Today is day 2 following cataract surgery in my non-dominant (left) eye. A Vivity Toric IOL was implanted targeting -0.75D. I'm scheduled for cataract surgery in my dominant eye in two weeks. Yesterday, my optometrist checked my eye pressure and the condition of the cornea. The incisions are healing nicely, and the Vivity lens is centered perfectly. My pupil is still enlarged, but getting smaller slowly. I’ve noticed that vision in my Vivity eye is improving as the pupil returns to normal size. I still cannot see my cell phone clearly, even at arm’s length. I also see the ghosting of letters. My optometrist said my vision will improve as healing progresses. My Vivity eye is giving me good distance and fairly good intermediate vision. I’m relying on my myopic dominant (right) eye for near vision, however. I’m currently going without glasses all day. I’m effectively doing monovision (a.k.a, blended vision) and it seems to be working for me. With my very myopic dominant eye, I can focus on objects 6” away which allows me to see clearly to put on eye makeup and pluck my eyebrows. I would hate to lose that ability, but c'est la vie. I notice some interference from my myopic eye, but I have not experienced any headaches. In the next 5 or 6 days, I have to decide what IOL to have implanted in my dominant eye. It will depend on what near vision acuity I get from the Vivity lens in my non-dominant eye. My plan was to have my dominant eye implanted with another Vivity lens at plano (optimized for distance) if the loss of contrast sensitivity isn't too severe. If it is, I would elect to go with an Acrysof monofocal toric at plano instead.I don’t notice any significant loss of contrast sensitivity in my Vivity eye compared to my right eye, in fact, it’s brighter than my natural lens. Of course, the cataract itself reduces contrast sensitivity. Implanting a second Vivity is looking more and more feasible. I still have to check out my night driving, though. I could have a second Vivity implanted in my dominant eye offset to match that in the non-dominant eye, i.e., offset the same -0.75D. Binocular vision with Vivity increases visual acuity over monocular vision with Vivity. I could get 20/32 (logMar 0.2) or better at 13" with only a slight decrease in distance acuity and no loss of depth perception. An alternative, if the Vivity near vision is not good enough to go without glasses for reading, but gives good distance and intermediate vision, is monovision, implanting an Acrysof monofocal toric IOL in the right eye targeting -2.50D (my current right eye sphere is -3.00D). Whether or not this is a viable option depends on how I adapt to my current monovision in the next few days. Another option is to have a Panoptix multifocal IOL implanted in my right eye. I’m still wary of doing so, however, because of the visual disturbances (halos and starbursts) that occur at night. I'm probably over thinking this, but I have a tendency to do that (sigh). Any thoughts?
"Vivity eye compared to my right eye, in fact, it’s brighter than my natural lens. Of course, the cataract itself reduces contrast sensitivity." . Yes, the new IOL should be much brighter than a cataract eye. With a cataract in the other eye I don't think it is possible to evaluate the loss of contrast sensitivity. You will have to do it with the Vivity eye only in dimmer light conditions and driving. . A second Vivity will improve contract sensitivity, but I suspect an aspheric AcrySof IQ lens will improve it more. If the Vivity actually leaves you myopic at -0.75 D, my guess is your reading should be very good with it. If so a plano (ideally -0.5 to -0.25 D) AcrySof IQ may be your best bet. With only a -0.75 D split between the eyes, I would think depth perception should be excellent, and not a risk. It is a personal thing, but I can't see any advantage in doing your second eye at -2.5 D. Seems to me that would be locking you into needing glasses. It would also potentially have more risk of lost depth perception when you don't wear glasses. . A Vivity combined with a PanOptix makes some sense, but it is going to bring the light effects (halo, flare, possible spiderwebs) into play. If you like the Vivity eye, then I think I would go for plano Vivity in the second eye over a PanOptix. . It kind of depends on what you see with the Vivity, and what your expectations are, but I think my preference in order would be: . 1. Vivity (-0.75) + AcrySof IQ (-0.25) 2. Vivity (-0.75) + Vivity (-0.25) 3. Vivity (-0.75) + PanOptix (-0.25)
Thanks, Ron. My pupil has returned to its normal size. I can read email on my cell phone with the Vivity eye at 16 inches. I'd like that to be 14" for comfort and convenience, but 16" is functional. Would a Vivity lens in the right eye give me 14"? Distance in the Vivity is functional, too, in bright light. I still have some ghosting of letters that's noticeable for white lettering on a dark background (residual astigmatism?). I'm going to do a night driving test tonight. As you say, that is the only way to assess the contrast insensitivity factor and determine if visual acuity is sufficient to read street signs at a distance.
