Eyhance help please

lynn, im curious. what was your prescription before you got the surgery if u dont mind sharing? . you said you got excellent far distance even with an implant set for intermediate. do you think ones level of myopia actually affects results good or bad?

thank you

dan

Only one of my eyes is eligible for Eyhance, so that's likely to be my choice for that one. The other eye, due to extreme astigmatism, has to have a monofocal toric.

I'm curious to learn how much is too much astigmatism for Eyhance to no longer be an option?

The Eyhance is available in IOL plane cylinder powers of up to 6.0 D. That equates to a corneal plane power of 4.11 D. If you google this you should find a specification sheet on the lens.

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Tecnis Eyhance Toric II IOL spec sheet pdf

Do you know who puts the target focal point in an iol? Does the doctor do that and can it be modified given the patient changes her mind and wants a different focal point before surgery or is it set in stone once it is ordered?

It really depends on the range of powers of IOLs that the surgeon has on hand to implant. The surgeon does not really set a specific target for the outcome. They select between choices that the IOL power steps makes available. A simple example:

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Power of IOL needed to get plano: 19.0

If the surgeon selects a power of 19.5 D then the outcome will be -0.375

A 20.0 D power will give -0.75 D

Here's what I meant. When an IOL order arrives say Clareon -0.39D that is not in stock at the facility. Can the surgeon change the focal point so that I might have closer in vision or does she have to re-order it? Can she alter the IOL after receiving the order?

The other info. on power steps is interesting as that is the first time I have heard anything about that and did wonder about it.

Let me try again. There is no such thing as a -0.39 D IOL lens. They come in powers typically starting at 5 D and going to about 30 D. In the more popular powers they will be available in 0.5 D steps. Some of the more extreme power lens may be in 1.0 D steps.

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A person that has a cornea that needs essentially zero correction will get an IOL power in the range of 18.0 D to 20 D. There may be some exceptions, but that is typical.

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When the eye measurements are put into the computer the formula used by the surgeon will tell them what power is needed for the specified target. If the surgeon has specified 0.0 D which is plano for a target, then the computer program will display a table of IOL powers that are in that range. The program for example may say a power of 18.10 D is required. That power of lens does not exist, so the computer will display what the outcome will be in your eye when an 18.0 D power is used as well as 18.5 D, and other powers around that range. In this example the outcome may be:

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18.0 D outcome would be about +0.075

18.5 D outcome would be about -0.30 D

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The surgeon/patient has to make a choice. Most surgeons would choose the 18.5 D lens to avoid the risk of going positive. It means you will be slightly near sighted, instead of slightly far sighted.

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On the question of lenses stocked, it will depend on the size of the clinic, and the popularity of the lens. If you pick a clear Clareon lens that very few surgeons or patients want, then they probably do not stock anything and will have to order the for you ahead of time. They will choose the power and order it.

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If you are using a more popular lens in the popular power sizes, they likely have lots of lenses in the 0.5 D steps.

It looks like my doctor will have to order a brand new lenses if I decide to change the focal point to get some more close in vision.

Ron Regarding your statement that monofocals with glasses will givethe clearest vision. Would you imagine that there would be a difference in the clarity of vision from glasses and two distance monofocals as compared to glasses with minimonovision? I am still considering what to do with my second eye, My first surgery was to be distance and is toric (both will be toric) and now has a prescription of +1. I want to be sure to have the very clearest distance vision with glasses, as I will still wear glasses at least for some things as the toric has not corrected all of my astigmatism. I knew that would be the case. Thanks for your input.

No, based on my experience there should be no difference in corrected vision with both eyes corrected to distance compared to mini-monovision. In mini-monovision eye glass lens for the near eye will be slightly thicker at the edge than the eye corrected for distance. That is what I have and these glasses are the thinnest and lightest glasses I have every had, and they are not high index. With no glasses I am 20/20 or slightly better. With progressive glasses I am 20/15. If anything I think my left eye which is my closer eye with more astigmatism is possibly better than my right eye with the eyeglass correction.

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The issue with correction of an Eyhance eye is that the power of that lens varies slightly from the center to the periphery of the IOL. There is no way of correcting that with an eyeglass lens that I am aware of.

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And the issue with eyeglass correction is that the peripheral vision I find is reduced when driving compared to no glasses and depending on mini-monovision.

when considering a defocus curve, i'm wondering how many diopters of useable vision a monofocal can realistically provide?

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so when a monofocal lens is set to a near target (perhaps 15"), what is the usuable range? (10"-20"?)

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and why wouldn't it be better to go with Eyhance or another EDOF lens to increase that range?

I believe that if usable vision is defined as 20/30 or better than the usable defocus range of a standard aspheric monofocal is 1D. Eyhance extends that to at least 1.35D but there is some disagreement on that (I've seen as much as 1.45D mentioned). That extension is also more light dependant than the 1.5D range of Vivity (for example). So in dim light with Eyhance you won't get much benefit.

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Not sure about the second question but if you look at a defocus curve you will see that the closer you get, the more diopters you need to see clearly. So the range you get when you target near focus is tighter. But if you set for distance you can be pretty well assured that everything from 3 feet to infinity will be good.

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As for the third question, I haven't done the math but again I think the closer you get, the less range that EDOF effect is going to "buy" you. So personally I'd rather just go for the absolute best quality image and contrast with a classic monofocal. I'm sure Ron will have some thoughts though and maybe more specifics.

Have a look at the defocus curves in this article which compare the Alcon monofocal to the Vivity, and in another graph the J&J Tecnis 1 monofocal to the Eyhance. This is not a direct apples to apples comparison though as the Alcon graph is for both eyes together, while the J&J is monofocal. The Tecnis 1 provides LogMAR 0.2 (about 20/32) vision out to about -1.1 D. If you divide 1 meter by this number you get the distance in meters, or in this case about 91 cm. The Eyhance stretches this out to about -1.5 D or about 66 cm. To see the impact of targeting something other than plano you just slide the whole curve to the right by the amount you are targeting. At some point there will be no benefit in moving the offset too far to the right as it will give best vision at a point that is too close. And the idea is to move it as little as possible to preserve distance vision as much as possible. However, when you are in a monovision configuration distance is being provided by the other eye, so that is not as critical.

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Review of Ophthalmology PUBLISHED 15 APRIL 2021 IOL Review: 2021 Newcomers

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Hey Ron. You mentioned monovision but I would point out that the original poster was talking about a surgeon recommendation to set one eye for intermediate and the other eye for near. Neither eye will be set for distance. This seems unusual to me. I'd just go for distance and then maybe a little monovision to improve near.

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FWIW I have Eyhance in one eye which is now 3 months post-op. It was set for distance and we nailed the target but I got some residual astigmatism which isn't great. But with glasses to correct the astigmatism I see 20/20+ for distance and it's breathtakingly clear. The other eye hasn't been done yet.

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For near, in super bright direct sunlight (so TONS of light) I can easily read J1 at 14 inches. But only in very bright direct sunlight. In normal room light, nope. The astigmatism is probably helping me achieve that result. I also have small pupils. Similarly my Dashboard looks amazing during the day but for night driving its not great. I can read it but it's not great.

So in theory, targeting -.25 with an eyehance lens would get you to LogMAR 0.2 at around -1.75 = around 57.1 cm = around 22.5 in

Targeting -.50 with an eyehance lens would get you LogMAR 0.2 at around -2.0 = around 50 cm = around 19.7 in

Targeting -.75 with an eyehance lens would get you LogMAR 0.2 at around -2.25 = about 44.4 cm = about or 17.5 in.

Targeting -.1.0 with an eyehance lens would get you LogMAR 0.2 at around -2.50 = about 40 cm = about or 15.7 in.

Of course you're also degrading your distance vision every .25 D.

Is that more or less correct, or is it not that simple in practice?

I agree that targeting for that close is unusual. Based on the quoted distances the dominant eye is being targeted to -1.5 D (66 cm), and the near non dominant closer (possibly 33 cm, -3.0 D?).

Not sure what the logic is there. Does not seem to take advantage of the extended depth of focus of the lens. I think some surgeons are focused on not having to spend "extra chair time" with patients that are surprised with their outcome. For that reason they may want to keep a patient myopic if that is what they are used to. I look at differently and as an opportunity to improve vision from being myopic to something much better.

Yes, that is basically correct. The whole curve just moves linearly across as you offset the target. I have a monofocal with -1.0 D sphere, and -0.75 D cylinder, so about -1.375 D spherical equivalent. Not sure if it is LogMAR 0.2 but I can read a computer screen with normal print down to about 10-12". This is what makes me think that an extended depth of focus lens is not really necessary when doing mini-monovision. And on top of that, correcting the vision with eyeglasses for any residual error is simpler.

...because all you're really accomplishing by doing mini-monovision using two Eyehance lenses is achieving binocular vision over a very short range of distance that can basically be measured in inches in exchange for a slight decrease (but a decrease nonetheless) in visual acuity at a range of distance which can be measured in yards (and LOTS of them)?

This is a conversation I'm currently having with myself. What am I gaining in spectacle independence by going for mini-mono vision in my second eye with a toric Eyehance lens vs. sacrificing binocular vision from -..25 to -1.75 even if the low end of that range is at logMAR .2? Right now, it seems like I would only need readers for extended screen time at work and at home on my iPad. That doesn't seem like that big a deal. I was concerned with not being able to see my dashboard clearly, having to fumble for glasses to read and reply to a text or read a menu, and other everyday activities requiring some degree of intermediate vision. That doesn't seem like it will be an issue.

...which also leads back to Kelly and what level of spectacle independence (and what field of vision) is desired.

I believe I have good binocular vision from about 20" out to 6 feet or so, with two monofocals. The only time I have really missed binocular vision has been when pruning bushes in my yard at a distance closer than 20". I do occasionally miss the branch I am trying to cut. I see it well, but my distance judgement is not so good. The good news is that so far I have not cut any fingers off!

"...improve vision from being myopic to something much better."

I don't agree. In my value system, myopic vision is better than distance vision if I have to be presbyopic . I respect that others have different values and reach a different conclusion, but suggest that everyone should respect that some of us LIKE myopia.

I'm tired of emmetropia chauvinism. Emmetropia is great for the young. There is no advantage to myopia if your eyes have 10 diopters of accommodation. But if you have very little accommodation, and you do have money to buy glasses, myopia is superior to emmetropia.

Once you have presbyopia, you cannot avoid needing glasses for something, unless you want to accept the risks and drawbacks of a multifocal lens. So, it's just a question of at what distance do you want to use glasses for and at what distance do you want to see sharp without them. There is no objective better or worse answer to this question.

To me, if I have to carry around glasses, the most convenient place to carry them is on my face where they will always be handy and I won't lose them. I don't want them in my pocket, falling out, getting misplaced etc. Most of the time we need distance vision, so it's better for distance vision to require glasses, so the glasses will mostly be on my face where I won't lose them. The need for close vision is intermittent and comes up unexpectedly and frequently, so I want that built into my eyeballs, conveniently available just by peeking over my glasses or momentarily taking them off.

If I have a long session of needing close vision, I'm probably sitting down and can lay the glasses on the side table, and will put them back on when I get up. But if I have a long session of distance vision need, I'm probably active and susceptible to misplacing my glasses if they are not on my face.

I would hate to be dependent on glasses for close vision. Glasses in bed? Glasses when I've got my hands full of tools and parts and need to quickly see exactly if two little things I'm assembling are lining up? Glasses when I need to measure something precisely? No thank you!

But glasses to walk around, drive, socialize, do computer work -- no problem.

Also, most things that require eye protection are done with distance vision. I don't want to be tempted to skip the eye protection. I want it to be normally on my face when things are flying around that might damage my eyes. How many of you with glasses-free distance vision have skipped putting on eye protection to do something where eye protection is advisable, like hammering, sawing, some sports, certain types of yard work? I bet 100% of you at least 80% of the time.

As to whether to use Eyhance with a close target -- why not? They don't cost much more do they? And they have superior depth of focus, so less issue if there is a refractive miss and a bigger sweet spot for sharp vision wherever they are targeted, and they supposedly have superior contrast sensitivity to monofocals. Yes there is a portion of the defocus curve where they are a little less sharp than a monofocal, but I'll bet that's barely noticeable.

I think it is all a personal choice, and one size does not fit all. I have been myopic up to the -4.0 D range all my life. I know the pros and cons very well. To me while getting cataract surgery is a not something that many look forward to, it is an opportunity to make some changes to our vision. No, there is no holy grail, see like you are young again, but in my case I have never seen perfectly, and I have never liked being dependent on glasses. I believe it was about 1975 or so that I got my first set of contacts - two soft contacts from B+L that cost about $300 for the pair! Because I had accommodation I could wear them as long as I could tolerate them in my eyes. I wore them for many years, but when I lost my accommodation they became a pain. I don't like to carry glasses like you, but I would inevitably get stuck in a store not being able to read price tags and other small print. So at some point I gave up on them and just got some much cheaper daily ones to use for snorkeling when on vacation. And later still I found out about monovision and I did it with contacts for some time. It worked quite well other than I could not tolerate contacts all day, and the contacts I got prescribed were outright miserable to handle (J&J Acuvue Moist). So while I liked the vision I gave up on them.

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Then came the cataracts. When I had my first consult the surgeon told me that he could not recommend MF IOLs as he was not willing to put them in his own eyes, but he suggested I consider mini-monovision. I had about a 9 month or so wait until my surgery, so I put a lot more research into contacts and tried them again for monovision. I found the newer hydrogel silicone type lenses much more comfortable and affordable. I liked the vision and went into the first surgery with mini-monovision as the objective. After the first eye was done I did more monovision with a contact in the non operated eye. Again I was still liking it, so that is the way I went with my second eye. My only regret is that I didn't get a toric, but I still got very good eyeglasses free vision from 12" out to infinity. While it is a personal thing, that is to me a much better outcome than being myopic and dependent on progressive glasses.

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I believe the statistics are that about 90% of people requiring vision correction are myopic as compared to hyperopic, and of those getting cataract surgery, about 90% choose to have the myopia corrected to give distance vision. Out of this I suspect very few even consider mini-monovision as an option. People seem to get hung up on the binocular vision aspect and some brand name lens as the magic solution, rather than considering to target each eye differently.

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On the Eyhance I don't believe that contrast sensitivity is better than a monofocal like the Tecnis 1. That is just marketing hype. They achieve the increased depth of focus by varying the power of the lens from the centre out to the periphery. This smears the point of focus, and the dimmer the light the more the point of focus is smeared as the pupil opens up to use more of the lens diameter. My thoughts are that using an EDOF lens for a mini-monovision solution is a marginal advantage at best. Excellent results can be achieved with basic monofocal lenses.

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Like I say this is all a personal choice. Pretty much anyone can get excellent vision with progressive glasses regardless of the target and even if the surgeon misses the target. The real question in choosing an IOL and target is "What do you want to see without glasses on?" The answer will vary depending on the priorities of the individual.

Excellent summary, Ron, based on your years of experience and studying vision optics. I wonder if my situation, where I was also myopic with 2D of astigmatism and I got excellent distant and intermediate vision by targeting both eyes for intermediate distance and use readers sometimes for fine print. Was that just a lucky outcome for me or is that likely to work for other patients?

Do you know what the target was for "intermediate" vision in diopters, and what your eyeglass prescription was after surgery? That is the best measurement of where you ended up. About outcomes, the defocus curves published for lenses should be a based on a large number of test subjects, but will always be an average, with pretty significant variations from individual to individual. For example I have a monofocal AcrySof IQ that tests at 0.00 D Sphere, and -0.50 D Cylinder, but I can still see a computer monitor down to about 18" well enough to read normal text. But that seems to be an exception.

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If you look at the defocus curve for the Tecnis 1 compared to the Eyhance in this article, you will see there are error bars at each data point for the Tecnis 1. They represent the statistical range of outcome for the study the curve is based on. You can see that some individuals with the Tecnis 1 end up with vision equal or sometimes better than those with the Eyhance on average. The error bars or the Eyhance are not shown, but I would expect they would be similar in magnitude to those for the Tecnis 1. So, considering the error bars there is a large overlap in the visual outcomes. I have not see good information on what the reason for the variation is, other than one study that found those who are myopic and have smaller pupils (older?) prior to surgery seem to get better near vision than those that are hyperopic with larger pupils (younger?).

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Review of Ophthalmology IOL Review: 2021 Newcomers

I agree that targetting pure Emmetropia is not a good practice. We do not live life at 20+ feet. Just about everyone other than an airline pilot or a bald eagle will be happier with a -0.5D binocular target. This will give most people good distance vision and good enough near for momentary day to day stuff (dashboard, cooking, glance at watch) but they'll still need readers for reading and computer and labels etc. and low light. It is a good compromise that gives most people a decent range of functional vision even with monofocal IOLs. I think a lot of myopes (I am a lifelong myope) fear losing their near vision. I know I did! I was terrified! I put off surgery for years and researched everything possible. But I'm happy I targetted mild myopia as opposed to near. But I know some people are happy with a near target too. It depends on your lifestyle and what you value and do for a living and for fun etc.

Targeting -.75 with an eyehance lens would get you LogMAR 0.2 at around -2.25 = about 44.4 cm = about or 17.5 in.

this might be a winning combination. -0.75 is barely noticeable myopia and near at 17.5 inches is close to trifocal at 16 inches. how would the quality (think hd video) of near be?

Targeting -0.75 with an Eyhance would give a LogMAR of 0.2 (20/32) at 18" or so as you say. However it would reduce your distance vision to 0.2 or 20/32 as well. If you have good distance vision in the other eye, that could be quite acceptable. If you don't then you could be marginal on ability to drive. I also think a LogMar of 0.2 at 2.25 may leave some feeling a little short of reading ability. If distance vision is in the bank with the other eye, I would be more comfortable targeting -1.0 to -1.25 D in the second eye. That would push near vision down to -2.75 or about 14".

20/32 at 18 inches is what on the J scale?

It is kind of an apples and oranges comparison. The Snellen test is done at 20 feet, and the Jaeger is done at 14". However 20/32 is equal to 0.0 on the LogMAR scale and from one conversion table I found, that is said to be J4 on the Jaeger scale.

i learn so much just reading comments by you and others. much appreciated.

I see I made an error on the scales, and I guess it is too late to edit it. 20/32 is equal to about 0.20 on the LogMAR scale, not 0.0 as I posted.

can i ask what you chose for correction for each iol?

thx

dan

My favorite glasses are -0.75 under correcting. No problem driving with them. 20/32 is fine for driving. 20/40 or better is the legal requirement in Massachusetts.

I'm trying minimonovision with contacts. I wanted -0.25 and -1.25 but my optometrist gave me plano and -1.50. Computer and phone are absolutely fine. I'm a little bothered so far by the blurry eye on TV watching at 15 feet, but it's no big deal.

