Advanced replacement lenses in Adolescents and Teens

No experience, but one of the issues you should talk to the surgeon about is that of pupil size. Since your daughter is very young compared to a typical older cataract patient, she is likely to have a relatively large pupil. There may be some IOLs that are more suited to a larger pupil size than others.

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The other issue is the longevity of the IOL material. The Vivity lens is from the Alcon AcrySof line of lenses that have been associated in the past with development of glistenings. They are tiny voids in the material that fill up with fluid. Some say if they appear it is quite soon after they are put in, and the issue is manufacturing quality. Others say they develop over a longer period of time. I have this material in my IOL and I certainly have seen nothing like it over the 6 months or so I have had it. Alcon of course says they have corrected the quality control and it is no longer a factor. It is something to ask the surgeon about though.

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The competition, J&J, say it is an issue and their material is resistant to it. The somewhat similar lens to the Vivity in the J&J Tecnis offerings is the Eyhance IOL. It does not provide quite as much intermediate vision though.

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One other issue to ask about is blue light filtering. Alcon lenses including the Vivity use a slightly yellow tinted lens that filters out blue light. Their claim is that the natural lens filters out blue light and they use it to match the natural lens. Tecnis typically do not use it, although some of their more recent lenses may have violet light filtering. Some say that not filtering out blue light can lead to macular degeneration over time. With an implant age of 14, there would be lots of time compared to a senior for that to happen. I have looked at it and couldn't find any sound evidence of it happening. Again something to ask the surgeon about it.

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Hope that helps some. Your other option is to use a monofocal lens and depend on the natural accommodation of the other eye for closer focus. That may work very well too out to age 45 or so. And, by then there may be much better options available than the current presbyopia correcting lenses.

So glad to hear your Daughter is a survivor. I hope she's with us for a very long time to come.

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Cataracts are tricky in young people because they're accustomed to having phenomenal vision. The biggest difference between an IOL and the lens you're born with (as you may know) is that the lens you're born with can focus all the incoming light for objects at any distance. So you get fantastic vision quality from 9 inches from your face to infinity. The human lens (a.k.a. crystalline lens) does this by changing shape. An IOL is a static piece of plastic so it can't do that (although there are innovations in the works like the Juvene IOL supposedly coming in 2023). So you have to make a choice between convenience and quality.

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Basically a static piece of plastic can only do so much with the incoming light. The best image quality is to focus all of the light from one focal point (usually distance). So you'll have amazing sharp distance vision but you will lose the ability to focus up close in that eye. In order to see up close (anything within say 3 feet) you'd need glasses. And in order not to have to be putting the glasses on and off all the time you'd probably want progressives. That could be a hard thing for a 14 year old to accept as they're used to their vision just being perfect and automatic in all scenarios.

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Vivity is a new IOL that stretches the incoming light out. This gives you a wider range of focus. So that 3 feet might be more like 26 inches (66cm). And objects even closer might be "good enough" to make out but will NOT be sharp. The other trade off with Vivity or any IOL that tries manipulate the incoming light to give you more focus depth (split it up or spread it out) is that you will lose some contrast in the image. This is slight and probably would only make a noticeable difference in dim lighting (might need a light and glasses to read paper media).

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I think Vivity may be a good choice. Everyone is very excited about it now. It does have some slight tradeoffs in image quality but it may be worth it for the more functional/ natural vision and less dependence on glasses. Don't let the surgeon promise you that she'll be able to read her phone with it though! She will not. Not without glasses. Although the other natural eye will do that for her until about age 42 when Presbyopia sets in.

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Another option is a multifocal IOL. You can for sure read a phone / text with that kind of IOL but there are more tradeoffs, mostly things like halos around lights at night. This can bother people that have very particular / picky / dare I say "neurotic" personalities (Type A). They will focus on that one little thing and can't stop being bothered by it. More easy going people will learn to ignore it. J&J Synergy might be one to look at if you're in Canada or Europe (it's not in the US yet). The data on it looks amazing (almost too good to be true).

Your daughter has been through a lot - glad she's a survivor.

It is hood you are looking onto this - unfortunately I do not know anyone who had cataract surgery so young but there are a few in their 20s on these forums.

RonAKA makes s good point about pupil size. If your daughter's pupils are larger they may extended beyond the IOL and cause visual disturbances in low light/dark situations.

There are advances all the time - wondering if she can manage with her good eye or if the recommendation from specialists is she have the surgery?

I do wish her and your family a good outcome.

I think the Vivity or Eyhance could be a good IOl in this case. I would try and manage expectations and not let the Opthamologist over promise. No Man-Man IOL will match the ability of a young persons lens. Maybe discuss instead of shooting for Plano going a bit myopic, maybe -.5d to get a little more close vision. I am hoping the other eye will provide great close to distance vision and then the 2 eyes working together combined with neural adaptation will provide overal great vision.

Your daughter will be so use to great vision I would not risk any defractive IOL in her case. That is just my 2 cents worth.