. The IsoPure is better, and the AE2UV/ZOE is very close to the Eyhance. I am not sure where the enVista would place compared to the RayOne, but I suspect it may be significantly better. The enVista is a standard monofocal offering at no cost in some provinces in Canada.
Hi Ron,
Thanks for that info. I think I was reading the wrong graph earlier but I can see from Figure 2, that the defocus curves of the Tecnis and Rayone are very similar in that study. So how do we explain then the following article (I’ve put a space in between dot and com) where the Rayner lens is indicated as having an extended depth of focus. www(dot)review of ophthalmology. com/article/an-update-on-monofocalplus-iols, or to the study referenced in Rayner’s materials showing an elongated, less sloped defocus curve than the Eyhance lens, or the myriad surgeons (and Barrett himself) who are touting the Rayner lens as anything but a standard monofocal? I honestly don’t think all these guys (and Rayner itself) would risk their reputations on a conspiracy of an apples to oranges comparison of the EMV to other EDOF lenses (i.e. comparison of monovision to a normal single lens scenario). There are too many compelling reasons not to. First, Rayner has to pass the government regulations hurdles, FDA approvals, etc. Second, they need to win over the hundreds or thousands of opthalmologists/surgeons across the globe to adopt the lens into their practices. It would make no sense for Rayner, an already very established player in the field, to make claims about a lens that it doesn’t deliver on. All I can say from first hand experience is that I’m very happy with the Rayner EMV lens. I’m reading J1 sized print (20/20) and seeing 20/30 distance with a 0.75D offset. I’m getting far more binocular summation, less suppression, than when I had my natural lens with a 2.00D offset. I imagine there are people that may have varying results depending on their unique circumstances, eye shape, etc.
Cheers,
Indy G
That Review of Ophthalmology article like much of the Rayner sales info is very misleading. They talk like it is one lens, when in fact it is two lenses; one at plano, and one at -1.0 D. The extended depth of focus comes almost entirely from the monovision configuration, not from the lens design itself. See this key point in the article:
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“This monofocal lens offers up to 2.25 D (with 1-D offset) of extended depth of focus.”
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In other words you need two of these lenses in a standard mini-monovison configuration to get this depth of focus. And you could get basically the same thing with two Tecnis 1, Clareon, or B+L enVista monofocals in a -1.0 D offset configuration.
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“the study referenced in Rayner’s materials showing an elongated, less sloped defocus curve than the Eyhance lens”
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Keep in mind this “elongated, less sloped defocus curve” is when the RayOne EMV is used in a mini-monovision configuration. This less sloped effect is due to monovision configuration and very slightly due to the non asphericity correcting lens design. Unlike the RayOne EMV, the Eyhance is achieving the extended slope from the lens design itself.
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I think it is good that Rayner (and Barrett behind the scenes) are promoting mini-monovision as a good solution compared to multifocal lenses. But this solution does not require the EMV lens. The B+L enVista is likely just as good or perhaps better.
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To get back to the original question asked by @oscar11025 I would recommend the Eyhance over the RayOne EMV lens. As you can see in that figure 2 I posted earlier, the Eyhance in a one lens configuration has a much more gradual slope than the RayOne EMV. The Eyhance in a -0.75 D near eye configuration would most likely provide better close and intermediate vision as well as better distance vision than the RayOne at -1.0 D.
I’ve always understood that the Rayone EMV provides a 1.5D depth of vision per IOL and a total of 2.25D depth of vision when the second IOL is implanted within an offset of -0.75D. The other advantage is that their MTF is shifted to the right and the peak isn’t at 0D when plano is targeted. I believe that it would provide a good depth of vision and it has also a rigid structure that makes me considering it for myself.
The only concern I’ve is the MTF curve at 4.5mm aperature for the lens implanted at plano and at -0.75D offset. Rayone EMV looses performance dramatically with larger Pupils, and this raises my concerns that it would provide low contrast sensitivity and low vision quality at night or low light conditions. Also it’s clear from the MTF curve that the vision quality of EMV at distance is lower than Eyhance. I am not able to quantify the concussion to the vision quality to understand whether its an acceptable trade off or not to the depth of vision it provides.
Indy, what’s your experience in the EMV eye in very low light conditions?
In the Rayner meterials they state emmotropic targeting (“best distance vision”), not a monovision scenario.
Then there’s this:
–RayOne EMV is the only patented aspheric IOL that induces controlled positive spherical aberration.
Compared to a lens with zero spherical aberration, the carefully controlled positive spherical aberration induced by RayOne EMV spreads light along the visual axis, elongating the focal range from far into intermediate with over 1.5 D of depth of focus (per lens on the spectacle plane).