Trying to remember to carry readers for those odd moments when I need to see something tiny up close. It's very odd not to be able to take off my glasses for that. I reach up to do that -- or I try to peer over them -- and there are no glasses there!

Planning to get glasses to correct the near eye to emmetropia and maybe another pair for reading.

A side benefit of mini-monovision: it revealed to me and the optometrist that she had been telling me the opposite of the correct information as to which lens was for the right eye and which was for the left! They have different base curves, as well as well as different powers, so it was kind of important to get that right!

@david98963

With Eyhance Toric II you can see 20/20 far and J1 at 36cm (14 in)? That's fantastic!! Much better than J&J's marketing material.

Have you done the second eye yet? If so, how are both eyes working together?

How is your vision at 20 -25 inches? How about 30 to 40 inches? I am looking at eyhance currently.

All of this is 100% dependent on the complex geometry of your eyes and the surgeon doing the job. So if someone has a great vision from far to near with a lens (this can happen with monofocals for some people too), is no guarantee you will have the same outcome.

I had one eye done about 9 days ago with Eyhance, after a grueling deliberation and research on my own. I'm artistic and a writer and spend a lot of time outside, so quality of vision is important. My cataracts were worse than thought. The eye that hasn't been operated on, is so yellow and blurry, I am having a very hard time adjusting or assessing the intermediate vision in the surgical eye, distance is amazingly crisp and clear. The doctor's office told me they won't test the eye for intermediate until the second eye is done. Is that typical?

I developed an infection in the left eye and may have to delay surgery. The surgeon said he would set the (left) second eye to .5 diopter, because that is "what he usually does." Doesn't feel very personal.

I like the surgery team but the practice dumbs everything down, it is so frustrating, I also had to change ophthalmologists because of some insensitive remarks at my first post op visit. I am considering waiting for the second eye, until I can get more answers. But the imbalance is huge.

At the post op check, the new OD tells the assistant recording information :Residual PCO". I comment on that and he acts surprised "Are you a doctor?" 😊

Is it really that surprising that a patient wants to know what you are implanting in their body and takes the time to learn about it?

I am supposed to have the second surgery in 12 days, if my infection clears. I am searching for answers so I get the best outcome. I feel it's up to me to do my own research as its pulling teeth to get information from the office. Any thoughts? I appreciate input! 58Y female, never wore glasses, only readers (occasionally) in the past few years. But it was the pandemic and everything was a blur anyway.

"The doctor's office told me they won't test the eye for intermediate until the second eye is done. Is that typical?"

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No, that is not typical. The gold standard for the cataract process unless there are extenuating circumstances that require a speedier completion time is to"

1. Do an eye exam 24 hours after surgery, but not a full vision test. They are mainly checking that the lens is in properly and has not moved.
2. Do a preliminary eye exam at 3 weeks where vision is tested, but only to the extent needed to decide if there is anything abnormal.
3. A final eye exam which will be of the quality required to get eyeglasses if you want them.
4. Before the second eye is done, the surgeon should review the outcome of the first eye compared to the target, and decide if any adjustments are required for the second eye.

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   Do all surgeons do that? No, many are in too much of a hurry to get you in and out.

I am with an HMO and have had a lot of problems getting information also. It is like pulling teeth, basically. My assumption is that they are so pressed for time and there can be so many questions that they are afraid to be available to answer them. I would think if you were with a private group where you pay more money you might get better care.

These doctors are just have so little time and we are all being short changed. Recently, I went for surgery on my left eye and they refused to admit me to surgery because my doctor and others did not supply the essential information that you need a person to stay AT YOUR HOME after surgery if you have even a mild sedative. That person has to be with you at check in and also pick you up. I had a medical transport company for check in and out but then they asked who would be at my home that night?

I had to turn around and go home! Bottom line is the HMO did not give me this information! Can you believe this!! Some facilities are really disorganized and depts. don't communicate properly with each other.

This is an A Rated HMO, btw!

PCO is scary and certainly you have a right to know everything. Do they have a complaint dept. I have already registered a complaint with mine. Good luck to you!

Yikes! It shouldn't be surprising at all these days that people are more informed about their procedures and want more specific information. If you had "residual PCO", why didn't the surgeon mention it before? I would think that was a pretty important piece of information to give your patient so they are prepared for it. Do you know what the target was for the eye you had done? I had to insist with my surgeon about my upcoming surgery about what I wanted my targets to be. He just thought, like yours, that he'd just do what he usually did, which was to make the decision for the patient, without even finding out what was important to me. He seems on board with it now, but was kinda rude initially when I insisted that I knew what I wanted. I told him that I'd researching this for months and agonizing over what was the best direction for me, and given it a lot of thought. He backed off after he had time to digest that.

That is exactly what I am going to do even though my doctor did not indicate any other appointments than the 24 hour follow up.

I have gotten her to agree to taking feedback from the 6 week appointment on the first eye and using it for the second eye.

Good to get that information and I am going to follow that schedule but will have to take the initiative myself.

That is how it is in healthcare in general now. You often do have to take the initiative. Insurance is paying drs less, and the all the Baby Boomers are at that point where their bodies are needing care. So, the entire healthcare system is overwhelmed. Covid only made things worse.

I am doing everything...my doctor very little! Healthcare does seem to be in bad shape and I absolutely hate to even visit doctors unless I have to which is the case of having cataracts...no escape!

Well, it's going to work out eventually. But I know it's frustrating.

Thank you for the information. I have a eye infection and flu now so it looks like my second eye surgery will be postponed, or I will postpone it. They only do a 24 hour and 10 day post op check in this practice.

Before the second eye is done, the surgeon should review the outcome of the first eye compared to the target, and decide if any adjustments are required for the second eye. -this is exactly the information I need going into the second surgery. Thank you.

I have PTSD and the surgery team was great with it, they asked what I needed and I said I need everything explained. They did, the day of. But actually, there was no explanation of side effects. I immediately had an eye infection and now the flu, plus weird tinges and headaches. I didn't like how rushed everything was and postponed the first time, but just two weeks. I spent two weeks researching when I could, and decided on Eyhance, even though they were pushing for Panoptix. In India, now most surgeons recommend against Panoptix because of haloes and glare.

The post op O.D. (who I had never met) was a nightmare, asking me personal questions and bursting in in the middle of my eye exam saying, "You're really young for cataracts". I felt like saying, "That's not relevant now, I had surgery 18 hours ago." Then he went on to ask me personal questions that had nothing to do with my eye surgery. It really disturbed me, it's complicated, but he triggered my PTSD 18 hours after surgery. I called insurance and asked for another O.D. who immediately diagnosed an eye infection 5 days later. Now I have excessive congestion and sneezing and feel horrible.

I am nowhere ready for a second round of this and am thinking of going to India for the second eye surgery. Any thoughts on how long one eye surgery can be tolerated? My nonoperated eye is very fuzzy and yellow, but I can now see well enough to get through an airport.

I'm also considering a Vivity lens in the second eye. Does anyone have experience with different lenses like this? Eyhance in one, and Vivity in the other? Or some combination like it?

Thanks again. This group has given me more information than the doctor's office. The research is out there for most topics but if we don't even know where to look, or what questions to ask, we are alone in the dark.

I asked the surgery manager about PCO, or secondary cataracts but she never answered me. The O.D. who works with the surgeon said he didn't have that information. It's very suspicious to me.

I would think a lot of these questions are common and just having information printed out or on their website would benefit a lot of people. It's a large practice so I have to kind of feel like they are purposefully keeping information from patients.

Yikes is right!

They are being paid, there is no place for rudeness. What did you decide on your target and how?

I don't understand how they can be this disorganized if they are doing so many of these surgeries every week. One surgeon said he does 40 cataract surgeries a week. There really is no excuse for not providing commonplace information. If they can't handle the workload, they need to cut back.

I am so sorry you had that experience. It's nerve wracking enough getting ready for surgery, the eyelid wipes, the drops 3 days before and fasting for surgery. And then, to find out they made an error like that.

They don't seem to care about wasting our time. But they cant give enough of theirs.

I was told my eye infection was a "coincidence". That's just not logical right after surgery. Do they think we are that dumb?

I have been thinking about a complaint but I am so tired of this process, I'm not sure whether to push through or bail on it and go somewhere else.

It is sad that people have to go through negative experiences like that, especially from medical professionals. Doctors seem so busy these days and no time to give to the patients. My doctor was the same. I was trying to decide if I wanted the Eyhance, but the doctor did not answer my questions. I did my research and received a lot of help from people on this forum, but no help from the doctor. They seem to have a set thing they do and cannot fathom the patient might want to be part of that decision or want something different from their normal. Good luck with your second eye. It will be nice when it is finished and you can get past this experience. I hope you feel better soon. Let us know how things turn out for you.

My thoughts would be to hold off on the second eye until you find out exactly what you got for outcome on the first eye. Get an optometrist eye exam at 6 weeks post surgery with a written eyeglass prescription. Then you have a document showing where you stand for refraction in the eye. Based on that, you can make an informed decision on the second eye. If you are happy with the nearer vision then it would make sense to target the second eye for distance (0.0 D to -0.25 D). If you are happy with the distance vision and want better close vision then a near vision target would best. With the Eyhance -1.0 to -1.25 should give you good near vision.

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There is nothing wrong with a Vivity in the second eye, but you do take on a little extra risk of optical side effects. They are not as bad as the PanOptix in that respect, but do have some risk. They also have reduced contrast sensitivity even at the peak point. I am not sure that would be worth it. If you are willing to go back to the same surgeon they will now be experienced in what the outcome is in your eyes with the Eyhance and should be more accurate in predicting the outcome.

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There is no limit on the time you can go with only one eye operated on. I went about 18 months between eyes, and got through it mainly by wearing a contact in my non operated eye. It sounds like that would not be an issue for you as you said you have not needed glasses prior to the cataract issues. But, of course the cataract restricts vision. I would not be rushed on the second eye. Find out where you ended up at 6 weeks and then make your decision on the second eye.

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On the eye infection issue it is very important to follow the post surgery eye drop schedule to the letter. Surgeons vary a lot on what they prescribe. The one I had is also a university professor and has written papers on eye drops. His formula for infection prevention is Vigamox 4 times a day for 7 days starting with the day after surgery, with no drops in the days prior to surgery. But, surgeons are all over the map on the method they use.

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Hope that helps some. Any questions just ask.

Thanks. I think I will hold off as much as possible since I have bad cold symptoms and sneezing now, it doesn't seem advisable to have surgery in 8 days. I was in good physical health before the surgery, only now am I having bad physical (and mental) health.

I am concerned about quality of vision, but needing glasses more often after surgery doesn't seem like that good of an outcome for me. I guess the surgeon set for plano in the first eye, and plans on .5 in the second, unless I request something else. I am paying out of pocket for the lens, so I do have some say. It seems like 1.0 in the nondominant eye would give me good enough near distance that I wouldn't need reading glasses for most tasks.

So from, thomas84367-1446901 previous post it would be 19.7 inches of near vision with - .5 diopters and 15.7 inches with -1.0 diopter. Is that a reasonable assumption of visual outcome? Those 4 inches can make a big difference for reading writing tasks. I did ask and the surgeon told me my pupils "were on the small side". Another reasonable assumption would mean I would have slightly better depth of focus then, correct?

Based on your advice, I will request the surgery notes now. I asked for my chart already, but again, no response. I did request and pay for ORA during surgery, so I should at least get the results, right?

It seems they should have been uploaded to the online health portal...

The infection I have is in the non-surgery eye. That is getting 4 drops a day (neosporin, etc.) plus warm compresses. But it is not getting better. The eye with the new Eyhance lens gets just one drop a day of Prolensa. It's odd that every surgeon has a different recommendation but that may depend some on the insurance from state to state.

When I asked about the residual PCO, they told me I need to "wait for the lens to settle." It's those kind of vague answers that are making me crazy. Why not be specific or even ballpark it? They must have statistics on when and how often patients develop secondary cataracts, at least in their practice.

I haven't been sick like this in a long time. It just doesn't seem right. Did you or anyone else also have facial twinges? I still feel like a dull tenderness or pain in my cheekbone. It's just been two weeks though. The day after surgery, I felt like I had a head cold on one side of my head, the opposite side from the surgery. It was a feeling I had never had before. I called and they said it was normal. But it wasn't. It was an infection.

I think I should wait for the new lens to "settle" and get some more answers.

Were your cataracts advanced, i.e. yellow and cloudy compared to the new lens? The imbalance is hard for me to manage right now.

Thanks again. This group is a lifeline.

On my end after writing my doctor twice and telling her about the complaint she finally got back to me and said she is complaining to the pre op people who handle the instructions.

Now the really weird thing is that I attempted to do a Colonoscopy two times a year ago but for some reason I got deathly ill on the prep and had to cancel... BUT there were no instructions given except about the driver. Can you imagine me showing up l5 miles from my house for a colonoscopy after having diarrhea for several hours and not eating and then having them turn you away! Because I got sick and didn't make it this did not happen to me and I am grateful!

I think now they have had this rule for a long time but possibly have been letting people " slide through with a driver only" and all of sudden they have started enforcing it but have not updated the instructions yet.....something like that???

I am worried about an eye infection as my doctor is not giving any antibiotic drops? She said there is an antibiotic shot in surgery. I assume you had antibiotic drops and still got the infection?

BTW, complaints at my HMO are very simple and take a few minutes in writing an email to the complaint dept. I think a good idea in that it would help others! Good luck!

If the infection is in your eye that has not been operated on, for sure you need to wait until it is fully resolved. That last thing you want is an infection in the operated eye. I would have to think the infection is coincidental, but regardless you need it to be resolved before the eye is operated on.

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I would hold off on making any decision on where to target the second lens. After 6 weeks you will have a lot better idea what the Eyhance is giving you for closer vision rather than rely on charts and rules of thumb. The combination of knowing your refraction (eyeglass prescription) and what you are actually seeing should let you make an accurate estimation of where you want to target the second eye. Yes, a smaller pupil should give you a deeper depth of focus.

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The Prolensa seems to be just an NSAID. It would seem the surgeon must be depending on an antibiotic injection at the time of surgery. Some go that way.

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PCO normally takes some time to develop. Your optometrist at 6 weeks should be able to tell you if it is a significant isssue or not.

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The cataract in my second eye was not all that advanced. But, it was to the point that it was obviously more yellow than my operated eye. My biggest issue was the need for a contact in the non operated eye. I got tired of it. But in your case, I think it is well worth your while to wait for 6 weeks before proceeding.

I think they are so streamlined by cost limitations that they can only answer the very most essential questions. I am now being very careful about what I ask my doctor and I look everything up myself. Before the necessity of cataract surgery I avoided my HMO and the doctors like the plague! Can't stand anything about it but will deal with them if I have to! I wonder how much satisfaction they are getting from their jobs and treating patients so shabbily?

That's helpful. I was scheduled for 3 weeks between surgeries so another 3 or 4 weeks seems prudent. I don't like being rushed through this and don't mind being a pain to the office staff.

I will ask for a 6 week assessment.

In the mean time, I can get a new roof on my house. Something I have been postponing because of this surgery. 😊

In general are you happy with the Eyhance choice?

In India, they strongly suggest Vivity but the surgeon here doesn't use it, which just added to the decision stress for me because going abroad is an option for me.

I don't know about the cost limitations as much as they are just trying to make so much money. Many of the surgery centers are surgeon owned. The surgeon here does twice as many surgeries per year as the highly qualified surgeon I spoke with in India.

It just seems like many of the questions are similar and they should be ready to answer them. I don't like the western health care system. I feel like everyone is over medicated. But I thought it would be covered by insurance and then found out about the expensive lenses and questioned my choice to have surgery done here. Especially with the inappropriate way I was treated by the first O.D.

The total cost for laser assisted surgery with Vivity lens was less abroad compared to the out of pocket cost of Panoptix here.

I think that there is good job satisfaction in cataract surgery in general because it's better than a cataract.

Read a book by someone who had it done in Thailand. Much cheaper!

I do not have Eyhance lenses, but I think they are a good lens for their intended purpose. I am not sure that Vivity is a better choice, and I don't think I would travel to India to get it. I considerd Vivity for my second eye, but got cold feet at the last minute. I have a monofocal in each eye but in a mini-monovision configuration. One eye is set for full distance and the other is myopic at about -1.40 D. It lets me go essentially eyeglasses free. You can do monovision with the Eyhance as well. Since you are half way into it, I think it is worthy of consideration once you find out where you landed on the first eye. With the EDOF that the Eyhance provides you can target a little less myopia for the close eye. Probably -1.0 to -1.25 D is ideal.

Are you in USA? I would not go to India for cataract surgery. just because it's cheaper over there.

Go instead to one of the leading eye hospitals in the USA and get a monofocal like Tecnis, Eyhance or the Clareon. You can Google search for best eye hospitals in USA. That would be simpler, easier and cheaper.

Not at all, just because it's cheaper. I live half time in India. Indian doctors are highly educated and professional, among the best in the world.

Indian medical schools are very competitive and difficult to get into. The top hospitals have the best equipment, the one I looked into, had better equipment than the American one I am using. People come from all over the world to receive the excellent medical care India offers.

Indian citizens are given the same basic monofocal cataract benefit as here, as well. And in keeping with Asian culture, older people are treated with great respect.

Alas, I am American by birth and my cataracts were advanced so I felt I had to have surgery while here.

But the American healthcare mill is really discouraging.

In my experience, Indian doctors actually treat the whole patient, not just body parts. I mean, my post op check, the O.D. didn't even check the other eye! Even when I complained about it. Obviously they are connected! It took me quite a few phone calls to get in to see a different O.D., who immediately diagnosed an eye infection, that should have been diagnosed a week before. The whole process is extremely stressful; stress is something that is known to aggravate a medical condition.

With a rich and beautiful tradition of Ayurvedic medicine, India offers wonderful medical care, addressing the person wholistically.

Last year when I was in India, I had a house call. I miss India and its people.

After this experience, the rush through medical care, the disorganization of hospital staff, the lack of information ....I am planning to stick with India. They are definitely better for dental care, in my experience. That's next. I will probably have the residual PCO taken care of in India too.

What made you get cold feet about Vivity? I was concerned about loss of contrast. I work abroad and often find myself in low light situations. I found Indian doctors who talked about the "quality of light" and UV ratings; they definitely don't normally recommend Panoptix in India.

That's why I was thinking of waiting.

I will ask about the first eye and where it landed based on your advice. I really appreciate it. I have an appointment tomorrow. So, I'll see...

