Appointment yesterday: thoughts and your insights appreciated

I do think -1.75 is a bit much and yes, some surgeons have a strong preference for plano while others have a strong preference for first minus… but those numbers are theoretical. Once you have an IOL Master scan done and the IOL calculation sheet for instance, if your dominant eye has predictions of +0.14 and -0.20 he would surely choose the minus power. But if the sheet said +0.04 and -0.30 he would choose the +0.04 whereas other surgeons would choose -0.30. That may just be his own bias or it could be that because you are doing monovision he wants the best chance at nailing plano in your one distance eye. And maybe he has a history of nailing his targets so he has confidence in that approach. Also I suppose you could say that when we are debating differences of a quarter diopter, we are, to some degree, splitting hairs. And the outcome can vary by as much as half a diopter above or below target anyway.

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I would insist on 5-6 weeks between the surgeries.

Attempting EDOF with monovision for $3499 out of pocket each eye? Simply use Vivity. There is possible loss of CS in either approach to extend range of vision. Chance of visual effects and problems post surgery seem similar for both, based on reports here and in the literature.

I have a theory that when they target "plano" they build in the margins to keep you from going farsighted. I could be wrong.

What was your prescription (sph and cyl)?

Do you have insurance (Medicare or other)?

For what it's worth, I had a consultation with a cataract surgeon in PA within the last year who suggested Eyhance lenses. The cost at that time in that practice and if I remember correctly was in the range of $1800. Definitely less than $2000 per eye.

I don't think I can tell you anything you don't already know. They are your eyes, and your goals are the ones that matter. You should consider the doctor's advice, and then inform him what you want for lenses, timing, and refraction. If the doctor is uncooperative or too expensive, he's probably not the best one for you.

Regarding Eyhance, all these lenses involve tradeoffs. My impression is Eyhance differs only slightly from standard lenses in both favorable and unfavorable effects. The price seems high. I would agree with your considering Clareon or enVista. Doctors do get volume discounts on their preferred lenses, and tend to recommend or require them.

I see some issues in what you are reporting. Comments:

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1. Eyhance would not be my first choice for a monofocal but it certainly is OK. I would not pay extra for it over another monofocal. I would pick Clareon and enVista over the Ehyance.
2. Targeting -1.75 D for near is a bit much. Yes, I think it would be tolerable if you targeted a more conventional -1.50 D and there was a miss to -1.75 D. When he says plano for the distance eye that is fine if you end up there, but is risky to target exactly plano. The standard approach is to target -0.25 D to have some margin of safety from going far sighted (positive) with a miss. Not being willing to target -0.25 is a bit of a red flag.
3. A second red flag was only allowing 2 weeks between surgeries. This indicates he is not interested in what the accurate outcome of the first eye is, before he does the second eye. It indicates he will not adjust his calculation to suit your particular eyes.
4. Best practice is to do the distance eye first with a target of -0.25 D and then give it 5 weeks minimum to heal so you can get an accurate refraction of the outcome. If at that point the eye is -0.25 D then you could consider -1.75 D in the second eye and respect the guideline not to exceed 1.5 D between the eyes. And if it turns out as plano then -1.50 D as a target would be safer.
5. $3500 per eye seems way out of line from what prices are like around here. I would expect more like $1500 per eye for a monofocal. You may want to try to get a reference from B+L on who in your area uses the enVista. And the same with Alcon to find who would do a Clareon lens.

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   All in all I think I would pass on this surgeon. Ideally you want a surgeon that is doing things correctly without you having to tell them to do it correctly.

4. Best practice is to do the distance eye first with a target of -0.25 D and then give it 5 weeks minimum to heal so you can get an accurate refraction of the outcome. If at that point the eye is -0.25 D then you could consider -1.75 D in the second eye and respect the guideline not to exceed 1.5 D between the eyes. And if it turns out as plano then -1.50 D as a target would be safer.

If we are to presume doing one eye, see the result, and then do the second eye with data learned from the first, it would seem to me to better to do the near eye first. I think we agree that hitting the mark with near is less critical than hitting the mark precisely for the far eye.

I think 1.75 sounds ideal. I know you are not in agreement with that. That is good.

Sorry, I forget your particular circumstances -- are you too young for Medicare? Eyhance is considered a monofocal by Medicare and doctors can't charge extra for it . At $3,500 an eye, I'd be tempted to at least see what LAL would be in your area. There is a forum for eye surgeons only that used to be open for us peons to browse (they've since locked it down to members only), and there were some posts by surgeons who said their practice was making Eyhance their standard monofocal.

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I'm with others, from what I've read here and other resources, I wouldn't agree to a target of plano but would want the slight safety factor of targeting -.25. Refractive surprise is one of my biggest concerns.

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Your appointment sounds better than my first one. I got a "I'm God. I'll do what's best, and you'll love it" surgeon. Which is why I'm seeing another in January. Good luck to us on finding someone who suits.