Definitely an Ey(en)hance for me!
Posted , 11 users are following.
I thought I was going blind before, wearing my glasses, and even at times with my contacts; everything was so shaded and blurry. My prescription a year ago was -13 D (left eye), and -12.5 D (right eye), with about -1.0 of astigmatism. It used to be stable for the past decade at around -11.50 D (LE) and -10.25 D (RE) until at least a year ago. I went in for my bi-yearly checkup (instead of yearly thanks to Covid and OHIP ripping off optometrists in Ontario), and my optometrist couldn't figure out why I wasn't get my usual sharp distance vision with gas permeable contact lenses -- my eyes kept fluctuating a lot just in the hour I was there, so she did more tests and discovered early stages of cataracts. Because of my high myopia, these cataracts were really messing with my vision, despite being relatively early on in terms of developing. She sent me to a cataract clinic, who started the ball rolling -- as into my deep dive into the dark recesses of the world of IOLs, lol. Choices, choices, and yet more choices... yet still somewhat of a crapshoot in the end.
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I had the cataract replaced in my first eye (RE) yesterday (06-03-23) with an Eyhance IOL targeted to -1.25 D. Just prior to yesterday's surgery on the right eye, I discussed it again with the surgeon who was thinking of -1.25 to -1.50 for that eye (RE), but I told him that I didn't want to take the chance of going as high as -1.50, but was okay with -1.25 if he could hit that. He responded that the increments for this lens was .33 to .50 and that he would do his best, but it wasn't an exact science (actually felt good to hear him say that, lol). He wasn't sure until he opened the eye(s) and used the ORA scan whether or not he'd need to use a Toric lens, but which he did ending up using for my right eye. I'm scheduled to have the left eye done tomorrow (08-03-23) with another Eyhance lens, with a target of -0.50 D (see first comment).
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I was given three eye drop prescriptions to fill the week before my surgery (an antibiotic, an anti-inflammatory, and a steroid), and instructed to start the first two the day before surgery and then again the morning of the surgery -- didn't start the steroid til afterward. I'm supposed to use the antibiotic for a week, and the other two for a month after the surgery. On the day of the surgery itself, I was given a combination of drugs via IV to just relax me during the surgery (not to put me out), and they put seven types of drops in my eyes prior to surgery (antibiotics and for freezing) -- all of which I was told about, and given handouts about, weeks before the surgery itself. They had also required that I fill out a detailed list of previous medical conditions, and any prescription medications I was on. After they took me into the surgery room, they applied more drops, then the surgeon draped a protective shield over my face and upper body, and then he cut an incision in the shield over my eye and inserted some other type of protective wrap around the area. He did the insertion by hand instead of using the laser system "package" (which cost another $1100 CAD which I couldn't afford). A lot of what this laser package does was already done in the pre-op tests already. The surgeons usually do the insertion of the lens by hand anyway when cataract surgery is done in a hospital in Canada, at least, since most hospitals aren't equipped with that level of technology, so my surgeon wasn't bothered by me not paying for the extra tech.
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The surgery itself, was both weirdly cool and unnerving. They shine a bright light into the eye being operated upon (the other eye is covered by the surgical shield), and although my eye was completely frozen, I was worried that I'd be aware of the knife cutting into my eye, or the surgeon breaking up the old lens, but I wasn't aware of either. It seemed only maybe five to ten minutes before I was told to look at a red light, which was the ORA taking a scan of my opened eye, which meant the part I was worried about was already done. I'd been instructed to keep looking straight up to where the light (mostly) was, and at times I could see what looked like small shards floating above me (the broken lens??) and even after the lens must have been removed, I still had a sort of "ghost" image of the surgeon sitting beside me -- I could see his outline, but the "filler" was grey. So can we actually see something even without our eye's lens? It didn't seem to take very long before the surgeon said, "Okay, we're done, you can close your eye if you want.". I'd been told the actual surgery took about twenty minutes, and it looks like it was. When I sat up, of course I felt kinda woozy and since my pupil was huge from all of the drops they'd put in it, so the vision was blurry (completely blurry in my left eye since I wasn't wearing glasses), and they assisted me walking out to the recovery room where they went over again, what to expect, about following the rest of the eye drop schedule, what to be concerned about, and what I could and should not do for the next two weeks. I was given a pair of black sunglasses that I was told to always wear outside for the next two weeks, whether it was sunny out or not.
