Some backstory: I had LASIK when I was 40 and I had no problems until I underwent six weeks of hyperbaric oxygen treatment in 2017. HOT causes vision changes but it is suppose to revert to pre HOT vision. Mine didn't, and my vision settled to where I had distant vision in my left eye and close up vision in my right eye. I did not need correction at that time. In 2018, I developed pretty severe dry eye. Dry eye further degraded my vision. Although I can still see distance with my right eye and close with my left, my vision is sharper with contacts. My cataract on my right eye is now to the point we can't correct it much further than it already is. Monovision has never bothered me. I am scheduled for cataract surgery on 12/28/21 (right) and 1/11/22 (left). My surgeon plans on using Vivity IQ with monovision correction on my right eye. I have read about Vivity issues on here. I have almost decided to have my right eye done and wait to do my left eye. The surgeon wants to do the left eye since the cataract there is growing, but I can still see well with it. My thinking is to see how my right eye settles and then decide if I want to go with Vivity in my left eye or go with a different lens. Or, I could go complete different, maybe get the Light Adjustable Lens. I am so new to all this. At this point, I don't want to settle and get something I am not going to like. I don't want to wear contacts or glasses afterwards.
I think the surgeon's plan is basically good. One question I would have is about which eye is the dominant eye. Point your finger with arm extended at a small object across the room. Close your right eye. If you are still pointing at it, then your left eye is dominant. If you are not pointing at it, then your right is dominant. Ideally you want your dominant eye to be your distance eye in monovision, and non dominant for closer vision. . The one issue with the Vivity lens is reduced contrast sensitivity in lower light levels. It may not be the best lens if you do a lot of night driving. I think one solution is to have the distance eye corrected with a monofocal (AcrySof IQ, or Clareon), and then do the close eye with a Vivity. Then to a large degree the monofocal can help with contrast sensitivity at night. . The LAL lens advantage is the ability to adjust the power after it is in your eye. If there is uncertainty about what power of lens you need, then it can be helpful. It does not offer extended depth of focus ability like the Vivity does.
Thank you! Yes, my left eye is dominant. I am now monovision naturally, left eye distance and right eye close. My right eye cataract is the worst, so it is being corrected first. I have eye measurements next Friday. I don't anticipate with them having problems determining the powder of the lens needed.
That is good that you already have experience with monovision and are OK with it. I currently simulate monovision with a contact that under corrects my non operated eye by about -1.25 D. I like it a lot. My plan is to make it permanent with a monofocal IOL targeted for -1.25 to -1.50 D, or a Vivity targeted to -0.75 D. You you know by how much the surgeon is targeting your right eye for monovision? . There are issues with measuring and calculating the power for eyes which have had Lasik done on them. There are special formulas used to do the calculation. . Have they talked about any need for a toric lens? I guess they would not know that until after the measurements are done. I believe both the Vivity and AcrySof IQ are available as a toric. The newer Clareon monofocal, is not, at least in Canada.
I'm not sure what the target is for my right eye. I will ask at my measurement appoinment. I have pretty steep (?) monovision. In my right eye, I can't see except really close up. In my left eye, I can only see semi-good close up but real good mid and long distance.
The Lasik is what bothers me. Even with special formulas, you can still get focusing refractive errors.
I had astigmatism correction with Lasik. He did say I have some minor astigmatism. I will find out more at my measurement appointment. If he uses a Femtosecond laser for cataract, it can fix low level astigmatism during the cataract surgery.
After reading on this site, I have quite a few more questions. I might end up cancelling and going to a doctor in a city close by who may offer more than my clinic does.
There are toric IOL's to correct astigmatism if you have a significant amount. You won't really know until they take the measurements. Astigmatism corrected by a contact or eyeglass has to correct the total astigmatism in the natural lens plus in the cornea. When the lens comes out during cataract surgery, that component of the astigmatism is gone. However, it may be offsetting to astigmatism in your cornea which now includes some created by the Lasik. So it can get worse and more correction is needed as a result of the lens being replaced. The eye measurements should tell the story.
If you're doing full monovision I don't understand why the surgeon would choose Vivity. Why not use Acrysof monofocal lenses? The image quality would be better and the monovision would still give you spectacle independence.