I recall that the discussion with the ophthalmologist started with the possibility of using the PanOptix. I told him bluntly that I would not take a risk on that one. After that I think he decided I was likely a hard to satisfy patient and he then discouraged me to get a Vivity. I settled on a monofocal. It was for my second eye in a mini monovision configuration.

I had both eyes done only two days apart this week because of my extreme myopia (was -13.0 D in left eye, and -12.5 D in the right eye). I just made a post about it (entitled "Definitely an Ey(en)hance for me") a couple of days ago. The difference in vision between the operated eye and the un-operated eye would have been debilitating for me. After the surgery this past Monday for the first eye, I ended up putting a piece of cardboard in the lens of a pair of non prescription glasses, to block the un-operated eye as it was detracting from the clear vision of the newly operated eye, and messing up my depth perception.

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I've been researching this stuff extensively for the past five months, and finally decided upon the Eyhance for both eyes. I've been wearing my glasses pretty constantly around home but I can't drive with them because of the difference in depth perception as everything is at least a third smaller than it's real size with the glasses. I could only drive wearing gas permeable lenses. But as my eyes worsened over the past year, I wasn't getting good vision with the contacts either. I wanted to be glasses free for distance, but as I thought more and more about it -- as I moved around my own home and thought hard about what I spent the most time doing -- and from reading comments from other people, I realized that if I had to wear glasses for something, I'd rather it be for distance for something like driving as that is a specific thing that was easy to prepare for -- take the glasses with you in the car, or when you drive or go for a walk, take them off when you're done. The idea of having to take glasses off and on repeatedly around the house, depending upon you happened to be doing at a particular moment, would have driven me completely bonkers, especially since I have very little short term memory due to a brain injury.

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I'd been reading many excellent outcomes of people here and on other sites who targeted the Eyhance for nearness and intermediate, but still ended up with very good distance vision also. So I targeted my right eye for -1.0 D to -1.25 D (ended up at -1.21 D according to the surgeon) for nearness/intermediate (surgery 06-03-23), and the left eye for intermediate/distance at -0.50 D (ended up at -0.36 D -- surgery 08-03-23). So far, I'm very happy! My near eye (RE) tested for distance at 20/30 earlier today (though it was 20/25 the day before), and the near and intermediate vision is excellent. I can read my 6" screen cellphone easily at 12", and easily read small print on things like a large bottle of Tylenol, or say the microwaving instructions on at frozen dinner, at 20" to 33". I've only had to put cheap readers on twice to read the tiny print on the back of a movie ticket over the past four days.

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The distance eye (LE) tested for distance today at 20/20. The near isn't great for that eye, and the intermediate starts to get clear at about 40" but not for small print like the other eye. I know both eyes will keep fluctuating over the next month, but the two eyes working together is currently giving me amazingly sharp vision at all distances. They are working together exceptionally well. I'm not noticing where or when one particular eye is picking up the load. I had minor floaters before the surgery, especially in my right eye, but they were only really noticeable when I'd overworked my eyes, or when I was really tired. I'm experiencing them now, post surgery (still mainly in the right eye), which makes sense since my eyes just went through surgery. My surgeon said that in general, since so much more light was now getting into my eye, that they would be more noticeable, but that they should subside as the eye heals (or as before, I just get used to ignoring them). They are worst right after I use the trio of prescription drops I was given, but they ease off to almost nothing a couple of hours after.

It does sound very good I had never heard anything about it before.

Indian Dr's are good. I work in a hospital and most of our hospitalists are Indian. In fact there are many Indian Dr's in the USA because we pay them better. And yes, they do have excellent medical schools. Since you live half time in India then it makes sense

for you to be treated there. Google " Forbes India is investing billions to create a robust health care system."

Those D values for your eyes post surgery to two significant decimal points must be predicted values from the surgeon's software. While they look very promising, the real truth is what the optometrist eyeglass prescription ends up being at 6 weeks post surgery. That said, it sure looks like you will get a good outcome.

If your distance LE at .36 is not good for close up and only clear at 40 inches I am getting worried about my doctors choice with Tecnis 1 of .27 LE distance eye. I was hoping to have more close in vision and am now asking her about selecting .50D for LE which I thought would help. Maybe you have to get something like -0.1 LE to get decent close in vision?

my friend at Harvard told me to go to India for cataract surgery because they are good because if the sheer volume of the surgeries they do.

the medical facilities and support staff is not so clean as in the US though and there is no accountability.

go to the US for PCO management. they struck the retina with the YAG laser for my mother and causwd her retina to detach. there is also risk of IOL pitting if not dine carefully. while pitting can happen at some places here as well the quality control is much better.

I didn't know the YAG laser was that dangerous. Where did your mother have the laser treatment?

That's scary. I'm so sorry that happened. How is your mother now?

I know a surgeon in the U.S. who declined eye surgery because of risk of retinal detachment. It wasn't anything that was explained to me at all.

Studies show that laser assisted cataract surgeries cause less PCO- but the surgeons in the U.S. don't often use laser because it takes more time and expense. In Delhi, it's more normal. When I asked the surgeon's office in the U.S. why they don't use laser assisted, they said, "Because we don't have it."

Not too reassuring.

I will probably go to a good Punjabi doctor in Chandigarh if it comes up.

Again, so sorry that happened.

My surgeon did not even warn of the PanOptix risks, we discovered it online. That didn't give me much confidence in the team. After weeks of discussion with the surgery staff, Someone finally said 50% of their patients get glare and haloes from that lens.

What configuration is still considered mini monovision? I asked the new surgeon about setting my left eye at 1.0, the right is plano and he discouraged it. the other surgeon also did. What would be the negative affects of going 1.0 vs. .5 in the second non-dominant eye?

Both surgeons say .5 for the left eye - are they just being cautious?

It's sad how little trust I have in them.

Maybe due to the eye infection and severity of the cataract in the left eye, but I am not getting good intermediate vision yet 16 days post surgery, and am wondering if requesting 1.0 will be my best outcome or if it will cause problems.

dr ashok shroff in mumbai did the YAG. she lost that eye. if you go to india then janik shah in gujrat is well recommended.

she had gotten the surgery from dr daljit singh in amritsar who was only doctor in india who used IOLs back then. he was very good. YAG was done 8-9 years later.

there is no correlation with femtolaser and PCO. i used femtolaser and had PCO at 4 weeks. if you are young you will get PCO quickly.

The risk of retina issues with YAG using modern methods is about 1% or less. The risk is there, but is low.

My distance eye ended up at -0.25 D on a spherical equivalent basis, while the near eye is at -1.40 D. That is a 1.15 D differential between the eyes. I suspect it would also be fine up to 1.5 D differential based on studies I have read. Keep in mind that you will almost never get an outcome exact to the 0.25 D refraction. I think a reasonable target for the near eye in mini-monovsion with a monofocal is -1.25 D to -1.50 D. I would pick the lens where predicted outcome is within that range. Ask the surgeon what the power choices are in that range. Their IOL calculation sheet has that data in it. In fact better still ask them to give you a copy of the IOL calculation sheet.

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Not sure there are formal definitions but this is what I have gathered:

Micro-monovision -0.75 to -1.0 D

Mini-monovsion -1.25 to -1.5 D

Full monovsion - -1.75 to 2.5 D

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Full monovsion used to be commonly used and I suspect that is what has given monovision a bad name. The current trend is to mini-monovision.

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These surgeons view of monovision seem quite out of date.

Great. That's so helpful. I will definitely ask for the sheet. Odd thing is, both surgeons are young. I wonder how the bit of EDOF in the Eyhance would alter those calculations?

Thank you for the information. Did your new lens completely cloud over with the PCO? How did you know it was time to laser it? You must have been nervous based on your mother's outcome.

It's just awful that happened to her.

I manage a small nonprofit and we have provided some cataract surgeries in Ktm: all of this is very valuable information. But I was not involved in the surgery side of it.

I am 58 - do you think the PCO effects will come on quickly for me? The surgeons here have not been forthcoming with information, concerning PCO, it's almost as if they are hiding it, acting surprised when I even knew what it was.

So you were you happy with Dr. Daljit Singh in Amritsar? That's a lot closer for me than Gujrat. I'm in HP. I may be there when the time comes to take care of it. Thank you.

i have not had a YAG yet. at 4 weeks when PCO started the halos started becoming grainy. then the near vision became blurrier. then i had to blink to make distance vision clearer. now it is very foggy because i have 4+ PCO.

i have picture of the 4 week PCO and the PCO now.

at 58 it is possible to get PCO but retina detachment risk after YAG is lower because your vitreous inside the eye is not as thick as a younger person.

Daljit Singh is not alive anymore. he was fantastic. the OG of iol cataract surgery in india. you can try netradham in Bengaluru with Dr Sri Ganesh.

If your eyes were done with an IOLMaster you can google this for an explanation as to what the numbers mean on the IOL Calculation sheet. If it was a Lenstar 900 then I would expect something similar.

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IOLMaster 700 Quick Guide Printing Functions EN pdf

I am getting eyhance in 10 days and hoping my astigmatism .50 glasses will help my near vision also.

with ipad i can adjust the light so i'm optimistic. How high did your residual astigmatism end up?

I am impressed with how much information you have. I have no idea what was used, this office seems to be purposefully withholding information. That's easily something they could put on their website. I know you said they were reluctant to give information at first, but I requested my chart a couple of weeks ago, and they haven't sent it.

They did send the initial eye test results but only after a week or more of trying to get to the right person.

I was supposed to have the second eye surgery on Thursday, but I am postponing it, until i can get some answers. I postponed the first and in the mean time, I decided on the Eyhance.

Did you specifically ask if they used the IOL Master or the Lenstar? Is IOL Master more common?

I have very clearly told them I want all the information, that's why I am so frustrated with the lack of it. The lack of information is stressful, and stress is definitely not good going into surgery, no matter how much they want to minimize the seriousness of the surgery.

I am noticing some increased intermediate vision in the Eyhance eye now, after 18 days, but they keep telling me they won't give intermediate test results until both eyes are done.

Unfortunately I learned most of this AFTER I had my surgery. My brother was smart enough to ask for the IOL Calculation sheet and I have a copy of his, but nothing for myself.

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My first eye was done through a hospital clinic and the second at a private clinic. I don't know for sure, but I think my first measurements were done with an IOLMaster 700, and I know for sure my second eye was done again right before surgery with an IOLMaster 500. I was not impressed by that, but I believe they had my measurements from the first time around. My brother's measurements were done on an IOLMaster 700. Not sure how popular each is. I have gone for two Lasik consults and I believe one of the clinic was using the Lenstar. The Hill RBF-3.0 formula for determining the lens power apparently was developed with the Lenstar, but claims to be suitable with the IOLMaster as well. If you get your measurement numbers you can run them yourself using the online Hill formula.

When I had my post op eye exam, the (American) doctor told the nurse: "residual PCO", and then he was surprised I knew what it was and asked, "are you a doctor?", like it was secret information I wasn't supposed to overhear. They didn't warn of anything about PCO. For myself, having information is much less stressful than not having it. I have told this office this over and over and they come back with vague answers. I worked as a botanist and with animals (some animal science background), I can't help get frustrated with the constant vague answers to my specific questions. When I get very frustrated by them. I just close my eyes and listen to Ghazal by Jagjit Singh.😊

I will definitely be careful with where I go for YAG laser when the PCO becomes problematic. But Chandigarh or Delhi are a lot closer. Eye7 hospital in Delhi posts informative youtube videos and I was thinking of using them.

Another online surgeon in Punjab, discussed the "quality of light" in India, which I found very interesting. He said because of the quality of light in India, he did not recommend Panoptix lenses, which most Indian surgeons, also do not recommend. Since I will be spending a lot of time in India, it weighed heavily into my decision process against Panoptix, which the American office seemed to be heavily promoting.

thats interesting with the amount of sunlight in india the multifocals could cause glare but it isnt that bad in my experience with symfony. in india you will also have access to the zeiss lisa trifocal. advantage with india is that you have access to european and american approved products. and the drugs are inexpensive.

btw the residual PCO means he didnt polish the capsule thoroughly and those cells will multiply. my iol is 95% covered with PCO. let me know if you want to see how it looks.

Google "Grading of Posterior Capsular Opacification - Researchgate"

It is graded in four stages. There is no "residual" stage. Unless he meant "trace," the first stage, then mild, moderate and severe.

I had seen a discussion you had about the steroid drops given after surgery. I was given prednisone but asked my doctor about a more expensive drop which is more mild I believe called Loteprednol. She gave me a prescription without any comment so must be ok. Any insight on these drops or any you like? I thought getting something milder would be best but don't have much info. on it.

I actually was wrong about my intermediate vision not being that great. I've started patching one eye for periods of time to get my brain to focus on just that eye and push it a bit, and the intermediate and even near vision is much better than I thought. I think my eyes have been working maybe a bit too well with each other, each just accepting a specific role and not reaching for more. When I would just cover my right eye briefly to check intermediate vision with the left, it seemed not very good. But after patching the right eye off, and doing things around the house with just the left eye, after about fifteen minutes or so, I realized it's not bad at all. Not as good as the right eye of course, but much more usable than I had thought. I'm doing the opposite to try and make my right eye push more for distance.

The Hill RBF-3.0 formula for determining the lens power apparently was developed with the Lenstar, but claims to be suitable with the IOLMaster as well. >

When they did the scans at my pre-op, I made a point of noting the names of the machines, and all three of those machines were used. I was surprised that they used both the Lenstar and the IOLMaster. The printout they gave me was from the Lenstar. I couldn't tell which models they were, but this clinic seems very up to date.

Those D values for your eyes post surgery to two significant decimal points must be predicted values from the surgeon's software.>

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Yes, I'd asked him just before he started surgery on the left eye, if he remembered what he thought what he'd gotten with the right eye, and he said he didn't, but then he went and checked the computer and I guess pulled up my results from there. After he finished with the left eye, he told me immediately what he thought he'd gotten with that eye. It will be interesting after I go to the optometrist to see how correct he was.

I think the EDOF in the Eyhance gave me quite a nice kick for the eye I targeted at -1.25D for near. The near is so good, very clear, but the intermediate is freaking amazing. When I was picking things up with small print like pill bottles and such, I automatically was putting them closer to my face -- the same distance as my phone for example (around 12" - 13"), and the print was blurry. Then I moved them about 20" away, and the same small print was very sharp and clear. I'm talking about the small print on the side of the box that the antibiotic drops came in for example, or the instructions inside, or the small print on the side of a hydraSense eye drop box -- and even smaller print than those. I've only used cheap +1.50 readers a couple of times for stuff like the really really tiny print on the back of a movie ticket (the clinic gave me a free Odeon pass for two people as thanks for choosing them so I used it as a test).

I'm actually not having problems with the Eyhance in dim light at all. Of course bright is better, but I'm able to read small print at intermediate distances in a dimmer room - say a shaded part of a room when the sun isn't as bright. I did my first night driving test (no moonlight - it was a bit hazy out) two days after the left eye was done, and had no problems. I took dark side roads, initially at slower speeds, then finally at highway speeds (no white lines down the side), and once again had no problems. On some of the side roads, I pulled over to look into fields and could see brush etc above the snow at more than a hundred feet. I could see a satellite that was covered by the haze in the sky through the sunshaded part at the top of my windshield -- and could see clouds in the sky itself also. I could easily see at least fifteen feet into copses of trees along the road while driving slowly down a side road, and I could easily see the shape of house set from the road that had no lights on it, or around it. I was really nervous, but ended up being very happy. I don't think I could see that good on dark, dim roads with my contacts before the cataracts hit.

I am not familiar with the Loteprednol. I was given a choice for steroid drops; Prednisolone three times per day for three weeks, or Durezol once per day for 3 weeks. I picked the Durezol once per day option.

I was really nervous, but ended up being very happy. I don't think I could see that good on dark, dim roads with my contacts before the cataracts hit.

Yes Eyhance should be very good for distance vision at night. That's a scenario where any Monofocal while shine compared to a Vivity or Multifocal. That's one of the reason I choose Eyhance, because I'm a hiking / camper and wanted good distance vision in the woods at night. I was worried I wouldn't have that with Vivity. Where Eyhance (and any IOL for that matter unless you target near vision) will struggle is reading vision in low light. I do need a reader for reading the iPad in bed in a dark room for instance. And a +1 does help when cooking in normal light too for instance (reading a recipe)

How high did your residual astigmatism end up?

The corneal Astigmatism kept changing actually. I haven't had a recent optometrist exam but I think it's settled in around -0.5 to -0.75. It was -0.5 before surgery. At one point when I did a pentigraph / corneal scan it was as low as -0.4?! Another time it as almost -1D. Which seems weird. I was also on drops for a VERY long time due to other surgery complications (Macular Edema). I was on Steroids for basically 5 months non-stop. So maybe that was slowing down the corneal healing or something? Dunno.

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In any case I would say that at the end of the day... 6-7 months later... my residual astigmatism is negligible. I DO think that the EFFECTS of the Astigmatism (very slight ghosting on computer text and a very slight "smear" for sharp high contrast objects like overhead power lines against the sky at distance) are far more evident to me now because the light coming into my eye now is SOOOO much brighter and better focused. It's kind of like how I didn't realize the window in my apartment were filthy (LOL) until I had the surgery. Now I see every speck of dust. LOL.

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You can also bump up font size on the iPad

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Also just a comment, I think the issue really with glasses for most people isn't the glasses themselves. I don't mind one bit wearing them for cooking or using the computer or reading in bed at night. Because those are extended activities done in one place. The issue is the quick day to day glances where you only need help for a second and/or you don't have readers readily at hand... like checking your watch when or reading a label.

Sorry I just asked this question to you on another thread, but...you have Eyhance at 1,25 in your non-dominant eye? I postponed my second surgery until i figure this out. My first eye (right, dominant) has very crisp and clear distant vision but typing on my laptop, I am still struggling to see. I had hoped for better intermediate, laptop vision. Thanks.

Ok. Thanks. I will look into this. The doctor's office isn't responding to my question about using 1.0 in my second eye, vs. his recommendation, "he usually makes" of .5. I asked for the calculation sheet on Friday, still no answer.

Thanks for the clarification. He may have said "some residual PCO". It was like I had to overhear what he was telling the nurse who was recording it in the computer. Then he didn't clarify other than to ask if I was a doctor. I just don't get it, why they won't readily give information, even when I am literally face to face with them. I will ask what stage the PCO is next time I go in.

Most of the Indian surgeons seemed to like Vivity best. I think it gives the most reliable outcome. The government also provides basic lens surgery, same as the U.S. but it was interesting that the Indian surgeons said they only would suggest Panoptix for "housewives and retired people", i.e., if you need to see to walk and cook and not much else.

Can you post a photo of the PCO here?

I will be asking even more questions at my next visit. Thank you!

