I am 71. I am nearsighted and astigmatic and have worn eyeglasses since I was 12. Ten years ago before I had bilateral cataracts by eyeglasses Rx were -4 and -5. Now with my dense (+3 NSC cataracts), my Rx is -7 and -9. I have never worn bifocals or progressives in my life. Tests show I have 2D of astigmatism. I also have mild ptosis in both eyes. My opthalmologist likes to use the Eyhance IOL. She said she could use the Eyhance toric to fix my astigmatism or she could implant a regular Eyhance monofocal. She said either way I would still need eyeglasses. 1. The toric IOls will cost me $1,300 each. From what I have read, the toric IOL calculations have to precisely right and some patients don't do well torics. 2. The other optiion is the regular Eyhance monofocal. It's cheaper and easier to implant. 3. Which option should I choose? I am leaning towards the regular Eyhance monofocal. 4. My opthalmologist said she could set either IOL for distance or near, but she recommended near for me. Does that mean that if I got the Eyhance monofocal I could read a computer without eyeglasses? Could I see my cellphone? 5. She said whatever option I choose, I would need progressives for really good vision. I have never worn them and dread using them. Thank you all for your advice.
- You say that you have 2.0 D of astigmatism. Is that what the ophthalmologist said you would have after surgery without a toric lens? The reason I ask is that eyeglass astigmatism correction is different than toric lens astigmatism. When your natural lens is removed any astigmatism in it is gone. All you have left is what is in your cornea. But, they can measure that prior to surgery, and that amount of astigmatism is worth considering. 2.0 D is quite a bit, and is correctable with a toric lens. I would not say that torics are hard to get used to, but they do have to be inserted at the correct angle and they have to stay in place. And, if you plan to wear eyeglasses the astigmatism can be corrected by them, and it is not necessary to spend the extra money on a toric IOL.
- The Eyhance is not really a monofocal lens. It is a mild extended depth of focus lens (EDOF). It lets you see a little bit closer if your eyes are set for distance. If your eyes are set for close, I kind of think it is a waste of money. You may as well get the true monofocal, which in the J&J line is the Tecnis 1.
- I think it comes down to whether or not you are trying to be eyeglasses free. As I say if you plan to wear glasses any residual astigmatism can be corrected by the eyeglasses.
- Near would not be my choice. I would go for distance and get a toric so I could be eyeglasses free except for close reading. You can also ask to have your dominant eye set for distance and your non dominant eye set for about -1.25 D. That should let you see both distance and do most reading. And also in that case I would go for the Tecnis 1 lens in the distance eye, and the Eyhance only in the near eye. This is a mini-monovision solution.
- I think that you can get the best possible vision with progressives in addition to whatever option you choose. There will always be some residual error that needs to be correction. IOL surgery is not as exact as eyeglass corrections.
I am 72 and have had similar eyes to you. My vision was in the -4.0 range when I was younger, and for some reason got better as I got older. But, I did need progressives at about age 45 or so. I am amazed you got away without them. My solution has been to get monofocals in both eyes but with a residual of about -1.25 in my closer vision eye. Since they are monofocals I would like to have -1.50 D and am looking at Lasik to get it closer to that amount. Still, I can read my iPhone, computer monitor, and generally down to about 12" before vision starts to suffer. I have 20/20+ at distance. Mini-monovision works well for me.
Good analysis. I had Eyhance toric done a month ago. Saw my optometrist today and will see him 2 months from now for a final post surgery exam. I have a slight residual astigmatism remaining but I see 20/15 now uncorrected. 2.5 adds in both eyes and OS +0.00 -0.50 x010 (left eye). Not worth filling a prescription. I have several reading glasses lying around the house. Yeah the toric worked out well. My astigmatism was bad enough prior to surgery that drugstore reading glasses was quite blurry.
If you got Eyhance in both eyes and set for distance exactly how much extra intermediate without glasses would you get compared to a standard monofocal , would it only be a tiny amount extra or quite a bit . Would for example you be able to read your mobile phone in your hand if you outstreched your arm or not need glasses for daily intermediate tasks like making a meal , reading car dashboard?
