I have one “good” eye and am having an IOL implanted in my dominant right eye. I am reading too much I think, and having anxiety around the single implant and how that will affect contrast if I choose Vivity. I have a myopic left with focus at about 10-12" but the cataract right doesn’t focus until about 18-20". how will that change if I go with a mono lens for Plano? Where will I see the drop off? I have read it’s anywhere from 2m and closer maybe a timy bit closer, but my doc told me I’d notice a drop off at about 3m (10ft). I want crisp clear vision and ok with readers, but worried about the contrast with a single vivity and the drop-off of a mono.
Thank you
I am not totally clear on where your eyes are at now. If you have a recent eyeglass prescription that would be helpful information in understanding where your eyes are at now.
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On a monofocal lens like the AcrySof IQ or Clareon the standard average minimum distance for 20/32 (good) vision is about 3 feet with it getting better with further distance. It varies from individual to individual and with my AcrySof IQ lens set to plano I can read a 24" computer monitor down to about 18", but that is probably with vision that is not as good as 20/32 but useable. I have no trouble reading the dash instruments of my car.
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The Vivity set to plano has a standard average minimum distance at 20/32 of about 2 feet, so a 1 foot improvement over the monofocal. I do not have one so can't provide personal experience. But in any case it is not good to set expectations on one individual experience as there can be a lot of variation. using the average is a more realistic.
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Assuming you are going to do both eyes at some point there is an alternative to using extended depth of focus lenses like the Vivity. It is called mini-monovision. You might want to do some research on it. If you go ahead with a standard monofocal like the Clareon in your dominant right eye, you can do mini-monovison with the left eye later one by just leaving it mildly myopic at about -1.5 D. Sometimes surgeons don't like to present that option as it only requires basic monofocal lenses instead of premium lenses. This is what I have and as a result have eyeglasses free vision from about 10" out to infinity without glasses.
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Monovision can be simulated with contacts, so that may be a good thing to do now if it is of interest.
I have never worn glasses and have no real idea of my prescription.
OK. I can kind of see why. If I have to guess I think your right eye is about plano and is only suffering from presbyopia which is limiting your closer distance to 20" or so. A plano monofocal IOL is likely to be very similar. Your myopic left is likely giving you pretty good close vision and sounds very similar to what I get with my -1.40 D near eye. You potentially have natural mini-monovision right now, and would not need contacts to simulate it. If so, and you are OK with it, mini-monovison could be a very good solution for you with monofocal IOLs only. You would get what you have right now without glasses. The only difference may be that vision will get a whole lot brighter without cataracts in the way.
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It may be worthwhile to get an optometrist eye exam to see exactly where you stand and see if a contact trial is even necessary. Normally when a cataract surgeon does they initial evaluation they will do an eye vision test. Perhaps just ask them for a copy of it.
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In any case, if my estimations about your vision are correct you would be the perfect mini-monovision candidate using a monofocal lens like the Clareon. The beauty of monfocals is that they provide higher contrast sensitivity which peaks at the distance they are set at. So you will have two peaks in contrast sensitivity; one at distance and the other close.
Somewhere I read that some doctors don't use clareon as it has not stood the test of time yet and could be risky? I will soon have to choose a monofocal lense but unsure what my HMO uses and I can't get a preimum lense because of AMD according to my doctor. Will find out tomorrow what lense she recommends for me in monofocals.
The Clareon material replaces Alcon's AcrySof material that many patients found problematic because, over time, it produced an unacceptable amount of glistening. Alcon claims that the Clareon material does not suffer from this problem. A number of surgeons, my own included, are taking a wait-and-see attitude because Alcon previously claimed to have fixed the problem with AcrySof, its claims didn't prove out.
I do also have the option of choosing a panoptix, a lot of people talk about the halos, which I can’t imagine would be worse than when I’m dealing with having cataracts, I understand it also has a contrast reduction. I wonder what the halos are like for vision with panoptix at concerts with lights on a stage.
I guess you were the one I had read who said that. Probably wise advice!
