Alcon Clareon IOL review (said no to Vivity but still got similar result)
Posted , 21 users are following.
I got a lot of good info out of this sight when researching IOL implants for cataract surgery and wanted to offer my experience so others might benefit. I'm adding some lifestyle info as well so it can give some perspective to why I chose what I did. It's a real struggle to determine if the drawbacks of the premium IOLs are really worth the risk. So here's some background.
I'm a 55 year old male. Have been wearing contacts since I was 12 years old for being nearsighted. The correction was always the same in both eyes, starting out not so bad but has been in the -4.25 range for the better part of 30 years. I had EXTREMELY good closeup vision without contacts/glasses. I also had what I would call EXTREMELY good corrected vision. 20/15 if I kept my contacts fresh and clean. At age 48 if I wanted to see something up close while also wearing contacts I began to need readers. Otherwise, I was pretty happy with my corrected vision. I considered lasik when I was younger but just never got there. I like to hike, cycle, shoot sporting clays, build furniture, maintain my own home and autos. Vacations are typically trips to see natural wonders, so color, clarity, and contrast are extremely important to me....even though 90% of what I do is considered in the up-close to intermediate range.
I developed a cataract in my left eye in late 2021. Literally went to bed seeing just fine and woke up the next morning with considerable blurring. The right eye was just fine. In January of this year I needed some retinal repair work done in both eyes with a laser by a retinal specialist. Once that process was complete I was cleared to go get cataract surgery. I agonized over my options. The cataract was aggressive and by late April my left eye was little more than a garnish on my face. My initial consult was 4/11 and I could have literally had surgery the next day if I'd wanted, but I scheduled it a month out to give myself time to fully grasp my options and their potential downsides. Since it was my eyesight, money wasn't even a factor. Vivity really stood out and seemed to be the best option since I was already wearing contacts that corrected some for presbyopia. But there was that nagging loss of contrast issue with Vivity that I couldn't wrap my arms around. I relaxed, took a vacation, took inventory of just how much up close/intermediate vision I engaged in. (a lot) I waffled at least 3 times before finally coming to the conclusion that I'd have to kick my own backside if I went with anything other than whatever gave me the best color, clarity, and contrast even if it means I have to wear readers for that 90% up close things I do. So I confidently went with the Alcon set for distance vision and made sure it was the Clareon version.
So on 5/11 I got that left eye done and had 20/20 vision before 8hrs had passed. I also took note that I had pretty decent intermediate and functional close up vision, but up close was a little more comfortable with 1.25 readers (looking at my phone or reading a book). I went for a walk that afternoon and there was an unexpected depth perception issue between my right eye and my newly clear left even though both could see clearly. It felt as though judging rough terrain or throwing a ball could be more challenging that I was used to. Also, being able to compare, I realized my right eye was a little subpar compared to the newly fixed left. I went for a drive when the sun went down and there were no halos or starbursts. I could also see the dash just fine. The only thing I noticed apart from my natural lens was during the day, a little flickering at certain angles when light was coming from the side during eye movement.
The doctors office called to check on me and based on my progress, offered to do the right eye as early as 2 days later. At that point I needed no convincing. 5/13, just like the previous surgery, within 8 hours I could see 20/20. The depth perception issue was also gone. I'm typing this with my naked eyes and can see just fine. Even though I was formerly wearing presbyopia correcting contact lenses I need readers less now than I did with those, really only in low light. I'm really super happy with my decision. I have great color, clarity, and contrast and I basically have what was promised with Vivity without the risk of contrast loss. But truthfully, even if I had to wear readers for all things intermediate and closeup, I wouldn't complain one bit. Glad I took the time to settle in my heart what was important and didn't knee-jerk react to what seemed best to me in the beginning.
3 likes, 80 replies
kip33412
Edited
Something I failed to mention that might be important to others... I went strictly binocular vision with these. (both are -13.5D). I love the idea of mono-vision....and even attempted it with contact lenses for a time. While I'm tempted to call that an "old dog new tricks" issue, when I really think about it I've always been really picky about both eyes seeing equally well at distance.
On another note, during the time between the formation of the cataract and the surgery, I learned something about how my brain works with regard to eyesight. I've always been right eye dominant, however, I noticed when my right eye gets even the slightest bit dry or a bit blurry because I need to blink, my brain will instantly switch to my left eye regardless of whether the left eye can see clearly or not. (Even if I'm wearing an eye patch over it) Which explains why a few of those sporting clays got away on occasion even though I knew I was on target.