If you look at the graph in this article you can see that with a visual acuity of LogMAR 0.2 the Eyhance extends the curve out from about -1.1 D with the standard monofocal Tecnis to -1.5 D on the defocus curve. If you divide 1 meter (39.4") by the defocus D you get distance. So this works out to 36" as the limit of good vision with the standard Tecnis 1 monofocal, and 26" with the Eyhance. So it reduces the good vision distance by 10".
"Review of Ophthalmology PUBLISHED 15 APRIL 2021 IOL Review: 2021 Newcomers"
If your goal is to be glasses free as much as possible then you need to correct for Astigmatism. I would add there is both regular and irregular astigmatism. You cannot correct irregular astigmatism. I would get a few different Astigmatism reading using the latest and greatest IOL Master machine and make sure your results are consistent, as mine where not.
The other thing is the surgeon has to properly rotate the IOL and of course the IOL needs to stay at that rotation. One thing you might consider is to find a top Ophthalmologist that used the newer Callisto machine over the mark the eye method.
A little bit about the Eyhance IOL. The goal of Eyhance is to provide just a little bit of EDOF with the same dysphotopias of a monofocal. In fact the EDOF is so small it does not actual meet the threshold to be an EDOF Lens. Is there a free lunch? Only time will tell. The other goal from what I read is for insurance companies to cover the Eyhance, so it would become a monofocal replacement IOL. Again only time will tell.
I would make sure you fully understand what setting your vision to near would mean. I cannot stress this point enough. Pull up a defocus curve for Eyhance and makes sure you fully understand it.
Here is where you need to start researching and providing more definition; as the term “Close” means different things to different people. But I can tell you if you set your vision to “Close” you will probably need to wear glass most of the time and it will probably need to be progressive glasses.
Which brings me to another point that is critical to understand. The natural lens you currently have adopts by physically changing shape to point the light where it is needed. That lens will be removed and replaced by a piece of plastic and you will no longer have that accommodation. You vision will be maxed for a single point and quickly degrade from that point. Yes Yes the EDOF will give a bit more.
So you really need to think about what activities you do and want you want your vision customized for. You mentioned computer and cell phone, which is more intermediate vision.
The more you are willing to degrade your distance vision the greater your intermediate vision will be.
Here is what you might be able to do depending on how bad your cataract are. Use contacts to degrade your distance vision and see what is acceptable to you. Some people must have 20/20 distance, maybe you are perfectly fine with 20/32 distance.
This information could be used to set your dominate eyes vision quality. So instead of 20/20 you shoot for 20/25 or let’s say -.75 diopters in your dominate eye. Then use micro-monovision to gain addition intermediate vision so in your non dominate eye set it for -1.25 diopters. This should accomplish your goals to see the computer and cell phone and then you wear glasses for close vision. Though keep in mind everyone’s results will vary.
Many folks just blindly depend on the doctor to make the best decision for them. Coming here shows you want to make the best decision. My advice is take the time to do some research and really understand the tradeoffs as there is no perfect solution and everyone is different. And sadly there is no way to a youthful accommodating lens vision. You will be making a custom vision that is best for your particular situation.
I opted for Eyhance torics in both eyes. It has worked out well so far at less than 4 weeks post-op. I have clear vision and don't need glasses for driving including seeing the dashboard, watching TV, casual computer use or grocery shopping. Currently, I use Dollar Store type reading glasses for indoor smartphone reading and some kitchen tasks as examples. I don't need glasses to shave my beard.
If I had wanted to continue using progressive glasses full time then I would have chosen the Tecnis ZCB00/PCB00 monofocal. The IOL cost savings would be better spent on good progressive glasses in my opinion if wanting to use glasses. However, I wanted the chance of not needing glasses for distance and intermediate vision so I chose Tecnis Eyhance torics for both eyes and am happy that I did.
