Eyhance and Clareon monofocal experience?

Not intending to argue here, but I don't think it's accurate to say Eyhance is "not really a monofocal", and not just because it is defined as one. Numerous studies put its distance acuity and contrast sensitivity (tested in patients, not just in bench tests) as noninferior to monofocals. The defocus curve of Eyhance is closer to a standard monofocal than it is to a Vivity. Anecdotally, my surgeon described it as being far closer to a monofocal in real-life characteristics than anything else, with the Vivity being somewhere in between the Eyhance and something like a multifocal.

Well I guess we will have to argue then. A lens is either a true aspheric monofocal or it is not. In the J&J line the Tecnis 1 (ZCB00) is a true aspheric monofocal. The Eyhance (ICB00) is not. The power of the Eyhance varies from the middle of the lens to the outside. It is not a pure single power monofocal and as a result stretches the focus point of the lens from a single point to a stretched line. I am in the camp that there is no free lunch. Either you want a sharp single point of focus or you want the enhanced depth of focus of a stretched focal line. The enhanced depth of focus does provide a slight increase in visual acuity at closer distances where the depth of focus is extended by about 0.35 D, but it also causes a small loss in visual acuity at distance. To many people that is a good compromise. The outcome is clearly illustrated in the image I posted in this thread. J&J marketing like to pretend there is no loss of distance visual acuity, but there has to be a loss. You can't fool the laws of physics. This curve is realistic. Some of the curves presented from other sources are not.

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If you look at defocus curves carefully comparing single lens vision to single lens vision the focus extension of the Eyhance is about 0.35 D, short of the 0.5 D standard to be called a EDOF, while the Vivity is just slightly over the 0.5 D. That difference is very small when compared to diopter increments which are typically in steps of 0.25 D.

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https://patient.info/forums/discuss/eyhance-defocus-curve-and-landing-zone-791445

"The enhanced depth of focus does provide a slight increase in visual acuity at closer distances where the depth of focus is extended by about 0.35 D, but it also causes a small loss in visual acuity at distance."

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I understand where you're coming from and that the stats you posted might be so on paper, but the fact still is that even with technically landing at -0.25D in my distance eye, I've definitely got 20/20 vision in it, but even more importantly, I'm sitting in a room looking out through a window screen, yet I can clearly see individual needles on fronds of the branches of a red cedar that is about twenty feet away from me, and the delicate blue tinge to them (they're in the juniper family). And I can even see differentiation in the fronds waving in the wind of the white cedars that are a good seventy feet away from me, and that the fronds on those trees are clearly a softer, but a truer green with a yellowish tinge to them in places. I guess if I had the eyeglass prescription made up to bring that eye exactly to plano, they could be even sharper. And of course, "visual acuity" is a selective thing based upon individual experience and understanding, but I'm not sure how you could think what I'm seeing could have been made better by using a standard monofocal as opposed to the Eyhance?

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I think the clinic I went to markets the Eyhance very well as a monofocal+ lens. They don't refer to it as an EDOF lens at all. On the other hand, I don't think my results would have been as good, as sharp and true, if I had gone with a Vivity EDOF lens as I initially had planned upon doing.

Defocus curves done properly are the average of a large number of patients. And, when you look at the ones that include an error bar with each data point, you can see how much an individual can differ (better or worse) than the average.

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If you look at @Analytica has posted for her final refraction it would seem to be:

Sphere plano, Cylinder -0.75 D, SE then is -0.375 D, and she reports a distance vision of 20/30. I would have expected better than that. That may be the price of having some EDOF in the lens, or it could be just bad luck.

I tested around 20/25 monocular at my optometrist with a plano to -0.5 targeted Eyhance mere hours after my surgery (though with some ghosting since everything was/is still settling), and my vision has improved in the days since then. I don't yet know what my refraction outcome is, but I'd guess it's closer to plano than -0.5 based on my vision so far. If I had to guess, I expect to test at 20/20 or maybe better at distance at my next appointment.

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I only can compare it with my other eye which has a slow growing, seemingly minor cataract, but I have significantly better contrast sensitivity in the Eyhance eye. Who knows if I could discern even better given a true monofocal, but I can say that I have no concerns about lack of contrast with my Eyhance so far.

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I came across a study today with the following title which might help specifically with some the original poster's questions:

Comparison of visual performances of enhanced monofocal versus standard monofocal IOLs in a mini-monovision approach

I'm not allowed to post the link, but according to the Johnson & Johnson Tecnis Eyhance Website, J&J refers to the Tecnis Eyhance IOL in the following context: "TECNIS Eyhance™ is the next generation of monofocal lens. What sets it apart from other IOLs is the breakthrough design. It's the first monofocal lens designed to slightly extend the depth of focus". It's definitely not a EDOF, but I have seen it referred to as a monofocal plus (+) due to its slightly extended range.