Below shows an illustration of a lens with zero aberration and a small focal range (Figure 1), shown together with RayOne EMV with positive spherical aberration and a larger focal range (Figure 2).–
Note,“Per lens” above, not a monovision scenario. Even when targeting emmetropia, the Rayner lens virtually guarantees intermediate vision, something standard monofocals don’t. And the lens often achieves functional reading vision in 30%-70% of cases.
I imagine Oscar will be happy with either choice and, as always, there will never be a way of knowing for sure which option would give him the better outcome. Certainly the Eyhance lens is more popular in the US as its been out longer, earlier approval, etc. All I know is my surgeon abandoned it because he felt the Rayner EMV was giving him better results.
I recommend Oscar do as much research as he can and get comfortable with his and his surgeon’s choice. After all, we are not professionals.
Cheers,
Indy G
Sorry, but my conclusion after looking at the Eyhance and RayOne lens is that there is no comparison in the extension of depth of focus. The RayOne may provide a very slight (0.1 D) of extension over a -0.27 SA aspherical lens like the Tecnis 1, but it is not even in the same ballpark compared to the Eyhance. I suspect the extension of the RayOne compared to the basic B+L enVista will be even smaller to the point of being negligible, compared to other factors. I looked pretty hard to find how much positive spherical aberration is achieved with this RayOne lens, but could not find it. They seem to keep it a secret, and only say it is positive. Many older design spherical lenses have positive spherical aberration in the range of 0.1 SA. They have been around for many years.
My suggestion would be to research the B+L enVista if you want a lens that is more forgiving and has a small extra depth of focus without sacrificing significant contrast sensitivity. Instead to reducing SA to zero like the Tecnis 1 does with the -0.27 SA built into the lens, the enVista is neutral and does not correct any SA in your eye. Typically this leave you at about +.27 SA. This is likely a good compromise between contrast sensitivity preservation and distance acuity vs depth of focus. It is less sensitive to being off center in the eye compared to SA correcting lenses. You may also find that the B+L enVista is more available and at lower cost. For min-monovision a good target is -1.25 to -1.5 D in the non dominant eye on a spherical equivalent basis.
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For a hybrid monovision solution, a Tecnis 1 in the dominant eye set to plano and a Eyhance at -1.0 to -1.25 D in the non dominant eye should work well too. The Tecnis 1 should give you good distance visual acuity along with maximum contrast sensitivity, while the Eyhance will give good close vision and intermediate vision. In the Alcon world, a Clareon at plano in dominant eye, and Vivity at -0.75 to -1.0 D should work. But as the Vivity stretches EDOF more the risk is elevated for optical side effects.
Hi Wiley,
Thank you for your comments and question. I agree with you on your interpretation of the Rayner lens in terms of depth of focus both individually and in a mini-monovision setting. Now, it does seem there are differing defocus curves floating around out there when comparing the Rayner EMV to Eyhance. In the Rayner literature, they show both a more flattened curve to the negative side further out as well as a “hyperopic bump” where, in theory, you’re getting more distance vision than the Eyhance. The “sacrifice” in the Rayner lens appears to be in the first diopter “in” where apparently the Eyhance wins out. As we know, there’s no “free lunch” with optical light and thus it’s all about how the light is allocated.
Now in my own experience 2 months in with the Rayner EMV lens (standard, not toric) I can honestly say I neither feel handicapped in any way from a low light vision perspective nor from a dysphotopsia perspective nor from a visual acuity perspective. Bear in mind I had a Zeiss monofocal lens (implanted 4 years ago) in my “distance” eye and my Rayner lens is set -0.75D from that. Because both eyes overlap in focus at intermediate range, I like to play my vision off each eye by closing one then the other and observing the differences, if any. For what it’s worth, when I do this I’m rather surprised to see that the Rayner eye is somewhat brighter, more vibrant. It’s not by much, but it’s detectable. Maybe because the lens is newer? I don’t know. In any case, I feel blessed we live in these times where technology basically solves vision affected by cataracts. I feel I have the vision of my 12 year old self long ago. If I could go back in time I would perhaps put the Rayner in my distance eye as well to eek out a bit of extra near vision (via the extra depth of focus) but it’s a very minor matter. I’m essentially spectacle free for everything except perhaps endurance small print reading. At near arms length to computer distance where focus converges in both eyes I’m absolutely fine. I hope this helps.
