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Ehance IOL with no intermediate vision

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allen43308
allen43308

Had an Eyhance monofocal model# DIB00 inserted 2 weeks ago into the right eye.

Rx before the surgery was SPH -3.0 CYL -1.0.

Rx 2 weeks after surgery SPH +0.5 CYL -1.0.

The surgeon used the ORA and Lensx laser with LRI.

The good: no halos, no glare, no artifacts of any kinds. Uncorrected distance vision is about 20/40. I think my contrast is good in all light conditions, but not sure how to evaluate it.

The bad: no useable uncorrected intermediate or near vision. Vision is progressively blurrier from about 4-5 feet down to 24". From 16" to 24" a total blur.

The strange:

How is it possible that my Astigmatism remains the same even with the LRI done both by the laser and additionally by the surgeon manually?

In operated eye the progressive bifocal glasses (SPH +0.5 CYL -1.0 ADD +2.50) allow me to see well for both intermediate and reading distance, but make NO DIFFERENCE for distance vision. Distance vision is about 20/40 either corrected or uncorrected. The surgeon seems surprised.

Does anyone have any knowledge that may explain this? I'm a bit discouraged, and wonder if it may improve in the future? I had good eye health (cornea, retina, macula, etc.) before the surgery. No prior LASIK surgery (was told my corneas were too thin 20 years ago).

Many people with the Eyhance reported good intermediate vision, why not me?

Appreciate any comments/insights. Thanks.

0 likes, 28 replies

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  • rwbil
    rwbil allen43308

    Edited

    Just a few thoughts.

    First without knowing what all your eye conditions and problems were before surgery it is all guess work. From being at this site, I have learned about eye conditions I had never even thought of before.

    My first question is why only 20/40 at distance? Something is going on there. Is this due to previous eye issues? Did the surgeon miss the mark? But if that was the case, you should have gained close vision.

    In general the Eyhance IOL does not provide much EDOF. From what I read it is less than .5 D. But it is supposed to accomplish this without contrast sensitivity loss. So it is basically an improvement over monofocal IOL. In time, if it is proven to provide the same outcome as a monofocal in every sense and gain just a little bitty intermediate vision, it might become a monofocal replacement IOL. From what I understand you probably would not even gain a line with the Eyhance IOL. Did the doctor check what your intermediate and close vision is?

    In addition everyone is different. Someone with a monofocal might have better intermediate vision than you have.

    Did you Doctor dilate your eyes and make sure everything looked good?

    You need to give your eyes a little bit if time to heal, but if you do not get a satisfactory answer then I would definitely get a 2nd opinion and make sure it comes from a Top Opthmalogist.

    • allen43308
      allen43308 rwbil

      Posted

      My eye health is good, had 20/20 corrected vision before the onset of the cataract. The surgeon doesn't communicate much, but said CME may be an issue. I'm having dilation and exam tomorrow.

      Thanks.

    • allen43308
      allen43308 rwbil

      Posted

      RWBil, how do I find a TOP (or a just plain good) Opthalmalogist or any other doctor?

      I have the talent for picking less than acceptable doctors (and also plumbers and car mechanics).

      Focusing on years of experience and self-promotion on their website didn't serve me well, to say the least.

      Thanks,

      Allen

    • rwbil
      rwbil allen43308

      Edited

      First I was in no hurry and took my time to find an Ophthalmologist to perform cataract surgery. I can give you ideas based on what I did:

      1. Look for an Ophthalmologist that is involved in clinical trials, preferable on the IOL that you are interested in. Medical Companies want to get the best outcomes possible, so they are going to do the research for you and pick top Ophthalmologist for their clinical trials. You can go to the FDA Clinical Trials website and see which Ophthalmologist are/were involved in the clinical trials,

      3)Look for Ophthalmologist that does research and publish papers, article, or/and books.

      4)Go to Castle Connolly Top Doctors, these are doctors that other doctors recommend and if selecting a Tecnis product like myself, JNJ has a site that lists recommended Ophthalmologists with experience with the lens you are interested in.

      5)Contact these ophthalmologists and set up appointments to see them. Just as important is to find an Ophthalmologist is that you find one that you have a rapport with and trust. During this process, I meet Ophthalmologist that I would not let operate on my eyes in a million years.

      6)Do your research so that you are knowledgeable about the topic, so you can talk intelligently to the Ophthalmologist. In some cases, I knew more about the IOL I was interested in than the Ophthalmologist. I was asking them about issues like glistening and so forth.

      One Clinical trial Ophthalmologist that I talked to had implanted every premium lens out there and gave me the entire rundown of his experience with the different IOLs. He was so impressive I was planning on making a 5-hour drive to that doctor, but in the meantime, I found another Ophthalmologist in my area who did trials, written papers, goes around the world doing cataract surgery for the poor and had a really good reputation. And just as important I had a great rapport with.

