Alcon Acrysoft impla.nted some years ago

Thanks very much all of you, this is very helpful information.

It is being so difficult for me to decide. I live in Spain and the Clareon Vivity is not available here. I was offered 3 options by different doctors. Vivity Acrysoft, AST Asqelio Edof (of which I could not find any clinical results , only the commercial paper from the lab), and Eyhance.

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Vivity anf AST Aqelio edof are Edof which will allow me to see at 66 cms. Eyhance is monofocal plus and will allow me to see at 100 cms.

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I really don't want to use glasses all the time. I am 50 years old. I have one lazy eye (80% vision) and I don't have binocular vision, this is why I am not a candidate for trifocal.

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So I doubt between the 2 edof (one with potential glistenings, the other one very new with no info), and the monofocal that will force me to use glasses quite a lot....

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Also, due to lazy eye, I can not do mono vision, maximum 0,5D.

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And, I am also a bit concerned about the contrast sensitivity, that could be lower with the Edof.

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Please, it would be very helpful to have your opinion. Thanks very much!!

There is not a huge difference between the Vivity and Eyhance. The Vivity adds about 0.5 D of extended depth of focus, so it technically qualifies as an EDOF as the minimum requirement is 0.5 D. The Eyhance adds about 0.35 D of extra depth, so it falls just slightly short. If the surgeon targets 0.25 D more myopia with it, it will likely give the same range of closer vision or perhaps a bit more. The risk of optical side effects will be lower with the Eyhance compared to the Vivity.

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I would also suggest there may be other more important differences between lenses to consider. For example most Alcon lenses have blue light filtering which gives a more natural colour spectrum than the J&J lenses which are typically clear. The J&J ones however offer a brighter image. There is also some research which shows that the Alcon material is more resistant to PCO than the J&J material. However, J&J may have improved their edge design so that difference may no longer be significant. Clareon claims their edge design has been improved over the AcrySof.

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When I got my second lens in Canada earlier this year the VIVITY or even toric monofocals were not available in the Clareon material. However, I expect they are coming and the only real issue is the logistics of distribution. It takes some time to move the new stock into the pipeline.

This Dr. Krad does not seem to consider that the AcrySoft material has been improved very significantly over the years. He make a big deal about the material developing glistenings over a long period of time -- like 10-15 years or more. What he does not consider is that if a person has lenses in their eyes for 10-15 years that lens is what was being made over 10-15 years ago, not what is being made today.

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I do agree that if you have a choice then the Clareon is a better risk choice. I paid an extra $300 to get a Clareon over an AcrySof. However, to be very frank the main reason I picked the Clareon is that in our public healthcare environment, the AcrySof IQ (which is free) would have required a year or so wait to get into a hospital to have it done. I got the Clareon in a private clinic in 3 weeks. My wife got AcrySof IQ Torics in both eyes and waiting for a Clareon was not even a consideration. She needed an improvement in vision, and there was no point waiting for the Clareon. Sure we would have gotten it, if it was available, but it was not. There are more important things to think about.

if you have lazy eye then i would go with monofocal probably set it at -1. and have the lazy eye set at plano and then use reading glasses.

my 16 year old daughter has amblyopia. undiagnosed until age 10 so it has gotten better only so much. her normal eye is -1 but she does not correct it. wears +5 contact lens on the lazy eye. the lazy eye helps with distance vision and near vision is good with both eyes.

acrysof panoptix has been in the US for only 3 years and i have had a long conversation with safran about having to explant those for glistening. so the glistening has been happening in recent acrysof lenses.. it is bothering to some and not so much to others.

search for plos one timur yildirim. it is an interesting read on the topic.

My wife also has a lazy eye issue with essentially no vision in that eye. The surgeon thought there would be some hope with a maximum power toric and a lens for very high myopia. This eye was done first with no significant improvement. On the second eye which will be the only vision eye we wanted to be sure the vision was good. For that reason the Vivity and PanOptix was discounted. She went with an AcrySof IQ Toric, and got an excellent outcome. She uses readers for close work, and occasionally her prescription progressives.

I discussed the issue of glistenings with the surgeon I went to. He said in his practice that he has seen glistenings in lenses but the issue has never required an explant. He offered me a Tecnis 1 instead of the AcrySof IQ but I went with the AcrySof IQ anyway. I was sold on the blue light filtering and potential lower risk of PCO. With a AcrySof in one eye and Clareon in the other, I can attest so far there is no difference in clarity with the AcrySof being 2 years old now.

Yes, Timur Yildirim has done a lot of research on glistenings. This article convinced me that quality control improvements have significantly reduced the impact of the issue.

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David J Apple Laboratory Glistening through the years Timur Yildirim

i am scheduled for surgery in 12 days. preference is clareon panoptix. i am worried about glistening even in clareon. as a myopic all my life i wonder if -1 both eyes tecnis monofocal is the way for me.

PanOptix and Synergy probably have the highest risk of optical side effects like flare, halos, spider webs, and somewhat reduced contrast sensitivity at night. From what I read here, Synergy probably provides better reading while PanOptix gives better distance and may need readers for small print in dimer light. But results seem to very widely with some being very happy and others not so much.