I will repeat again that the reason for the discrepancy in the defocus curves comparing the RayOne EMV to the Tecnis Eyhance is because the RayOne EMV is a Raynor patented use of their lens in a binocular mini-monovison configuration. I find their document which you can find with the search terms below to be very misleading. While they say they are comparing the Eyhance in a binocular configuration to the RayOne EMV in a binocular configuration, the monovision configuration for the RayOne is not included in this paper, which I find deceptive. However, in other news releases they say:
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“RayOne EMV extends a patient’s range of vision with a patented non-diffractive aspheric optic profile, designed to: Provide up to 2.25 D of extended depth of vision (with 1.0 D offset)…”
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Raynor RayOne EMV White Paper PDF
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This White Paper is a very unfair comparison of the two lenses. If they wanted a fair comparison they should have offset the Eyhance lens by the same amount as the RayOne EMV was offset. This would have shown that the Eyhance with the same offset would result in a far superior range of depth of focus.
Ron,
But in the materials I’ve read that compare the Eyhance to the Rayner EMV defocus curves it states as follows: "Bilateral emmetropia was targeted for all patients in both groups. ". They’re not comparing apples to oranges there. I don’t know how that can be taken as comparing a Rayner monovision strategy with a set distance lens Eyhance. Rayner’s materials also show graphically how the lens outperforms (in terms of depth of focus) standard monofocals again set at emmetropia with images of the focus zone hitting a drawing of a computer screen, again set at emmetropia.
I urge anyone reading this to consult the Rayner PDF’s and draw their own conclusions. In my mind, anyway, I have not been convinced of any sort of misleading adverts or conspiracy here.
I have found that sometimes one can get good technical and non bias information on these lenses from the FDA approval process. For example if you search for FDA Vivity Package Insert PDF, you will find good information on how the Vivity lens defocus curves etc compare to their standard monofocal.
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I tried that with the RayOne EMV but did not find much. It appears that Raynor has not submitted any clinical trial data to show there is any extended depth of focus achieved with the lens. They have submitted some theoretical data which suggests there may be a slight amount, and said that it is up to surgeons to determine the benefits and risks for themselves.
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If you search for this phrase you should find the only document that I could find.
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RayOne-EMV-IFU-USA-PF000142-02 pdf
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Some quotes from it:
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"All IOL optical designs are associated with a certain amount of depth of focus. For
monofocal IOLs, the amount of depth of focus is typically limited. The The EMV IOL
uses an optical modification of the IOL surface to have an aspheric profile that adds
positive spherical aberration (Figures 3 & 4) that is designed to slightly extend the
depth of focus as measured in bench testing compared to the parent monofocal
Aspheric IOL (600C) (Figure 4). The positive spherical aberration of the EMV lens
smoothly transitions to negative spherical aberration towards the edge of the optic
to help control the total spherical aberration at larger pupil sizes. (See Warning #1. for advisory on patients with large pupil sizes). However, clinically meaningful
extension of depth of focus has not been demonstrated in clinical trials . In general, extending the depth of focus negatively affects the quality of vision. Vision quality can be estimated using non-clinical testing (Figures 3-5)…
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Warnings:
Patient with large pupils (> 5 mm) may
not be suitable candidates for this
intraocular lens. Although this lens has
not been studied clinically, its optical
design is expected to be associated
with increased risk for subjective
visual disturbances (glare, halo, etc.),
as well as increased risk for the
reduction of visual acuity and retinal
image quality in patients under large
pupil conditions, as well as in the event
of lens decentration."
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They do not include defocus curves in this information but do include an MTF curve (figure 4), which if you expand it up to 300% or so you can see a comparison of the EMV 200E lens to the standard 600C lens. The MTF is reduced at peak focus with the EMV lens, and has a very slight improvement in the -1.0 to -1.25 D range. In the scheme of things this improvement does not seem very significant to me. In general LogMAR visual acuity tends to track with MTF. This slight improvement seems to be in the same order of magnitude as was reported in that paper where they measured the visual acuity of the various lenses and found that the EMV was slightly better than the Tecnis 1.
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This still leaves me searching for credible information that shows the EMV has a significant extension of depth of focus on a single lens basis. Keep in mind when reading Raynor material that EMV is short for Enhanced Monofocal Vision. They have patented the use of their lens in a monofocal configuration. I am not aware of anyone else doing that, and it would make sense for them to use a monofocal configuration when comparing their lens to others. That is what they patented - but on a quick search I cannot find their patent details. It would be an interesting read if one could find it.
I must say, as I have said before, that some of the regular members of this forum are extremely well-informed about the technical aspects of IOLs and optical physics, and probably know as much about those topics as most optometrists and ophthalmologists . People who come to this forum to seek information are fortunate to have members like Ron and others who generously give of their time and knowledge to them to become well-informed patients. I thank them for what they do.