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I was able to walk out of the clinic about ninety minutes after I'd first entered the clinic, accompanied by my support person. Vision was of course still blurry, and my depth perception was wonky, but I could still see a lot better than when I walked in wearing my thick glasses early. Hours later after I'd gotten home, just out of interest, I put the lens of my glasses up to my left eye (-13.0 D) and opened the "new" right eye to look into the mirror at the same time, and immediately wished that I hadn't -- I almost threw up. So definitely no wearing of glasses with a lens removed for me. In general though, after the surgery yesterday, and today, there was very little discomfort in the surgery eye itself. It felt like there was maybe a tiny bit of something in the eye, but nothing that made me want to rub it, or feel that I needed to flush it out, etc -- pretty minimal. It took til this morning for the pupil to return to it's regular size (about 2mm), so my vision was a lot more stable today. I've been putting lubricating eye drops in my eye after I finish the prescription drops, so my eyes aren't feeling dry or itchy at all -- though from what I've read, that could change. I had bought a pair of non prescription (plain glass) glasses to wear around until I got used to the new eyes -- and to protect them from dust or anything else that might fly around, especially since I was told to be careful to not rub my eyes for at least three weeks, as I could dislodge the new lens). So earlier today, I cut out a piece of a Kleenex box to fit into the left lens of them, and I'm preferring that to the completely blurred vision from my left eye messing with the good vision in my right eye. Depth perception is better this way, as is looking at the computer screen or anything else.
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And oh yeah, have I mentioned yet, how amazing it feels to have the pretty much sharp, clear, vibrant vision that I'm experiencing today in at least one eye!!! I am so very happy with this lens and my current results. Although my near vision isn't quite what I had hoped for (maybe 8"), as is my distance vision (seems about 20/40 right now - was hoping for 20/30), this is only the first day after the surgery, and right now, if it even stays at what it is, I'll be as happy as can be, especially with the left eye being targeted tomorrow more towards distance. Definitely a game changer for my life! Thanks to everyone here who contributed towards my final choices, whether you're aware of it or not. Sorry if this is too long, but I was trying to give a full cohesive picture.
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My vision (right eye) first day after surgery...
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Sharpness (print):
- I can read the letter sized page I hung on the wall containing a multi-coloured chart for my eye drops pretty clearly at 5' (print: black on white, black on medium yellow, white on medium teal, and white on medium brick red). Not sure what size the fonts are but the chart fills about 2/3 of the page vertically, and 3/4 horizontally.
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- Reading print via my computer browser zoomed to 110% is sharp and clear from about 19" to over 40" (using a MacBook Pro laptop - screen size 15" / 1680 x 1050 resolution). Decreasing the zoom to 90% still gives me sharp print (black on pale grey) over the same distance. I just reduced the font size in my menu lists from 15pt to 13pt which is sharp and clear.
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Overall clarity:
- Contrast quality in daylight is excellent, even in a dimly lit closet, as is image clarity. Contrast was still good inside the house as the sun started to go down (around 5:30 pm EST). Colours are true. The pictures on my walls are full of detail and the subtleties are easy to see (now from about seven feet with right eye only). I used to do desktop publishing and design as well as make my own clothing, so I'm very particular about colours. I'm always correcting people about the subtleties between shades of colours.
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- Haven't been walking outside in the dark yet, depth perception is too off between the two eyes until I get the second eye done. HOWEVER, I'm noticing a huge drop in contrast, and vision in general, in an almost completely dark room. I'm used to walking around in near darkness in my home, but I just walked into the living room with my left eye blocked, and closed the blinds before turning on a lamp, and could hardly see anything in the room. If I hadn't already known that there was a brown coffee table sitting about a foot in front of me, I wouldn't have known with the Eyhance eye at that level of light. When I removed the block from my untouched left eye, everything might have been blurry, but the contrasts in that dark room showed up far far better. I probably would be able to navigate that room far better with just my highly myopic blurry left eye then I would with just the new Eyhance eye. Whites looked mid grey and dark objects were almost undistinguishable. Good to know before I head outside with both eyes using the Eyhance lens. Unfortunately, this probably will not improve so I will need to make sure that I carry a flashlight at night. Sure hope it doesn't affect my night driving very much.
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- I haven't noticed any "transition" problems. The accommodation appears to be very smooth in this one eye. I'm not noticing any real delay in focus when say, looking up from the laptop screen to a picture on the wall (from 19" up to 60"), or even from the laptop screen to the light switch on the wall in the hall (from about 19" up to 10').
