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
Guest kip33412
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Great result. Just goes to show that your mileage may vary… a lot. For all the research we do you just never know. I certainly don't think one should go into surgery expecting to get any near vision with a monofocal set for distance but… you never know! My Dad was the same. He got monofocals both set for distance and his near vision is great. So many variables.
kip33412 Guest
Posted
True. Your Dad and I are fortunate. For those inevitable occasions when I'm out running around, cycling, hiking, or needing to read a label in a store and just can't make something out I wear a necklace with a monocle around my neck tucked in my shirt.
Guest kip33412
Posted
A monocle eh? Hmm. That's actually kind of badass! I love it. LOL.
john20510 kip33412
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are you saying you got both eyes monofocal set for disatance and still have some good nearer vision without the contrast loss you would have had if you went with vivity.were both eyes distance or was one adjusted to intermediate sort of mini monovision? lm in the situation where l am having sugery in a few months and still deciding to go with vivity or monofocal, if l have both eyes set for distance monofocal will l still have arms lenght , or dashboard reading ability
kip33412 john20510
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Yes, I got both eyes set for distance with the monofocal lenses. No mini-monovision. Only had the one cataract so I was able to compare my natural corrected vision with the IOL corrected vision. I would go as far as to say I gained contrast with the IOL . (perhaps not if I were 25 years old, however) Color was spot on.
By decent near vision I mean I can get by without glasses when reading text or email on my phone, well lit menu, or book. It's not what I would call clear, but I can read it in most cases. If asked to look at a photo or video I would opt to see it with reading glasses. 1.25 reading glasses makes it all perfectly clear...text and photo/video.
There's very little chance you will know what your outcome will be. As Ron says above, he read an article indicating "that those who are myopic (long eye) prior to surgery and have smaller pupil tend to get better closer vision with a monofocal." This actually describes my situation. I also had read something along those same lines but went into it knowing my outcome wasn't defined.
My ophthalmologist was blown away by my results, but from what I've gathered they aren't typical. (I'm chalking it up to my wife's prayers for me before each surgery.)
I couldn't get anyone to tell me how much of a loss of contrast I was going to experience or what that would even look like. But Alcon's own literature says it is significant. I know it has to be perfectly centered or your vision will be terrible. Those were the two biggest concerns I had. There seemed to be very few issues with the monovision....and based on that I'd made up my mind.....then my wife's ophthalmologist threw a wrench in the machine by saying he wouldn't hesitate to get them. So off I went on the Vivity wagon again for awhile.
I know I said a lot in these posts....trying to help people come to a decision just like I was 2 weeks ago. In doing so I likely muddied my message so I'll break down what I was trying to get across. Each one is a roll of the dice in that your outcome isn't set and it may require more correction before you reach your goal. Having said that:
Just relax and figure out what is most important to you. There isn't a choice that gives you it all. But there are choices that give you what's most important to you.
Sue.An2 john20510
Posted
Hi John20510 - it is really an unknown and a prediction cannot be made as to who will end up with better intermediate and functional near vision. It is super if you get that. I often wondered if I would have if I had chosen monofocals vs Symfony
I think kip3314 mafe his decision based on best clarity and least contrast loss and wanted both eyes equal ( no monovision). And got a bonus.
Important to narrow your decision to what the iol does deliver to fit your lifestyle and criteria.. If you get more it's all gravy.
RonAKA john20510
Posted
From your other posts I can see that you are having a hard time deciding between a monofocal and a Vivity. I really think you should take the time to google "Vivity Package Insert PDF" and look at that document. It not only has the data on the Vivity but also how it compares to the monofocal. Based on the defocus curves in that document the monofocal give good vision down to 3 feet (1 meter), and the Vivity down to 2 feet (.66 meter). However that is an average. Some people like @kip33412 and myself get better than that, while I expect others would get worse.
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The other thing you can find in that document is the comparison of contrast sensitivity or MTF. What you will see is that at distance (0 defocus) the monofocal is significantly better than the Vivity. However as your viewing distance gets closer the monofocal and Vivity become about equal for MTF at the 0.5 defocus position (1 meter divided by 0.5 = 2 meters or about 6 feet). Closer than that the Vivity has superior contrast sensitivity or higher MTF. Many think that the Vivity compromises contrast sensitivity at all distance. It doesn't, and is significantly superior to a monofocal at close distances.
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I think I have given you this advice before, but given your objectives I would consider this approach. Think about the surgery as a two step process. First identify your dominant eye, and have it done with a monofocal like the Clareon set for full distance. Then wait for 6 weeks to see what you get for distance and intermediate vision, before you decide on the second eye. If you get lucky like @kip33412 and myself and are happy with your intermediate vision, then get the Clareon again in your second eye. If you do not get enough close vision, then get a Vivity in the second eye. The upside of having the Vivity in the non dominant eye is that contrast sensitivity will actually be higher at closer distances.
