Posted , 9 users are following.
It seems that Alcon has released the Vivity earlier this year to a small number of surgeons for use. They have now opened up distribution to everyone in Canada. More details can be found by googling the phrase below.
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Alcon Canada introduces AcrySof IQ Vivity, the only presbyopia-correcting intraocular lens with X-WAVE technology
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rwbil RonAKA
Posted
I should add I read about some revolutionary IOLs like Juvene that suppose to give 20/20 or close to that at all distance without the halos and glare. But who knows how the lens will perform over time and if it ever will be FDA approved.
RonAKA rwbil
Posted
Have not heard of that one. However, if you want to avoid halos I would avoid any lens using diffractive technology. Here is a Alcon claimed simulation comparing the Symfony to the Vivity.
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This comes from a presentation by someone that is probably an Alcon consultant. If you have not seen the presentation it is worth looking at. Google this:
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Clinical Outcomes of a Novel NonDiffractive Extended Vision IOL CATHLEEN MCCABE, MD
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In this presentation it is claimed the Vivity has a Depth of Focus of more than 0.5 D compared to a monofocal. It is also claimed that it has a range of vision of > 1.5 D. I guess that must indicate you get some range of vision from even a monofocal, but even more with the Vivity. Don't know for sure. They show these defocus curves which suggests at the dashed reference point that the Vivity goes out to 2.0 D?? My thoughts are that the 0.5 D depth of focus is comparable to a 0.5 D monovision. So if you do 1.25 monovison, you would potentially get the equivalent of -1.75 monovision with the Vivity. Or, you could do -1.0 monovision and get the equivalent of 1.5 D. In short it adds a little but not a lot. One would get more reading ability out of monovision than with Vivity and no monovision.
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rwbil RonAKA
Posted
There was just an article out Today in healio about the Juvenile lens. According the article:
"One-year results show that the Juvene fluid-optic IOL succeeds in providing stable, full range of vision from distance through near, according to a study.
“Of note, there is very little or no glare and halo with this lens,” Eric D. Donnenfeld, MD, said at the virtual American Academy of Ophthalmology annual meeting."
It was study of only 45 eyes.
I cannot tell if the lens is still in developmental stage or will be available anytime soon anywhere.
RonAKA rwbil
Posted
I have read some about it, and would put it in the early developmental stage. It seems to me it kind of works like those wonky looking eyeglasses that have a round lens that is essentially fluid filled. There is a control, typically on the bridge of the nose that you adjust manually to focus close or far. I think they are called Truefocal or Superfocal. There is an even wonkier looking version that adjusts focus automatically. Fitting all that technology in a lens implanted in your eye sounds a little scary to me.
RonAKA
Posted
It will be interesting to see what the user reports on this IOL are like after it gets more widespread use in the US and Canada. It seems it was introduced on a select clinic basis, and now has been opened up to the wider market. I did see this recent tidbit of information from an Alcon pofessional site that is a little concerning.
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"Most patients implanted with the AcrySof® IQ Vivity™ IOL are likely to experience significant
loss of contrast sensitivity as compared to a monofocal IOL. Therefore, it is essential that
prospective patients be fully informed of this risk before giving their consent for implantation
of the AcrySof® IQ Vivity™ IOL. In addition, patients should be warned that they will need to
exercise caution when engaging in activities that require good vision in dimly lit environments,
such as driving at night or in poor visibility conditions, especially in the presence of
oncoming traffic."
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This seems to be at odds with an earlier presentation by a paid Alcon consultant, Cathleen McCabe that had this slide her presentation. The slide shows a drop in contrast sensitivity compared to a monofocal lens, but claims it is not clinically significant??? It would be interesting to hear from actual users, and especially ones that have a standard monofocal in one eye, and the Vivity in the other eye.
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xen42188 RonAKA
Posted
I'm not an actual user but based on what I've read, I wonder if the reference to dim light has something to do with Vivity’s blue light filter. Blue light absorbing lenses are thought to affect scotopic vision particularly for high spatial frequencies (the 'for' camp says the impact is insignificant). I thought the IQ also has a blue light filter so don’t know why the brochure would have that statement. As an aside, J&J makes a big deal of not filtering blue light in their Synergy literature and claim of better dim light contrast.
RonAKA xen42188
Posted
I have the ArySof IQ Aspheric lens with the blue light filtering in the IOL I have -- which is essentially the same one they compared the Vivity too. Alcon not surprisingly make the opposite claim that the blue light filter increase lower light contrast and night vision. They have some graphical claims about it increasing the distance you can see with headlights at night. Don't know about the accuracy of those claims, but I can tell you that the colours and contrast that I see with the IOL are just amazing. I have an older plasma big screen TV and now the colours just pop off the screen like it was one of these newer OLED screens that I see when I go to Costco.
