I am a 53 year old male with a right eye cataract present from early childhood that unfortunately started rapidly developing causing night driving issues and rapid onset presbyopia and decrease in vision. Both eyes have strong myopia and extreme astigmatism. I also have equidominance and visual snow syndrome so while i have a high blur tolerance I see every detail in both eyes all the time so long as the eyes are balanced. Fortunately if one eye is blurred it is immediately suppressed in favor of the other. I am hoping i can provide some information helpful to others.
After significant research on the topic I choose bilateral implantation of vivity with an intermediate target. Due to extreme astigmatism I will need PRK followup. I had my first surgery in November 2025, but it experienced a black swan rotation event leading to unexpectedly poor outcome. A follow on surgery reduced the astigmatism to the expected 1.25d level and was a night and day success. While I am still recovering from hazzyness, with an small cylinder correct I was able to see well from 10m to 40cm. In office with glasses I have tested 20/20.
Now for the information that you won’t get elsewhere. First when they discuss residual astigmatism one typically thinks if it as being the same but a lower magnitude. That is largely incorrect. The angle of the astigmatism depends entirely on the exact rotation in the eye relative to the original. For mild and moderate astigmatism this is likely not noticeable, but for extreme astigmatism this can be in a radically new direction. In my case the first 55 degrees off the expected and after rotation it ended up -15 degrees. And we are talking about miniscule displacement (order of 7 degrees) in surgical rotation. Anyone with extreme astigmatism should request marking the surgical datum in an upright position prior to starting. Even with the best equipment placement better that 2 degrees is challenging. Oblique astigmatism is much more challenging to read though.
The second piece i can share is the defocus curves for vivity. It uses a special design to stretch the light wavefront creating a continuous 2 d focal point. In the Snell charts they give 20/20 at best focus dropping to 20/32 at 2.5d. So if you had it targeted to plano that means 20/20 at distance and 20/33 at 1/2.5 which is 40 cm. This is exactly what I see with glasses that remove my targeted myopia. However, as I have it in a monofocal setting of -1.25 d the range pushes inward. What is unstated is what happens outside that “nice” band they advertise. The result using a set of lens off Amazon and careful mapping is every 0.25d of residual myopia opens up a starburst pattern of fine spokes (~50). At the -1.25 d target it is a small dot inside of a gap with a much larger starburst. This clearly explains why Snell acuity falls off so rapidly with myopia in the vivity design. Based on my experiences I believe that those with significant Starburst looking like a set of fine spokes likely has a vivity with myopia. The good news is that glasses will resolve this artifact or at least that is what I observed. This does have important implications for those that choose a myopic target with vivity such as a minimonofocal, you will experience significant starburst.
In short vivity delievers exactly as promised with proper positioning. Though someone who can’t tolerate artifacts should stick to a monofocal.
I would post a followup of my journey or answer any questions others have.