Alcon Acrysof IQ Vivity IOL Unhappy Night Vision

hi kevin,

what issues did you have with monofocal and how did you correct it? thanks!

hey the problems I have night are due CS loss and glare mostly. Since the distance just seems so blurry at night like I wish i could just put on glass like pre catarct when i had -2 dioptren and when i put on glasses i had 4k full hd 3d vision and could see every single bit. every dark shadow moving thats 500m away.

but now i have -0.25 dioptren on both eyes and using glasses maybe change 1%. at daytime i dont notice the difference at night time i think i notice 1% or its just a feeling since you look through clear glass. nethertheless its not enough.

so im downtown 9pm its night at the traffic light. street lights illuminating the street. up to 50-70m everything is mostly clear. some glare and starbursts from traffic lights. but every car or traffic light streetlight after 50m becomes less visible and blurrier. like darker and their headlights form a big glare starburst so what im seeing in the distance is a light sources and pure black/grey inbetween which is the road usually. im just seing either black grey and light sources with a huge diameter or blurry things where i can't tell what it is. sometimes i even get irritated because i see lights from windows but not the house even tho its not pure darkness.

even at dawn 6pm when I leave the house for work my distance vision ready is reduced by like 40% and everything seems darker the headlights more intense and blurring everything.

somehow my left eye has less glare starburst, but less is definitely definitely definitely not enough. a car comes ahead i have to FOCUS BE CAUTIOUS whats behind it.(even at dawn) i feel so old because sometimes i drive like a snail, my confidence at night driving is definitely greatly reduced. ive used to own fast cars and it was no problem for me to catch the spots where i could accelerate for a bit without endagering anyone. but now I feel like i could hit a jaywalker even tho im driving normally.

also i dont see this young pupil theory working on me since using these eyedrops literally cause more glare and not less.

my wishes would be:

sharper vision for the distance since the world at night feels so small suddenly due my 70-100m vision. being able to tell whats in the distance. so that's low CS I assume.

less glare starburst and these lightstreaks are pretty annoying.

not feeling like the world is so dark anymore, needing to use flashlight to walk on steps which i could see WELL before.

hope that could help, my doc said i could have glare with monofocals too but they for sure didnt say contrast vision will be reduced i remeber just seing it on the paper to sign AFTER the surgeon left the room. anyway they will get their place in hell enough anger for those ppl.

SO IF YOU WANT TO PLAY IT SAFE TAKE A MONOFOCAL. They say my lense has low probability for glare and visual disturbances. okay but still the risk is there and its higher than on monofocals. its like with stocks high risk high reward when you risk taking premium lenses. low risk is monofocals.

You can always fix distances with glasses, but you cant fix WORSE vision quality.

hey i didnt ignore your message. i sent you private message check your inbox

Hey, ok, I'm really sorry, I didn't notice it. My fault! I'll reply asap.

My opinion is that Vivity should not be used in both eyes. If a monofocal like the Clareon is used in the other eye, it helps to offset the loss in contrast sensitivity of the Vivity.

ron you feel the same about eyhance?

Yes, if one was to use an Eyhance I think it would make good sense to just use it in the near eye, and use a true monofocal in the distance eye.

I am 49 and got Vivity in one eye and although i can see letters and read this now on my phone with it, all the letters have halos. so nothing is exact. I wonder why? was it sized wrong? i had no rx before. i think they measured my eye wrong. night driving does not work bc of this. Lights still have halos.

Vivity has two levels to the surface of the lens. The purpose is to spread the focus point out to in turn extend the depth of focus. The halo is likely the second image that you are seeing. Most learn to ignore it. Does not indicated the power is wrong though, but you could get an eyeglasses test to find out for sure.

thank you this helps. i did go in for the follow up exam at optometry and she thought i was 20/20 and only had eye drops recommendation. so for the surgery in a couple weeks i may reject their Vivity lenses because i think it is that second layer image i am seeing and the standard monofocal has only one layer i assume

Yes, a pure monofocal like the Clareon will have a clearer image at distance, but will not let you see quite as close.

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The important part of an eye exam is the prescription for glasses. That will tell you whether the power is correct for your eye or not. Ideally for distance vision you will want to see the sphere value to be 0.0 D to -0.25 D.

I do not have a prescription?

Without and eyeglass prescription you really do not know where you stand. Normal practice is to wait 6 weeks after surgery and then get your eyes tested with a written eyeglass prescription. For ideal distance vision you are hoping it will be 0.0 to -0.25 D.

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With the eyeglass prescription information, then you can make a better decision on what to do with the second eye.

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You could call the eye exam place and see if they will give you the refraction numbers over the phone. Sometimes they will not want to give it to you in writing if the exam is too soon after the surgery, so you will not go out and get eyeglasses based on preliminary numbers that can change.

I went and she said I do not need a prescription for the right eye with the Vivity that is 20/20. I don't see correctly with it there are fuzzy borders around letters after a month and may be wrong diameter but the eye test could not improve it with prescriptions so she thought maybe it was just dry, or if I wanted a prescription it was very slight to magnify for a sort of reading glasses I guess.

The left eye next week may be getting the AcrySof IQ aspheric (that is what they have in stock at Kaiser or I can do another Vivity). It is so clouded she can not evaluate for a prescription until we get the lens switched out for a (clear?) one.

@RonAKA, I need both eyes done. I run my business from my smartphone at 13" away and drive at night. I am okay with glasses at night, if absolutely needed, but want to stay away from glare or starburst as reported on this thread. And, I do want decent internediate vision glasses free, ie tv and meetings and computer

. What are your thoughts on this configuration: Dominant eye set for distance with a Mono focal lens or Vivity edof and 2nd eye set to near vision with a monofocal or Vivity or Eyehance? I also read Alcon Restore can be set to 12" close.