About all I have to go by is that with my 0.0 D spherical, and -0.75 D cylinder post op IOL, I can see down to about 18". I would suggest not really good enough for a computer monitor the size I have. My other eye which I simulate to -1.25 D with a contact gets me down to 10-12". Very comfortable to read a bright screen computer, and OK with my iPhone for most text. A Vivity at -0.75 should get you close to the same thing. A Vivity at plano may be in the 14" range, but as I have no experience with them that is just a guess.
i think binocular Vivity should give you another roughly another .25D and that could bring near to 14 inches
are you seeing ghosting while reading near or at far distance?
yes, driving at night time on poorly lit roads with oncoming traffic would he a good real-life test of CS,
how would you describe functional distance vision that you're getting? Is it better than 20/32?
thanks for sharing your experience
I went for a drive last night with my uncorrected dominant right eye. It was not good. The monovision really messes things up. No halos, but starbursts were everywhere, and visual acuity was poor. It was not easy reading street signs. If contrast sensitivity was reduced in the Vivity eye, it wasn’t obvious to me.
I realize now that there’s no way I can tolerate driving with monovision. Tonight I’m going to do the drive again, this time with a contact lens in my right eye to simulate a monofocal toric IOL for good distance vision. The cataract in my right eye is not as advanced as the one I had in the left eye, so the test should be fairly representative of what I’ll experience after my second surgery with a monofocal toric IOL targeting -0.25D.
With my right eye corrected for distance with a contact lens, I can work at my laptop easily with the screen 16” to 18” away. I can also see text on my cell phone well enough at arm’s length to read an email or text message. I'm thinking I'll need glasses for sustained book reading, or for reading very small text. Time will tell. My optometrist says that my vision should improve as healing progresses.
First I would wait to my eye fully healed to accurately evaluate. I see no reason to rush into a 2nd eye surgery in 2 weeks.
Then you and only you can determine what is best for you. I can only give you thoughts and opinions.
I absolutely would not target the right eye at -2.50 D.
A couple of things. I think it is best to target the dominate eye for distance and the other eye for close vision.
You also have to realize when getting the Vivity you are more than likely not to get Great Close Vision. It is designed to give you a little extra intermediate and close vision; all of -0.5 diopter; without more dysphotopsias than a regular monofocal. Therefore when getting Vivity you should expect to need reading glasses.
If close vision is important and you are OK with dysphotopsias I would select the PanOptics or Synergy IOL for the 2nd eye.
In your 2nd pick, your non dominate eye is the one that is going to give you close vision, so I would set the 2nd Vivity at Plano to get the best distance vision.
If you are leaning towards your first pick, I would recommend looking at the Light Adjustable lens that way you can adjust it post operatively to try different setting (not sure how many you get) and see what works best for you.
My last thought. When I had my cataract surgery Vivity was not available in the US, neither was Synergy or Panoptics, but I would have considered a Vivity / Synergy Mix. I think that might be a good combo. I suggest talking to several doctors that have done that mix and see what their patient experience has been. the Synergy would be in the dominate eye providing both distance, intermediate and close vision, while the vivity would help reduce dysphotopsias. Of course this is all guess work as have not seen any clinical trials on that combo.