Guest RonAKA
Edited
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True. But Vivity is designed for glasses-free intermediate / functional near. Monofocals are not. Vivity spreads the light out across a greater range of focus (as you know). So of course Vivity has more light (better contrast) at intermediate / near without glasses (by definition… as an EDOF). But few people use Monofocals in intermediate / near without glasses. In other words a monofocal with glasses outperforms a Vivity without glasses (for intermediate / near).
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I think what it may boil down to in the real world is Vivity has enough contrast for most situations but might struggle with distance viewing (driving or indoor sports) in low light / low vis conditions (as the patient info sheet warns). And there's not much you can do about that (maybe put a light bar on your Honda Civic… LOL). It also might struggle with near viewing in low light (menu in a dark restaurant) but that's easily solved with a light or readers… same as a Monofocal but there's a much better chance your will not need to do that with Vivity.
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As someone that is heavily involved with backcountry activities (often at night in very thick woods) such as camping and overnight search and rescue operations, that was a concern for me with Vivity. I want to retain the best possible long distance night vision.
RonAKA Guest
Posted
I believe the large majority of people that get monofocals set for distance (like my wife) do not use glasses most of the time. They go eyeglasses free and when necessary wear over the counter reading glasses to see close. Close usually means 2 feet or less, or more practically when they can't read something. In other words they are seeing with less contrast sensitivity than someone with a Vivity from 2 feet to 6 feet most of the time, while thinking that they have better contrast sensitivity. They don't.
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My thoughts remain that the best way to take advantage of the Vivity lens is to only use it in your non dominant eye, while using a monofocal set for distance in the dominant eye. Then you get the best of both worlds - closer vision with higher contrast sensitivity as well as better distance vision with higher contrast sensitivity.
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I would have gone with Vivity in my closer vision eye, but there were complications for me. I have irregular astigmatism to deal with, and I had higher expectations for close vision than Vivity could deliver without an offset. Because of this I could not get the support of my surgeon.
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But it seems to me that for someone going for both lenses targeted for full distance, it makes a lot more sense going with only the Vivity in the non dominant eye. That is better than a Vivity targeted for distance in both eyes.
Guest RonAKA
Posted
My point is simply that of course Vivity has more light (contrast) at intermediate / near… that's what it was designed to do. Monofocals even don't try to do that so I'm not sure its a fair comparison. Vivity still has less contrast overall at any focus point with or without glasses. But it gives you more independence from glasses. So ya. Not an easy decision. It's too bad there's no way to "try before you buy".
RonAKA Guest
Posted
"Vivity still has less contrast overall at any focus point"
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That seems to contradict your point that "Vivity has more light (contrast) at intermediate/near".
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The MTF curve indicates to me that at less than 6 feet the Vivity has the most contrast sensitivity, while further than 6 feet the monofocal is best. That is why I think a Vivity in one eye and monofocal in the other is the best of both worlds. It is better than a monofocal in both eyes, and better than a Vivity in both eyes. This is with all lenses set for distance. There are other options of course with monovision.
Guest RonAKA
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Yup I understand your point. It's a good point too that although a monofocal with glasses will outperform Vivity (in terms of contrast, image quality, etc.), most people don't wear glasses (progressives) regularly after surgery.
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As for the "contradiction", I mean that even at it's peak focus (which is what I meant by "at any focus point") Vivity underperforms a Monofocal (at peak focus). It's light is spread out so even at it's best it can't match the image quality of a Monofocal.
RonAKA Guest
Posted
Understand now. I agree. But the real life issue is that we are not able to always view the world at the peak focus point.
Guest RonAKA
Edited
Which is exactly why I have struggled so much with the decision. Yes I could wear plano progressives with monofocal IOLs… but if my eyesight is great most of the day (3 foot+) will I want to do that? I don't know.
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Regardless I'm sticking with my Eyhance plan. I'm a perfectionist and worried about any potential image quality compromise with Vivity (even if it's only in certain specific scenarios).
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My surgeon is willing to offset the second Eyhance eye if the functional / lifestyle vision in the first (-0.2 target according to IOL Master) isn't great. I won't need much. I'd simply like to be able to make out my watch and phone well enough for quick glances. Otherwise I won't mind readers. Or plano progressives.
RonAKA Guest
Posted
My wife only has vision in one eye. She got a toric monofocal IOL and is 0.0 D sphere, and 0.5 D cylinder in the good eye. I've mentioned to her a number of times that she should get some progressives, but she won't do it. She had pretty good distance vision before cataracts and while she had progressives she essentially would not wear them. This said she now has dozens of OTC readers stashed in every room of the house, and in the vehicles, and soon I expect our travel trailer too!
kip33412 Guest
Edited
My optometrist was aware that I'm an engineer. She warned me that since many engineers are perfectionists (at least about certain things) they tend to be less satisfied with premium lenses. She said hands down my "best possible vision" would come from monofocals + readers, but if I was willing to give up some of that perfection I could get by with much less dependency upon glasses.
