Eyhance help/choice of iol ?? cataract newbie
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First I have thank everyone that posted. Each experience,diagram, suggestion has been far superior to any information from Dr. I had no idea I choose type of lens and subcategory brand of lens. Without everyones help here no doubt I would have been given Drs choice. I learned about Eyhance from this forum recently diagnosed overnight with cataracts myopic my whole life contacts work excellent just learned have astigatism i think 1 diopeter The Dr is awesome skilled and I trust his judgement at pre op I about Eyhance and luckily he does offer it. He seemed against Eyhance preferring the other Technis zcb00 and even that im not sure of. My question is does anyone have either Eyhance or Zcb00 and some advice as to basic and general vision after surgery? Is one a little better ? Does one have better outcome? Also if I have 1 diopeter astigatism is it necessary to get laser vs manual cataract surgery. Stay safe and thank you forum for guiding me Procedure is Nov 1
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RonAKA mary27273
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The Tecnis ZCB00 is the basic monofocal IOL from Johnson & Johnson. It will give you very good distance vision but will require reading glasses for sure, and intermediate vision varies from individual to individual. The Eyhance is also from J&J, but offers a little closer vision. The best way to compare lenses is with a defocus curve. It will tell you about what distance vision will be good. The vertical scale is called LogMAR, and a value of 0.2 is considered good vision. The horizontal scale is harder to read, and is in Defocus Diopters. You divide 1 meter by the diopters to get the distance you could see at. If you google the link below you will find an article that has the defocus curves for both the standard Tecnis and the Eyhance. The way I read it the standard lens intersects with the LogMAR of 0.2 at about 1.0 D. That means vision should be good down to 1 meter. For the Eyhance the intersection is 1.5 D, so vision is good down to 1 meter/1.5 or 0.67 meters. So approximately 3 feet for the standard lens and 2 feet for the Eyhance.
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Review of Ophthalmology 15 APRIL 2021 IOL Review: 2021 Newcomers
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You will also see the lenses from the competition which is Alcon. Their standard lens is the AcrySof SN60WF, and their extended focus lens is the Vivity. Their graphs are not directly comparable to the Tecnis ones because they are based on binocular vision vs the monocular that Tecnis used. But approximately, the Vivity provides an extra 1.0 D of closer focus vs the 0.5 of the Eyhance. At LogMAR of 0.2 it indicates 2.0 of defocus, so the close vision range goes to 1/2 or 1/2 a meter or about 18". The risk of optical side effects is likely higher with the Vivity though.
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These extended focus range lenses probably come at a premium price, which may be a consideration. I was really interested in the Vivity but eventually dismissed it in favour of monovision with standard monofocal lenses. Later I have seen some here posting what I would consider as really high prices for the Vivity, like $4,000 a lens extra. For that price, I really don't think the benefits are worth it, especially compared to monovision. Keep in mind that you probably will still need reading glasses with Eyhance, and probably with Vivity too.
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On astigmatism a value of 1.0 D if that is what the surgeon measured on the cornea (not the eyeglass prescription) is worthy of a toric lens to correct it. The basic Tecnis lens is available in a toric, and I read that the Eyhance is too, but you best check to be sure. One question to ask the surgeon is whether or not the astigmatism is symmetrical or irregular. A toric lens will correct symmetrical astigmatism well because the correction is symmetrical. If the astigmatism is irregular the toric lens will not correct well, and may make it worse instead of better. i.e. wasted money on the extra cost of a toric lens.
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On the laser surgery, my conclusion in reading the research on it is that it is not worth it. The thinking at some clinics is that if you spend lots of money on a "premium" lens then you should also spend more money on a premium laser surgery. I don't buy it based on what I have read about it. I believe the outcomes depend more on the skill and experience of the surgeon. In other words a skilled surgeon using the manual method is likely to do better than a less skilled surgeon using laser...
mary27273 RonAKA
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Ron aka need a whole pack of cigs to polish off that info above. Your good i read alot of your posts and they were like the opening guide to cataract surgery will start on your knowledge asap
mary27273 RonAKA
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symmetrical or irregular. dr didnt even tell me diopeter i had whisper question of diopeter to assistant on the sly. it was a previous post of yours that introduced me diopeter of astigmatism. i had no clue. for forty years im getting fitted with contacts not one optician ever said i had astigmatism and as for cataracts Ron had yearly eye exam Nov then March had tiny accident scratch with long nail eyeball. Optician never saw cataracts till July specialist appt due to left eye started seeing blurry can they grow that quick? And yes reading research I see that opthamologist generally agree that laser is not worth it and outcome based more on skill and experience. Learning from this forum last week I saw pre op appt and said i wanted Eyhance. Dr gave me no information about my choice when the last day of choice for iol is or contact him for my choice. He only said he does Eyhance but also does the other JJ iol mono and he likes that one
mary27273 RonAKA
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"So approximately 3 feet for the standard lens and 2 feet for the Eyhance."