You're welcome.
Ghosting is at both near and far, but the separation has diminished over the past 24 hrs. When I do the pinhole test the ghosts disappear completely, so the improvement was probably due to my pupil returning to normal size. I probably still have some residual astigmatism.
With the Vivity lens at approximately -0.75D, my distance vision is definitely functional. The defocus curve for Vivity at -0.75D gives about 0.1 logMar which is 20/25 Snellen. I don't know how close to the -0.75F target my ophthalmalogist was able to get. I'll be seeing my optometrist next week to have my near and far acuity tested. I'll report the results then.
I think that is the biggest advantage of a Vivity in the near eye at -0.75 D compared to a monofocal at -1.25 D. Near vision will be very similar, but distance vision in the Vivity eye will be better.
With a Vivity IOL (-0.75D) in my non-dominant eye on day 4 post-op, and a toric contact lens to correct -3.00D myopic vision in my dominant right eye, I took a drive after dark this evening.
Last night I did the same without the contact lens in my right eye, and I learned that monovision and night driving don't suit me at all. The quality of vision was intolerably poor. Poor visual acuity, glare, and huge starbursts made driving very uncomfortable.
Tonight it was a different story. It was amazing. Quality of vision was really good with this mini monovision configuration. I could read street signs. There was no glare, and only the brightest lights produced bothersome starbursts. I didn't notice any reduction in contrast sensitivity which was unexpected. My Vivity eye was very sharp at distance and I could see the instrument panel perfectly.
I'm now convinced that an Acrysof Monofocal Toric IOL implanted in my right eye targeting -0.25 D will be a great choice. Alternatively, a second Vivity lens at plano would have the advantage of giving me another 0.25D of near range in trade for some small loss of distance acuity and contrast sensitivity. I'll make a final decision next week.
This mini monovision approach is working. I can work at my computer without glasses (I'm doing so now), and I can read text on my cell phone, too. I do have to use reading glasses to read small print in dim ambient light, and I'll have to get use to not being able to put on makeup without using a magnifying mirror. It's a tradeoff I'm happy to make for being able to function virtually my whole waking day without corrective lens.
I'll report more after my 1 week checkup. Further insights are much appreciated. This forum has been tremendously helpful in navigating these, for me, uncharted waters.
Trial testing with contacts is a Great way to go.
First IMHO -3.0 D is crazy! There are a lot of steps from -3.0 to -0.25.
I am not sure -0.25 is considered mini-monovision (I think mini is -0.75 to -1.25). I don't think you would even loss a line with that setting. In fact one might shoot for -0.25 just to try and avoid going hyperopia as doctors do not always hit the mark and there are steps to IOL power.
If you want to try micro-monovisions, you might also try more power steps like -0.75.
I guess I really need to read you posts again, as I am confused on the goal. To me setting the other eye to -0.25 does essentially nothing for close, I consider that just setting to Plano, which is fine.
The Vivity IOL at -0.75 should be providing your close vision in this setup, while the other eye gives you great distance. In fact you might be getting pretty good distance (maybe 20/25) with your Vivitiy IOL. Maybe I missed it, but what is your distance with that Vivity IOL.
I would wait for the eye to fully heal and go to the doctor and get your distance and close vision. After that answer the questions under all lightening conditions:
1) Are you happy with the Vivity distance vision 2) Are you happy with the Vivity intermediate vision, and 3) Are you happy with the Vivity close vision.
Testing these under all lighting conditions and environment takes time. You might find issues at a indoor basketball game you did not see before.
I will give you a perfect example for me. I was working on a door latch and it got dark and I could not see to work without bringing in more light. That is the reason I am not implanting the MF I currently have in my other eye, as I want, if possible, less light splitting or at least less as possible MTF degradation in dim light conditions.. The one I am getting supposedly has less light splitting based on clinical trials and MTF, but I am not 100% confident in that and frankly will not know until I have it implanted as that is the way it goes in cataract surgery.