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Near & Intermediate Vision: Can read my cellphone (6" screen) clearly at about 12". However, I can clearly see the small print on a small hand cream bottle (about 3.5" tall) from around 12" to 22". And interestingly enough, the instructions on the side of a large bottle of Tylenol are sharp and clear at 2'. Am needing cheap readers of about +1.75 for some closer things though.
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Distance Vision: According to a printed Snellen Chart at 10', I'm about 20/40 for distance right now, although I can see some of the 20/30 line. My hallway is medium lit, and it's a little sharper when I turn the light on. My bird feeders are about 35' from where I sit on the deck, and they are pretty clear, not completely sharp, but I can determine what small bird is eating on them (couldn't do that with my glasses, which were only giving me barely 20/50 in the right eye -- left eye was blurry even at 20/100). I can even see the bird feeder at the back of the yard (approx 110') -- it's a little fuzzy, but I can see if something is sitting on a perch attached to it. The windows are pretty sharp on the two-story brick house behind me that's about 200' behind me. And I could read the street sign earlier this afternoon clearly at approx 35'.
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Visual Distortions:
- Mild floaters started day after surgery:, which I expected as I had them before. They were only really noticeable before if I had been straining my eyes and not getting enough sleep. They got quite strong today after putting in the required trio of drops (see above), but then eased off considerably about two hours later to a mild occasional state again.
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- Noticing a small flickering to the outside bottom left of the right eye from time to time, mainly when in bright light (inside house), but it's not constant at all.
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- Light sensitivity increased, though I always have been sensitive and it was a lot better the next day, after my pupil had gone back to it's regular size (around 2mm). Needed to put on a pair of light tinted sunglasses to wear inside this morning when I first opened the blinds and curtains, but that eased off a couple of hours later. No distortions when looking at a bare led or fluorescent bulb.
1 like, 62 replies
karbonbee
Edited
I ended up having my surgery done in a different clinic than the clinic my optometrist initially sent me to, as the first place wasn't experienced (or offered) a specific lens I began to be interested in after researching them all extensively for a couple of months. I started out being interested in the Vivity and PanOptix. Was thinking of using them both in different eyes, or perhaps just one of them mixed with a monodical, but after reading more and reports (studies and actual outcomes by uses) of loss of contrast with the Vivity in particular, I decided against them both. I was already experiencing halo and glare problems due to my high myopia and then the cataracts starting, and had learned to compensate for them, so wasn't really worried about that aspect. Was very concerned though about loss of contrast and loss of colour definition especially in dimmer lighting, so moved on (read too many outcomes for both of not being able to see the moon clearly unless there was backlighting such as street lights).
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I then became very interested in the Tennis Synergy, which led me to the clinic I ended up having my surgery in. I know the Synergy is somewhat hit and miss -- how it is placed is extremely important, so you need someone who is experienced with it -- but read quite a few outcomes of pilots, truck drivers and hunters who had exceptional outcomes with it, so thought I'd give it a try. But then I started to read more and more good stuff about the Tennis Eyhance (was considering the Clareon monodical also), so that is what I ended up deciding to go with, and so far am extremely happy with my choice. Thanks to more months of research everywhere, and especially with help from people here sharing their results and the discussions in general about the different lenses available -- so thank you all! I chose a target of -1.0 D for my right eye, and -0.50 D for my left eye. As many of you already know, I won't know what exactly my outcomes will be for around a month, and I go to see my optometrist.
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I know everyone suggests to wait at least a month between doing surgery on the second eye, even my surgeon would have preferred to leave more time between the surgeries, but with my extremely high myopia, he knew that it would be too difficult to manage the differences between the eyes for any length of time. And yes, I could have searched for a soft lens that I could maybe wear in between the surgeries, but since I wasn't even getting good distance vision with gas permeable lenses which usually give sharper distance vision in a higher myopia than a soft lens, I didn't think it worth the trouble. I know soft lens technology has improved, but I'd already gotten a start in not wearing my contacts for a month before pre-op testing (as required), which meant I couldn't drive myself anywhere to even start that search (I don't live in a city). And truthfully, from reading so many outcomes of people's surgeries versus what their targets were, waiting that time between the two eyes did not seem to make that much of a difference, so... I was very sure that my own targets that had taken me so much time to decide upon were not going to change no matter what the actual outcome of the first surgery was, and they haven't. Another bonus is that the healing time for both eyes will be completed at almost the same time, so I won't have to start those types of restrictions all over again. If my eyes do change for the worse down the line, or even for the better, I don't think that the time between my surgeries would have had anything to do with it.