I appreciate all replies. Let me elaborate further. I was told I had 2D astigmatism after having a Lensmaster scan and computer tomography. The technician had difficulty doing them. I have seen one general opthalmologist here in my small town and two cornea specialists in a large city 100 miles away. I got conflicting opinions. One said my ptosis and deep orbits made the IOL calculations difficult to obtain and might affect me having a toric. He said just get a monofocal and wear eyeglasses. Another said the ptosis wasn't that bad and a toric would be fine. My local opthalmologist mentioned a toric and micro-vision but she said at my age and it might be hard for me to adapt to it. She recommended the Eyhance monofocal (EDOF). She also said there was really "no right way or wrong way" to fix my cataracts and I would just have to make a choice . She did emphasize that she thought I should aim for near vision because I have been myopic for many years
All this confuses me, especially now that my husband and best friend died in December after a 7 year struggle with dementia. I am mentally and physically exhausted, but I need to have my eyes fixed. It seems like a monofocal and eyeglasses would be simpler. I don't know. Ron, did you say the Technis monofocal would be better for me? I don't mind wearing eyeglasses for distance, but since I spend a lot of time on a computer I would like to see the screen without peering through progressives or bifocals, which I have neve worn before. I had a malignant melanoma skin cancer on my scalp removed about a year ago, but I was not as apprehensive about that surgery as I am about this cataract surgery because I had no choice to make about the surgery. There was only one way to remove the skin cancer and that's what my surgical oncologist did. I wish cataract surgery was that simple. Again, I would appreciate further advice Lynda.
My choice would be Eyhance Toric with a first minus target in your dominant eye (distance) and the second eye done a few weeks later (or 6 ideally) and targeting first minus again if you are happy with intermediate / near results of the first eye or second minus if not (micro monovision). You'll still need readers but probably only occasionally and for prolonged reading. Quick glances to check the time on your phone for instance have a good chance of being doable without glasses with an outstretched arm (or better… i.e. relaxed elbow if you are lucky) . Personally I would not target near. Most of day to day life (for most people) is not at 12". It's not what you are used to but nothing after surgery will be what you are used to. One way or another your vision is going to change. There will be something to get used to either way. Just a matter of what (which is what your surgeon means by there being no right or wrong answers) . And I think 2D astigmatism calls for a toric. Yes you can correct with glasses after but with the approach I've suggested you have a chance of not needing glasses that often. With a standard monofocal (esp. non-toric) there is little to no chance of being spectacle independent. . That said progressive glasses are not bad if you get good ones. They are not ideal. You have to look through the right spot in the lens and the "channels" can be very narrow. But I have been using they for a year now (still waiting for my surgery) and I kind of love them. They work really really well for things like looking at my Apple Watch and within a week of wearing them I was completely unaware of any issues with distortion or "swim". If you get good ones they're easy to get used to.
Ron, I read the article you quoted from. On Page 4, Figure 2, under the defocus curve it says" Eyhance performed better at intermediate and near distances." On page 6, it says "Several studies have shown the modified Eyhance delivers superior intermediate distance compared to standard monfocals." On page 7, it says," Another independent study found Eyhance provided better visual acuity than the the ZCB00 across a greater range of defocus levels, including near vision.
I started using progressives about 25 years ago. I did not find them hard to get used to at all. About the only big "learning" I had was to NOT look down through the bottom half of them when going down stairs. Don't look. "Use the force Luke"! . Now that I have mini-monovision with near and far without glasses, I have become spoiled. When I last used my progressives, I found it annoying to have to hold my head up to look at the computer monitor. But, you do get used to it. I had never even thought about it until after I became spoiled.
This is why it is difficult to give accurate advice here as no one knows your particular eye health. My advice was based on having no other eye condition other than cataracts and have regular astigmatism that can be corrected.
When you say you have some issues that are making it difficult to get accurate readings that is another whole ball of wax.
My best advice is contact a Top Opthmalogist even if you have to fly there. I will PM you.
I am sorry to hear about your husband passing. That is very hard to deal with, and I can understand that you would be stressed. Cataract surgery options are almost endless and working your way through them is not easy. Sometimes ignorance is bliss, in not knowing what all the options are. . The unfortunate reality is that we have "progressed" in the approach to cataract surgery, from the past times described well by one of your ophthalmologists. "He said just get a monofocal and wear eyeglasses." Many, many people get this option and don't even realize there are other options. They go without glasses most of the time and use over the counter readers for the times they can't see smaller print. My wife had undiagnosed lazy eye in childhood and as a result only has usable vision in one eye. She got a toric monofocal, and only uses readers when she needs to. Her current Rx after cataract surgery is 0.0 D sphere, and -0.5 D cylinder. She has a prescription for progressives and I keep suggesting she should get some, but she won't. Instead she has several pairs of readers. The point is that if you go for a monofocal toric you don't have to wear progressives if you don't want to. But, you will get the best vision by wearing them, as they will correct any residual error. . This said I plan to eventually get progressives as well, but have not yet. I am still considering some touch up Lasik and don't want to buy them before that surgery if I have it. I can see quite well without progressives, but I will eventually likely buy them if for nothing else but night driving. . My point about getting a monofocal lens over an Eyhance was if you are going to set them for close vision. I think the Eyhance would then be somewhat redundant, and you would get as good or better overall vision with basic Tecnis monofocals (toric if you want the best vision without glasses). The other situation would be if you were to consider mini-monovision. In that case it may make the best sense to get a Tecnis in the distance eye, and an Eyhance in the close eye. Both should be toric in this case as you will likely be able to go eyeglass free almost all the time.