Ron does that mean that Eyhance does not see distance as well as standard lens and that is trade off for better intermediate distance? Or does that mean that Eyhance sees better close up than other iol Excuse my not yet learned basic questions thanks for your patience and wealth of knowledge
mary27273
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sorry other technis monofocal i think the iol that Lucy has
RonAKA mary27273
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Keep in mind that astigmatism is the result of astigmatism in the natural lens in the eye plus the astigmatism in the cornea of the eye. An eyeglass correction has to correct for both errors in the natural eye. Once you have the natural lens removed in the cataract surgery, the IOL then only has to correct for astigmatism in the cornea. It is possible that your natural lens astigmatism was correcting for astigmatism in your cornea. So, when the natural lens is removed there is more astigmatism to correct for. That may be why your eyeglass prescription has not astigmatism (cylinder), but your IOL may need to have it. The option of course is not to correct for astigmatism with the IOL and do it with eyeglasses.
RonAKA mary27273
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The advantage of the Eyhance is that it should give you both good distance vision, and intermediate vision down to about 2 feet.
mary27273 RonAKA
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thank you so much for the irregular and symmetrical suggestion. The Dr did not say much at all. I agree with laser not worth it due to same reading. How is your vision near with mono? Were you myopic before surgery? Can you correct with contacts instead of glasses? i do not know how to message Dr with questions. there is a disconnect so thank you
mary27273 RonAKA
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Ron great point about iol has only correct astigmatism cornea and natural lens correcting. Never saw that point. wow natural lens removed more to account for thank you put alot in perspective about post surgery astigmatism decisions Wish Dr would have advised me i will message him and ask for advice based on pre and post astigmatism solutions.
RonAKA mary27273
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I seem to be able to see a bit closer than others report here with their monofocal lens. My eyeglass prescription for it is 0.0 D spherical, and -0.75 cylinder (astigmatism). I get a bit better than 20/20 vision at distance and can see text down to about 18" in bright light. It drops off in dimmer light. I was about -2.5 D before the IOL was put in. I use a contact in my non IOL eye, but have not tried in my IOL eye. I believe you can do it, but that would be a good question for the surgeon. You would want to wait until your eye fully heals before trying it.
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In another post you asked about using the Eyhance for distances other than full distance. It would not really make any sense to set an Eyhance for real close vision. However, some ask to have it slightly under power to leave your non dominant eye about -0.50 D. The normal target is -0.25 D.
lucy24197 mary27273
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I have ZCB00 put in 1 eye, second eye scheduled for next week. Today, 5 weeks after the first surgery, I still have some variable blurriness, but it seems to be related to the drops (another week to go for the prescription drops) and dryness. When I saw my optometrist a week after surgery, he said things look good but my cornea was dry. He gave me a sample of OTC lubricating drops to use, and I'm still needing drops for dry eyes, so I"m hoping my vision will improve slightly when the prescription drops end and the dryness settles down. I have another appointment tomorrow and may have more information to share then. Overall I'd say I'm quite happy with the lens. My target was -0.5. A week after surgery the optometrist said I was between -0.5 and -0.25.I have a Snellen chart taped to the wall--tonight I can just make out the 20/20 line, although I might miss a few letters. At about 27-28 inches in good light the Jaegar chart is in focus, but a lot of the text is too small to read. At 14" I can read line 9 and larger (although not clearly.) This is probably the closest I've been able to focus yet--it's actually improved somewhat over the last couple days. I have a little bit of glare when I look directly at exposed light bulbs, but light fixtures don't have glare. When I look on lights on neighbors' houses at night, I don't see any halos or glare; I haven't been driving at night to see how that will work.