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The one thing to keep in mind about the blue light filtering is that it is not giving you an unnatural view of the world. The natural lens has blue light filtering, and Alcon is essentially trying to replicate the natural lens. If you look at their graphs it is not a perfect match, but much closer than the lenses without blue light filtering. The advantage of not having blue light filtering is that the lens passes more light, more than a natural lens, so things can look a little brighter. The other issue is that some believe that the extra light may cause some longer term damage to the eye like AMD. Again not sure about the accuracy of those claims.
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Alcon has a very similar lens without the blue light filtering, but I gather it is not very popular. I asked for the lens with blue light filtering.
xen42188 RonAKA
Posted
Hi Ron, did the IQ brochure have a similar statement? As you say, the IQ and Vivity are based on the same platform with a few differences. For instance, one would expect that Vivity has a different spherical aberration profile which contributes to what they call as xwave dispersement. Not sure what its contribution to contrast sensitivity would be. One of the papers on pubmed did say that blue light filtering would provide more retinal protection. It also calculated 14.6% reduction in scotopic sensitivity which they call insignificant. They claim it translates to 0.1 log loss of contrast sensitivity which I don't think I'd ever be able to notice!
I wonder if the statement you quote from Vivity brochure is just a standard cautionary statement that shows up in most non-mono brochures or is it unique to Vivity?
RonAKA xen42188
Posted
Here is a graphic from the AcrySof professional site which I believe is trying to show that in night driving in fog the AcrySof IQ Aspheric blue light filtering IOL gives you a 130 foot stopping advantage at 55 mph over a non blue light lens.
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They claim it is based on a study, but one always wonders about factory funded studies...
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Alcon has been very vague about how this Xwave technology really works. I am guessing it may be a change in effective power from the outside of the lens to the middle. They claim it is aspheric, but I think it really may not be... I recall the Tecnis Synergy lens uses that method to get their EDOF.
The statement from Alcon may be a bit of a CYA statement, but I suspect there is a difference between the standard AcrySof IQ and the Vivity.
We can't post links here but if you google this phrase you may find it.
professional myalcon vivity is in view coming soon
In any case this statement is cooling my views a bit about the Vivity as an option. A standard AcrySof IQ Aspheric monofocal with a -1.25 D under correction for monovision may be a safer route to go for me with my second eye.
xen42188 RonAKA
Posted
Ron, I may have found the answer to this question.
The following image is from fda site. It shows MTF delta between Vivity (DFT) and IQ (SN). MTF is basically modulation depth of image divided by modulation depth of object. In other words, it calculates how much contrast (modulation depth) is lost through the lens. Higher numbers are better. We see a loss of 20% with Vivity at Plano compared to IQ. At near distances, it’s slightly better than IQ. (I have my thoughts on why there is a loss but those are just my thoughts). Of course this is based on a model eye and real life experience may be different. Also this is modelled for 3mm pupil size which mimics day light, night time numbers will be different.
As a compare, PanOptix at plano for 3mm aperture is .38, vs .25 for Vivity and .45 for IQ.
RonAKA xen42188
Posted
Thanks for the graph. I have seen it before but have never taken the time to digest what it means. I have the SN60WF lens now. And, if I get the same lens but under corrected by 1.25 I would assume that this curve shifts 1.25 to the right. It would hopefully give me better contrast closer up using the two eyes together. I guess the same with the Vivity, by shifting that curve to the right. It would probably give me better contrast reading, but less at distance.
xen42188 RonAKA
Posted
I wanted to add some more info re Vivity contrast in case someone comes to this thread looking for it.
There is an interesting video on YouTube where a bunch of surgeons talk about multifocals
In glaucoma eyes but after 38 min, they get into a brief conversation about Vivity contrast loss. Basically they say in mono configuration, Vivity did not pass FDA benchmark (hence the warning that Ron referred to) but not clinically significant in binocular config. You can look for it by searching for the following:
Presbyopia IOLs in Glaucoma Patients!?
RonAKA xen42188
Edited
Thank you for the reference to the Zoom session where the Vivity lens was discussed.
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I gather that those suffering from glaucoma contrast sensitivity is more important as the glaucoma reduces sensitivity and if the lens does too, then you are doubling up on a critical vision loss factor.
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One participant, Brian Schafer, makes the case that the warning is based on the monocular vision not binocular. To me that is still relevant as I would use it in one eye only as my other eye is already done with a monofocal lens. I wonder if that means my contrast sensitivity would be reduced for closer vision through the Vivity but would be better at distance due to the monofocal? Don't know, just guessing. I don't have glaucoma but my pressures are in the upper end of the pressure range at 21, and I can't dismiss that it may develop as years go by. It is something to be aware of.
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Thanks again. I am amazed you found this information on the Vivity as it is well buried in a YouTube video....