RonAKA kip33412
Posted
It sounds like you had a very good outcome. I also got reasonably good closer vision with a monofocal set for distance. There seems to be a considerable variation in what people get for intermediate vision. My distance eye is perfect for reading the dash in my car or truck, but focus starts to suffer at about 18" or so. I could read a computer monitor but it would be a struggle. And reading my iPhone would not be possible with my distance eye.
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One article I read suggested that those who are myopic (long eye) prior to surgery and have smaller pupil tend to get better closer vision with a monofocal.
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I did go with monovision and with astigmatism I am at about -1.5 in my left eye. This had let be be essentially eyeglasses and contacts free since I had the surgery on my second eye back in February. No regrets but I am looking at the possibility of a touch up in the close eye with Lasik to deal with the astigmatism. Not sure I will actually go ahead with that though.
kip33412 RonAKA
Edited
The fix seems easy enough for the astigmatism and you have more than one option and a clear path forward (I read your other post). Your chances seem really high to be able to get to where you want to be. I appreciate all the contributions you've made to the cataract thread over time. Was nice to see someone else's research and conclusions came very close to my own.
On another note....I just got back from my 1 week checkup. (even though one eye is only 5 days in) I could see the 2015 line all day with both eyes. I could easily make out 3 of the 5 letters on the 2010 line and could see one of them well enough to solidly guess it was an E, the last one "S" looked like a dot. So I'm declaring my eyesight at 2012 😃
The presbyopia test yielded easy 2050 but could read most the words on the 2040 line. 1.25 readers makes the closeup golden until about 7 inches from my face. My computer monitors are positioned about 24" from my face and I don't require any reading glasses for them. Starts to blur up at 20" and closing.
lucy24197 kip33412
Posted
Interesting that your IOLs are both -13.5D for binocular vision. My target for my first eye was -0.5, and second was -1.75 for mini-monovision. My first eye got a -22D lens, so when I was in the OR for the second eye and the doc told the nurse he was going to use a -22D lens, I piped up to see if they were sure about that. I ended up with my minimonovision, and the doc pretty much nailed the targets.
RonAKA lucy24197
Edited
The power of the IOL needed mainly depends on the correction your eye needs prior to cataract surgery. An IOL power of about +19.0 is used if you have plano 20/20 vision prior to surgery. There is no - power IOLs. They range from a minimum of about +5.0 to as much as +30. A power less than +19 is used if you were myopic prior, and one more than +19 if you were hyperopic prior to surgery. left and right eyes tend to be about the same, but they most like differ by some degree. Monovision is accomplished by targeting less than plano, ideally in the non dominant eye.
Guest RonAKA
Posted
Ya my eyes differ from each other by 0.17D. Almost a quarter diopter. It brings up an interesting question if I decide to do an offset after the first eye is done (-0.21 target). Do I choose first minus again in the second eye (-0.38) or second minus (-0.88). I guess it completely depends on how the first eye goes… where we land and how good or bad my vision is inside that critical 3 range. If I luck out and see pretty good close up I'll probably stick with first minus. If not, I'll end up with a .67 offset, which could work quite well actually. We'll see!
Myope_PSC Guest
Posted
Most IOL's seem to come in 0.5 D steps but does the refraction result follow those 0.5D steps? On the few biometry printouts that I've seen online it looks to me that the resulting refraction prediction is in steps of 0.33D to 0.35D for Tecnis at least (for the ones I've seen). Anyone know for sure?
RonAKA Guest
Posted
Reading vision depends on the absolute amount of myopia you have in the eye for closer vision. The difference between the two eyes is somewhat irrelevant. IOLs come in 0.5 D steps measured at the lens plane. This works out to about 0.35 D steps at the cornea plane. Your surgeon should be able to show you the available steps in cornea plane outcomes.
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Since your eyes are so close together in power your surgeon should learn a lot with your first eye and be more accurate on your second eye. For that reason I would wait 6 weeks between eyes to see what you really got on your first eye. If you are attempting monovision the closer eye is the one you want to be most accurate with and would be best done second of the two eyes.
RonAKA Myope_PSC
Posted
Yes, based on the outcome steps presented to me based on the IOL power calculation I would say 0.35 D at the cornea plane is what you get with 0.5 D lens plane steps. The surgeon should be able to give you the outcome steps for each IOL power choice.