FWIW I believe both in the US and Canada there have been Supreme Court decisions which have determined that the ultimate owner of medical data is the patient, not the doctor. They are obligated to give you the information. However, the fine print in at least Canada is that if push comes to shove, you have to make the request for your medical records in writing, and have to allow them time to prepare it, and they can charge you their out of pocket costs to give you your data.

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That said it is just one click of the mouse once they have your IOLMaster or Lenstar records displayed on their computer.

see the PCO thread. i have posted the picture there.

I'm actually not having problems with the Eyhance in dim light at all. Of course bright is better, but I'm able to read small print at intermediate distances in a dimmer room

Yes but I see above you said your Eyhance eye is -1.25 and your scenario is a shaded area of a lit room. So that makes sense. When I say I need readers in low light, my specific scenario is reading my iPad Air 5 in a pitch black bedroom (can't see my hand in front of my face due to blackout shades) with the screen dimmed almost all the way and an Eyhance eye that is at 0 Sphere with only minimal help from a bit of Astigmatism.

The office said they don't recommend a 1.0 difference for Eyhance lenses, unless I have used monovision before. I've had a time trying to get answers. I saw karonbee's post about her implant card and realized some answers were there. It was weird because someone handed the implant card to my daughter when we were leaving the surgery center. No one said it was important and it sat in her car for at least a week. I see now that my Diopter is +21.5D and there are 2 other numbers on the card: Ot 13mm and Ob 6 mm. Model DIBOO. I had the ORA technique and paid out of pocket for it.

One other odd thing was I was an advocate for organ and tissue donation due to a mistake made by a medical examiner's office and explained this in detail to the surgeons office and no one bothered to tell me I would have an Implant Identification card. I assume this means I can't donate my eyes and I should make extra copies just in case....

I am trying to figure out what my numbers mean, but please let me know if you have any insight. Thanks!

Since you have delayed your second eye surgery do you have enough vision in your unoperated eye to use a contact to simulate mini-monovision? That would be the best thing to do. It would also be helpful to find out where your first eye actually ended up with an optometrist phoropter check. Then you will know how much differential there will be between the eyes with the various options available. If it is a minus D then there will be less differential between the eyes with each close eye power choice.

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With the small extension of depth of focus that the Eyhance has, I would suggest the ideal target in the close eye with Eyhance should be between -1.0 D and -1.25 D. Your surgeon should be able to tell you what the actual predicted residual refraction will be. There is no reason that I am aware of that would have a differential in that range.

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On your IOL card the DIB00 just means it is a non toric Eyhance. The 21.5 D power just means your vision was likely slightly far sighted. But, there is no way of telling from that power what your residual refraction will be. It is the difference between what your cornea needs and what that IOL power provides that determines your residual. You would need the IOL measurement data sheet like @karbonbee posted to tell what your predicted outcome would be.

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The 13 mm and 6 mm are just the outside diameter of the lens including the haptics, and then the lens itself respectively. I was told that one should keep the card in case there was a recall of the lens and you could confirm your lens was included or not. They said there was no need to carry it around in your wallet.

Thanks. I was just thinking I should see the optometrist again, before I decide. It's a lot easier to get an appointment there than with the surgeon. The optometrist was the one that diagnosed the cataracts.

I feel like the surgeon is just playing it safe, and I am the one who knows myself best and can only make the determination for myself. We live in our bodies 24/7 and the doctors see us for five minutes to an hour, that is , if we ate lucky enough to be able to avoid them.

I've never worn contact lenses and don't think putting one in that eye now, with the recent infection, is a good idea. I was thinking of popping the glass out of cheap readers and trying that. How long did you try monovision before you decided? What are the signs or symptoms to watch for, of not being able to neuro-adapt to monovision?

Your optometrist should be able to advise you on whether or not you could wear contacts. They also of course can refract your eyes to determine where your first eye is at. The idea with contacts is to under correct your non operated eye to leave you -1.5 D myopic. A few days is probably all you need to determine whether you like it or not. I used monovision with contacts long before cataracts came along and generally liked it, but was annoyed with the hassle of contacts so stopped. As time moved on I found it harder and harder to put them in my eyes, and blamed it on my advancing age and arthritis in my hands/fingers.

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After my first eye was done for distance I then got more serious about trying it before going ahead with it with an IOL. I found much better contacts and got over the handling problem. I liked it so much that I started wearing a contact almost full time in the unoperated eye for about 18 months or so. I may have mentioned it before but I think the secret to contacts is getting the silicone hydrogel material, not just hydrogel. Hydrogel only lenses are far too thin/flexible and difficult to handle. They are like trying to put a scrap of Saran wrap in your eye. One example is Acuvue Moist. They were impossible for me to handle. Examples of the Silicone Hydrogel would be Alcon Total 1, Acuvue Oasys, and the one I like the most, Costco Kirkland, which is really CooperVision MyDay. If you are a Costco member they will give you samples of 5 contacts to try for free. At least here they have the last three I mentioned. You will need a current eyeglass prescription to get them though. Your optometrist may offer the same service.

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I really did not find it difficult at all to adapt to monovision. It seems natural to me. The only real learning experience is that being at -1.5 D does not provide super close vision like I had when I was more myopic. So, you have to learn to not bring your iPhone closer to see better. You have to move it a bit further away - the opposite to what I was used to...

Because I had an eye infection and am not sure if it is all the way clear, I just am not comfortable trying contacts for the first time. I don't even want to touch my eyes at all. My daughter wears contacts though, so i will pass the information about lenses on to her. I think I will take my time trying to decide, my operated eye makes me functional again, so i feel like i could wait a bit. I have much more anxiety going into the second operation because of the surgeon's office, not giving information and dismissing concerns. Obviously they are not able to give individualized attention due to the large amount of surgeries they are cranking out. Shouldn't a surgeon's office know how many of their patients have to be treated for PCO? Because I have asked twice, with no answer.

My research shows 30 -50% of cataract patients have PCO "complication" . I would think a large office would keep track of this information, at least for their own records.

The other thing I am trying to figure out, is how much near vision would I gain with am Eyhance lens set to .5 in the non dominant eye. What would be the calcualtion for this? I chose Eyhance because it said i would get up to 22-26 inches of vision, so the .5 should bring that a bit closer but I am wondering how much vs. 1.0? The office won't answer this question either. One of the last emails I sent them I said I only wanted a projection of what to expect as I know the results are not guaranteed, but again no answer. I did get my initial test results when requested, and need to look those over but they haven't given surgery notes or my chart after asking twice. I was concerned whether they even put the right lens in because one doctor had something different on my chart. This is exactly why we have to be so diligent. They make mistakes all the time and it's our life and health, not theirs.

Just a suggestion, but be careful to use the - when talking about getting more near vision. .5 or 1.0 won't get you any near vision.** -.5** or -1.0 would.

I have seen numbers as high as 50% of patients needing a YAG procedure. However you may want to look at this study.

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Evaluation of Nd:YAG Laser Capsulotomy Rates in a Real-Life Population Roland Ling,1 Eva-Maria Borkenstein,2 and Andreas F Borkenstein2

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Some key quotes:

"the true rate of Nd:YAG carried out for PCO at 1 year was 3.5% and at 2 years was 8.5%."

"Posterior capsular opacification (PCO) happens when cells in the eye grow across an implanted lens and adversely affect the ability of the patient to see through the lens. The only way to remove the cells is to use a technique called laser capsulotomy where a Nd:YAG laser is used to ablate the cells. Although PCO rates have been falling with developments to IOLs and surgical technique, Nd:YAG rates have not fallen at the same rate and we wanted to explore the reasons why this might be. In clinical trials Nd:YAG treatment is usually used only when the PCO has had a significant effect on a patient’s vision. However, we found that, outside of the controlled world of clinical trials, Nd:YAG laser capsulotomy is sometimes performed without confirmation that clinically significant PCO is the cause of impaired vision. As a result, the treatment does not bring about any improvement in visual acuity and is also a waste of resources. Our findings highlight the importance of reaching a proper diagnosis of PCO before undertaking Nd:YAG in order to conserve healthcare resources, and to avoid placing the patient at risk. Studies reporting Nd:YAG rates in clinical trials should be obliged to report the grade and extent of PCO so that other readers can see that the procedure was necessary. Unfortunately, there is currently no standardized method of evaluation for severity prior to a planned capsulotomy in standard clinical practice."

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I think the readers digest version is that YAG is being done unnecessarily too often.

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On the vision with an offset issue have a look at the figure I posted in this thread.

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

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The dashed line represents the limit of good vision. The green line is the Eyhance compared to the Tecnis 1, the grey one. The green line intersection with the dashed line when the lens is set for peak visual acuity at 0.0 D (infinity) is at about 1.3 D. If you divide 1 meter by 1.3 you convert that to distance in meters, or about 3/4 of a meter. When you target an offset the whole green curve shifts to the right by the amount you offset it. So the limits of good vision become:

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Offset - Intersection - Distance

0.0 D - 1.3 D - 0.77 m

0.5 D - 1.8 D - 0.55 m

1.0 D - 2.3 D - 0.43 m

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Similarly the left side of the curve also shifts. So with a 0.5 D offset distance vision (0.0 D) drops to 20/25, and at 1.0 D offset it drops to about 20/35.

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Keep in mind these are average results bases on a study. Individual results vary from the average by quite a bit. This is likely why your clinic is reluctant to give you a specific number. YMMV, and they don't want to take the blame for it.

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Hope that helps some,

Yes, it would be a 1.0 D offset or -1.0 D target.

On the American Academy of Opthalmology website, I read that needing a YAG procedure means the surgeon did a good job by not taking too many risks...I will see if I can find the citation again.

Great explanation - "If you divide 1 meter by 1.3 you convert that to distance in meters, or about 3/4 of a meter."

It's so simple, not very complicated math - I can see why the doctors don't want to commit to an outcome though, because it's a wide range.

I have always been clear about just wanting an estimate.

Here is how I understand the predicted distance outcomes (converted to inches): it appears that a -.5 offset ranges from 30 to 21 inches (.77-.55 m) and going to -1.0 offset ranges from 30 to 21 to 16.9 inches (.77 -.55 -.43) - since -.1 falls within the (3) distance ranges. So, it seems it's easier to predict a -.5 offset than a -1.0 offset. Is that how you read it?

Right now, my laptop is at about 31 inches but I am still having trouble reading the screen without 1.25 -1.5 readers. It's hard to judge myself though because I still have a cataract in the other eye, which I think is fairly advanced,

When I decided on Eyhance, my personal prediction was I could get to about 17 inches of near vision, ( with the .5 offset) but now I am not so sure...my pupils are "on the small size" - but I have been trying to find confirmation before the second surgery. I was hoping to be glasses free at about 15 or 16 inches. My surgeon did say the opthalmology community used to predict outcomes based on arm length, i.e, if your arms are on the long side, you will have a better outcome (because you can hold things farther away) - I have had a tape measure by my side and I don't need to hold anything closer to my face than 15 inches, 17 inches is ok too. 30 inches is a little too far, but 21 inches could be manageable. I am assuming the distance is measured eye to fingertip?

Writing by hand is about 21 inches for me, so that's fine too. Even for woodworking, and art (close work) I don't want to have my face right on top of things for safety's sake and also glare, bluelight, and whatever we don't yet understand is emanating from screens. In India, the surgeons gave more practical advice, I'll have to go back and check but I remember them saying things like, "if you want to see where you are walking, chopping vegetables, writing etc, as a way to make a decision on lenses..." In the U.S., it seems the surgeons only used phone and computer distances as a barometer. I want to get away from using a phone so that is not a good indicator, for me. It's interesting if I was asked, "what do you do all day?" during the pandemic vs. now, I would probably choose different lenses at different times. As we get older, our needs change. I never thought it would get this complicated - it's pretty overwhelming. It's my first surgery, so I'm still getting used to have unnatural body parts. 😊👓

I am not sure I follow your range of focus estimates. Let me try to clarify. This is the average range of focus for each offset based on the Eyhance defocus curve, which is an average. Some will do better and some worse.

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Offset - Range of good vision (20/32+)

0.0 D - 30" to infinity

0.5 D - 22" to infinity

1.0 D - 17.5" to 17 feet (20/35 at infinity)

1.25 D - 16" to 7 feet

Thanks. That does help to clarify. That's the reason I can't see my laptop too well. It's closer in than 30", about 26 inches, which was the number I had in my mind after researching the Eyhance, and why I have been disappointed with the first lens. . In the throes of somewhat panicked research when I felt my surgeon's team wasn't giving sufficient information, I had found the Eyhance lens range to be between 22" and 26" which falls perfectly in your calculation. I think it must be the industry standard to offset the second eye at .5

I've been reluctant to get the second eye done because of not understanding this. Thanks for clearing that up. Still mulling the 1.0 because an additional amount of near vision, sure would be nice, but I do want to lose that infinite vision. How do they determine what infinity is with vision?

Yes, -1.25 D on the non dominant eye. The results for me at least, are amazing. The intermediate in particular. I can read the small print on the side of an eye drops box okay (a little blurry) at about 12", but move the same box another seven to ten inches further away, and it's crystal clear. I just tried it in the kitchen with just the LED equivalent of a 40-watt bulb (warm) on over the sink, and could still see the small print at arm's length with the light behind me. What's so freaky is that it's the opposite of what you would instinctively do. I was automatically bringing the small items, or instructions on a box, or a can, closer to me to read, and the smaller print was a struggle to get into focus, but when I move it further away, it gets sharp and clear. And using both eyes makes it even sharper. Pre surgery I was always aware of specifically focusing my right eye to take care of the small stuff, whereas now, there is no such feeling at all. It really feels like both eyes are doing the job, no matter what their actual capabilities are. I think you'll notice a really nice overall boost once the second eye is done.

"When I say I need readers in low light, my specific scenario is reading my iPad Air 5 in a pitch black bedroom (can't see my hand in front of my face due to blackout shades) with the screen dimmed almost all the way...">

Yes, I have a similar situation -- black room, and I can read my phone (6" screen) even dimmed right down at about 12" without any assistance. Now with the distance eye, I need readers but not with both (or just the near eye).

I'm actually glad that the surgeon suggested the bump from -1.0 D (my original target) to -1.25 D (he estimates that he hit -1.21 D) as I don't think I would be as happy with my near and intermediate results as I am, while still leaving me decent distance vision in the non dominant eye. It was strange because he initially was really pushing me to plano for both eyes, or possibly -0.5D for the non dominant eye and kinda dismissed the targets I requested. But as he listened to my explanation for my choices, he slowly warmed up to what I wanted. And I think my results will make him more likely to suggest similar targets to others in the future.

"The other thing I am trying to figure out, is how much near vision would I gain with am Eyhance lens set to .5 in the non dominant eye.">

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I'm not getting great near or even intermediate vision in my dominant eye targeted for -0.5 D. If that was my only "near" vision eye, then I'd definitely need to wear readers for anything closer than maybe 32". It's functional, but I have to work at it. It's nowhere as good as the other eye. I have very small pupils also, they barely hit 4mm after dilation with the drops. In their normal state, they're only around 2mm.

I'm pretty sure that I'm not getting "22" to infinity" with -0.5 D, granted the surgeon didn't actually hit that target. The distance, definitely, but not that kind of near vision.

Yes, I have a similar situation -- black room, and I can read my phone (6" screen) even dimmed right down at about 12" without any assistance.

It's not really similar though because I still have one cataract eye with horrible vision and my Eyhance eye is at plano. I would expect you to have pretty good near vision with an Eyhance set to -1.25 although this will vary from person to person.

I don't think it is any kind of industry standard to target -0.5 D. Surgeons may adopt the practice with Eyhance clients as they have expectations to see closer. Setting the focal point at -0.5 D improves those chances of better near vision, but at the expense of course of some distance vision acuity. They should explain that, it that is what they are doing.

Individual results do vary quite a bit. The defocus curves are just an average of a number of people. I can see from about 20" out to infinity with my AcrySof IQ monofocal which ended up with a spherical equivalent of -0.25 D (0.0 D sphere, -0.5 D cylinder). This seems to be quite a bit better than what I should be getting based on the defocus curves for this lens.

Oh, no that is not similar at all. Sorry, I was thinking that you'd had both eyes done. Yes, my near and intermediate vision is pretty amazing in the eye targeted at -1.25 (surgeon thinks he hit -1.21). In some ways, the intermediate vision is giving me better "close" vision than the near eye, because if I hold things like pill bottles at arm's length, I can actually read the small print on them, sharp and clear. Even the smaller print on the prescription eye drop bottles. Not what I was expecting at all by "enhanced intermediate vision", lol, but really happy to have it. Distance in the near eye started out at 20/25 two days after surgery, but after the second eye was done (targeted at -0.50 -- surgeon thinks he hit -0.36), distance has dropped to around 20/35 and seems to have stayed around there. That's what it was at the check up done on the third day, the day after the distance eye was done. Vision in the distance eye then came out at 20/20 and I don't think it has shifted from there. I see my optometrist April 13th, so it will be interesting to find out where I'm at there.

Yes, and I'm actually being a bit picky about what range I'm getting with my distance eye. When I patch the "near" eye and wander around the house, doing tasks using just the distance eye, the near and intermediate vision is actually is a lot better than I think that it is when I just cover the other eye with my hand for a few minutes. I haven't been measuring any distances, but I'm not having any real problems negotiating my way around or seeing most stuff, except for smaller print stuff closer than 24". I don't have the amazing "detailed" intermediate sight with it that I have with the other eye, but it's not as bad as I seem to think it is. Maybe it's because the other eye is so good at the closer stuff, that I'm setting unrealistic expectations for the distance eye.

And, at the end of the day things are very good if you see what you want to see at any distance without thinking about it.

Exactly! That's how I feel. I sit outside in particular and enjoy just looking around, focusing on different objects and revelling in how bright and sharp everything is. The same with going for a walk once the sun is down. There was a new moon last night here, and I pulled over so I could roll down the window and stare at it, lol.

That's exactly what concerns me, is not getting enough intermediate and near vision with the right eye set to plano and the left to -.5... the surgeon didn't even discuss the possibility of setting one eye to .5 and one eye to 1.0 or 1.25. I am still waiting on the second eye and want to have a vision test at six weeks. But what I am thinking is having the second eye set to 1.0 and not .5 as the surgeon says he "usually does".. I had dinner with a friend last night, my first time driving at night since the surgery and driving was great but I couldn't read the dinner menu at all. Turns out, my friend also needs cataract surgery and she is confused by the process as well and was literally taking notes. They are also pushing her towards Panoptix. She is an artist and a perfectionist and so she is now delving into the research.