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I can't say I am a fan of the -1.0 in both eyes solution. Peak visual acuity is going to be at 1 meter. I guess if you have some particular activity at that distance where you want optimum vision then perhaps it would make sense. In golf for example it would provide excellent vision in seeing the ball on the tee. However when searching for your target or seeing your ball after you hit it then it is not going to be ideal. You may even have difficulty reading the print on the ball close up. I guess if you use a very large screen TV type monitor and sit well back, it could be OK for computer work. I think it is kind of a half pregnant solution. Distance is not going to be good, and reading not great either unless you use reading glasses.

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I am very happy with mini-monovision, and I still think if one wants to avoid the optical side effect risk of the MF PanOptix or Synergy, then it is the cleanest and simplest way to get eyeglasses free (95% of the time). And I am not sure it is enhanced significantly with an EDOF lens, although a case could be made for an EDOF in the close eye only. I was very close to doing that with a Vivity but the surgeon talked me out of it. He basically said with my high expectations for vision I may be disappointed. In any case I didn't do it, so I will never know. All considered I think monofocals with a -0.25 D target in the distance eye, and a -1.5 D target in the near eye is the way to go. Ideally the distance eye should be done first to verify you have achieved your distance vision goals, and then do the close eye 6+ weeks later. With monofocal IOL lenses there are no complications to using prescription progressives to achieve perfect vision in both eyes for those situations where it may be of use. There almost always will be residual error that can be corrected for the ultimate best vision.

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As far as for lens choices I don't think enough attention is paid to asphericity. Different lenses have different targets for asphericity and manufacturers have different philosophies as to what amount is best. The Tecnis 1 targets 0.0 residual asphericity. The Clareon targets 0.07 residual, and the B+L enVista targets 0.27 (neutral correction). J&J claim zero asphericity is best, while Alcon has studies which found those with about -0.1 is best, while B+L maintains that there are other factors to consider and if the eyes are less than perfect then some positive asphericity makes the lens more tolerant to being off center. The enVista also claims to have a deeper depth of focus than the J&J and Alcon monofocals. With my AcrySof IQ distance eye which ended up at 0.0 sphere and -0.5 D cylinder I get 20/20+ vision without glasses. I can read about half the 20/15 line. My brother recently got the enVista which ended up at +0.25 sphere, and -0.5 D cylinder (SE of 0.0). He says he has tested twice at 20/15. So it seems you can get excellent visual acuity results even with +0.27 asphericity, while having a lens that is more tolerant and with more depth of focus. I have not done a lot of research on the enVista but I believe they claim lower glistenings than Clareon and also claim low PCO rates. I find it interesting that the Tecnis 1 and AcrySof IQ/Clareon are so popular, but the province of Manitoba has selected the B+L enVista as their basic monofocal that they get at no cost in the public healthcare system. You can find more information on it by googling "envista simplifeye brochure B+L pdf". The issue may be that since this lens is less popular it may be harder to find surgeons that are using it.

soks, how myopic are you? I agree with Ron that -1 in both eyes is neither fish nor fowl. You won't see perfectly at distance, and you won't have the close-up vision you're used to. How important is the latter to you?

-2 in both eyes prior to cataract. close up vision is extremely important.

fours doctors i saw and none are offering synergy anymore.

spider webs, halos and flares i have them all. spider webs and halos are not a big deal for me. flare is a function of pupil expanding beyond iol. i can manage it with alphagan. contrast loss is real and a bit debilitating. especially when driving on non-lighted streets.

rationale for -1 is that at -1 i didnt really need glasses. i started wearing glasses in eight grade just to look cool. i am mostly a home body and i am assuming that indoors i wouldnt need glasses with -1. secondly monofocal provides best resolution and if i dont like -1 i will just use distance glasses when driving or going out and near glasses for close up .

i do realize that speaking with certainty is risky when it comes to iol.

-2.0 is very close to what I was before surgery. In my younger years I was more in the range of -4.0. While I had terrible distance vision without glasses, for very close detailed vision all I had to do was take my glasses off, and did that often. However for reasons I don't understand my myopia decreased as I got older. It got to the point I commented to the optometrist that I had better close vision with my progressive glasses with a +2.5 add than I got by just taking my glasses off. Perhaps for that reason I don't really miss the take the glasses off to see close effect. I am much more happy with not having to wear glasses at all, and very occasionally needing readers, or progressives. For driving unless it is very dark in the country, I prefer no glasses. I get better straight ahead vision with progressives, but I lose the peripheral vision that one needs for driving, especially in the city.

If you do -1, you're going to need glasses for close vision (as well as far distance). But if you want the same kind of vision you had before cataracts, but without glasses, then you have a couple of choices:

1. Do both eyes with -2 monofocals. That's what your brain is used to. Then you'll need glasses for TV, driving, and being outside in general, but not (at least in my experience) for reading, computer, or most household tasks.
2. Do one eye at -2 and the other at something less than that to do mini-monovision. That will still give you the close vision you're used to, but also more intermediate vision and less time in glasses.

Ron's mini-monovision suggestion (-.25 and -1.5) can work really well as long as you don't mind giving up your really close vision. You might need to wear glasses for reading, computer, etc., depending on how things turn out.

Like Ron, I'm really leery of multifocals(my surgeon won't implant them.) His advice above is very sound: "With monofocal IOL lenses there are no complications to using prescription progressives to achieve perfect vision in both eyes for those situations where it may be of use." So no matter the outcome, you'd have correctable vision. That isn't always the case with multifocals.

In the end, you have to figure out what's most important to you, clarity of vision or time without glasses. If you don't mind wearing glasses, then monofocals in some configuration would seem to be the way to go, giving you the sharpest vision with the fewest artifacts.