Yes, the Eyhance probably has almost as much depth of focus as the B+L enVista, but both are still just short of the amount needed to be marketed as an EDOF lens.

I think I found the site you were looking at. It had the following notes in the "fine print".

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"The safety and effectiveness of the TECNIS Eyhance™ IOL has not been substantiated in clinical trials. The effects of the TECNIS Eyhance™ IOL optical design on quality of vision, contrast sensitivity, and subjective visual disturbances have not been evaluated clinically.

Clinically meaningful extension of depth of focus of TECNIS Eyhance IOL has not been demonstrated in clinical trials.

*The TECNIS Eyhance™ IOLs are designed to slightly extend the depth of focus compared to the TECNIS® 1-Piece IOL, Model ZCB00 as measured in bench testing."

Re @Analytica... so her final result was -0.75 D, but her target was around -0.39 D, wasn't it? I started out with my near eye that landed at -1.25D with 20/30 but dropped to 20/40 in that eye five weeks post surgery. I don't think that is too bad of a result for her, if she ended at -0.75D in the first eye. And she mentioned some uncorrected astigmatism, so that would account for some distance loss, wouldn't it? If she can handle the switched dominant eye, and does near in the other eye, she will still have reasonable distance vision when using both eyes (and good near vision), and just maybe need glasses for driving in difficult weather.

Actually in a later post @Analytica clarified the refraction. If I am reading it correctly it is:

Sphere Plano, Cylinder -0.75 D which converts to a spherical equivalent of -0.375 D

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That is actually pretty good for refraction, and much better than a -0.75 D sphere only. Barrett predicted the SE to be -0.29 D, so only a miss of 0.085 D, which is almost nothing. I am a bit surprised that distance is not 20/20, and that she cannot see closer than 30" though. Usually some astigmatism improves near vision, and the Eyhance should also be providing some nearer vision.

Okay. I thought that the 0.75D was her eyeglass prescription? Which seemed a bigger discrepancy from the target. She should have better distance vision then. The near vision seems about right though compared to my own results.

Hi Ron,

Relative to the AcrySof IQ lens seeming more resistent to POC than the Clareon, could you let me know if the two lenses were implanted by the same surgeon? Many thanks,

Yes, the AcrySof IQ lens was implanted by the same surgeon as the Clareon lens. One difference is that the AcrySof IQ lens surgery was done in a public hospital, while the Clareon was done in a private clinic, but yes, by the same surgeon.

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I would put more faith in the fact that the edge design of the Clareon is improved (sharper) over the AcrySof IQ, and the results of this small study described below, than I would in my personal experience. I think it was just bad luck, or my surgeon having a bad day. My experience is with two lenses. The study used 40 lenses (20 IQ, 20 Clareon). The study which considered 40 lenses over 3 years seems much more conclusive. A quote:

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"PCO

No patients were presented with PCO in the eye that received the Clareon® IOL within the3 years following surgery. Four patients (20%) were presented with posterior capsular fibrotic changes in the eye that received the AcrySof® IQ monofocal IOLs with 3 patients (15%) requiring Nd: YAG capsulotomy within three years following surgery."

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In other words the YAG rate in the AcrySof IQ was 15%, while the YAG rate in the Clareon lenses was 0%.

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"Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal Smita Agarwal1, Erin Thornell2"

Thanks very much!

Following up on the comparison of Eyhance and Clareon monofocal, has the safety and effectiveness of the Clareon monofocal been substantiated in clinical trials? Thank you!

It was FDA approved in January 2020, so I would assume the required studies would have been done. You can find some further links in this summary document. I saw this in one document P190018:

"STUDY RESULTS FOR Clareon™ ASPHERIC HYDROPHOBIC ACRYLIC IOL

The subject population in the clinical study consisted of 350 subjects in need of cataract surgery that were unilaterally implanted, the percentage of females (60.9%) exceeded the percentage of males (39.1%) enrolled. The

mean age for the total population was 69.7 years. "

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FDA Clareon Aspheric IOL, Clareon Toric Aspheric IOL, Clareon Aspheric IOL, AutonoMe System, Clareon Toric IOL, AutonoMe System – P190018

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Here is a report on a small trial comparing the Clareon to the AcrySof IQ.

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Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal Smita Agarwal1, Erin Thornell2

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And this is another interesting document from 2017

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Clareon® IOL: A New Monofocal Platform Highlights from Alcon’s Satellite Symposium, held on October 9, 2017, at the XXXV Congress of the ESCRS, Lisbon, Portugal.

Thank you!