I love your description of pulling over to see the moon. I am outdoors whenever possible and this was a big factor for me in "how I wanted my vision to be", which was the only question the surgical team asked. I love the vision in my right eye and it tested at 20/20 for distance - it's amazing t be able to see again. I wanted to be able to see birds and plants at a distance, but I also want to be able to see some things up close. It sounds like your surgeon listened. Did you try monovision before deciding on the lens ?

So you have .5 in the dominant eye and 1.25 in the non-dominant but still see really well at distance? I pushed a lens out of a cheap pair of readers (-1.0) and tried to use those to see if I could neuro-adapt but I couldn't really keep them on more than a couple of hours, out of force of habit.

Getting anything explained by these doctors is exhausting. I have to ask the surgery manager who knows almost nothing and then wait a few days for an answer. By then, I have a new question.

** I am just trying to decide on what I will tell the surgeon I want because I don't feel comfortable with his recommendation based on what he usually does. Still wavering between -.5 and -1.0 for the non-dominant eye. Surgeon didn't give me a choice about the dominant eye, which is set at plano so I don't want to go with too big of a difference between the two eyes in case I don't neuro-adapt. My distance vision is 20/20 in the plano eye, and I love my distance vision. I've been working on outside and doing heavy lifting again before my next surgery. I had eye drops for one month post surgery and stopped those a few days ago so now I know the opthamologist was wrong about my left eye, it's not allergies ( he thought the right eye wasn't showing symptoms because of the drops). The only thing i could see to do was wait the month out and now I know the left eye problem is isolated or, due to the cataract. I had terrible watering in both eyes - now the right eye with the Eyhance lens doesn't water but the left one still does. Two eye surgeons told me that the watering was Not from the cataract, but its not my empirical evidence, it sure seems like it's having watering problems because of the cataract. Did you or anyone else have eye watering cleared with cataract surgery? I've seen mixed information, some sites saying cataracts do cause watering and others, not.

I would lean to the target of -1.0 D for your second eye. -0.5 D is going to do a little bit but not a lot for reading. I believe @karbonbee has in the range of 1.0 D differential between eyes with the Eyhance without doing a trial with contacts, and seems to be doing very well. My differential is in the range of 1.2 D and I have no issues. Have you had a refraction done with your operated eye? I see you have said you have 20/20, but you still could be under plano so the differential will be reduced between the eyes. I have 20/20+ in my distance eye, but I am -0.25 D SE in that eye, which reduces the differential between the eyes. My distance eye is -1.4 D SE.

Keep in mind that due to the steps in lens powers you will not likely to be able to choose exactly -1.0 D unless you get really lucky. You should ask the surgeon to show you the steps available in that range. There almost always will be a choice between two powers. I would go for the one that is slightly over -1.0 rather than the one just under.

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I can't think of any reason that having a cataract would cause tearing. The usual explanation for tearing is that it is dry eye and the eye is over compensating.

I hope that is the case! I notice my vision is better using both eyes even with the left eye still having a significantly blurry cataract in it, then when i cover the left eye with my hand and try just using the new right eye. The thing that bothers me is watching a movie because the left eye has so much glare. I know both eyes work together but I haven't read much about how that happens, exactly.

The whole science of it is fascinating and if I was younger, I might consider opthalmology...😊

I wonder if the way your vision is set, with a .75 difference (1.25 minus .5) is significantly different than if I set the difference at 1.0 (plano and 1.0) The surgeon's office told me Eyhance doesn't come in .75 so I would have to go up to 1.0 or use .5

I didn't have enough information going into the first surgery to know that setting the Eyhance at .5 was an option. 😒

I'm so frustrated by the process and having to do so much research on my own. A lot of surgeons in this area don't even provide Eyhance as an option, so at least I have that going for me. I think the surgeon just doesn't have that much expereince with Eyhance since it came out in 2019, and maybe like your surgeon, didn't know what was possible. I'm glad you had such good results and are spreading the word. Any other thoughts on a right eye set to plano and the left set to -1.0 ? That's my next decision.

"The surgeon's office told me Eyhance doesn't come in .75 so I would have to go up to 1.0 or use .5"

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It is more complicated than that. The Eyhance comes in steps of 0.5 D at the lens plane of the eye. This converts to 0.35 D steps at the cornea or eyeglass plane. So your choices will be in approximate 0.35 steps but they will start at some odd number based on the error in your cornea. That is why you will want to ask the surgeon what your specific step choices are. Take a look at this report which is focused on the differences between formulas used to calculate the IOL Power. In the article skip down to the first image. Don't worry about the different formulas and just look at the predicted outcome for each step of IOL power. Lets just look at the left column which is the Haigis formula prediction.

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FP1232 : COMPARISON OF ACCURACY OF IOL POWER CALCULATION OF BARETT’S, SRK T & HOLLADAY IN HIGH MYOPES

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The IOL (D) column is the power of IOL, while the REF (D) is the predicted residual refraction if that lens is used. For this example the surgeon has targeted plano. Note the Target Ref: Plano in the top right of the form. The computer has highlighted the power of 22 D to achieve the closest pick to get plano. The REF (D) is predicted to be -0.04 D which is essentially plano. At the bottom of the column is the emmetropia IOL Power of 21.94. That would give perfect plano, but of course a power in that exact number is not available. It is just a reference. In this situation many surgeons would not actually choose the 22 D power lens but would instead choose the 22.5 D power which would result in a refraction -0.39 D or slight myopia. This is to reduce the risk that you would go to the positive (far sighted) side which hurts near vision. Your surgeon may have done that, and that it is worthwhile to get an eyeglass prescription to find out where you actually landed.

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But, in any case this is the process for selecting the lens for the distance eye. Now, lets switch to selecting the power for the near eye. Ideally the surgeon would switch the target in the top right to -1.0 D, instead of plano. Then the computer would highlight the closest power to achieve that and display other options above and below that. That said, the range in this example is wide enough that it covers the range of a -1.0 D outcome. Look up to the top of the column and you will see that a 23.5 D lens would produce an outcome of -1.09 D, and a 23.0 D lens would result in an outcome of -0.74 D. There is no choice between these two powers, so you have to choose one or the other. Of these two with the Eyhance I would select the 23.5 D lens. That is the one that would give the better reading ability.

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If you take the time to understand this you can have a much more productive discussion with the surgeon in selecting your target with the Eyhance lens. Ideally they should give you a printout for your eye. It should have choices predicted for your eye based on your measurements.

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I hope that helps some. If you have any questions just ask.

"So you have .5 in the dominant eye and 1.25 in the non-dominant but still see really well at distance?"

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Yes, definitely decent vision, re distance in non-dominant eye. I go to my optometrist in two weeks time, but I think I'm hanging in with distance at around 20/30 in that eye. Of course it's not as sharp as the dominant eye, but good enough. And I'm easily reading J1 with it. It's interesting that although each eye is doing their own thing really well individually, but with both of them, it seems that everything is even sharper -- I guess that is the benefit of blended vision and the 3D effect. I don't notice that the one eye is weaker for distance, and I don't notice that the other eye is weaker for near, etc. They just pick up from each other really well. You'll notice that yourself when you get your second eye done. No, I didn't try monovision per se before, although because of becoming farsighted in the left eye in addition to already being highly myopic, I had to have the distance in that eye backed off for contacts and glasses, so I had gotten used to not having great distance (nor near either) vision with it -- although, I suspect that anyone who had cataracts for any length of time has gotten used to the same thing also. I used that eye as my dominant one for the surgery. But I was far more aware of that eye not seeing up close before than I am now.

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"I am outdoors whenever possible and this was a big factor for me in "how I wanted my vision to be", which was the only question the surgical team asked."

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So, your surgical team asked you this, but then decided upon their own targets without consulting you because that's what they're "used to"? My surgeon initially wasn't interested in listening to me either -- but I insisted. He was kinda abrupt, sternly saying stuff like "well, you'll need glasses for distance...", etc. He thought I should go for plano and "maybe" -0.5 D in the non-dominant eye when I mentioned mini monovision. I just told him that I'd been researching this for months, and had thought hard about how I used my eyes, and that I'd read multiple positive outcomes with these targets and that that was what I wanted. He backed down, or at least didn't try to change my mind any more. At first, I wanted the target of -1.0 D in the non-dominant eye, but once he started listening to me, he was the one who actually suggested -1.25 D, and after thinking about it, I agreed with him, and told him to go for it. I started to worry that -1.0 D might not give me enough near vision, if he undershot the target. He thinks he hit -1.21 D with that eye, and -0.36 D with the dominant eye -- I'll know for sure when I see my optometrist. He was really excited though when I went in for the check-up two days later for the non-dominant eye, and I had 20/25 in it (he said, "that is phenomenal!"), so hopefully my experience will open him up to consider other options with other patients.

I have to agree with Ron, regarding your target for your second eye. If I had to rely on just the dominant eye that had been targeted for -0.5D (and apparently landed below that), I would have had to wear glasses around the house and for computer or phone use. I can see the laptop screen okay-ish from about 32", but it would get tiresome to do it regularly -- and I have to be closer to type, lol. I really haven't lost that much distance in the non-dominant eye by going over -1.0 D -- wouldn't have been happy if the surgeon had ended up below that. Like Ron, I feel that I have a full range of vision now, with rarely even a need for readers at any time.

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My eyes have a tendency to be dry, so they used to water up a lot (I know, it sounds like a contradiction in terms). I don't remember it being any worse over the past year since the cataracts starting up. They are definitely are not watering up now though -- in general, they've been a lot less drier since the surgery -- though I have been using the lubricating drops a couple times a day and overnight. I have noticed a little puffiness around my eyes from time to time, and when I looked that up, it was suggested that either I was having a slight allergic reaction to one of the prescription drops, or that the septum around my eyes had loosened, which apparently is a common side effect post surgery. I have started just laying a warm facecloth over my eyes a couple of times a day, and the puffiness goes away, so for me it's probably just a reaction to the prescription eye drops. I was using a hot moist gel mask prior to the surgery which made my eyes feel great and helped with the dryness, but don't want to use it now til at least a month after surgery as they are kinda heavy, and I do move my eyes around when it's over them.

"I wonder if the way your vision is set, with a .75 difference (1.25 minus .5) is significantly different than if I set the difference at 1.0 (plano and 1.0)."

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If the targets my surgeon told me he hit were correct, then my eyes are about 0.85 apart (because he under hit both targets), and if he'd hit the -1.25 in the non-dominant eye, it would have been even more. And like I said I'm not aware of either eye doing different jobs at all, so I think you'll be okay at 1.0 or even a bit more. Even 1.25 in difference is within the scope of mini-monovision. It will be helpful when you see your optometrist and find out what your surgeon actually hit for the first eye. That will give you an idea of what his scope is -- as in, was he above or below plano. For example if he was below with the first eye, he probably will be the same with the second eye. As Ron suggested, I think you would want to land on the minus side of -1.0 D (ie toward -1.25), not below it, if you want to be glasses free.

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It's a good thing though that we all started doing our own research though, cos otherwise we wouldn't know what our options are. I'm comparing in my mind what I might have ended up with, if I hadn't started doing all of this work and asked so many questions. I'm pretty sure that my outcomes wouldn't have been half as good if I hadn't done my own research. I don't know if it's that the surgeons just don't know, or that they're just playing it safe, by not thinking outside of the box with regards to targets, or suggesting such options to their clients, or that they're used to mass production and the standard choices are the easiest cos they think that's what will reflect back best on their skills -- but they're very wrong if that's it. When I left my first appointment with a cataract surgery clinic, I was pretty clueless. I looked through the brochures they gave me, read the descriptions about the lenses they offered, and just took it all at face value. But me being me who is used to researching everything before buying, lol, once I decided to go ahead with the surgeries, I automatically started looking up more information on the lenses I was initially interested in, and reading one article lead into another, and then I'd read something that left me with questions, and I started looking for answers to those questions, and then the whole ball just really started to unravel and I realized that those nice brochures weren't telling the whole story at all -- or even a piece of it -- so I had to keep searching! I am so glad that I ended up here at this discussion board though, as it has been the most helpful, with people like Ron, sharing their own experiences and knowledge, solidifying the other knowledge that I had gleaned. I would watch the videos by various surgeons or cataract coaches, but it was the comments that I found the most useful when someone who had used a particular lens shared their experiences -- that was far more useful to me than a spec sheet -- and that is what this site offers in spades.

If it wasn't for these postings, I would be run through the cataract mill not knowing what hit me like most people. My surgeons haven't even mentioned anything about "hitting a target" for example. But thanks to you and Ron and others, I know what to ask for. I just requested a six week post surgery appointment so I will see what they say. I know I am a thorn in their side, but when it comes to healthcare, I'd rather be a thorn than end up with regrets.

They told me 1.0 or 1.25 is monovision but I specifically asked about mini- monovision, which they just say the doctors "don't recommend" - so frustrating.

They just tell me I might not be able to neuro-adapt. It sounds like you haven't had any trouble neuro -adapating? From what I have read that could mean headaches, etc?

I do think the surgeons are just playing it safe and only offering lenses they have a financial interest in. My friend in the same state, with better health insurance than me, was only offered a choice between J and J monofocals and Panoptix. She was surprised to hear what I have learned. Knowing she is a perfectionist, and considers herself one, she was surprised that Panoptix might not be right for her.

I know the day I went in for surgery, someone was in there getting an IOL changed, I barely overheard her saying she wasn't happy. I just wish the surgeons could be more transparent but I think it is just a side effect of how litigious the U.S is.

Right now, with one Eyhance done, and set to plano, I need 1.25 readers to see my laptop well. I'm not very happy about this outcome and think I might try a contact lens for a week or so and see if I can neuro-adapt. The whole process has been much more aggravating than I think it should have been, if the surgeons had been more forthcoming. Thanks for your input! It helps a lot.

This helps tremendously!

I feel like I am constantly being talked down to by the surgeon's office. I understand a lot of people just want to trust their doctor's recommendation b ut since he is doing 40 surgeries a week, it's not a stretch to understand that he simply doesn't have time to give everyone an individual recommendation. I had misgivings going in and postponed two weeks, but my vision was so debilitating with the cataract that I decided to go ahead. Now I'm functional and feel less at their mercy... I will insist on talking to the surgeon again. Squeaky wheel gets the grease.

I think I will print this out and take it with me. Thank you!

A few thoughts.

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First I think there is benefit in doing the 6 week eye exam with an optometrist that is independent of your surgeon's clinic. This is the best way of getting an objective and accurate refraction. Always ask for a prescription in writing. At least with the surgeon I went to, he has a tech do the refraction but it seemed very hurried and they were not willing to give me the prescription in writing. I also think they really don't want to discuss the potential of a miss in the power selection. Your optometrist should be much more objective.

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I don't think there are any hard formal definitions of micro, mini, and full monovision. The one that I have seen that makes the most sense to me is the following differences between the eyes (anisometropia):

Micro: <1.0 D

Mini: 1.0 D to 1.5 D

Full: 2.0 to 2.75 D

Most surgeons now focus on the mini-category, with full monovision not being used to any extent any longer.

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Using readers with your IOL eye is an excellent way of checking how much myopia is necessary with the Eyhance eye. I would check to see if +1.0 readers would be enough. The general idea is to only use as much as is necessary to get the reading ability that you want. This should a little more accurate than simply using a contact in your non operated eye. But, to simulate monovision trying a contact in the non operated eye to give you -1.0 and -1.25 vision is a good idea. However, the readers with your Eyhance eye will give you a more accurate idea as to how much is needed.

Oh, you're very welcome. I'm just trying to pass on the help I received from others, as like you said, it all very confusing trying to sort it all out. Trying out a contact lens sounds like a good idea. I think for soft contacts, it only has to be out of the eye for about a week before the pre-op scans, as it doesn't change the shape of the eye like a gas permeable one does. I just looked up mini vs mono vision and got this "Modified monovision or 'mini-monovision' requires a smaller interocular diopteric power difference between eyes than traditional monovision, typical calculations of the near eye are anywhere between −. 75 and − 1.75 diopters of myopia". Also, "Oftentimes, the mini-monovision technique provides the patient with a better depth of field than correcting both eyes to the same degree.". Anything more than that would require the eyes to work individually instead of together, and that is what most people have the most problem with. I remember reading that people with higher myopia seemed to get a bigger bang for their targets with regards to near vision when using the Eyhance.

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I used to get additional headaches when I wore glasses because "clear" vision for me was only 3" to 8" without correction, so the strain of just looking through the lenses caused stress to my eyes and my brain. I didn't get those type of headaches when wearing contact lenses. I think most of the neuro adaptation is from training your brain to dismiss the differences between the eyes and focus on them working together. I can't remember if you've ever worn contact lenses, but the soft ones are pretty easy to get used to. I think the problem most people have is getting them out -- being able to put your fingers onto your eyeball and fold them away. It was easier with the gas permeable cos you just looked down while holding your finger on your eyelid then "blinked" it out -- unfortunately that was also why they were so easy to accidentally lose, lol.

The material used for the contacts makes a big difference to the handling of them. With poor contacts I find it even harder to get them in than to get them out. I would recommend a silicone hydrogel material like used in the CooperVision MyDay, Alcon Total1, or J&J Acuvue Oasys. The J&J Acuvue Moist are just hydrogel and awful to handle. The Silicone Hydrogel also tends to stay more comfortable longer than the hydrogel ones which seem to dry out (despite the name Moist) as the day goes by.

Yes, thank you for sharing that info about the soft lenses. I had entered that into my notes in case I decided to try soft contacts to sharpen my distance vision. I tried a variation of the J&J Moist ones decades ago when I was told that wearing the gas permeable contacts had improved my astigmatism to the point where I could then wear soft contacts. I was really excited until I started wearing them and found that within thirty minutes of wearing them my eyes had sucked all of the moisture out of them and it felt like I had a piece of saran wrap in my eyes. It was awful. These lenses were supposed to able to be left in the eye for a week at a time, and I couldn't keep them in for less than an hour without wanting to scratch my eyes out. I quickly switched back to gas permeable contacts. Luckily though my partner had a prescription similar to mine, and he was able to use them, so it wasn't a complete waste of money. At that time the highest power they came in was -8.0 and my weakest eye at the time was -9.50 so they weren't giving me the best distance vision anyway. They were strong enough for him though, and he didn't have any problems with them drying out in his eyes like I did. When I first read your information about the silicone hydrogel contacts, I looked them up and was happy to see that they were available up -15.0 now -- granted hopefully I won't need a prescription that high anymore , but still good to know. And very good to know that I now might be able to wear a soft contact without it driving me nuts. I wouldn't have even considered them if not for you talking about the differences.

Here is a spreadsheet I did on the contacts I looked at.

Dk/t - Is the oxygen permeability. Higher is better and should allow longer wear.

Water % - May be a little misleading. Higher water content sounds good, but it reduces oxygen permeability and may dry out faster.