My surgeon let me in on a little known secret in the cataract surgery industry when I asked about the issue of glistenings in Alcon IOLs. He had recommended Alcon AcrySof IQ lenses for me and they have collected the reputation of developing glistenings over time. His response was that he had seen glistenings in the AcrySof lenses when doing an exam with a slit lamp but they were never to the point of impairing vision or requiring a lens explant. He also went on to say in somewhat guarded language that some private clinics get all of their very expensive exam equipment like the IOLMaster and Pentacam "donated" by a lens manufacturer. In return there is an "expectation" that they will specialize in using that manufacturer's lenses only. And, further there were certain clinics that liked to spread the "glistenings" story. The conclusions were left to me. He did not say more, but offered to use the J&J Tecnis 1 lens instead of the AcrySof IQ if I wanted it. I was having this first eye done at a public hospital and where I am both the AcrySof IQ and Tecnis 1 monofocals were fully covered by our Alberta Healthcare System.
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So I took the time that I was in the queue for surgery to do some of my own research. I found that the AcrySof lens did in fact have glistening issues in the earlier production days and over time they have significantly improved their production quality control, and it was no longer a real issue, but the stories do continue, especially from certain clinics that use J&J lenses.
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He called me again right before surgery and asked which lens I wanted. At that time I told him I would prefer the AcrySof IQ and that is what I got and have had for a little over 2 years. I like the use of a blue light filter in the AcrySof as it duplicates the colour spectrum of a young natural eye. The J&J lenses do not use the blue light filter and the result have a much higher transmission of the blue light end of the spectrum to the eye with a blueish unnatural colour balance. It is not huge but may be of interest to someone that does digital darkroom photography work. The AcrySof also has a reputation for resisting PCO development and has a lower YAG rate than the J&J lens. It also does not fully correct the asphericity like the Tecnis 1 does and there are some claimed benefits to that. It also has a reputation for being a "stickier" lens that stays in position better than the J&J material which is slightly different. This factor is more important with toric lenses as the benefit of a toric can be significantly reduced if it rotates out of position even a small amount. In any case these are the factors that caused me to select the AcrySof lens over the Tecnis 1.
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When it came to my second eye the Alcon Clareon had become available. So I did some research on that and liked what I saw. It had the similar advantages to the Clareon and even claimed slightly lower risk of PCO. And, I found a study which found that the AcrySof material had improved to the point where glistening were highly unlikely and that it was even lower with the Clareon. You can find it by googling this.
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David J Apple Laboratory Glistening through the years Timur Yildirim Feb 05, 2021
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So I decided on the Clareon. It was not covered fully unlike the AcrySof and Tecnis 1, as it was a new lens. I paid $300 extra for it. And, in the evolving healthcare system in Alberta this also got me into a private clinic with a 3 week wait instead of the many months in the public system. To me the $300 seemed like a bargain!
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As for monofocal lenses I would say all of the following are acceptable; Tecnis 1, AcrySof IQ, Clareon, and a less popular one called B+L enVista. They all have their pros and cons, but really they all are acceptable. I did not have the choice of the enVista but if I had, I would seriously consider it. Between the Tecnis 1 and Clareon, I obviously prefer the Clareon, and others may choose differently.
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But, keep in mind when selecting a surgeon you may very well be selecting a brand of IOL when you select the surgeon, for the reasons I made above. They may be "locked into" one supplier or another. So, ask up front what lenses they offer.
Interesting and detailed discussion of these lenses. With AMD, AcrysofIQ or Clareon would seem a possible good choice because of the blue light filter. Other things you mentioned sound convincing that it is a good choice. Will speak with doctor tomorrow and know what she is going to choose and whether I might have a choice on monofocal selection?
At EyeConnect International, a forum limited to ophthalmic professionals that for a time I was able to peruse via websearches (but, alas, no longer), ophthalmic surgeons talking to themselves often mentioned glistening as a problem with the AcrySof material--and Alcon's many unkept promises to have fixed it--that dissuaded them from recommending AcrySof IOLs and made them cautious about Alcon's new Clareon IOL. This also was my surgeon's experience. Specifically, he told me that he'd be comfortable recommending a Clareon IOL if I were over 80, but that at 73 he was concerned that, if Alcon hasn't solved the glistening problem, it would show up during my lifetime.
