Combo lentille Vivity et réglable en lumière à venir

Soins des yeux
1

I am having cataract surgery next week. The plan is for the Vivity lens in the right eye and the Light Adjustable Lens in my left eye. Will do right eye first. I had LASIK in the late 1990s so that limits some of my choices. LASIK was a huge success. For years, I only had to wear readers when reading a book or something and that was OKish. But, about 6 years ago I started having to wear glasses at the computer which I hate since I spend at least 8 hours a day most days at the computer.

I guess I probably would have ended up with the Vivity in both eyes but I had a curveball a few months ago. My left eye vision got worse fairly quickly. I knew I had cataracts in both eyes that had been slowly progressing so I thought that was what was going on. When my vision suddenly got distorted (wavy lines, slanting), though, I saw a retina specialist. Turned out I had a torn retina that had resulted in a macular pucker. The only way to fix it was to do a vitrectomy and then peel the scar tissue. I did that at the end of July. The surgery went well and about a month after surgery my left eye vision improved from 20/60 to 20/40. It takes months (sometimes years) for all the improvement to happen. But my eye scan looked great and so I was (am) expecting more improvement.

But, then my left eye vision cratered to 20/80 in a matter of days. Basically, the vitrectomy vastly increases progression of cataracts. So this was not a shock. My retina doctor basically said I would not be able to see any improvement in my left eye until I had cataract surgery.

Before the vitrectomy I had a cataract consultation (same surgeon who did my LASIK years ago) and it was recommended I do the light adjustable lens for the left eye and Vivity for the right. Initially, the recommendation was to do the left eye first. However, with the known improvement of my left eye after the vitrectomy it was recommended I do the right eye first. The idea is to know the results of the surgery on the right eye when I do my adjustments on the left eye.

While I plan to do the left eye week after next I don’t plan to lock in my adjustable lens until probably January. I wanted to see the improvement I get from the peel before I lock in (most improvement happens in the first 6 months after surgery). The online downside is I will have to wear UV blocking glasses all the time (except when sleeping) until I lock in.

The tentative plan is that the Vivity lens will be set for good distance vision. My right eye pre-cataract had the best distance vision of the two eyes and is dominant. Then the light adjustable lens will likely be optimized more for medium which should help a bit with near as well.

The beauty of the light adjustable lens is that I can try that and if I want better distance vision I can adjust it to give more. I will likely want to fine tune it to have the best intermediate distance combined with the two eyes. I would love it if I could so some casual reading without glasses but know I will need reading glasses for anything extended. And, I am OK with that.

2

That is an interesting plan and kind of the reverse of a more normal practice. But, you have some significant other issues to deal with so it probably makes sense. Normally one would put a monofocal in the dominant eye set for distance (-0.25 D target), and then use the EDOF lens in the non dominant eye to provide some monovision reading. A lens like the Vivity can use about -0.75 D of myopia to give better reading, without causing much of a distance vision loss.
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The big plus with the LAL is the ability to try different powers of correction. Lasik can make the power of the lens needed hard to calculate so that is important.

3

Yes, I knew about the LASIK difficulty before I even had the macular pucker issue. When I did my evaluation before I had the vitrectomy I expected that they were likely to recommend the Light Adjustable Lens in both eyes due to the LASIK. So I was a little surprised by the Vivity recommendation. But, they felt the power could be adequately calculated. Of course, since I am doing the light adjustable lens in the other eye, if my right eye power is “off” little bit then that can probably be handled by what I do in the left eye.

They do want to see me the morning of surgery to update some stuff from my evaluation a few months ago so this plan is a bit subject to change which is fine. I live about 250 miles from where I am having surgery so I can’t just drop by their office without having to drive several hours. So we are doing the final look at everything the morning of surgery. (I want to have surgery with the specific surgeon who also did my LASIK years ago, but I moved a few years ago. )

4

Last Wednesday (5 days ago) I had the Vivity Toric Lens implanted in my right eye. So far, it is a huge success. I was a bit nervous about the power since I have previously had LASIK. I made clear when some of my tests were repeated the morning of my surgery that if the power was missed that I hoped it would be on the myopic side. It was mentioned that two different machines that morning from different manufacturers had both come up with identical astigmatism readings which is unheard of that they agree that closely. And I was reassured that in the extremely unlikely event the power was significantly off there was a window of time to change out the lens. I was assured though that they didn’t believe that would happen.