Modulus - Is the stiffness of the lens. For handling higher is better. For comfort you would think lower is better. I found there not to be a direct correlation.

In the end of my testing I found the CooperVision MyDay to be the "just right" combination of enough stiffness to handle well, but also be comfortable. I could get 15-16 hours out of them, enough for most days.

I will call my insurance company on Monday to ask about another optometrist since the one I used, who diagnosed the cataracts, is in the same building. The IOL I have is 21.5D and the REF range is .2 -.33 , from the study you cited.

Am I correct in understanding that if they hit in that range than a 1.0 lens in the non dominant eye would put me at about .7 to .8 differential which is what karonbee said she has with good results? Since I paid out of pocket for ORA, they should have given me the results. It's been 5 weeks.

I do have my pre surgery test results but it's a lot to sort through. I couldn't really see to read very well when I first requested them. I sent the results to a surgeon in India, and he recommended Vivity. I feel like I would have been happy with Vivity but since my cataracts were pretty advanced, I decided to have the surgery done here with Eyhance. This surgeon doesn't use Vivity.

I have requested my chart 3 times from the surgeon's office. There are 4 people cc:ed on the emails, so it's troubling that no one responds.

I'm not sure why the office is stalling on providing my chart, it is law that they provide the chart within 30 days of request. If the chart is online, it's a simple click to send to my email. They did record my lens wrongly in my chart, as a ZBOO monofocal lens, the second O.D. said he would correct it, but I want to make sure it's correct myself. My level of trust in this office is almost nil at this point. I am thinking of waiting for the second eye until I leave the country. It's been so frustrating and stressful. Especially with the first O.D. who asked inappropriate questions at my 18 hour post surgery check up, which is why I had to request not to see him again. He also told me he " didn't know anything about IOL lenses" and I had to ask the surgeon. Then a new O.D./surgeon who "doesn't take my insurance" but is doing the follow up since it's covered under the surgery costs from the same practice. But he won't give me advice on lenses, because he is not my surgeon. Ugh! American healthcare system.

I have been using 1.0 readers. 1.25 is a bit better but 2.0 is too strong. I think I would be happy with a 1.0. It seems like if I have my refraction done and it falls within the range of .2 -.33, then a 1.0 in the left eye shouldn't pose any neuro-adaptation problems.

I'm not sure how the slight EDOF of the Eyhance comes into play with the charts though.

I really feel better the more information I have. My fear was having the surgeries done and finding out afterward, there was a better way. At this point, with one eye done, I can still try and figure it out. Maybe the eye infection bought me some time I needed.

I never wore glasses at all which is why I have been working hard to understand my vision needs. From the study Ron sent, it appears the differential for me would only be .7 to .8 since the lens I have now is 21.5D and has a .2-.33 REF projection and I would request a 1.0 for the non dominant eye. That seems pretty safe to me. I think a lot of Americans just blindly follow the advice of doctors. And doctors just choose what is easiest for them.

I don't like wearing glasses and I think that a slightly greater differential would make a big difference for me. If my REF taget is .2 and he wants to put .5 in the non dominant eye, than that's only a .3 difference. Right now, I am not happy with my near vision, which is why I am waiting until I have more information. But I also want to put this behind me... Do you know how the EDOF of the Eyhance lens comes into the equation of the differentials for mini- monovision?

Thanks again!

I think you may be misinterpreting the IOL Calculation sheet in the study I posted. That data is for a specific patient (not you), and each patient will be different, so it is extremely unlikely it would apply to directly to your situation. I was only using it as an example of what the numbers look like. That said they will be in the same ballpark. This particular patient needed a 22.0 D for a predicted plano outcome. If you got a 21.5 D then you must have somewhat similar vision. But what you need is a calculation sheet that uses your eye measurements not those of someone else. Those measurements at the top of the sheet like AL (axial length) are for that person's eye. The computer uses those measurements to calculate the specific power that person needs.

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That said, if you really are in the -0.25 range and they hit a target of -1.0 D in the other eye, then the differential (anisometropia) will be 0.75 D. For an Eyhance lens that may be a little on the low side, but close. If it were me, I would target -0.25 D in the distance eye. You need to get your eyes tested to find out where you really are. Then I would target -1.25 D in the near eye. The differential will be 1.0 D.

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This is for Eyhance lenses which have a slightly extended range of vision. For a standard monofocal, I would target -0.25 D for the distance eye, and -1.50 D for the near eye. The extension of the depth of focus of the Eyhance is what lets you use less differential. If you were to use a Vivity lens in the near eye which has a higher risk of optical side effects like halos, the differential could likely be reduced a little more, with a target of -1.0 D in the near eye.

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Hope that helps some. Sorry for the confusion on the posted study.

In my case, I felt pressured to opt for the Panoptix by the surgery staff. No one at the doctor's office said anything about haloes and glare and when I discovered that very real and likely side effect, I became very hesitant about the practice. They even sign something that says they explained everything to me, but they did not. My daughter is a scientist too and went with me and we found out on our own about "visual disturbances". Her comment to me was that I would be highly sensitive to haloes and glare, she just knew it. 👓😊

At the time, I couldn't even be outside very long because of the bright light. It was debilitating for me.

I saw Whoopi Goldberg just had one eye lens replaced with an IOL, sounds like Panoptix although she hasn't said - and that she is promoting it, the ads say "Whoopi Goldberg now glasses free!"

I just feel with a little more care by the doctors that we could all have a better visual outcome, because Eyhance or monovision can do great things too. But Panoptix is just easier to predict.

I realize those were individual patients, I was just looking for a projection about what might be likely for me since I don't have any information from my doctors. I've been asking my doctor again and again just for a ballpark figure. The study is very helpful.

I have already had the right eye done with an Eyhance so once I can get my own numbers, I will then know what lens would be best for the left eye (or what differential I can tolerate) and my hunch at this point it is: could be closer to 1.0 and not the .5 the surgeon told me he "usually uses".

My feeling is that the surgeon is just playing it safe and cranking out as many surgeries as possible.

So it's a programmed computer calculation? Enter the numbers, including axial length, and receive the specific power needed? Is that correct?

Is it that the calculation for the differential between the two eyes is more nuanced, i.e., what can be comfortably tolerated?

I watched a video that states the Eyhance has .5 -. 6D of additional visual acuity over the ZCBOO monofocal. That alone doesn't bring the Eyhance close enough to giving good near vision. Bumping that to 1.0 or 1.25 then gets the vision to fall in an acceptable place. But you're right, I need my own numbers. I think they are trying to exhaust me to the point that I give up. But I'm not planning to. Thanks so much for all your help. I feel like I am getting a lot closer to a good outcome.

I think you are correct. Targeting -0.5 D is likely to leave you short on reading ability. I would target -1.0 to -1.25, and ideally closer to -1.25 D. As you see from that example calculation you have to pick one which is closest to what you want. They do not make a specific IOL power to suit you. It is an off the rack fit, not a custom tailor job!

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If you want to see how the number is calculated I would suggest you google this to open an on line calculator:

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Hill-RBF Calculator Version 3.0

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It is quite simple to use and will not calculate until you have filled in sufficient data. It does seem to consider even the gender. I took the measurements from that study example and put them in with a male gender, and age of 01.01.1950. I took 119 for an A constant. And I also used the AL, K1, K2, and ACD (4.05) data from the paper. For a measurement instrument I selected the IOLMaster 700. I used Microsoft Edge as a browser as I had issues with Chrome. In any case when targeting Plano (Target 0.0) I got the same outcome of a 22.0 power lens as in the paper. However at that power the estimated REF (D) is a +0.05 which I think is risky. You could end up well into the plus range. The safer choice would be the 22.5 power with a prediction of -0.29. When I switched the target to -0.25 then it recommended the 22.5 power IOL, which would be the one I would pick for a distance eye.

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The interesting point is that these eye measurements prompt a caution flag that the RBF calculation is out of bounds, and to use the outcome with caution. I have not seen that before. This Hill RBF formula is AI based on actual data submitted by surgeons and there must be something unusual about these eye measurements. I put @karbonbee 's data into this calculator and it issued no warnings. I also used it with my brother's data and no warnings.

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I also set a target of -1.25 D as one would potentially want for a near eye. This time the computer selected a 24.0 D lens with a predicted residual of -1.33 D. The next lower power of 23.5 D predicts a residual of -0.98 D. So you would have to choose between those two if you were this individual picking a near eye lens.

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In any case this is how the calculation process works. The differential between the eyes is just simple math based on the difference between the outcome in each eye.

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I think the video you watched is overstating the extension of the Eyhance a bit. The Eyhance does not qualify as an EDOF lens which requires a minimum of 0.5 D. So, it has to be less than 0.5 D. I think the best indication of the extension the Eyhance provides can be seen in the image I posted in this thread:

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

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If you follow the dashed line at a LogMAR of 0.2 (20/32) you can see the limit of good vision with the Tecnis 1 (standard monofocal) compared to the Eyhance. To my eye, and it is not easy to read, I think the Tecnis 1 is about -1.0 and the Eyhance -1.3 D for an extension of 0.3 D. But it needs to be remembered that these curves are just an average of a large number of people, and each individual will be different. But when predicting what you will get, I think 0.3 D is a reasonable number to expect based on the average curve.

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Hope that helps some,

Nice. Thank you. Very helpful.

Maybe you should just go to their office, and request the printout. I asked for mine when I went in for the day after checkup for the second eye, and they printed it out for me in about twenty minutes (it was a busy day there). I just sat and waited in the waiting room until it was done. It is much easier to ignore you from a distance, lol. Not that my clinic gave any trouble about printing it out in any way.

"Do you know how the EDOF of the Eyhance lens comes into the equation of the differentials for mini- monovision?"

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What Ron says below sounds right to me. Especially if the surgeon lands on the negative side of -1.0D (ie say -1.10D etc), rather than below it, ie -0.9D, etc. I too would stay away from the Vivity. You aren't experiencing any halos, etc with the Eyhance with the distance eye, so it's unlikely you'd have any problems with the second eye. I'm certainly not. Excellent colour, contrast, with no problems with lights, night or day. The Eyhance is referred to as an enhanced monofocal for a reason, as it provides the benefits of a monofocal with just enough EDOF to increase your range, but not enough to cause the problems associated with the other lenses.

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Ron: "This is for Eyhance lenses which have a slightly extended range of vision. For a standard monofocal, I would target -0.25 D for the distance eye, and -1.50 D for the near eye. The extension of the depth of focus of the Eyhance is what lets you use less differential. If you were to use a Vivity lens in the near eye which has a higher risk of optical side effects like halos, the differential could likely be reduced a little more, with a target of -1.0 D in the near eye."

I would go to the office and get personally get your chart. Tell them you will file a HIPPA complaint if they don't comply and that you will hire a lawyer and subpoena your chart.

When you entered my information though, you got different calculations than what was on my Lenstar scan, or would they have been closer with the Hill-RBF Calculator? I've reattached them below for reference.

"Out of curiosity I ran your numbers through the Barrett Toric calculator and got a bit different results. Basically the Barrett is calling for a 6.5 D sphere and 1.5 D cylinder compared to the DIU100 used which is 7.5 D sphere and 1.0 D cylinder. The residual refraction predicted by Barrett is -1.13 SE.

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On the left eye, things seem closer. Barrett says 5.5 D sphere and 1.5 D cylinder which is exactly the same as what your got with the DIU150. Barrett residual refraction is predicted at -0.86 D SE.

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Don't rush out and get your RE lens changed though! This the first time I ever used the Barrett Toric Calculator.... I would trust your surgeon first!!! Once you get your eye exam you may want to check back and see how accurate it was though."

Thanks. My friend with lots of medical issues suggested the same thing, to just go to the office. It's kind of far away though. I've now requested the chart 3 times in writing. I'm not sure if they are past the 30 day legal requirement yet. An O.D. told me they listed the wrong lens on my chart - that's why I am concerned! If not for that little card you alerted me to, I would have no evidence they implanted the correct lens. But at least that card lists Model: DIBOO

I've had enough experience to know that I am the best keeper of my own records, because I care the most. Withholding my chart is very concerning.

At this point, I'm prepared to insist on the 1.0 lens for the next surgery. I'm not currently satisfied with the .5 option I've been told is what he usually does, especially without any post surgery measurement for the first eye. I'm pretty fed up with the practice and may go elsewhere. The problem is I liked the surgeon but not the practice. I just couldn't imagine before surgery that I would have no follow up with the actual surgeon,. Thanks for standing by.

I found my IOL Master 700 test results. I can't seen to get the online calculator to work. I inputted the numbers but don't know what the A constant is and the "n" value uses a default.

Right eye: CCT:23.40 ACD: 3.23 LT:4.34 K1: 43.90 K2:44.80 n 1.3375 WTW: 12.5

Left eye: CCT:517 ACD: 3.17 LT:4.43 K1: 44.01 K2:44.83 n 1.3375 WTW: 12.6mm

I appreciate any help you can provide. I will try to get results this week from where the first eye landed post surgery. I really think I will be much happier with a 1.0 or 1.25 target for the near eye.

The other measurements I have from the office are:

MR Dry: OD --Sph:+.5 Cyl -.25 Axis: 119 20/40 OS --Plano Sph 20/40+2

AR Dry: OD--+1.50 Cyl: -1.00 Axis: 121 OS: +.75 Cyl: -.25 Axis: 073

Not sure about the 20/40 measurement because a few days before surgery, I measured at 20/30.

The surgeon also said I had a minor astigmatism which surprised me because when I was younger, I had 20/15 vision. He said he would correct the astigmatism at the time of surgery, which I did not question. I wonder though, if it could have caused the side effects I had. I assume he did a "relaxing" astigmatism correction, sorry - I don't remember the exact terminology. I went into this in the dark, excuse the pun, because I never needed glasses before and my eyesight was not discussed with me sufficiently, although I tried. With the added pressure of having to arrange a ride to and from surgery, I just went in within asking enough questions. I've seen online surgeons say repeatedly that a satisfactory pre surgery discussion eliminates many of the problems patients have because they know what to expect going in. I have not had that experience and am so glad I found this forum. And really appreciate your help.

The calculator is a bit finicky. I could not get it to calculate when using Chrome as a browser. It does work with Microsoft Edge though. The A-Constant for the Eyhance is 119.3. That is the optical A-Constant as the IOLMaster 700 is an optical device. If you mouse over the fields it should highlight them in red if they are needed or are incorrect. I found you had to put the date in the correct format, and also enter the gender. The data you listed above is missing the K1 and K2 angle which will be needed. It is also missing the Axial Length AL which is the single most important measurement. It should be between 19 and 35 mm. I also think you may have some numbers wrong or decimal points wrong. CCT needs a number between 260 and 760. ACD should be between 1.25 and 5.25. Make sure you have all required fields entered and none are highlighted red, and there are no warnings.

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If you were given the IOLMaster 700 calculation sheet it should show what formula is being used for the calculation and what lens power is being recommended along with the REF (D) or residual refraction predicted for that power of lens. Those would be of interest.

Not to be a nitpicker here, but the A constant of 119.3 for the DIB00 (Eyhance) lens was the original one used in the FDA trials and which was included in the early materials when this lens was first approved. After much "real world" experience with the lens and after analyzing large numbers of pre- and post-op patient results from very high-volume surgeons, J&J now recommends using the A constant of 119.39 for this lens and the ZCB00 (Tecnis 1). It won't make a huge difference in the IOL power outcome, but these algorithms are extremely precise, and a data entry error of even a tiny amount results in a huge difference in the visual outcome. For example, a 1 mm error in the axial length causes about a 3 diopter change in prescription! That's the difference between a focal distance of 20 feet and a focal distance of 13 inches. Given this, it shouldn't come as a surprise that the refractive aim is hard to achieve precisely.

I did try the calculation with Edge as you suggested. But where it says, calculate, nothing. I retyped the numbers wrong here - sorry about that, this platform was being finicky for me when I navigated away from the page. I left out the first axial length.

It should read: Right eye: AL: 23.40 CCT:496 ACD: 3.23 LT:4.34 K1: 43.90 (6 degrees) K2:44.80 (96 degrees) n 1.3375 WTW: 12.5

Left eye: AL: 23.34 CCT:517 ACD: 3.17 LT:4.43 K1: 44.01 (177 degrees) K2:44.83 (87 degrees) n 1.3375 WTW: 12.6mm

The office did include the calculation sheet the day after my initial visit, two months ago - I wasn't sure how to read it and it printed out small so it's hard for me to read even now. But now, I see it.

When I asked my surgeon about pupil size, he just said "on the small size" but I don't know how my pupil size factors in, except I read it has more impact for Eyhance, which is why I was hoping for a better near outcome. I see now from the calculation sheet, the target was Plano, but no one ever discussed it with me if that is what I wanted, although I was clear I wanted as much information as possible. I honestly think the surgeon is doing twice as many surgeries as he should, because most surgeons have a heavy schedule at 1,000 a year but this surgeon is doing double that: 2,000 a year. He could have taken a few minutes to explain everything, When I asked, I was just told they don't recommend monovision but I expressed that I was interested in it. Post-surgery, I was passed on to this awful O.D., who claimed he didn't know anything about IOL lenses, when I asked about my outcome. The O.D. said they wouldn't even test my intermediate and near vision until the second eye was done. That made me suspicious because once both are done, I can't change it easily. They really are rushing people through these surgeries without giving much consideration to their individual needs. I can see that don't want me to have a refractive exam so I will have to call the insurance company to request it.

What are the 4 references in the calculation chart: Barret Universal II, Holladay II, Hoffer Q, and SRK -- what do these refer to?

Thank you, again.

The color and contrast I have right now is amazing in good light but in low light, not as much. But that's just one eye done and almost six weeks post op. Did you also have a six week eye test done? How long between your surgeries?

Those numbers worked for me. I will post an image of the output in a separate post, so you will have to check back after it is moderated. You can compare what numbers you put in to the screen shot clip. But in summary this is what I got:

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OD Right Eye: Target -0.25 D

IOL Power: 21.5 D REFR(D) -0.35 D

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OS Left Eye: Target -1.0 D

IOL Power 22.5 D REFR(D) -0.95 D

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So basically according to Hill-RBF Version 3.0.2 you have the right lens in your right eye, and should expect a residual refraction of -0.35 D. If it actually turned out that way, that is about as good as you can get for a distance eye. A 21.0 D lens would theoretically have left you exactly at plano or 0.00 D. However, that is risky, as you may actually go positive. I guess you will find out when you get your 6 week eye exam how accurate this formula is for this eye.