RonAKA karbonbee
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It sounds like you have had a really successful surgery. One never knows for sure, and it is always a relief to have the eye done and see good results. I think you will get very good close vision with a target of -1.25 D with the Eyhance lens. That should give you something very similar to what I have in my close eye. I find I need some +1.25 D readers very infrequently, but some very small print does need it. But, I never bother to take them with me when I leave the house. I can manage to do shopping etc without the bother of bringing glasses along.
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I'm sure you are looking forward to having both eyes done and being free of the thick glasses or hassle of contacts. Wishing you all the best for your second surgery tomorrow.
karbonbee RonAKA
Posted
Thanks, Ron. Yes, so far the surgery on the second eye has been really good. The surgeon told me that he got -0.36 D on the left eye yesterday. Distance vision today in that eye has been great, I tested 20/20 at the clinic with it today, but I know it will probably change. No real near vision with that eye, and the intermediate doesn't really get clear til about 40". Though, I just tried reading my laptop's screen with that eye and I can see it at about 24" (browser print zoomed to 95% on a 15" laptop screen), but there seems to be a weird "smudge out" effect in the very center of the eye -- noticed that reading print on the TV also -- it's not noticeable when using both eyes though.
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The surgeon said that he got -1.21 D with the right eye done on Monday. The distance vision with it wasn't quite as good today as it was yesterday. They tested it at 20/25 yesterday, and today it was 20/30. Still good results considering how good the near and intermediate vision still is. I've been decreasing the size of the fonts on my phone, my tablet and the laptop today. I had the print on my phone set to 110% before and now it's down to 95% and I could see it fine at about 10". I could see it even if I went smaller, but this is quicker. Both eyes together are great. It really is fantastic after all of these years of negotiating with gas permeable lenses. I have a pair of cheap readers that are either +1.50 or =1.75 that I've used once or twice for really really fine print, but the intermediate vision on this right eye is so amazing that for even small print like ingredients on cans and boxes, all I've had to do was to hold it arm's length, and it's really sharp.
Spring1951 karbonbee
Posted
Curious. Had you tried mini-monovision before the implants?
karbonbee Spring1951
Posted
No, not really. The retina of my left eye tried to detach a couple of times years ago, and although it didn't succeed, I was left far sighted in that eye, in addition to the high myopia I already had. I was left (at the time) at -09.75 D, and +1.50 D in that one eye. The far sightedness aspect would make me kinda queasy and dizzy when focusing on anything within three to four feet, when my contacts (or glasses) were set as usual for distance (I used have to have decent near vision in that eye also). So the optometrist(s) started backing off the prescription distance in that eye when making me up contacts or glasses, which stopped the queasy feeling, but also diminished my distance vision in that eye, so it was no longer my dominant eye. There was a small amount of a discrepancy between the eyes, but I didn't really notice it that much until the past year or so when the cataracts started messing with my vision in general. The left eye was hit the worst, and even with contacts, it hasn't been giving me clear vision at any distance, and that was very noticeable to me and hard to deal with. That was one of the reasons I didn't want much of a difference between the two eyes with the IOLs, just in case. I would use my right eye for both distance and near, because even backed off, the left eye still wasn't giving me any really useable near vision, but I always was very aware of choosing to use the right eye for up close. What I'm noticing now after surgery on both eyes, is that I am not noticing the switch over at all. Both eyes are working together as a team, and I'm no longer conscious of one eye doing something different than the other.
Spring1951 karbonbee
Edited
That is good news. I think I am going to target-0 .50 LE and -1.25 RE for mini monovision. My doctor just ordered -0.27 LE which I am now not happy with. I am going to insist she place a new order as I want to get it right and am going to need both distance and close in vision. I had tried contacts but an Optometrist could not get them in as my eye kept shutting. I think now I am willing to take some risk on the mini mono as it is worth it. I am glad it is working for you thus far.
Would you have chosen those targets again or pick new ones? Thanks!
Spring1951 karbonbee
Posted
Had you thought of targeting -0.75 LE and -1.50 RE instead. It seems that the distance might not be as good which could be a problem?
