1. Community
  2. Eyes
  3. Cataract

enVista lens

Posted , 4 users are following.

phil09
phil09

I am thinking about getting the Bausch & Lomb enVista lens, and I don't know that much about it, though I see advertising and internet articles noting several features that sound good. A couple of questions:

  1. Though it is marketed as a monofocal lens, there are some comments indicating the enVista gives significantly extended depth of field, through aspheric anterior and posterior surfaces. Doctors claim some enVista patients have obtained 20/20 distance vision, plus good intermediate vision, and even J3 or better near vision. How should this affect my target refraction? I want strong near-vision with the enVista lens -- might a -1.00 D refraction with enVista give me near vision comparable to another monofocal lens set for -2.00 D? Or does it not work that way?
  2. It appears that just last month, B&L introduced its new "enVista Aspire monofocal and toric intraocular lenses (IOLs) with Intermediate Optimized (IO) optics in the United States. enVista Aspire combines novel optics, which are designed for a broader depth of focus, with the proven benefits of the enVista platform to address patient’s vision needs in today’s modern, digital world." Anyone familiar with the Aspire line? Any info on what "intermediate optimized optics" might be? Does it sound like something that would be worth waiting for? It sounds like it might be available now, but I have not seen any hard data or experience and do not really want to be their first patient...

1 like, 15 replies

15 Replies

  • Guest
    Guest phil09

    Edited

    1. Impossible to say. I think you do the distance eye first and when you see how that turns out and how strong of a reading glass you'd need to meet your near needs, then you'll have an idea of the answer.
    2. Never heard of it but it sounds like it might be their answer to / version of an Eyhance style lens.
    • phil09
      phil09 Guest

      Posted

      Thanks. Yes, it would help to see results in the distance eye first. But my distance eye is 20/20 and I can't justify to myself the extraction and replacement of the healthy natural lens in that eye. It's only my near-vision eye that needs surgery, so I'll only get one chance to get that one right.

    • Guest
      Guest phil09

      Posted

      Honestly with one eye at 20/20 I wouldn't do surgery at all… I'd wait.

    • phil09
      phil09 Guest

      Posted

      Really? What would be the benefit of waiting?

      I could wait for a while. The doctors tell me the cataract does not need to come out now, but I should get it done before it becomes too mature, hardens up, and becomes more difficult to extract. It's currently somewhere between grades 2+ and 3+, and they figure I have a year at least before it becomes any kind of a problem for surgery.

      My vision is down to 20/500 in the cataract eye, but it still gives me good near vision, if stuff is about 6 inches in front of my face. I'm fine with my current eyesight for the most part, and if the cataract stabilized right here, I would probably never want to get surgery. But of course, cataracts always get worse. So I'm thinking early 2024 for surgery on the bad eye, and then wait hopefully for a few years till I need surgery on the good eye.

    • RonAKA
      RonAKA phil09

      Edited

      With vision that bad, I would not wait. And, I would be worrying that the cataract is getting to be too dense to get accurate optical readings. Good measurements are required to get an accurate IOL power prediction.

    • Guest
      Guest phil09

      Posted

      I didn't know the other was 20/500. Seems rare to have such a dramatic difference between eyes… one 20/20 with no cataract and the other so bad.

    • phil09
      phil09 Guest

      Posted

      The good eye has a cataract, too, but less advanced. The cataract development is maybe 3 years behind timing in the bad eye, but apparently progression can be somewhat unpredictable.

      For my bad eye, it seems it is time to bite the bullet and get the operation.

    • Guest
      Guest phil09

      Edited

      Yah. I had my diagnosis 5 or 6 years ago and its barely changed. I on,y have one eye done and the other still corrects to a decent 20/40 with glasses. But 20/500 is just about functionally blind. If you are sure about monovision I would maybe aim for -1.5D. That should give you a good near boost without too much risk of loss of depth perception or intolerance of the difference between the eyes.