Anyway, the day after surgery I could see 20/20 for distance. Reading I could see at J2 (20/30 equivalent) which astonished me. I didn’t expect it to be that good. My surgeon was very happy and said he thought it would likely only become sharper.

When I got home (I had gone out of town for surgery) I was able to test my vision at the computer. I have a set up with 3 monitors and being able to see without glasses at that distance is of primary importance to me.

So far, things are going well. My near vision has actually improved a bit. I can now read anything on my phone (I read Kindle books a lot) with no glasses. To be clear, that is a strain and I would not do it for extended time. I worse +3 reading glasses before. I bought a pair of +1.25 drugstore readers which are completely adequate. That is much better reading vision than I expected from a Vivity lens.

My computer vision is fine for things that aren’t heavy reading. For example, I can easily play a video game or watch a video on my computer with no glasses. I can read web pages without glasses. But, if it is extended reading it is a slight strain. I might be able to alleviate some of that by monitor placement.

However, I will have my left eye done later this week with the light adjustable lens implanted. The hope is that the left eye will help with the computer vision. Right now, my left eye is a drag on my vision since my cataract in that eye is causing very blurry vision.

In short, I have gotten better intermediate and near vision from the Vivity lens than I expected. My distance vision is totally fine. I know that the Vivity lens is supposed to decrease contrast. But, honestly, I haven’t noticed it. Maybe if I was driving at night I would. But, given I haven’t done my left eye yet I am not driving at night. But, just looking around at night everything looks fine.

Of course, I know this is early in the recovery period so I guess things could change. But, for right now, things are going very well.

Oh – one interesting thing to me. I did not expect that I would need a Toric Lens. Pre-Lasik (23 years ago) my astigmatism in that eye was -2. Most of the was corrected with LASIK. (I waited to have LASIK done until the laser that corrected astigmatism was approved in the US).

Since thing my astigmatism in that eye has varied from -.25 to -.5. I didn’t think that would need a Toric Lens. However, when they do their tests they measure my astigmatism as it would be without the presence of my natural lens. Without it, my astigmatism would be -1. Since the natural lens was being replaced, they implanted the Vivity Toric lens.

5

Yes, eyeglass corrections do not always predict the need for astigmatism correction. In some cases the astigmatism in the cornea is being offset by reverse astigmatism in the lens. Then when the lens is removed, bingo, you have astigmatism…
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It sounds like your surgeon has things well under control and you got a good outcome.

6

So yesterday I had my left eye done with the light adjustable lens. It is hard to compare the two experiences since the situation for each was so different. A week after my Vivity lens I am still doing well, seeing 20/25+ at distance and J2 for near. It is nice that I can read anything on my phone without glasses although I want light readers for anything extended.

For me, though, ultimate success will for my overall vision really depends on the computer distance. If I can eventually spend several hours a day at my computer comfortably without glasses then I am happy. This is true even with needing light readers or even occasional glasses for some driving (say at night). The right eye alone doesn’t quite get me there although almost. I am writing this on my computer without any glasses but it is a little bit of a strain.

So the Light Adjustable Lens in the left eye needs to pick up and help a little with that. The LAL is a monofocal lens that you can adjust the power after surgery. We plan to ultimately set the power of that lens where I can most clearly see at computer distance (with both eyes together). It is easier with the LAL to add power with adjustments rather than to remove power. So, the target was for the left eye to be at -1 D. the adjustments will be to increase that. Typically, I was told people can often see well at computer distance with it adjusted to -1.25 D. Of course, the idea of the LAL is that it can be adjusted after surgery to what works specifically for me.