I am a big fan of procrastinating as long as possible and doing 1 eye and evaluating and using the mix and match to select the 2nd IOL that address the weaknesses of the first IOL. In full disclosure I have mix and match IOLs.
The reason for the procrastination is newer IOL are in development. And not just IOL, but a modular base that will eliminate or come close to eliminate PCO and allow easy IOL exchange. Maybe in the future the LAL can be changed from a monofocal to a trifocal with adjustments for each foci point.
There is no perfect IOL and they all come with tradeoffs. My suggestion is learn all the options and decided which tradeoff works best for you and your lifestyle.
The IQ Vivity using monovision could be a perfect match for you. There is the risks of contrast sensitivity lose with Vivity, but my guess it is less than it is with a diffractive IOL.
If having any contrast sensitivity loss is a big factor for you then you could look at the Eyhance, which “Supposedly” does not have CS loss, but also has the smallest amount of additional near vision gain for a premium price.
You mentioned the LAL as you are worried about refractive miss. The LAL is going to be a monofocal IOL (yes I am aware of their EDOF Clinical Trials).
I would suggest you get at least 2 IOL Master measurements on different days and on different machines and make sure you are getting consistent results. And get a copy of those results. My astigmatism measurement was not consistent. And if you have astigmatism, get a cornea typography and make sure it is regular and get a copy of that image.
Also make sure you have a top doctor, with lots of experience, who participates in clinical trials and does research.
There is additional equipment, but you will have to look harder to find a doctor that has them. In fact I did not even know there was a Callisto Eye System, until after my cataract surgery with a toric IOL, whereby the doctor used the mark the eye method. In fairness, I imagine 99.9% of the eye doctors out there use the traditional marking method.
If there is a doctor with the credentials I mentioned and has some of the latest equipment and within a 4 hour drive, it would not hurt to get another opinion.
That is my question too. I called another eye doc in St Louis and I am having an exam tomorrow. They said they would lay out all of my options. My current doctor didn't discuss anything with me. When I said my OD said I could do monovision with monofocal lenses, he gave me the brochure on Vivity and said these were better. No further discussion. I wasn't in a frame of mind at the time, nor had I done any research, to ask further questions. Now that my husbands heart surgery is out of the way and he is doing well, I started questioning and researching. Once I have the exam tomorrow, I will be able to make better decisions. I will post here what they tell me.
I am having another exam tomorrow in St Louis where they also do LAL. They said they do eight different tests. They said doc will sit down and go through everything with me and lay out all my options. That sounds a lot better to me. I can also go to Chicago if need be. My doctor only gave me the Vivity brochure and said it was better than one distance/one close up monofocus lens. No discusssion either way. I wasn't in a great place to question him at that time. Now I am. I think my OD said my right cataract is far enough along. The MD said yes and he can justify to insurance doing my left eye too. I'm sure my vision is affected by the cataracts, but I can see. I think their attitude is, if we can justify it and insurance will pay, why not do it now rather than later. I believe I am going to procrastinate and wait until I have all of the info I need to make an informed decision.
My research indicates that to get good reading vision you have to under correct the close eye in monovision by about -0.75 D with a Vivity, or -1.25 to -1.50 D with a monofocal. The advantage of the Vivity monovision over monofocal monovision is that the Vivity should give better distance vision as it is under corrected by a smaller amount.
Actually yah I assume when the doctor says Vivity monovision he's not talking about FULL monovision but more like a half dioper or so offset. THAT would make sense. I'd talked in other threads about being hesitant to do any offset with Vivity BUT if my choice was a 0.5D offset with Vivity or full monovision with monofocals I would 100% choose Vivity.
If the offset with Vivity is only 0.5D or so I take back what I said above. I'd prefer than to monofocals with a big offset. I was thinking he was going to do a big offset with Vivity which makes no sense. But that's almost surely NOT his plan.
My manipulation of the defocus curves shows that a Vivity at -0.75 D under correction gives about the same close vision as a monofocal with -1.25 D under correction. The difference is that the Vivity maintains better distance vision though.
**My doctor only gave me the Vivity brochure and said it was better than one distance/one close up monofocus lens.
I tend to agree, though Vivity might have some Contrast Sensitivity loss. The reason I agree is I just had cataract surgery and in one eye I have a Tecnis MF and in the other I have the Synergy. And for close vision, I can do the 1 eye cover at a time thing and I see J1 for each IOL individually, but bilaterally I see J1+. So I think having 2 very similar images sent to brain the 2 eyes work better IMHO.
