Posted , 8 users are following.
I have a dilemma. I like the Eyhance lens due to some intermediate distance. However, all of the recommended surgeons that I found (recommended by people on Nextdoor ap) do not use it or do not use it regularly. Most of them are using Alcon. Do I go with the Eyhance and choose a random surgeon or go with the recommended surgeons who use Clareon? Thanks for the input.
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RonAKA aspen88
Edited
The difference in intermediate vision is probably insignificant. The Clareon will give better distance vision because it is nearly aspheric. You can get much more intermediate vision by leaving yourself somewhat myopic in your non dominant eye, but still with a monofocal lens like the Clareon. Mini-monovision is setting the near eye to -1.5 D spherical equivalent. That will give you much better near vision than an Eyhance set to distance.
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People seem to put a lot of effort into selecting a specific brand, and what needs more attention is the target that the monofocal lens is set to.
aspen88 RonAKA
Posted
thanks. if I haven't tried mini monovision should I insist on trying it first? i think the surgeon will not do monivision to those not used to it but i dont know if he'll do it for mini monovision. I'm not used to wearing contacts. i have a hard time taking out contact lens from my eyes.
trilemma aspen88
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And if you try it with a contact lens, how long should you try it?
Can you get a similar test by knocking one of the lenses out of a pair of reading glasses? I think not really, because of the distance between the eye and the lens, that would make the sizes different. And that would be harder to adapt I suspect.
Take a look at the second video of The link to the "Monovision: Underestimate at Your Peril" ( https://crstodayeurope.com/articles/2017-jun/monovision-underestimate-at-your-peril/
RonAKA trilemma
Edited
Yes, it is best to test for monovison if you can still see well enough to do it. The best way prior to surgery is to get a contact for each eye that brings you to plano in the dominant eye, and a comtact in the non dominant eye that leaves you at -1.50 D far sighted. A contact lens fitter should be able to do that for you. You may even find a place like Costco Optical where they will give you some trial contacts. That may be enough for you to evaluate whether you like it or not. I think a few days is enough time, but longer is better.
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A basic plan would be to do cataract surgery in your distance eye first with a target of -0.25 D. That is as close to plano you will want without undue risk of going far sighted. Then for the interval (minimum 6 weeks) between eyes, you can just use a contact in your near eye. This will give you a further evaluation as to whether or not it is for you. This is also a better option than taking one lens out of a pair of glasses, which some do not like at all.
RebDovid RonAKA
Edited
The Alcon-Micheletti video, which some have touted as showing intermediate vision with the Clareon monofocal to be not significantly inferior to the Eyhance also shows distance vision with the Eyhance to be at least as good as with the Clareon monofocal.
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Beginning at about 2:10 into the video, Dr. Micheletti says that "both Clareon and Eyhance both provided excellent binocular best corrected distance acuity". Even Alcon-Micheletti don't claim superior visual acuity for the Clareon monofocal.
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As for intermediate visual acuity, the Alcon-Micheletti claim, beginning at about 2:18, is that "Clareon was non-inferior to Eyhance for intermediate visual acuity with a clinically nonsignificant 2.5 letter difference. We also found that with Clareon IOL target corrected to minus 1/4 diopters intermediate visual acuity was noninferior to the Eyance group's distance corrected intermediate acuity with a plano target." The table appearing on-screen during this portion of the Alcon-Micehletti video shows a mean Clareon DCIVA of LogMAR 0.24 and a mean 0.19 LogMAR for the Eyhance, both with standard deviations of 0.11. The table also shows median DCIVA of 0.20 LogMAR for the Clareon and 0.18 LogMAR for the Eyhance.
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I've noted elsewhere that Dr. Micheletti biased his (spoken) comparison of intermediate visual acuities in favor of the Clareon by comparing Clareon patients with -0.25 D targets to Eyhance patients with plano targets. As the same table shows, this apples-to-oranges comparison reduced the mean DCIVA difference of Clareon LogMAR 0.24 vs. Eyhance LogMAR 0.19 to a mean Clareon target corrected IVA of 0.20 LogMAR vs. Eyhance DCIVA of LogMAR 0.19. Unsurprisingly, perhaps, it is this manipulated comparison that features in Alcon press releases and 'reporting' based on those press releases.
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This shows the importance of looking to, and trying to understand, evidence-based studies. Unsupported assertions that the Clareon IOL must provide better distance vision because, ignoring all other considerations, it has a smaller adjustment for asphericity fail in light of the available evidence. Also unhelpful is unsupported disparagement of a manufacturer's statements about its IOLs as propaganda and the like. Rather, when going beyond the anecdotal, we need to do the work of looking for, reading, and trying to understand scientific studies.