I would say my first 24 hours after surgery was more difficult with the LAL. I had blurrier vision overall and everything seemed more hazy. The negative with the LAL is the need to wear UV blocking glasses except when sleeping. Well, most people can remove them showering. But, I have a skylight in my shower so will wear them even when showering.

At the post-op appointment, I was able to take off the UV blocking glasses for my exam. Some of the haziness went away and it was overall easier to see without them. Anyway, I was 20/40 with my left eye today. I was quite happy with that. First, I was 20/40 knowing that my target was -1 so 20/40 seems very reasonable.

Also I had a vitrectomy 3 months ago to peel a macular pucker. Before that surgery I was 20/60 in my left eye. A month after surgery I was 20/40 implying improvement from the peel. It is expected to improve for several months. But, then the cataract got bad so I couldn’t see improvement. The fact I am now at 20/40 with the LAL supposedly targeted for -1 is a good sign.

And, it was stressed to me today that I still had a lot of swelling and it should get better. Right now, my combined computer vision is better than it was before the left eye was done.

I go back in a couple of weeks for a check. I don’t have an adjustment set yet for my left eye. They expect I will have an adjustment in 3 to 4 weeks. I want to be very cautious with the adjustments since they can only be adjusted a limited number of times and I may have more vision changes due to the peel. I am not planning on locking in anything until the end of January which will be 6 months after the peel. Wearing the UV blocking glasses is a pain but I am willing to do that and be patient if it helps with the results.

7

thank you for updates on your vivity toric and LAL . i have vivity toric in non dominate eye but have been delayed to get second eye due to flu tuating vision, severe dry eye i am also RK patient 30 yeRs ago
dry eye specialist recommending LAL for right eye once my dry eye under control and i am concerned about having 2 different lenses and my depth perception might be off
i dont like the loss of contrast with vivity compared to my natural lens how is yours with LAL? i have great near vision with vivity but horrible distance i also must be able to drive.. both day and night as well as hike, play tennis etc.., I have had a terrible time these past months with the fluctuation hoping your LAL is going well please update and thank you!
Inga

8

I appreciate your detailing your experiences getting a mix of Vivity and LAL together with a macular pucker peel.
I’m in an almost identical situation to you, facing how to approach my cataract surgeries.
Main difference is my puckered eye is on the right (20/60), my left eye has a cataract but is still 20/25 or so. I’ve always been myopic at -9D. I had been considering Vivity in my good left eye (for distance and intermediate vision) and a monofocal in my right puckered eye . Perhaps an LAL is a better choice, as you’ve done.
How has your experience evolved since you have now had both lenses replaced and the final LAL adjustments made? Did you do any adjustments of the LAL to move toward better distance vision, or were they all to improve closer vision?

9

They can do EDOF with LAL, by adjusting it to manipulate spherical aberrations. (I’m just parroting what I’ve read. i don’t really know much about it. But 2 ophthalmologists here in Massachusetts have confirmed that to me). Have you explored that possibility?

Codet talks a lot about this on their website. But my docs said they too could do it.

10

l recently got vivity in both eyes , mini monovison, right dominant eye plano 19.5 and left eye slighly near 20.5 l find the right eye vision perfect but the left eye slightly too shortsighted, l regret not having both eyes plano, l will try to get used to it, but if l cannot what would be the best way to get the left eye adjusted to plano or distance, would that be a LASIK laser or some other type of laser or a piggyback lens where they put another lens over the top or another way

11

John, I would not do anything until you have had an eye exam by an optometrist, and ideally someone other than at the clinic where you had the eye surgery done. The eye exam will tell you exactly where you ended up with each eye with respect to sphere, and if there is any astigmatism (cylinder). You need a minimum of 6 weeks recovery before doing the eye exam so you will get accurate results. Once you have those numbers you will have a better understanding of what you have for vision. Keep in mind that the objective of monovision is to NOT have the same vision in each eye. One gives you distance and one gives you closer vision.
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If it turns out that you are too near sighted in one eye, then yes, I believe you can get Lasik to correct it closer to plano. And, if you have astigmatism, they may be able to correct that at the same time. If you are far sighted, then it becomes much more difficult to make a correction with Lasik.