I would then choose a 2nd lens and its power setting to address the weak spot that bothers you the most.
Trying to use a -3.0 D eye for driving at night, or even in the day would be difficult. That really isn't monovision. I am about -2.0 without a contact, and I do not like it at all. It seems to me you have it narrowed down to a reasonable choice. I think if you are happy with the reading while using the -3.0 D toric contact you should be happy with a monofocal toric IOL fully corrected for distance.
Thanks, Ron. There's so much to learn about this subject. A month ago I knew virtually nothing. I'm feeling more confident that I'll make the right choice for my second eye.
The only decision remaining for me now is whether to go with a monofocal toric or a Vivity toric for my second eye. One can make a good case for either. I don't want to postpone my second surgery for several reasons. Mainly, I don't think doing so would buy me much.
If possible, I'd like to have a bit more near vision acuity for doing computer work than I now have with the contact lens. As expected, vision in my Vivity eye at 18" is better than the contact lens eye, and I find that the difference does detract from the overall quality of near vision. The contact lens and a monofocal IOL at plano can only give clear vision to as close as 36". A Vivity lens can extend that range to 20", which should give me good binocular vision at the computer.
Not experiencing noticeable or objectionable contrast sensitivity loss in my Vivity eye when driving at night was encouraging. I'm now considering having a second Vivity lens implanted in my dominant eye targeting -0.25D. I plan to discuss this with my doctor next week at my 1 week followup exam before making a final decision.
I think you understand the situation well and will make a good decision. As I think I have said before I think the key benefits of a monofocal IOL would be slightly better distance vision and better contrast sensitivity especially at night with no risk of additional optical artifacts. The key benefit of the Vivity would be perhaps slightly better reading vision with a slightly higher risk of optical artifacts. If you are paying out of pocket, the Vivity is likely to cost more. I guess it depends on what your priority is.
Thanks, Ron. Yes, I'm getting a better understanding this stuff, and I'm reviewing my options given what I've learned so far and my priorities.
I've been studying the defocus curves on the chart you shared in an earlier post comparing the Vivity at plano and -0.75D with the Acrysof Monofocal at plano, -0.25D and -1.25D. It's telling me that Vivity in both eyes might well give me the best overall satisfaction. Here's what I'm thinking:
The contact lens in my right (dominant) eye is simulating a monofocal IOL at -0.25D (dotted blue line). My left eye has a Vivity at -0.75D (dotted yellow line). While my Vivity eye is seeing the computer screen at 20/25 (logMAR 0.1), my simulated monofocal eye is seeing it at 20/50 (logMAR 0.4). The right eye is dragging down my combined near visual acuity. I'm wearing +1.25 readers to achieve better clarity. I'd rather not have to do that.
I realize that I might adapt to this visual disparity in time, but there's a chance that I won't, as well, and I don't have the time to find out. My second eye surgery is scheduled for just nine days from now.
A Vivity in my right eye at -0.25D will improve the near vision in my right eye to 20/32 (logMAR 0.2), almost as good as my left eye. As I understand it, when both eyes are close in visual acuity, binocular vision will be better than the acuity of either eye individually.
I'd like to ask my optometrist to demonstrate this for me at my follow-up review this week by simulating the Vivity with a -1.0 D monofocal lens.
The Vivity IOL at -0.25D will give 20/20 distance vision paired with the 20/25 in the left eye. I'm betting that the combined contrast sensitivity won't be enough to make driving after dark a problem. It wasn't a problem with the Vivity in the one eye.
I'm willing to keep a pair of reading glasses in my purse for those low light situations where the Vivity's MTF value is sacrificed for greater depth of focus.
Here's that defocus chart:
I just returned from my optometrist. My Vivity Toric eye looks good at 8 days post-op. Eye pressure is good, and the cornea is healing well with only a bit of inflammation remaining. The IOL is still well-centered.