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I put a target of -1.0 D for your left eye and it selected a 22.5 D power lens with a residual of -0.95 D. You can't get more exact than that if that is what you want. I think I would be tempted to take the 23.0 D lens for a residual of -1.31 D. But that is a personal choice. The 22.5 will give you a bit better distance vision, and less differential between the eyes. If you really ended up at -0.35 in the right eye then your differential will be just less than 1 D between eyes with the 23.0 D lens and you should have better reading with it.

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"What are the 4 references in the calculation chart: Barret Universal II, Holladay II, Hoffer Q, and SRK -- what do these refer to?"

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These are the names of different calculation formulas. Barrett Universal II is considered one of the most accurate ones along with the Hill V3.0 formula and the Kane formula. You can find the Barrett and Kane ones on line too. Ideally you like to see the best formulas giving the same consistent recommended lens power.

Here is the screenshot of the Hill-RBF Version 3.0 formula results.

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Thank you! After seeing your calculation, I saw the second K value was missing from mine but it didn't highlight in red, so that's why I couldn't get the calculator to work. Once I put the same numbers as you, it worked! Thanks. Is there a reason you put the target refraction at .25? Is that due to the 21.5 lens? Because when I put the right eye target at plano, 0.0 - the calculation I generated was different and a 19.5 or 20.0 lens was suggested for a 1.00 target in the second eye. I sent my results to the surgeon's office and said I want to discuss my options. I feel like I am finally heading towards a resolution. If I hadn't had the eye infection, I doubt I would be looking into all of this but time spent now, will ease my mind later.

My distance vision is great, I'm very happy with it, just trying to get good laptop and functional vision without glasses, which I don't have now.

Here are the numbers I have. 58 Y - F - don't know if age makes much of a difference. But it is one reason I did not choose Panoptix. A prominent U.S. surgeon says she doesn't recommend Panoptix for patients under 65 due to loss of contrast.

Target Refraction [D]: 0.00

Eyhance

Johnson & Johnson

IOL [D] Eye [D]

20.00 0.68

20.50 0.34

21.00 -0.00

21.50 -0.35

22.00 -0.70

A=119.30

Target Refraction [D]: 1.00

Eyhance

Johnson & Johnson

IOL [D] Eye [D]

18.50 1.77

19.00 1.45

19.50 1.11

20.00 0.78

20.50 0.44

A=119.30

RBF calculation out of bounds. Use with caution!

When I changed the target to 1.25 in the left eye- I received 22.5 or 23.00 as the suggested lens, without any exclamation mark warning it is out of bounds.

It doesn't allow a value less than 1.00, so if the surgeon is targeting .5 for the left eye, I can't see which lens is suggested. I will be interested to find out. I hope he calls today.

I haven't read all of your posts, but are you not trying to get closer vision with the eye you haven't had done yet? I just note for your target refraction you put 1.00 and not -1.00 (negative sign in front). Not sure if this was just an oversight in the post or if that is the target you put in the calculator. Ron can confirm this for you, but going on the plus side will make you hyperopic in that eye. Like I said, I haven't read all of your posts, so maybe I am misunderstanding, but check with Ron to confirm.

I have not done a thorough search but the only calculator that I have seen that does toric lenses that is one line is the Barrett Toric one. The Hill formula on line from what I can see does not do toric. The Barrett Universal II has a very good reputation for accuracy but only does non toric. However, I am not sure about the Barrett Toric formula. Dr. Hill seems to be affiliated with the company that makes the Lenstar, and it is possible there is a toric version for it that can be installed with the Lenstar. I kind of think the way it works is that the instrument comes with certain formulas pre installed. Then if you want more, you install them and possibly pay a fee to Dr. Barrett or Dr. Hill to do it??? Not sure.

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Do you have any information as to what specific formula the surgeon used with the Lenstar?

I did the calculation over again with an A-Constant of 119.39 instead of 119.30. It made a very slight change in the residual refraction prediction but did not change the power selected. I will repost the results with this factor for @Analytica.

The reason for selecting a target of -0.25 D (the minus sign is very important) is that this is slightly myopic. It allows for good distance vision and better close vision than for example +0.25 D which would make you slightly far signed.

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I noticed in your second set of numbers for the Left eye that you have a target of +1.00 D. It is very important to set it at -1.00 D to leave you myopic for closer vision. If you change your target to -1.00 you should get results the same as I got. This may also be the reason for the warning that the calculation is out of bounds. No surgeon would target someone to be +1.0 D, or any other plus value.

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@amy48002 posted that the Eyhance A-Constant has been revised to 119.39. I will post a revised calculation sheet for this value. It does not change the lens powers selected, but does move the predicted residual refraction down slightly. The 23.0 D power lens in the left eye now predicts a residual of exactly -1.25 D. This will go into moderation so I will put it in a separate post.

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The other thing you may want to refine is your gender and age. My limited Spanish would suggest the ending in an "a" means female. And I just used an easy date to enter, 01.01.1950. It sounds like you are younger than that. It may influence the outcome slightly. I tried switching the gender and it does make a minor change. That is likely due to the artificial intelligence derivation used by the Hill formula.

Be careful with the sign for the target. You would target 0.00 or a negative number, but never a positive number. That would make you far sighted, which is not a good thing!

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In any case here are the revised predictions using an A-Constant of 119.39 as suggested by @amy48002.

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I ran your numbers through the Barrett Universal II calculator using the 119.39 A-Constant. I got the results as indicated in the image below. I would suggest they are insignificantly different than the Hill RBF V3.0 predictions.

Right Eye:

Power D, REF (D), Hill V3.0, Barrett UII

21.5 D, -0.29 D, -0.24 D

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Left Eye:

Power D, REF (D), Hill V3.0, Barrett UII

22.5 D, -0.89 D, -0.85 D

23.0 D, -1.25 D, -1.20 D

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Predicted Anisometropia (differential between the eyes in diopters)

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Left Eye 22.5 D

Hill V3.0, Barrett UII

0.60 D, 0.61 D

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Left Eye 23.0 D

Hill V3.0, Barrett UII

0.96 D, 0.96 D

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These two formulas are very consistent. My choice based on this would be the 23.0 D power in the left eye to essentially give you -1.25 D myopia for reading, and a differential of 1.0 D between the eyes. This however would depend on what your eyeglass exam results are, and if they confirm these predictions are likely to be accurate. Eyeglass exams are in steps of 0.25 D so they will not exactly replicate these number. And, these predictions are based on the spherical equivalent which is the Sphere D plus 50% of the Cylinder D.

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My mistake. I'm getting pretty flustered by the lack of response from the surgeon. I had an appointment with an optometrist for today but they called and cancelled and said they can't give me a refraction until both eyes are done. They were very nice and were shocked I hadn't had a follow up with the surgeon. Turns out the guy I saw 18 hours post surgery was an optometrist, not an opthalmologist.

The doctors all say no one can give me answers except the surgeon but he is in surgery all the time. It took 3 months to get the initial appointment so I don't know if changing surgeons is feasible at this point.

I'm about ready to call it quits and just leave the other cataract in.

If my distance vision is 20/20 - can I assume the target was hit? Can I reasonably assume he hit the target of .35 for my right eye and 22.5 would be a .6 differential (which is maybe what he is planning) and a 23.00 lens would be a .96 differential. Are these assumptions since I don't have the actual target results, only projections?

I requested my chart 3 times without response. I just want to know what is planned for my eyes. So frustrated.

Thanks. That was a mistake.

"I had an appointment with an optometrist for today but they called and cancelled and said they can't give me a refraction until both eyes are done."

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Explain to them that you need a refraction so you can decide what to do with the other eye. You could also say you are interested in eyeglasses as it may be some time before you get the other eye done. Or, you could just see another optometrist. I think they are giving you the runaround. It makes no sense to wait until both eyes are done. I had no trouble at all getting an eye exam at 6 weeks with just one done. It is part of the standard cataract process.

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"If my distance vision is 20/20 - can I assume the target was hit?"

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Kind of, but not really. You could be somewhat far sighted, or somewhat near sighted. You don't really know where you ended up until you get an actual refraction done.

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In my case I go to an optometrist that is totally independent of the cataract surgeon. I feel he tells me like it is. And, he gave me a different refraction than the technician at the cataract surgeon's office. They will not issue a written prescription and I think they just do a quick and dirty check and not refine it for accuracy. Do you have an option to get your eyes checked by someone totally independent from your sugeon that is more cooperative. I would think it would be worth it at this point even if you have to pay for it. Normally an eye check is not that expensive.

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I put my estimates of the differential between the eyes in the post that is waiting to be moderated. But, from memory now with a 22.5 D lens in the left eye I think it came to a differential of about 0.6 D, and with the 23.0 D the differential is just under 1.0 D. And yes these are just projections on both eyes as you have no actual test results. If you get the first eye checked that does two things. First it nails down what you actually got in the first eye, which reduces the uncertainly to only one eye. Second it will give a good indication as to how accurate the formulas are for your specific eyes. If for example they are off by 0.2 D in one direction, you could reasonably expect them to be off by a similar amount in the second eye. Your two eyes are not really that much different.

Instead of being polite, like you all have been, the surgeon, through the surgery manager and then through the office manager, told me I wouldn't be able to see (with 1.0) in an arrogant way. Surgeon won't discuss it with me. I am so frustrated. I had to wait 3 months for an appointment. I'm not sure what to do.

These days, the best way to make this type of business pay attention is to post an online review. It works! Just do a search for the name of the clinic, and/or the surgeon, and add "reviews" to the name. Then add your own experience -- leave it on as many sites that you can find. Won't they be doing a pre-op on the second eye before surgery? You could "request" it then, and by request, I mean demand, lol. I think that's a good decision targeting -1.0D in the second eye, I think you'll be happier in the long run especially as you want good near vision.

Ron, when you refer to requesting a refraction, is that something separate that I should ask my optometrist for, or would that be part my overall check up with them? Thanks.

Interesting about you results in dimmer light, I'm not having a problem with that. Having both eyes done though does make a big difference. I'm only just a month past the first eye, and because of my extreme myopia, they did the second eye two days later, so that eye will be a month in two days time. I'm having a 5-week and 3-day check up done next week. I'll be a week done with the prescription drops for the second eye then, so that gives my eyes a chance to recuperate before the test.

"...the surgery manager and then through the office manager, told me I wouldn't be able to see (with 1.0) in an arrogant way."

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Whoah!!! Well, you just tell them that you are prepared to deal with that. However from your extensive research you know that if the surgeon does their job properly, then according to the actual outcomes of many people who have already used that target, then your vision should be more than adequate.

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You could also ask the surgery manager if they've had the surgery done themselves, and if not, then what qualifies them to make such an obviously incorrect and outrageous comment? And if they say that they have patients like that, then based upon your experience with them, you definitely would want to see actual proof. Although, it wouldn't matter if they provided it, I'm sure that it isn't true. Otherwise, I guess I've been imagining that I've been able to see quite clearly with an even higher target. Damn, and I don't even remember taking any hallucinogenic drugs, lol. The bottom line though is that you're paying for the surgery, they're not providing it for free.

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Tell them that you will be writing multiple online reviews about their clinic and their lack of professional behaviour. I didn't really meet with my surgeon after the initial consult either though. Although I'm pretty sure that he was in ear reach when I called the office and surgery managers, because of their responses. And a couple of times, they told me that they'd inform the surgeon and get back to me. But ultimately, they accepted that I knew what I was requesting, and stopped trying to push me to what they were familiar with.

"Do you have any information as to what specific formula the surgeon used with the Lenstar?"

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Okay. No, sorry I don't. But, thanks.

My intention is just the normal phoropter test (which is better, A or B?) for an eyeglass prescription, along with a written copy of the eyeglass prescription. I would not settle for an auto-refractor test (hot air balloon or cottage on the horizon). Yes, they normally do both on a regular eye test, but the written prescription should be based on the phoropter check.

Remember when comparing an eyeglass prescription to an IOL Calculation predicted outcome you have to convert the eyeglass prescription to a spherical equivalent. That means adding 50% of the cylinder diopters to the sphere diopter. For example if the eyeglass is this:

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-0.25 D Sphere and -0.5 D Cylinder

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Then it could convert to -0.50 spherical equivalent.

Okay, thanks.

Thank you.

I did call insurance and they approved the refraction but I think you are right, it's about $40 out of pocket. I asked the surgeon's office manager in an email if they are refusing to do the refraction. No answer yet. On the insurance company's advice - I asked why they are not providing my chart. I am now at 4 written requests for my chart.

I received an answer at ten minutes before closing yesterday, that the surgeon would do a -1.0 in the second eye, but they was no specific information about which lens that is. so I asked. I said I have a right to know which lens is being implanted in my eye.

I don't want to cause any trouble, the insurance company suggested suing: I just want to be involved in my permanent lens selection. It's not too much to ask.

This office does about 80% monofocals, and heavily pushes Panoptix, so I think I am in a fairly small percentile of patients with Eyhance and then, even smaller, wanting to know what is happening to me, and wanting to be involved.

I know from another patient in this practice that, he was not warned of haloes and glare with Panoptix and didn't know what PCO was until it happened to him. Overall, he is happy though so I guess he is the ideal - the easy-going patient.

I will try to get an appointment with an independent optometrist. It's a shame because I liked the original optometrist, but they are in the same building with the surgery practice. The woman I spoke with at the optometrist's office yesterday was very nice and she said it's not usual at all to get the refraction between surgeries, but getting a eye test between surgeries is a good idea - she said she thought it was a great idea.

It's a shame that the standard of care is so low, and patients are not getting the best visual outcome that they could if they were able to be involved with their lens selection. I imagine many monofocal patients could be getting much better visual outcomes with mini monovision, if the surgeon took the time to address their individual needs.

I remember you said you went 18 months (?) between surgeries, so I am holding onto that as an option as well.

Thanks again. I will keep trying to get the refraction. It does sound like it would be better to go somewhere else.

Sorry for the confusion. He did agree to the minus 1.0 but I had made the mistake in the calculation that you all so politely pointed out. That's what I meant, instead of politely saying I must have left off the minus sign, they were arrogant about it, and still....no actual lens suggestion. So I wrote back and said I have a right to know what diopter lens the surgeon is planning to implant in my eye. 😊

The bottom line is that I am paying for the surgery, I paid out of pocket for the ORA to be used and also for the Eyhance lens. I told my roofing company, I wish they could run my surgeon's office. The roofers have been stellar.

I don't want to threaten anything at this point, I just want the best visual outcome I can get. If I have to get the second eye done in India, that is what I will do.

Just before this, I accompanied my child to (yet) another country for a major surgery. The surgeon is famous and took the time with us to make sure everyone felt comfortable , the follow up was amazing, the results were great, and they are still available six months later - all for one very reasonable price.

I fell under the spell (not hallucinogens) - that this would all be a simple surgery in the U.S. Simple, I guess if I didn't get an eye infection and if, the office hadn't dumbed everything down instead of just giving me the information I needed. I have been lucky and haven't had to deal much with the U.S. medical system - now I understand what everyone means about the stress of it. It's enough to make you sick!

Sorry about all the typos. I am trying to use the laptop without readers and it is not very good vision, I am getting blurring of the keys and the screen. I'm wondering if the PCO is becoming a problem.

It is worthwhile keeping in mind that many surgeons have big egos, and that attitude probably gets passed on to the staff they have around them. It requires some communication skills to deal with them while getting what you want. Some surgeons will immediately get their back up if they think they are dealing with an internet (Google) educated patient. As a simple example, it would be unwise to demand for example a 23.0 D power lens. You have to lead them to making that decision themselves. For example if they suggest a 22.5 D lens, you may want to ask what the residual refraction will be with that lens. If you have done your homework you will know the answer to that question. A golden rule that lawyers have is to never ask a question that you do not already know the answer to. So, when they respond with x.xx D you can then ask what the differential will be between the eyes. If you have had your refraction done with the first eye, you will know the answer to that question too. I would then follow that with "what will I get for refraction with a 23.0 D lens and what will the differential be?". And when you get the surgeon to the point where they describe the outcome, then you can make the point that you have thought about it and are OK with that outcome (assuming you are).

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The surgeon that did my first eye and both eyes for my wife seemed OK in the beginning, but started to become difficult when it came time to do my second eye. By that time I knew a lot more about what was really going on. Perhaps I was becoming more difficult for him to deal with. I found him to be disorganized and not properly informed about the status of my eyes. The result was we ended up having the final lens selection power via phone. I got a little frustrated with it and asked him what the two lens power choices were? (Like you asking about 22.5 or 23 for example). He became abrupt and said "what do you mean by two choices?". On my first eye and both of my wife's eyes we had that discussion about the two lens choices. It became obvious this time that he did not have the IOL calculation sheet in front of him and was trying to get me to say "ok whatever you think...". I got more frustrated with him and finally said well lets agree on the target of -1.5 D if you can't give me the lens power. The discussion ended there. About an hour later he called back and said there was a choice of two lenses and "we" had to make a decision. i.e. he got his act together. We did discuss the pros and cons of each and a decision was made. I suspect most patients do not get that final discussion and choice.

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It is puzzling that the surgeon does not want you to get a final refraction on the first eye before doing the second eye. It is in their best interest to know the actual outcome. They can, and should learn from it. My surgeon even with his disorganization said that he always learns something from the first eye that can be applied for the second eye.

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This whole process seems easier with our public healthcare system. Through experience it is obvious that they have a set table of procedures that are fully covered by the system and there is no push back on doing them. They seem to be:

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1. A preop consult with IOL measurements
2. A final pre surgery consult
3. Surgery
4. A day after surgery check up
5. A three week check and refraction
6. A 6 week check and final refraction with written eyeglass prescription

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   In any case, I think it would be well worth getting a full refraction and written prescription, if it only costs $40. You should take a copy of this prescription with you along with your IOL calculation results, when you meet with the surgeon for the final lens selection for the second eye.

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   Hope that helps some,

Good strategy, Ron. I suspect that they are being stubborn about doing a refraction on the first eye as a way to try and bully Analytica into doing what they want, not what's necessarily in her best interests. I made a point of telling my surgeon and his staff that my research was far beyond just looking the lens up, but included multiple studies and the many outcomes of people who had had the surgery using similar targets. They related to when I said that I was surprised how many people didn't even know what their eye prescription was (I've known mine since I was thirteen), and outright laughed when I told of people describing themselves as "high myopics" with a prescription in the early minuses. It was a struggle in the beginning though and I definitely got some attitude, and if I hadn't done the prior (thorough) research that I had done, I could have easily ended up agreeing with what they wanted to do, instead of what would work best for me.

No problem. I understood what you meant when you didn't include a minus before the target, and it was pretty snotty and arrogant of your clinic to react the way they did instead of just pointing out the difference. They're bullies. I think what Ron wrote about approaching them is a solid strategy of how to deal with them about the target for the second eye. I always have found that "out-tech-talking" people like that works well -- using with them (and understanding) the terminology they assume that you don't know yourself. My surgeon was surprised that I understood what plano was and even what a "target" in the context of cataract surgery was.