If you want to stay away from glare, starbursts, halos, and spiderwebs, it would be wise to also stay away from multifocal lenses like the Restore, PanOptix, and Synergy. The Vivity typically does not have the starburst but still can have more moderate halos. It suffers from a loss of contrast sensitivity at night as well.

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I think your lowest risk option to get the wide range of vision without glasses is mini-monovision with monofocals. You could use a Vivity in the non dominant near eye, but to get some assurance of the close vision you want, it would have to be targeted to -1.0 D. Some surgeons may not be willing to do that. Having it in the close eye only may mitigate the risk of halso and starbursts, but it is still a risk compared to a pure monofocal.

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There is some controversy on whether or not the Eyhance provides any closer vision than a standard monofocal. If it were me, I would go with a Clareon monofocal in both eyes with the distance eye targeted to -0.25 D (slight myopia) in the dominant eye, and the non dominate targeted to -1.50 D or slightly more. There will always be a choice of powers, and you should ask to see it. Depending on how your predictions work it you may be able to get a lens that is just over -1.50 D. I currently measure at -1.625 D, and I think up to -1.75 D would be ok too. I would not go over -1.75 though, or you will starting to get into issues with depth perception. That said my surgeon told me that he has done monovision with up to -3.0 D in the near eye. I would not do that however. I think offsets like that are what has given full monovision a bad name.

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I use an iPhone 8+ and do not have any issues with it. In the Settings, Accessibility, Display and Text Size, I have everything turned off, including the larger text option. The only setting turned on is Auto-Brightness. If you were to come up a little short of the phone vision you want, you could use some of those options to make reading easier. I have not found it necessary though with a -1.625 close eye.

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With respect to glasses keep in mind that they can fully correct monovision to distance plano when you have monofocal lenses, for the very best night driving vision. If you have a multifocal lens with halos and spiderwebs, the glasses are not going to help get rid of them.

what a fantastic, detailed response! thank you! vivity Is not a multi focal, so I may see if that is an option for my close eye, if it can be set close enough. and, maybe mono for the Distance eys. do you know if the eyeglass correction you said was not available with multifocal, is available with Edof in one or both eyes?

The issue with eyeglass prescriptions is that they can easily correct refraction. For example if you are at -1.50 D in your near eye with monofocal IOLs, glasses can correct that along with any astigmatism to plano. The Vivity however stretches the focal point from one sharp focus point to a range of focus points. This is what reduces the contrast sensitivity and sharpness of the lens. An eyeglass lens cannot undo that EDOF effect. They can probably improve vision, but cannot completely undo the EDOF stretching of the focus point. Same with a multi focal IOL. You cannot undo the closer focus points that they have. You can just shift the overall distance vision a little, and probably improve it, but you will be left with the negative side effects of a MF lens.

The dr has said if I get Vivity, I can get distance and intermediate. The awful night driving posts have me scared, but many studies are not saying the same thing about the halo and starburst risk with vivity. not sure if that study was done at night. Are any here aware of real life results on that vs just relying on studies?

If you get Vivity set for distance (plano) I recall that in theory it improves closer vision from about 36" down to 26". That is not nearly enough to read a cell phone. To get the closer vision you want it would have to be targeted to -1.0 D. You can get the same closer vision from a monofocal if it is targeted to -1.5 D, and with lower risk of optical side effects. I was ready to do a Vivity in the near eye at -1.0 D, and the surgeon talked me out of it. I asked him what his experience was with Vivity and he said he had another patient with similar expectations to me that got a Vivity, and was not happy with the outcome. He said I was likely to not be happy with it, given my expectations, and I dropped it from consideration. I got the feeling he did not want to risk having another unhappy patient. He was quite OK however with doing a monofocal targeted to -1.5 D. There was an extra $2,200 in it to do the Vivity, but he recommended against it.

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What I have seen for documentation on the Vivity is that halos are more common and somewhat larger. I think there are some threads here that have posts on what people are reporting. You will see a whole range of opinion to it being the best thing since sliced bread, to it being awful. I think it comes down to individual tolerance of the optical side effects.

@RonAKA, you have been amazing! I hope to make this my last question unti I go on for my first eye for distance a week from tomorrow. I wrote down the settings you mentioned and you mentioned that too close and I could have a depth perception issue. The first eye will be for distance and I will have time to evaluate what I want in my 2nd eye. If the far distance is suggested for -.25, mono, and my plan is for a

close mono, s there a distance too far I should be sure my Dr doesn't exceed knowing I want mini mono and the 13" distance a few weeks later?

They target the lens in diopters. I would not go further than -1.75 D for the close eye. And, to be practical it is more realistic to target a range. With your desire for closer vision, I would suggest a range of -1.5 D to -1.75 D for the near eye.

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With the distance eye the normal target is -0.25 D. Some surgeons will pick the first available step under the 0.0 plano. I would ask the surgeon how close they think they can come to plano without going over into the + side.

hi ron

i have my dominant right eye set for plano with alcon mono lens. im thinking monovision -1.5 or. vivity at about -.75

sounds like monvision better option with less cs. halos etc. but vivity has better focus range

The potential advantage of the Vivity is that gives you better distance vision out of that eye, as you would only set it at -0.75 D. But, to give the same near vision as a monofocal at -1.50 D, you would have to target the Vivity at -1.0 D, so would give up a little of that distance vision. At the peak vision point the Vivity will not give quite the same visual acuity as the monofocal, and the risk of optical side effects is a little higher. I considered the Vivity in my near eye but with the advice of my surgeon settled on a monofocal which has ended up at about -1.6 D.