Overall I'd say I think I will be quite happy with the lens. My eyes have a fair amount of damage due to diabetic retinopathy, so monofocals were the only option recommended for me.
mary27273 lucy24197
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lucy thank you for real life experience. How was your vision before cataract ? Did you choose the zcb00 or did dr think it was best for your eyes? Blessings on continued recovery. does a target of 0.5 mean you have some myopia or are you closer to plano
lucy24197 mary27273
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Do you mean vision before the cataract, or before the surgery? Before the surgery my vision was very bad due to the cataracts. I couldn't even make out the top line on a Snellen chart and could not drive, even with glasses. Before the cataracts, I was mildly myopic-- prescriptions on the right eye (the one that's had surgery) of -0.25 when I first started wearing glasses, going up to about -0.5 about 12 years ago, then getting much worse as the cataract developed. I wasn't really given a choice of lens. Due to my retinopathy, monofocal lenses were considered the only/safest way to go. The doctor had originally told me that he would be using Acrysof (I think that's his go-to lens) but went with the Tecnis in my case. It seems like it was a slightly more conservative approach. I agree with the decisions this doctor has made, so I haven't fussed about his selections. That said, he was my 3rd option for a surgeon because I was really unhappy with Drs 1 & 2, and I went to him with the targets I wanted in hand--thanks to this forum and defocus curves. There is some myopia with the -0.5 lens, but it's what I've been used to. I will probably get glasses to drive because it will give my vision a little boost, but I can drive without them. My tv is about 12' away from where I sit and I can see almost everything except very small/small and low contrast print clearly (like the drug information they flash on the screen at the end of a commercial that they really don't want you to read--no loss not reading that.) I look out into the yard and can clearly see branches and leaves on the trees near the house, although I've still got a little blurriness from the drops/dryness that I'm hoping will go away when the drops stop. I didn't go for plano because I am a voracious reader and want more near vision, and I don't want to wear glasses to cook and have them steam up at critical points. The doctor nailed the -0.5 target and I'm pleased with it. There is some softening of vision at distance (I can't really read the whole number on the house across the street, but I can make out some of the numbers), but I think for around the house and puttering around in the yard it's going to be just what I was looking for. I did have a little more distance vision right after the lens was put in, and I can see why people love it, but for my lifestyle it wasn't the right choice.
mary27273 lucy24197
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Lucy thank you for your visual im sitting here seeing as you described Dr uses same zcboo lens I did watch Dr Devgan and he is a great source of experience . Is 0.5 an ok near vision like acceptable for your and with the zcboo is there a drop off point for sharp visual in distance? will you be using glasses or contacts for distance and or readers for close? Sounds like you healing well.
mary27273 lucy24197
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Lucy did you request a little myopia?
lucy24197 mary27273
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Everyone's eyes will be different, and my eyes are diseased and that may have an impact on my results.
I am still seeing some small variations in my vision from day to day (hoping it will stabilize after I finish the drops in a few days) so it's difficult to say exactly what things will be like. I see well enough at distance to safely drive in the daytime without glasses if I know where I'm going. I wouldn't want to do a lot of highway driving or need to be reading street signs without glasses. I haven't been out at night to try night driving yet. There isn't what I'd call a drop off for sharp distance vision, just a gradual softening. Right after surgery my eye was closer to -0.25 than it is now and things at distance were definitely sharper, but my near vision was worse. There's an evergreen tree that I'd guess is about 25 feet outside my window. When I was closer to -0.25, I could see the individual needes on a twig. Now if the light is hitting it I can pick out some individual needles and silhouettes of needles against a dark background, but not every single needle. I have no trouble seeing the tree or the twigs, or that it has needles, it's just a little softened so I can't see individual needles, so I'd say at that distance there is some noticeable dropoff. I have an oak tree that's probably 60 feet or so away. I can tell by the leaves that it's an oak, but I can't see individual leaves clearly. It's not that the vision is bad, it's just not Superman X-ray vision like it was right after surgery. To me, in my situation, it's worth it. Right after surgery I couldn't see anything clearly unless it was about 4 feet away. That's improved as my distance vision has gotten a little bit less sharp. My close vision is still variable, but things are sharp starting at about 30-35" away. I would NOT be happy with this for close vision for things like reading or using the computer. I can see my dashboard--the speedometer, gauges, etc. aren't perfectly crisp but they are just fine, but I can't read the odometer. I can't hold a letter far enough away to read it easily. My second eye will be set for closer vision, so I'm keeping my fingers crossed. I am also seeing better with both eyes than with one, even with the bad cataract in the second eye, so I'm hoping for a little boost in vision after my second surgery.
So--if both eyes were set for -0.5, I'd probably want glasses for both reading and driving. Your experience might be different. I"m hoping with my mini-monovision I'll only want them for driving and when I'm settling down with a book. I absolutely hate on/off/on/off glasses use, so if I end up wearing them only when I'll have them on for a while it will make me happy.
lucy24197 mary27273
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Yes, I wanted a little myopia to try to get more near vision. I'd asked for a target of -0.5, and it looks like I got lucky and the doc hit it.