**I think their attitude is, if we can justify it and insurance will pay, why not do it now rather than later.
I doubt your insurance will cover the Vivity IOL, unless your doctor is willing to do it at a monofocal price and saying it is a monofocal. This is something you need to check on. If on medicare, I am not sure their rules. My insurance did cover the other cost, minus the deductible, associated with cataract surgery.
Also depending how what your current corrected vision is another reason to procrastinate is they are constantly coming out with better IOLs.In your case where you are thinking of the LAL, they are clinically trialling EDOF and I am sure a few other.
I saw the doctor in St Louis today. He said I am seeing 20/25 in my left eye and it needs nothing done to it. My doctor here in town said he could justify cataract surgery on my left eye to insurance, but this doctor says it does not meet the standard where Medicare will pay. I could even read with my left eye dilated. My left eye is doing most of my close up vision too.
(I know Medicare/Insurance won't pay for Vivity as it is a premium lens. They gave me the cost of the lens.)
My right eye is the hot mess. My cataract is on the back portion of my lens. He doubts my vision is actual monovision. He thinks the cataract is causing all of the vision distortion.
He said he would not recommend Vivity for my right eye. He did use the lens but doesn't any more. He recommends the Johnson & Johnson ZCB lens followed by PRK in 3 months, fixing for distance. He will make adjustments if necessary for one year. He said he would fix the moderate astigmatism too. He recommends this over the LAL as he said he has had a couple of patients who didn't get good results with the LAL. He has had consistent results with the ZCB.
My next option is to go to Northwestern University Dept of Ophthalmology. They do not do LAL but they do research and studies, so it might be good to get their opinion.
All I know is I am cancelling the surgery I now have scheduled.
"They gave me the cost of the lens"
How much are they asking? According to "Cataract Coach" Dr. Devgan, Vivity's wholesale price is ~$900 (compared to ~$200 for the Eyhance).
The Tecnis ZCB00 is your basic tried and true monofocal. It will probably have less risk than any premium IOL, but not provide for great intermittent vision or for close vision. Probably will be able to see good out of that IOL up until 3 feet or so.
I would suggest getting 2 or more IOL Master measurements on different machine on different days (and get a copy of results) to make sure your Axial Length and Astigmatism measurements are consistent and maybe use a doctor that has the ORA system to help nail your refractive mark so you don't need PRK afterwards.
You mentioned St. Louis and Chicago, so I just did a very quick search looking at Newsweek Ameirica's best eye doctors 2021 list and their seems to be a few highly rated doctors in your area.
"He recommends this over the LAL as he said he has had a couple of patients who didn't get good results"
That is interesting. Out of curiosity did he say exactly want problems they had.
What was your astigmatism? Are they planning on using a toric IOL?
I always recommend to get a 2nd or more opinions, as all doctors are not the same. You want to find a top doctor that you also have confidence in and are comfortable with.
The cost of the lens is $1050 and the surgeon wants $1550 more for using it, so $2600 more over what Medicare/Insurance will pay.
He said he would go for distance in my right eye because my left eye is handling close up and distance. I can see up close to about 11 -12 inches with my left eye. Any closer and it gets fuzzy. I can't see anything with my right eye until it is about 5-6 inches from my face.
The doctor in St Louis is great in person and he has 830 5 star Google reviews, but he doesn't take insurance and it is expensive. He touts his cost covers the surgery, all appoints for one year and all laser enhancements. As far as the LAL, he said the patients didn't get the vision results they wanted. He also said the timeline Rxsight gives for wearing UV blocking glasses (3 weeks) to the end of the laser adjustments (He said up to 5, but I've read it is up to 3.) is too short. He said most patients are not healed enough at 3 weeks to start. He mentioned up to 3 months wearing the glasses. He said he was the first doctor in MO and IL to use the LAL. He would use it if I wanted it, but he recommends the ZCB over it.
They did one IOL Master measurement yesterday within the 8 tests they did. I asked for copies of my tests and the doctor's notes, but I have to formally request them and pay.
I plan on going to Chicago to see one of the top doctors there. I'm not adverse to go somewhere else in another state. If you had your choice, who would you go to?