Distance vision in my left eye was measured at 20/20, and intermediate vision at 20/25. My optometrist said my left eye is under corrected by -0.6D (how did they measure that?). My ophthalmologist wrote in my chart that she targeted -0.5D, not the -0.75 that I requested. I’m not sure why she did that; maybe it was necessary given the half diopter steps available for the Vivity lens.
Anyway, with the Vivity lens in the left (non-dominant) eye I have good vision at distance to 20” (20/25 or better). My optometrist recommended targeting -0.5D in the right eye when I have the second Vivity lens implanted next week. We discussed the loss of contrast sensitivity with the Vivity lens. She said that it hasn’t been a problem for other patients. From my own experience, I don’t think it will be a problem for me either which is why I’ve decided to go with a Vivity lens for my second eye, too.
So it looks like I'll end up with both eyes matched at about -0.5D. It’s not the mini-monovision I was aiming for. But I'm not disappointed. I’m giving up one line of distance visual acuity to get one line of near visual acuity (20/30 at 16”).If all works as planned, I'll have good depth perception, no night driving dyphotopsias, and be glasses free except for reading in dim light.
If I had to do it over, I would have had surgery on my distance eye done first as most people do. I chose to do my non-dominant eye first because I was concerned about the effect on night driving if I had Vivity lens in both eyes. That concern arose from information I read on the internet. At this point, having a Vivity lens implanted in one eye, I don't anticipate any problem implanting it in the other eye due to reduced contrast sensitivity. Others may disagree.
I would also have sought out an ophthalmologist who has time to be more involved in selecting the best IOL configuration. Having to go through an assistant for all communications is not optimal. My surgeon is very skilled, but also very time limited. Cataract surgery has taken on a kind of mass production character. Don't expect a lot of guidance from the people providing this service.
The eye health professionals I interacted with seemed somewhat reluctant to pass along useful information without direct questioning from me, and even then answers were not very helpful. My ophthalmologist did take the time to make sure that I understood that the final outcome of my eye surgery could not be accurately predicted or guaranteed. I guess I came off as one of the dreaded "perfectionists" mentioned in the patient questionnaire.
Many of the people I've talked to who have had cataract surgery in the recent past often have little recollection of the details of their surgeries. Few could tell me their IOL brand, type, or correction. That's surprises me considering how important eyesight is all of us.
Keep in mind that if the lens used left you with -0.6 D, the next lens choice would leave you at -1.1 D. I would probably choose the -0.6 D for all around good vision. It is really an insignificant difference between that and -0.75 D. With the second eye, you could consider a target range of -0.5 to plano. For example if your second eye was identical to your first the next lens choice the other way would leave you at -0.1 D which would be ideal for a distance eye. It is best to discuss the lens power choice directly with the surgeon as they will know best where you are likely to end up.
Thanks for your response, Ron. You've been such a great help. Not just to me, but others as well.
I'm not overly concerned about my distance vision after having completed my first surgery and seeing at 20/20 in that eye. I was expecting it to be 20/25 targeting a slight under correction. It could deteriorate some as healing continues. My distance vision has never been particularly good with so much astigmatism and eyes that constantly needed stronger and stronger prescription lenses. I'm more concerned about squeezing out a little better near vision to limit my need for glasses in dim lighting situations.
My optometrist noted in my chart and promised to inform my ophthalmologist directly that she should target -0.5D in my dominant eye. Yes, that could end up -0.9D or -0.1D, given the variability of the factors that determine the final outcome.
I feel that the best chance I have of being able to read text on my phone at 16" is to have the EDOF Vivity lens implanted in my dominant eye at -0.5D, matching my non-dominant eye. Clinical trials and other studies seem to suggest my being able to achieve that goal.
I'm pretty sure I can live with any myopia in my distance eye between plano and -1.0D. If my surgeon hits -0.5D, that'll be great. If not, I'll benefit from either better near vision or better distance vision. It's a bit of a crap shoot, isn't it?