    • phil09
      phil09 Guest

      Posted

      Both of my eyes progressed from "trace nuclear sclerosis" to stage 1+ "cataract" about 2 years ago. It seems one has progressed more quickly, or at least has had much greater impact on my vision so far. I am still 20/20 without glasses.

      I'm thinking to target somewhat greater myopia, because I am accustomed to very good near vision - I have never in my life worn reading glasses. Maybe -1.75 D or -2.00 D. I have tolerated monovision for many years with no problems, and I will gladly sacrifice some depth perception for good reading vision. I am hoping that even if I miss my target, I'll end up mostly free of glasses for the rest of my life.

  • Lynda111
    Lynda111 phil09

    Edited

    Google "Healio Envista Aspire." Seems to have just come on the market.

  • RonAKA
    RonAKA phil09

    Edited

    1. The enVista lens is aspheric neutral in that it is a constant power across the whole lens and does not attempt to correct for the positive asphericity in the cornea like the Tecnis 1 does for example. The result is an overall positive 0.27 um or so of asphericity. This gives an extension of depth of focus at a cost of some loss of visual acuity. It probably has just as much depth of focus as the Eyhance, and if you had to put a number on it, it perhaps is 0.30 D better than a standard monofocal. So, if you targeted it at -1.0 D you may get the equivalent of -1.30 D with a standard monofocal (like the Clareon). There is no way you are going to get anywhere near the equivalent of -2.0 D. My thoughts on these lenses is that you target them like a standard monofocal and if there is a touch extra in it, and it works for you, then it is a bonus, but it is not a good idea to bank on getting the bonus. My brother has this enVista lens in his distance eye. It was targeted using the Barrett TK formula and his outcome was +0.25 D sphere, and -0.50 D cylinder for a spherical equivalent of 0.00 D. In other words slightly far sighted with a estimated correction back to plano considering the astigmatism. It would not have been my choice. I would have targeted to get one lens power step more of myopia but he went with the surgeon's pick. This still got him 20/20+ for distance vision. He initially had trouble reading the dash instruments in the car, but that has improved and he can read them now. One step more myopia would have improved near vision and probably not hurt his distance vision. But, that is splitting hairs and he got very good distance vision. He is deferring his surgery on what will be his near eye, and is using progressive glasses now, so I really cannot comment on his near vision beyond that he can see dash instruments.
    2. I had not heard of the Aspire version of the enVista, but on a quick google I found this. "Device Description: The Aspire IOL uses an optical modification of the posterior aspheric surface to create a small continuous increase in IOL power within the central 1.5 mm diameter to slightly extend the depth of focus. However, clinically meaningful extension of the depth of focus has not been demonstrated in clinical trials." This sounds an awful lot like the J&J Eyhance, probably modified slightly to avoid a patent lawsuit! They do not advertise it as an EDOF lens so it has not been shown to achieve an increase in depth of focus of 0.50 D or more. If the enVista adds about 0.3 D then perhaps it is somewhere between that and 0.5 D of extra depth of focus. When you consider that in optical terms 0.25 D is essentially noise in the measurement. The difference between this lens and the standard enVista is probably statistically insignificant. What is probably more significant for you is that the power change is concentrated in the middle of the lens, whereas the standard enVista lens has a constant power across the whole radius of the lens. That is what makes it tolerant of imperfect eyes, and imperfect placement in the eye. With your prior refractive surgery this probably would be a poorer choice than the standard enVista. Just my thoughts.

      .

      My suggestion would be to stay with the standard enVista and put more thought into what target you are selecting, and what can be done to ensure you hit that target. With your priorities I would go with a -1.75 D target. If the enVista gives you the bonus extra 0.30 D that would put you at the equivalent of -2.0 D with a standard monofocal. You could get measurements done with two instruments like the IOLMaster 700 and Lenstar LS-900, and perhaps the Alcon Argos. This may require arranging and paying for the measurements at more than one clinic and getting them to give you the results, assuming your preferred clinic for surgery does not have all of these instruments. The clinic where you are getting the surgery would have to agree to consider those additional measurements when making the final IOL power choice. The last clinic surgeon you went to sounds like they would be open minded enough to do that.