      One final note. It is funny as you mention self-promoter. There is a famous Ophthalmologist in my area, that is a self-promoter. In fact clients come all over from the US and the world to go to him. He does all the news shows and so forth. And I avoided him like the plaque!! He might have been a great Ophthalmologist, but I did not like the arrogant attitude. But that is me. The Ophthalmologist I went with was like the exact opposite, he is kind of a meek person that goes around the world doing cataract surgeries for free for the poor.

    • allen43308
      allen43308 rwbil

      Posted

      Good info, my wife and I will need to use your strategies for our next cataract surgeries (one more for me, possibly two for her).

      Thanks.

  • Guest
    Guest allen43308

    Posted

    So if your refraction is +0.5 after surgery then it sounds like you ended up over corrected right? Which would explain the lack of intermediate vision. But I don't know if it explains the 20/40 line chart. I seem to recall reading somewhere (probably on this site) that the Eyhance has a tendancy to end up on the plus side. I wonder if it might be good with Eyhance for surgeons to target first minus rather than plano.

    • allen43308
      allen43308 Guest

      Posted

      Yes, +.5 indicates slight farsightedness, perhaps that and -1.0 of Astigmatism are killing any chance for some intermediate vision.

      Hope to get some answers tomorrow after a follow-up exam with dilation.

      Thanks.

    • tom50216
      tom50216 Guest

      Posted

      yes,that is something i am keeping a sharp look out for having just had them done yesterday.

      seems to be the case that the eyehance lense does "relax" a bit by around +0.25 after implantation.

      so the -0,25 will leave you at plano af 6 weeks.

    • Guest
      Guest tom50216

      Posted

      My target was -0.21 for my surgery 9 months ago. 2 months after surgery I was refracted at 0.0 (plano). Just got another refraction done last month as I've been noticing that reading isn't as good as it used to be and now I'm at +0.25 (although they round up so it might be more like +0.17 which I think it was the autorefractor said). Kind of disappointing but I hope we can learn from this when choosing the target for my second eye.

  • allen43308
    allen43308

    Edited

    Had my 2nd follow-up with the doc, and my confidence in him dropped another notch. He said a dilation exam was unnecessary, since from the retina scan he could see no CME. He did another refraction (at my request), and now it's SPH +0.5 CYL -1.75 (last time it was SPH +0.5 CYL -1.0). So my astigmatism took a nosedive, how is it possible? Not sure I trust the accuracy of his refraction. He said something interesting though: even though my SPH is +0.5 (indicating hyperopia?), he said I'm actually myopic because +0.5 plus half of -1.75 equals -0.375, indicating I'm near-sighted in this eye. Anyone understands it?

    Still, he offered no explanation why everything is fuzzy/blurry from 12" to about 60".

    He said SPH may shift either toward + or - in the next few weeks as the IOL heals into the capsular bag.

    To correct my astigmatism in about 4 weeks (my pre-surgery astigmatism was -1.0, and I was led to believe that the Lensx laser and LRI would fix that) he gave me 3 options

    1. PRK enhancement
    2. Additional LRI
    3. Replacing the IOL with a toric one

    I'm going for a couple of 2nd opinions, but very pessimistic about my options for better vision in this eye.

    My thinking at this time is that Eyhance is a good IOL, but I think he miscalculated the power, which I find inexplicable since he used ORA. What gives?

  • rwbil
    rwbil allen43308

    Edited

    Probably should have asked what city and state.

    My best advice is to get a 2nd opinion from a top doctor, because there are just too many unknows. I would give advice to someone thinking they had perfect healthy eyes and then find out they had a variety of eye issues / problems like short eye, severe myopia, previous lasiks, glaucoma, mascular degneration, previous cornea or eye damage and on and on and all those underlying conditions effected their vision.

    I just did a quick search and Cincinnati Eye Institutewas involved with the Tecnis Symfony Clinical Trials, so they are probably familiar with Tecnis Eyhance.

    Hopefully that is a different place than you are currently going. They have lots of doctors there so they might specialize in different areas. Their website talks about their clinical trials and many of their doctors are involved in clinical trials and also come up in the Castle Connolly Top Doctors search. William Faulkner, MD, seemed interesting, but again he might not specialize in this particular area.

    Assuming this place is close to you, I would suggest you call and find out which doctor(s) have the most experience with Tecnis premium lens.

    Then try and get that doctor on the phone, and yes I know it can be difficult (and sad) how hard it is to get a doctor on the phone, but by asking some basic question I could tell talking to a doctor on a phone their attitude and if I wanted to follow up with them.

    Hope this at least gives you a start for a 2nd opinion.

  • rwbil
    rwbil allen43308

    Posted

    Just saw an article on this topic.

    Search for

    " Helio Seeking second opinions encouraged as ‘normal"

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