RonAKA Spring1951
Edited
"My doctor just ordered -0.27 LE which I am now not happy with."
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I guess I am being a little picky, but your doctor cannot order a -0.27 D lens. All they can do is pick from the standard powers available in 0.5 D steps. I suspect what they mean is that they predict you will have a -0.27 D outcome when they put the lens they picked in. The next higher choice of lens would leave you at -0.65 D. There is no choice to be at exactly -0.50 D. It is one or the other. It it were me, I would be much happier with the -0.27 D choice in the distance eye than a -0.65 D.
Spring1951 RonAKA
Posted
The problem there is less risk if I go with closer to-0 .50 than around -0.27 ....as I am hoping for -1.25 on RE and want to keep the gap at about .75 having not tested monovision. I would love to get -1.5 in rhe RE but fear too much of a gap without a trial.
I read somewhere that most people do ok with monovision but there is a small percentage who do not. I know you have a large gap so I am sure it does work for some people.
RonAKA Spring1951
Edited
You are not going to get exactly what you wish for. Do it one eye at a time. You will have to pick between -0.27 and -0.65 D for your distance eye prior to surgery. And then you will have to wait 6 weeks to see what your really get. Then you can make an informed choice on the second eye. Again, ask what the two closest outcomes will be and then choose between them. Just like you can't specify -0.5 D for the distance eye, you also will not be able to specify -1.25 D for the near eye, unless you get really lucky.
Spring1951 RonAKA
Posted
Do you have any idea as to if targeting -0.75 in LE what is likely distance vision with a monofocal like Clareon or Tecnis 1...something like 20/40 possibly? Also, I saw someone had targeted -0.1 with a monofocal in both eyes. I wonder what kind of distance vision that would bring?
RonAKA Spring1951
Edited
-1.0 should give about 20/40 for distance and -0.75 probably about 20/32.
Spring1951 RonAKA
Posted
That is exactly the info. I have been looking for and have asked my doctor but never seem to get an answer. Thanks Much!
karbonbee Spring1951
Edited
Those targets would cut my distance vision back even more. And that would really cripple the lens -- there would be no benefit, just a waste of the Eyhance lens, especially for near and intermediate vision. My distance vision in the left eye is more than acceptable. It hasn't really changed since the surgery, so should end up at around 20/20, possibly better, and it's intermediate vision is improving. If I knew how it would turn out though (my eyes and the surgeon's skill), I might have targeted only -0.25 D in the dominant eye, and if he'd hit between that and plano, my distance would be even sharper with only a little loss on the intermediate. But hindsight is only that, and I'm very happy with my results. The right eye is doing such a great job on the near and intermediate, that I can even read pill bottles at 16" - 20" away.
karbonbee Spring1951
Edited
I would have possibly chosen -0.25 D for my left eye, IF I'd known how good the intermediate and vision would have turned out. But of course, I didn't, so very happy with the choices I made. Choices which I wouldn't have known to take if I hadn't researched so much and asked so many questions.
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Those sound like good targets for the lens you've chosen. If you could be sure that your surgeon won't go to the wrong side of plano, even -.025 D would give you excellent results in your distance eye. You should get a good mini-monovision result with that -- one that you can adapt to. I really appreciate that my surgeon apologized for not hitting the target I'd chosen, though I expected he might miss by more, and am happy with what his finally outcome was.
soks Spring1951
Edited
it is a 2 step process.
step 1
look at the defocus curve of your iol and see the logmar value for the myopia you are going to use. for -1 it is about 0.3 for tecnis 1.
step 2
search for visual acuity conversion chart. then see the snellen value for your logmar from step 1. for 0. it is 20/40.
Spring1951 karbonbee
Edited
The reason I picked -0.50 and -1.25 is I want to keep the gap at -0.75 between the two eyes. Distance with Tecnis 1 is sharper than Eyhance, however, so should be ok. Closer in vision is impt. to me as long as I can pass the driver test.
karbonbee Spring1951
Posted
Gotcha. Though with the Tecnis monofocal, you should have decent mini-monovision with a 1.0 gap. But I understand your concern. Hard to guess your results and it's hard to undo if you make a mistake. Which eye are you going to do first? Most people do the dominant eye first for distance, but maybe you'd do better to start with the near vision for the non-dominant eye first like I did? That might give you a better idea of what your distance vision would be with less myopia targeted?