Guest RonAKA
Edited
Yes the plan is to wait 6 weeks between surgeries. He is on board with that. My point is simply that my eyes are not the same. One eye is 0.17D stronger according to the IOL Master predictions. So even if we targeted "plano" in both eyes (first minus) one eye would theoretically be a smidgen stronger. We'll see. Can't really draw any conclusions until the first surgery is done. And yes we are doing the dominant eye first.
RonAKA Guest
Posted
Unfortunately the differences you are talking about are much less than the probable error you will get between what is targeted and what you actually get. The results for my wife and myself all ended up being more hyperopic than expected. That was good for my wife and my first eye. Target was slight myopia and we ended up at 0.00 D sphere. But with my second eye which was to be my close eye, this extra bit of hyperopia beyond the target was not so helpful. I'm still myopic but not quite as much as I wanted.
Guest RonAKA
Edited
Yes I'm aware… hence "theoretically". The +/- 0.5 margin of error makes me very nervous. I'd actually feel more comfortable doing the left eye for distance with it's -0.38 prediction (almost no chance of overshooting) vs. the right eye with it's -0.21 prediction. But the right eye is my dominant eye. And I don't think my doctor would agree to shooting for the next minus in that eye for distance (-0.55). Hopefully we nail it. Very worried about overshooting. I won't be happy if I end up +0.25. Hoping for the best! If we so nail it though the distance vision in that eye should be fantastic.
RonAKA Guest
Edited
Yes it is a bit of a crap shoot. My first eye was my right one and I recall had the same predicted outcome as you; -0.38, and my wife's eye was similar in prediction. We both came out as 0.00 D. My left eye was targeted to -1.25 and it came out as -1.00 or -1.25 depending on the optometrist... The other option we looked at for the left eye was -1.60, and now I wish I would have taken that option. I could have had Lasik for astigmatism only and been essentially right on the -1.50 D sphere that I wanted.
Spring1951 RonAKA
Posted
What distance vision are you getting in your near eye set for 1.4D?
RonAKA Spring1951
Posted
I would estimate it at 20/40 to 20/50. Probably not quite legal to drive here in Canada, if it was my only eye. But, with both eyes I have 20/20, so no problem.
Spring1951 RonAKA
Posted
That is what I have now and don't need them for driving but will wear them as it is mandated by law.
Just lost my night driving license privilege but that would probably improve with surgery.
RonAKA Spring1951
Posted
Keep in mind when your have two eyes set for different distances, with both eyes open you have as a minimum the vision of the best eye. The other eye may help, but will never hurt the combined vision.
Spring1951 RonAKA
Posted
Very interesting!
Spring1951 RonAKA
Posted
I was re-reading these posts again since I am probably going with Clareon and likely the intermediate focal point but will know next week. Since I could not test monovision with contacts, I wonder if it would be wise to vary the intermediate focal point between the two eyes without testing them first with contacts?
My doctor had said she could do the variance but I didn't get much info. on it and will talk with her again next Tuesday......Do you think there would be an issue in choosing the focal point for the L eye at 1.5D and the R eye at 1.25D to .75?
That way I would get better distance vision and still have the intermediate and close up good vision. I also have astigmatism but doctor won't offer torics as she said it is not enough. The intermediate focal point was recommended by my doctor because of AMD but I will get more complete info. on that next week since her brief explanation was not clear.
RonAKA Spring1951
Posted
Yes I think you could ask for a split in the correction for each eye. With the numbers you suggest you are likely to get pretty good close to intermediate vision. You are likely to come up short of good distance vision, but it sounds like you are used to that already.
rhett20790 RonAKA
Posted
hi Ron whats yr focus range with left eye ?
RonAKA rhett20790
Posted
My left eye has ended up at -1.25 D sphere and -0.75 D cylinder for a total spherical equivalent of about -1.60 D. I can read a computer screen down to about 8-10" or so. I have no problem with my iPhone 8+, or in reading most text documents as long as I have enough light. In very poor light or with 4 point text I resort to some +1.25 readers. On the distance end I can see a large screen HD TV at 8-10 feet quite well, but not as crisply as with my other eye which is set for distance. I was fortunate enough with my distance eye to have vision down to 18-20" so I can easily read my car dash, and if I back up far enough can also read a computer monitor. iPhone is a no go with the distance eye though.