She also said she wouldn't recommend Vivity to her own husband, who is an engineer/perfectionist.
kip33412 RonAKA
Posted
In response to your comment "The other thing you can find in that document is the comparison of contrast sensitivity or MTF. What you will see is that at distance (0 defocus) the monofocal is significantly better than the Vivity. However as your viewing distance gets closer the monofocal and Vivity become about equal for MTF at the 0.5 defocus position (1 meter divided by 0.5 = 2 meters or about 6 feet). Closer than that the Vivity has superior contrast sensitivity or higher MTF. Many think that the Vivity compromises contrast sensitivity at all distance. It doesn't, and is significantly superior to a monofocal at close distances."
I wanted to point out that I agree this is true as long as we are talking about vision with the "naked eye", (meaning IOL correction only)
It is my understanding that once readers are thrown in, the contrast will become again superior in the monofocal IOL eye, (at least directly within the focal point created by the readers)
Unless I missed something.
RonAKA kip33412
Posted
Yes, that is true. I never think of it as I essentially don't use readers. The same would apply to those using progressives. Based on my wife's habits it appears to me that those with monofocals resist putting on readers and only put them on when they simply can't read something. The Vivity would give improved contrast sensitivity for those times when you are pushing it to read without readers.
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I was close to getting Vivity in my second eye, but the surgeon did not encourage me, as I think he classed me as a perfectionist too. I am also an engineer...
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I suspect the Vivity would have been fine for me, providing I got an offset of -1.0 D. I would probably be not happy at all with no offset.
kip33412 RonAKA
Posted
Your behavioral observations are spot on. We all attempt to get by without them. LOL. Thank the Lord for that monocle I carry around on a chain under my shirt. I've actually used that for several years.
On another note, I actually just got back from speaking with my optometrist. I told her I was on a thread for people discussing satisfaction with premium IOLs vs monofocal and asked her to speak to that. She went into further depth based on her experience.
Her job is to manage expectations. She knows that anyone who has gotten used to progressive lenses has already learned to give up something to gain something, so they tend to be just fine with the drawbacks of the premium options. She specifically pointed out that my better-than-2015 distance vision would NOT have been obtainable with either the Panoptic or the Vivity lens. She also said that I would have definately noticed the degradation of contrast in lower light and dark situations. She's really happy with the premiums being part of the lineup for her patients, but she also knows anyone used to excellent corrected vision or someone who expects to get back to excellent vision may not be as happy with the premium choice outcomes.
Honestly she eluded to or just flat said these things before, however, my mind only heard what it wanted to as I was still holding out hope that I could somehow justify taking the chance. She's absolutely right though...lots of folks love the premiums and are happy with them. If you're expectations are so that you can live with the trade-offs, then you live in a great time for that. If you demand the best possible vision you really want to give it some thought.
john20510 Guest
Posted
Is the contrast issue with vivity only something that applies to low light situations such as dusk and dawn ? Would the image quality and contrast of vivity in a normal light situation be pity similar to a monofocal??
Guest john20510
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Yes my understanding is that it's only really a potential issue in low light / low visibility scenarios. In normal lighting Vivity image quality (especially for distance) should be similar to a monofocal. Not exactly 100% the same but still very good. That's it's big selling point / innovation really… distance vision similar to monofocal but with more functional range and a dysphotopsia profile (halos and such) similar to monofocal.
john20510 Guest
Posted
thats good to hear, l am getting a vivity in one eye in August. If l am in normal light watching TV or outdoors looking at a nice view l dont want it to look low contrast.
lucy24197 john20510
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Hi john2050,
I have monofocals set for mini-monovision, and wanted to give you another result as a data point. My distance eye is at -0.5D, my near at -1.75D--much more nearsighted that some others have their targets. With my distance eye, I can make out the largest line on a Jaeger chart at around 3 feet (I think it's J-11.) Not read clearly; it's very blurry, but I can figure it out. With my near eye I can make out the J-1 line as close as about 16-17 inches; any closer and I can't read it. I can read the mail if I hold it out a little ways, and on good days I can make out the fine print on a pill bottle, but not well enough to trust dosages--for that I use readers. Computer work is great. For reading a book, I wear readers, although I can make do if I have to. My vision is very good for most of the work I do in the kitchen, but I have a hard time peeling the skin off garlic cloves without readers (maybe because of the low contrast combined with starting to lose focus.) I wear glasses to drive and when I read at night, otherwise there's no problem that occasionally using a magnifying glass can't fix.
Selecting targets is so very frustrating and is a very personal decision--and it's not an exact science. Since I spend most of my time in a close to intermediate vision range, I wanted to make sure that I had good vision nearer in. I'm another fussy engineer, and when I looked at defocus curves I had 2 goals: be able to function without glasses where I spend most of my time, and to try and keep the eyes within 1.5D . Yes, there are people who get fantastic results with their IOLs targeting plano, but after a career in the space program my training and inclination is to avoid risk, and I REALLY didn't want to lose acceptable (in my opinion) near vision, so I was conservative and set my distance eye target at -0.5D. It was more important to protect my near vision than to have the best distance vision, and I am so thankful that I went that route rather than hoping to get some of the great results that others have experienced. My vision isn't perfect but I'm pretty happy with how it ended up.