    • phil09
      phil09 RonAKA

      Edited

      Thanks, RonAKA, your comments are very helpful, as usual.

      .

      I think your guesstimate of 0.3 D 'extra' DOF in the enVista lenses is reasonable. I have not yet located the ANSI standard monofocal control DOF used in the definition of EDOF. However, I did find a study comparing enVista with a random monofocal (Tecnis Z9000), and it determined that the enVista showed a greater DOF by 0.36 D. I knew it could not be close to 1.0 D of 'extra' DOF, I threw that number in just to provoke you 😉

      .

      It feels odd to choose a 12-year old product for my eye after reading about so many newer high-tech lenses, but I am thinking that enVista may very well be best for me.

      .

      I like the advice to focus (no pun intended) more on hitting the right refraction target for the artificial lens. I did not think to ask what system they use for measurement, but will inquire. It looks like they used Zeiss ATLAS for the wavefront mapping they did, but I expect the ultrasound measurement device is an entirely different thing. All things considered, perhaps -1.75 D would be the right myopia target.

      .

      Thanks everyone for the input.

    • RonAKA
      RonAKA phil09

      Posted

      I believe the Z9000 is the Tecnis 1, which is not really a typical monofocal. It has the very least depth of focus due to their full correction of spherical aberration. I posted a graph that is still in moderation. It shows the enVista to have 0.50 D more depth of focus than the Tecnis 1, and about 0.30 more than the AcrySof which would be a more typical monofocal.

      .

      Yes, the enVista is an older lens, but you could go even older and get a spherical lens. That would leave you with even a bit more depth of focus, but also with a bit more loss in peak visual acuity. When the aspheric lenses were first introduced they were not accepted as an improvement by all, due to the loss in the depth of focus. Spherical lenses are still available, and may still even be the base no cost choice in some healthcare systems. They have a spherical aberration of about 0.37 um. When you see the graph, you will see where that puts them compared to other lenses.

      .

      Unless your cataracts are so dense that they cannot use an optical device like IOLMaster 700, or Lenstar, you want to avoid the ultrasonic instruments. They do not measure the axial length as accurately as the optical devices. The AL is the most critical measurement in determining IOL power. Like spherical lenses some healthcare systems will only pay for an ultrasonic measurement, and you have to pay extra for the optical method. Ultrasonic is old school, but it may have a role if the cataract is really dense. Going from memory, but I believe one of the advantages of the IOLMaster 700 has over the older 500 model is that it can penetrate denser cataracts.

  • RonAKA
    RonAKA phil09

    Edited

    I'm sure I have posted this before but this graph of visual acuity vs depth of focus for the various lenses is very helpful in understanding the choices in lenses and the impact it. This is from the B+L published literature and as I understand it is a theoretical optical modeling of the lenses based on their asphericity. The lens marked AcrySof would be the same as the current Clareon. And the red dot is my reverse engineered calculation of where the Eyhance falls on the curve. Based on J&J data I added the additional depth of focus of the Eyhance to the Tecnis 1 depth of focus. My thoughts are that the new enVista Aspire lens is probably not significantly different that the Eyhance and enVista, but that is just a guess as there is no data to use.

    .

    A recent data from Alcon have indicated their Clareon lens has insignificantly less depth of focus than the Eyhance. When you consider that in the optics world, 0.25 D is on the limit of measurement noise, that is not surprising. The difference between an enVista lens and the Tecnis 1 is quite significant though.

    .

    image

    • phil09
      phil09 RonAKA

      Posted

      Thanks, RonAKA, I find this information very interesting. Today I learned a little bit about the Strehl ratio and mesopic vision. All of this is helping me get comfortable with the option of enVista for my first cataract procedure. I have not made a final decision yet, but I'm getting close.

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.