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If one is willing to consider unsourced information, however, I asked Bard, Google's large language model, about the significance of the Alcon-Micheletti reported mean Distance Corrected Intermediate Visual Acuities of the Clareon (0.24 LogMAR) and Eyhance (0.19 LogMAR): "In terms of intermediate visual acuity, how significant is the difference between DCIVA 0.24 LogMAR and DCIVA 0.19 LogMAR?" According to Bard, the difference is "small" but "clinically significant". I asked the same question of Chat GPT and got the following answer: "A difference of 0.05 LogMAR in DCIVA (Distance-Corrected Intermediate Visual Acuity) represents a clinically meaningful change in visual acuity."
jimluck aspen88
Edited
People who have gotten the Eyhance rave about it.
You can do the mini-monovision thing Ron is suggesting with the Eyhance and potentially get some near as well as intermediate.
Or you could do Ron's suggestion but with less myopia in the non-dominant eye and get the same amount of intermediate (due to Eyhance's greater depth of focus), with the result that you have better depth perception and better far vision.
Let me elaborate on that last point. The downside of mini=monovision is you are giving up some distance acuity in the nondominant eye and some depth perception at distance, because depth perception comes from the two eyes working together.
These effects are small.
RonAKA jimluck
Edited
The problem is that the extra depth of focus, and only if you believe J&J sales propganda, is only 0.3 D with the Eyhance. It is not enough for anyone to really notice. Mini-monovision with -1.5 D extra depth of focus is a night and day difference from the Eyhance set for distance. And the other issue is that J&J does not own up to a loss in distance vision acuity from the stretched depth of focus.
Lynda111 aspen88
Edited
Go with the Clareon. You will be fine. I hope you found a good cataract surgeon.
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RebDovid aspen88
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If your visual priorities align with the Eyhance's benefits, you don't need to go to a random surgeon. Searching "Find an eye doctor that’s right for you" should bring up a Johnson & Johnson website, when you enter a zipcode, lists surgeons who supposed to have "experience using a full suite of IOLs, ..l. including the TECNIS® Family of IOLs". You then can research the the individual surgeons to see if you think one or more of them may be right for you.
Lynda111 RebDovid
Posted
J&J says it will take you to a site not maintained by them. I tried it. I know 3 cataract surgeons in a 25 mile radius who use J&J iols. It listed only one and he is no longer in practice.
RebDovid Lynda111
Edited
Interesting, my search results just before writing my last post included the surgeon who did my eyes.
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Regardless, as much as I and my wife are enjoying the Eyhance, I wouldn't insist on a particular IOL at the cost of using a surgeon in whom I did not have confidence.
Dapperdan7 RebDovid
Posted
i had to call j and j and get the person to give me the sales rep for j and j in my area to give me a list of doctors who use j and j. seems stupid their website does not do as alcon does, making it east to find doctors in the area
Lynda111 Dapperdan7
Posted
Alcon has an excellent website.
RebDovid Dapperdan7
Posted
I agree.
RebDovid aspen88
Posted
Regarding intermediate vision, I have awaiting moderation in @Lynda111's thread about the newish (July 3, 2023) Clareon monofocal study by Drs. Clayton Blehm and Brad Hall a link to, and brief discussion of, the pre-print of a study by Dr. Rosa Giglio and six co-authors comparing the Clareon, Eyhance, and Tecnis 1 monofocal IOLs.
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Measuring intermediate visual acuity at 70 cm, Giglio et al. report the following binocular mean Uncorrected Intermediate Visual Acuity: Clareon, 0.31 LogMAR (20/41 Snellen) ± 0.09; Eyhance, 0.17 LogMAR (20/29.5) ± 0.12; and Tecnis 1, 0.32 LogMAR (20/42) ± 0.11. For binocular Distance Corrected Intermediate Visual Acuity: Clareon, 0.29 LogMAR (20/39 Snellen) ± 0.09; Eyhance, 0.13 LogMAR (20/27 Snellen) ± 0.11. Again, the p value for both comparisons is < 0.001.
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Finally, for distance vision, Giglio et al. report binocular Uncorrected Distance Visual Acuity: Clareon and Eyhance, both -0.03 LogMAR (20/18.5 Snellen) ± 0.06 for Clareon, ± 0.07 for Eyhance. Mean Corrected Distance Visual Acuity: Clareon and Eyhance, both -0.07 LogMAR (20/17 Snellen) ± 0.04 for Clareon, ± 0.05 for Eyhance.