Ron, I appreciate your reply. Can you please explain to me why you think the Technis 1 is better than the Eyhance? As I quoted in my post from the "Review of Opthalmololgy" that you had referenced, in your post, that article clearly says in several places that the Eyhancd delivers better near and intermediate vision than does the Technis 1. Thanks
The Tecnis 1, as well as the AcrySof IQ, and Clareon in the Alcon lens line are aspheric IOLs. They are designed to as close as possible focus all light at one single point. This is good as it provides the clearest possible image. . However, when you focus all light at the same point you reduce the range of focus or smearing of the image to provide a range of focus. If you google "aspheric vs spherical IOLs" and look at the images you will find many images which show the difference. The Eyhance lens and the Vivity in the Alcon line do what the spherical lens does but perhaps in a more controlled manner to extend the depth of focus. There is a cost to this in clarity at distance. So the Tecnis 1 will be better than the Eyhance at distance, or in the case of selecting a power to give you close vision, they will provide clearer vision at that distance. . At near and intermediate distance it is different of course. Because the Eyhance smears the image it provides a better image at those distances. But there is a cost at distance.
Ron, What worries me about progressives or bifocals is that I spend a lot of time on the computer at work. I have a pinched nerve in my neck and I was told by a neurosurgeon not to arch my neck for prolonged periods of time. I have seen some people with progressives or bifocals arch their neck to peer through the right lens to see a computer. That is something I don't want to do.
Also, I have read that for some people it is easier to look through a bifocal rather than a progressive because there is a larger viewing area. Is that correct?
Unfortunately most desks do not make it possible to get the monitor low enough for good vision. And, as monitors get bigger it becomes even more difficult. The last office I worked out of had a desk with a section in the middle that could be raised or lowered. I adjusted it as low as possible while still being able to get my knees underneath it. Often you will see information that says a monitor should be at eye level. I think it should be much lower than that.
Progressives would be for day to day around the house or out and about. I wouldn't use them for the computer. I have single vision lenses for the computer. You CAN get progressives customized in a ton of different ways though, so they're optimized for computer or near or general purpose etc… but really for the computer I think you're better off with single vision lenses. I got my computer glasses from Zenni for like, $30 and they're great. Just don't ever buy progressives from Zenni (or Costco). You will not like their progressives. For progressives go to a real glasses store / optometrist.
I got Eyhance in both eyes Oct and Nov 2021. I asked for -1.25 myopia im lifelong myopic didnt want lose some near. I can see near close and far. For total crisp distance clarity i can use the lowest script contact multifocal -50 with low near.
I have used progressives from Costco for about 15 years or so. For that time I used Accolade Freedom 3.0 HD Progressive Lenses that were high index, with the anti-reflective coating. They are made by Essilor and I believe they are the same as the top of the line Varilux HD Digital lenses sold under their brand name. For me they worked very well, but of course with the limitations of a progressive lens. . The last pair of glasses I got was a temporary solution with a prescription for my IOL eye in one lens and for my natural eye with a mild cataract in the other. For that pair I spent a bit less money on the lenses and got the Kirkland Signature™ HD Progressive Lenses: Digital Progressive Lenses. Although I never really wore them much, I didn't notice any significant difference between them and the Accolade Freedom ones. The optical technician said the add section was not as wide, but I didn't notice it. I would prefer to get lenses without the coatings as they make them difficult to keep clean. But with Costco it is part of the package deal. . My brother has used Zenni for progressives and he said they were poor. I have no personal experience.