In 2021 (published) open access article in PLOS One, authors Timur Yildirim and others published Qualitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials. The IOLs studied included the Alcon AcrySof SN60WF and the Tecnis ZCB00. Among the five IOLs, "mean glistening numbers were ranked the highest in the SN60WF" and lowest in the ZCB00. (IOLs from Rayner and Hoya also were found to "show high resistance to microvacuole formation.") Attaching some numbers, the average microvacuoles per square mm for the SN60WF was 66.0, with a standard deviation of 44.5, and for the ZCB00 was 0.9 with a standard deviation of 0.6.
The authors also note a controversy over the relevance of glistenings to optical performance of IOLs. The authors did write, however: "Lenses with
an elevated number of glistenings were found to have the potential to induce symptoms that could result in difficulties for patients while driving."
Regarding the rotational stability of Acrysof vs. Tecnis toric IOLs, it appears true that Acrysof is more rotationally stable. But a June 12, 2018, story in Review of Ophthalmology found "no significant difference between the Acry--Differences in Stability Between Tecnis and AcrySof--adds that "Despite these differences, refractive outcomes were statistically equivalent between groups." A more recent study by Daniel Schartmuller and others published in the December 2020 issue of the American Journal of Ophthalmology is to the same effect ("no significant difference" in overall rotation between the Acrysof and Tecnis groups): Comparison of Long-Term Rotational Stability of Three Commonly Implanted Intraocular Lenses. The whole issue of toric IOLs seems to be somewhat fraught, however. Also, the authors write that they could have shown a statistically significant advantage for the Acrysof IOL had they excluded results with more than 10 degrees of rotation, which I suppose underscores the importance of understanding the parameters behind any statistical claim.
A brief addendum. Two studies of JnJ's newer Toric II IOL apparently show rotational stability on a par with Alcon's AcrySof. See Reproducibility of the Magnitude of Lens Rotation Following Implantation of a Toric Intraocular Lens with Modified Haptics (2022) and Reproducibility of the Magnitude of Lens Rotation Following Implantation of a Toric Intraocular Lens with Modified Haptics (2023, reporting on a study that I haven't been able to locate).
Sorry, but that is a perfect example of the misinformation that J&J surgeons are spreading. Alcon did fix the problem with glistenings in the AcrySof material and quite a few years ago. And in accelerated ageing tests the Clareon is even better.
I have a friend who got PanOptix. She is very disappointed in them. She has not had them replaced as some do, but she thinks she wasted her money paying the $4500 it cost to get them over the fully covered monofocals. She ended up needing +1.75 reading glasses for any kind of close work. I would not recommend the PanOptix to anyone.
The jury seems to be out on whether blue light filtering could delay progress of AMD. But, since there are other good reasons to use blue light filtering it seems to be a good idea. It is said to improve contrast sensitivity in dim light conditions, kind of like the yellow shooting glasses I guess...
No comment. Believe what you want to believe.
So if I'm reading this correctly, a Clareon Vivity may be better contrast than the previous version thanks to a blue light filter?
Ron, what makes these opthalmologists "J&J surgeons"? And why should we think that the authors of the articles I referenced are acting dishonestly?
FWIW, my own surgeon, as part of his "welcome" mailing last summer, included brochures for both the Alcon PanOptix and the Tecnis 1. I see no evidence that he's a paid shil for JnJ. Rather, I believe him when he describes his experience and that of his previous patients with the material.
As for Alcon having fixed the glistenings problem with the AcrySof material, I don't know. On the one hand, my surgeon isn't convinced. Nor are a number of surgeons whose intramural posts I read at Eyeconnect International. On the other hand, you tell me it was fixed quite a few years ago. At this point--with Clareon replacing AcrySof and Toric II replacing the earlier Tecnis formulation--I'm not sure it matters. But if it does, do you have any published studies?
No I don't really think so. Essentially all the Alcon lenses commonly used like the AcrySof, Vivity, and PanOptix have had blue light filtering since they were introduced. In theory Alcon have non blue light filtering versions in the monofocal line, but I understand they are seldom used. Your selection of lenses is going to be limited to what the clinic stocks. The Clareon material does have a higher light transmittance factor, but I have not seen any data that would show it translates to higher contrast sensitivity.
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I have one AcrySof IQ lens and one Clareon, and other than the Clareon is set for a closer distance there is no noticeable difference in image quality between them.
I repeat. No comment. Believe what you want to believe.