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And yes, I was suggesting that you write reviews after the second eye is done, or if you decide to go elsewhere to do the surgery -- not before, lol. I told my clinic very nicely that I had found them through researching a particular lens and read that they were considered well versed with that lens, and that I had read multiple reviews about their clinic and practices and that they had a pretty good reputation, which made me feel confident in using their services. So in an unthreatening way, I let them know that I was comfortable using online reviews (just in case, lol), and that I didn't just pick their name out of a hat or because one person recommended them.

A lot of surgeons do have big egos and in my experience, the smaller, the pond, the bigger the ego. I realize that I have different expectations because my daughter saw a famous surgeon in South America who was not only excellent but extremely personable and available to his patients. That was less than a year ago. The contrast is glaring.

I am uncomfortable finding out post surgery that there could have been a choice between lens power selection and the surgeon didn't consult me and chose on his own, which is my case. It's a five minute conversation. A lot of surgeons who are online say that if you don't give the patient information and they aren't happy with their lens selection, that's the doctor's fault. If you give the patient all the information and the aren't happy, that's the patient's fault. It just makes sense to properly inform the patient. I've dealt with many huge egos and it doesn't bother me at all to ruffle a few feathers. I am not looking to be their friend, I just want a good result and I will be on my way.

I think I may have already shared this but, I do suffer from PTSD and it is in my chart. It's particularly frustrating that they will not provide information. When I went into surgery, I was asked if there was anything special they could do to ease the PTSD and I said, "Just tell me everything that is happening. I want all the information." The surgical team was great about it and one woman came in twice and said, "I don't like surprises either." And they spelled out the name of the anesthesia - VERSED. It really helped a lot.

I don't understand why the office won't provide the refractive eye exam either.

This practice does only a next day and ten day check as far as I know. They try to rush through the surgery so when I had the eye infection, it gummed everything up. The first consult was a blur after two hours of eye tests, it was only a few minutes, basically confirming I had cataracts, with some chit-chat about international work. My daughter was with me and the surgeon and staff definitely pushed Panoptix and had me sign forms for Panoptic although they said I could change it. We went home and my daughter immediately found the information about glares and haloes that the office did not provide.

By the time I found someone who would answer questions, they said, btw- you have to decide by tomorrow. So, I chose monofocal. Then I got cold feet because it was not properly explained to me that I would lose other vision. I have never worn glasses. So... then on my own I found out about Eyhance. I rescheduled the surgery for two weeks later and tried to learn as much as I could, knowing I could always cancel.

The next meeting with the surgeon - I had to push for because I felt so uninformed and it was just to discuss the options. I left saying, I am leaning towards Eyhance but I hadn't made a decision so it is only natural I would have more questions after that consult. Then, after surgery and when I was given a different O.D., he confirmed the infection which was another delay which led me to doing more research and coming to this forum.

I so appreciate knowing about the Hill -RBF calculation sheet. How did you find it? I feel like the surgeon is annoyed I had access to the calculation sheet.

Everything I have seen and read indicates that a less than 1.0 differential shouldn't cause any neuro-adaptation issues. After not being able to consult with the surgeon, I am a little concerned about deciding on my own.

That's good advice about knowing the answer before I ask the question.

I have made four written requests for my chart and still nothing.... At this point, it's less about the chart and why they will not provide it. I have never had this experience: a doctor's office that will not provide my chart. A good doctor shouldn't have any hesitation in providing my chart. The office is definitely disorganized too - which just means I need to be hyper vigilant, like asking for my chart.

Thanks for sharing your experience. It helps a lot to get other perspectives. The doctors do "become abrupt" when questioned. That is my exact situation: the surgeon is becoming rude (through second and third person) when I am questioning the lens power for the second eye. I asked for a phone call (because written messages can be misinterpreted) - but he seems to be too busy. Small pond, big fish. Interestingly, in India, they have this same saying but a little more eloquent, in Hindi. 😊

I rarely write a bad review - except being served meat unapologetically when I clearly asked for a vegetarian meal - it was the unapologetic part that was worthy of a bad review. And as a public service to other vegetarians. Online reviews can be quite damaging.

You are right, they are bullies. They are trying to bully me into doing things their way. I think the surgeon is good but the office and staff seem very uninformed. If I didn't think the surgeon would do a good job, I would just switch but I want to get this over with too. The last email I sent to the office was strongly worded.

I really appreciate hearing your experience as well. This forum is enlightening!

Wow. Every doctor and optometrist I have called isn't taking appointments until September. I'm on the wait list but it doesn't look good. The eye practice I am in, has a monopoly in this area. I think I will have to just use the projection from the calculation sheet, or wait. Ugh. This is troubling.

It sounds like you already have the IOL Calculation sheet information, or at least part of it. That is the main information you need from the surgeon's office. The other missing part now is your actual refraction on the operated eye. Then you can fit the pieces of the puzzle together to make sense of it all.

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Others here told me about the on line formulas to calculate lens power. I went into this naive and thought that was something I should trust the surgeon to do. My surgeon gave me the outcome of the measurements but I never got a data sheet. I recall when I asked him what formula he used he looked shocked and I think said something like "why do you ask?". At that point I was preparing for the second eye and had done enough research to know that some formulas are more accurate than others in calculating low myopia for monovision. The Hill-RBF and Barrett Universal II were two of the best. When I told him why I was asking he finally said "RBF probably". You mean Hill-RBF? And he somewhat grudging said "Yes". He is a university professor and I don't think was used to patients asking those kind of technical questions.

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I'm sure doctors and surgeons get training in bedside manner. Perhaps what we really need is training for patients in how to handle doctors with an attitude...

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In any case here is the article that compares formulas for accuracy when calculating low myopia for monovision. Since the time this was done, the Hill formula has been upgraded to Version 3.0.

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CRS Today 0221CRST_cs_Turnbull PDF OPTIMIZING OUTCOMES WHEN THE

TARGET IS LOW MYOPIA BY ANDREW M.J. TURNBULL, BM, PGDIPCRS, FRCOPHTH; WARREN E. HILL, MD; AND GRAHAM D. BARRETT, MB BCH SAF, FRACO, FRACS

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Dr. Hill is an interesting character. He still runs a clinic in Mesa, Arizona, and if I was in that area, it would be at the top of my list for places to get cataract surgery. His websites are a wealth of information in particular on calculating IOL Power. Check out East Valley Ophthalmology doctor-hill IOL Power Calculations and poke around. I found the section on the history of IOL power calculation interesting in how far we have come from the early days.

Where I am in Canada the Costco has an eye clinic with an optometrist or possibly more than one. Their main purpose of course is to provide eyeglass prescriptions so they can sell glasses or contacts. I wonder if that may be an option with a shorter wait time. I have never used them and get my prescription at a private clinic, and then go to Costco to buy what I want. They are much cheaper for glasses and contacts than my private clinic.

I've used the Costco in my area of the U.S., and it's been running through my mind that that would be one way to get a refraction without a fuss. I wouldn't go in and give the staff there an explanation of your circumstances. They aren't going to be able or probably willing to deal with anything unusual. Just sign up for their standard exam. Once you're with the doctor, tell him/her you've had the surgery in one eye and it will be a while before the other can be done, so you are wanting to experiment with soft contacts for the unoperated eye and would like to know how the operated eye is doing as the surgeon can't see you again for months.

My guess is they don't care. They collected their $xxx for the exam and that's that. What's the worst that can happen? There's some weird reason they can't do it and you get told no and are in the same situation you're already in.

Wow, what you describe is so frustrating. I feel your pain. I don't write bad reviews easily either, but sometimes it's the only way to make them pay attention. Like you said, I also consider it a public service to inform other people. The surgeon I went with has some pretty bad reviews about his beside manners, but none about the quality of his work, so I was okay with that. And to his credit, he did eventually get on board with what I was requesting, even if reluctantly, and was quick to reassure me that he'd do the best he could. His reaction to my post surgery results with the near eye, was great to witness -- he was really (pleasantly) surprised that my distance vision was as good as I'd told him it might be. So I hope that my initial struggle and then the final results with him will lead to him being more open to suggesting something more than plano or -0.25 as targets for mini-monovision to the next patient asking about this lens.

Good idea.

I was thinking that also; that if Anyalytica can get the refraction done prior to the next surgery then she'll have an idea of where her surgeon lands with his targets so then she'll know which lens to ask for in the second eye. I was surprised that when I asked my surgeon if he knew what he'd hit with the first eye, that he initially said he didn't remember, but then immediately went and checked it for me. And after the second eye was done, he told me right off what he thought he'd hit, and even apologized and said, sorry, that was the best he could do -- which didn't worry me because I knew it would vary and was happy that it wasn't more towards plano. Granted, if it weren't for the great people here, you included of course, Ron, I wouldn't have known to even ask that.

One of course is never going to get exactly what was predicted by the formula. And it also has to be remembered that refraction is a blunt measuring tool as the outcome will always be stated in 0.25 D steps. That is the difference between the choices we get to make. "Which is better? A? or B? They are 0.25 D apart. I have had my left eye tested a few times and the outcome seems to flip back and forth between -1.25 D and -1.0D for just Sphere. I suspect I pick one at one appointment and a different one at another. And I suspect that the Cylinder flips too. Perhaps when added together to a spherical equivalent the sum does not change. On one appointment I choose Cylinder to make the correction, and on another I pick sphere...

So, the optometrist won't really know then whether my surgeon actually hit the outcomes he believes he did, because they aren't in the 0.25 steps? Is there a way to find out? I sent my optometrist copies of my Lenstar scan and my donation cards so she'd have them for my five week checkup next week.

I guess there is some possibility they could determine your refraction with an IOLMaster or Lenstar. I don't know if that would work with a plastic IOL in the eye instead of a natural lens. The reality is that accuracy to 0.25 D is pretty good. I suppose the auto-refractor instrument might give you a number that is not in 0.25 D steps, but I would not trust them for the best accuracy.

Okay, thanks. Though, if using a Lenstar, etc, scan would be the only way to determine it, then what the computer told the surgeon about what target was reached is probably the exact one then.

Not really. It was probably accurate at that point in time, but as the eye fully heals from the surgery it will likely change. The important point in time is 5-6 weeks after surgery as the outcome should be stable at that point.

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As I mentioned before the eye is quite sensitive to internal pressure. The pressure can change the shape and thus the effective power of the cornea. About 25 years ago I got diagnosed with diabetes with a very high blood glucose level that had been occurring over a period of months. After diagnosis I was put on a drug that stimulated insulin production and rapidly brought my BG down. All of a sudden my vision changed. I could not see well at all with my glasses on. At the time I was myopic to about -3.5 to -4.0 D or so. With my glasses off I could see much better and good enough to drive. A miracle - my myopia was cured! I even went to the optometrist and he explained to me that while my BG was down the glucose level in my eye was likely still high and the differential was causing a osmotic pressure that was changing the shape of my eye. He further told me it would be a waste of money to get a different prescription as in a week or two the glucose levels would equalize and the eyes would return to their natural shape. He was correct. I needed my glasses again! No prescription change needed...

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Cataract surgery is not a BG issue but the trauma of the surgery itself plus the steroid eye drops like Durezol may also increase pressure. Again when the pressure returns to normal and things settle down, then you get the true indication of your final outcome.

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Your optometrist may be able to give you a slightly better estimate of what it is, if you ask. Say, for example your refraction for eyeglasses is -0.5 D, the optometrist could let you compare -0.75 D to -0.25 D. The one you find better would suggest that your more accurate actual outcome is on that side of the -0.5 D mark.

Oh, that was interesting situation. Thanks again. I will do that when I see her next week.

It sounds like your surgeon responded well to your questions. As did Ron's. Mine is still not sending my chart which makes me very uncomfortable, because of lack of transparency, it automatically feels like something is being covered up.

It sounds like based on your experience, that my surgeon may already know what target he hit? But isn't telling me? I really am not very experienced with eye tests because I never wore glasses. I can't remember if they did a refraction the day after surgery or not. Is that normal? I had a bad experience at that time with that optometrist and I believe that is the point when my lens was incorrectly recorded as a ZCBOO monofocal, not an Eyhance lens. If it wasn't for that little IOL card that was almost lost in my daughter's car... I would think they put the wrong lens in.

I have been in 3 times since the first surgery (because of the eye infection) and they do an eye test each time. I am starting to wonder if they have the refractive information but aren't telling me...

What's really puzzling is that if, for example, I decided not to have surgery on the second eye, then why would they refuse me a refractive eye exam until both eyes are done? What if I had to suddenly leave the area and needed the refractive test? Insurance doesn't cover out of state eye tests...

If my chart is recorded electronically, I think I will go to the local office and demand it.

Thanks! I hope your final eye tests goes wonderfully!

Good advice. I ended up with an appt. at a big box store, it's in another state so I don't think there will be an issue, with the eye care monopoly in my state preventing the exam. 2 weeks wait vs. 6 months for an in-state optometrist.

The surgeons act like we have surreptitiously uncovered a trade secret -- have they heard of the internet? 😊

I did get the calculation sheet when I requested my initial eye exam results but didn't understand what it was then. What I received prints out very small, which looked at objectively, has to be at least amusing for a cataract patient. Or extremely annoying.

I do not know how the surgeon came up with the lens choice he did - he implanted +21.5 when the calculation sheet suggests +21.00 across all calculation methods. Does that .5 extra give me more near vision? Or distance? I'm getting confused. I feel frustrated that it wasn't discussed with me - the person with the eyes receiving the lens.

Also - my calculation sheet from the surgeon's office has that big exclamation mark on it.

I really wish the surgeon would discuss this with me, but I am not getting anything from him, just brief third person messages that seem to be tinged with annoyance by my questions. A five minute conversation with him could clear it up for me.

I plan to organize more cataract surgeries overseas through my nonprofit in the future and what I can learn now, could be invaluable to others.

I know if I meet with an eye surgeon overseas, they would probably be more than happy to explain everything.

Do you know if the same calculation is used for Panoptix? I wouldn't think it would matter, but maybe the Panoptix calculation is different? Because that is initially what they signed me up for.

I will look up the website you suggested.

Thanks!

I wish the surgeons would take us more seriously from the moment we indicate we want all the information we can get. Maybe we are starting a movement... as more and more of our generation starts hearing they need cataract surgery.

"I do not know how the surgeon came up with the lens choice he did - he implanted +21.5 when the calculation sheet suggests +21.00 across all calculation methods. Does that .5 extra give me more near vision? Or distance? "

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A 21.0 instead of 21.5 would make you more far sighted. I suspect what he did is set a target for plano (0.00 D) and then selected the next highest power which would make you slightly myopic. That is how some surgeons do it. When I ran those calculations for you I selected -0.25 D as the target. That is why it selected the 21.5 D lens. If I had set the target to plano it would have picked the 21.0 D lens too. Based on your measurements I think the surgeon has done a perfect job of selecting the lens power for your right eye. If things turn out as predicted you should be very slightly myopic which is ideal.

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The vision check they did the day after surgery is not going to be very accurate as your eye has had not time to heal. The visual acuity check (eyeglass prescription) at 6 weeks is going to tell the tale as to where you really ended up.

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The PanOptix lens has a slightly lower A-Constant so it would make a slight difference. However, they should be selecting the proper lens in the computer and not make a mistake like that.

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The only thing I see wrong about what this clinic is doing is pushing your toward a target of -0.5 D in your left eye which would give you slightly better reading vision but well short of mini-monovision, and you would likely need reading glasses. As we have discussed earlier a target of -1.0 to -1.25 D would be more appropriate if you are willing to accept the risk of a higher differential between the eyes.

The target on the surgeon's initial calculation sheet is +.00 D (plano) - not -.25 so that's why I am puzzled because the he chose a +21.5 lens for me when the plano target from his calculation sheet indicates a +21.00 lens. This is using the Barret Universal II (and the others also highlight 21.00) - from his calculations. I'm wondering if he created a new calculation sheet later. I don't know because they wont give me my chart.

The reason I am bothered is because he didn't and won't discuss it with me, why he chose 21.5 and based on that lens, what is the best target for the second eye. His initial calculation sheet only goes to +22.00 - so there isn't a projection using those calculations for a +22.5 or 23.00 lens, only my calculation from the Hill-RBF.

He did agree to the -1.0 target but not directly to me, first through the surgery manager and then office manager and then like the telephone game, to me. so if I have a simple question like, -what lens would I be receiving in my second eye - 22.5 or 23.00 - which I asked a week ago - I haven't received an answer.

The 21.5 lens gives a projected -.29 and the 23.00 gives a projected -1.25.

The differential for a 22.5 is then .6 and the 23.00 is .96 which also falls safely within mini-monovision.

I asked which lens was the surgeon planning to implant in my second eye and I still have not gotten an answer on that either. Seems like a very simple question.

All of these differentials are of course as you pointed out just projections and why getting a refraction is important. Is it a simple refraction that will give the answer or does it need to include a dilation?

What I am learning is it's not me, it's America, or western medicine. It's a constant refrain that we can't seem to talk to our surgeons. It's very frustrating since the staff's constant refrain is that only the surgeons have the answers.

I'm glad to hear he chose well, but I haven't been happy with my vision yet, so I hope it can get worked out. I am paying out of pocket for Eyhance and ORA - so I don't understand why I can't get simple answers. Thank you!

I think for most surgeons targeting distance vision their default target is likely 0.00 or plano. That gives them a wide enough range of powers to choose from. I believe it is also common practice to select the first negative outcome power to reduce the risk of going positive. This appears to be exactly what your surgeon did. I have seen the IOL Calculation sheet from my brother's surgery. He targets plano and selects the lens closest to plano. I cautioned my brother against that but he went ahead with the surgeon's recommendation. His outcome was a positive sphere and a negative cylinder when combined to a spherical equivalent is essentially zero. He is not totally happy with his vision, but still tests better than 20/20. His near vision is not a good as what I have in my distance eye. That is the risk one takes when targeting 0.0 D spherical equivalent. I agree with the way your surgeon has selected the lens and agree with the power selected based on the Hill and Barrett formulas. Hopefully the refraction eye check verifies the outcome was close to what was predicted. You don't need any special test to get the refraction. It is the standard test used for an eyeglass prescription. You should not need a dilation. It is the "which is better A or B" test. Just make sure you get a written prescription.

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The other thing to consider here is that if you paid for ORA then the final decision on the lens power selection is made during surgery using the ORA measurements. It most likely will be the one predicted by the IOL Calculation sheet, but in some cases may not be. That is what you are paying for when you get ORA. It is a final check which is claimed to be more accurate. @karbonbee had that procedure used and perhaps can comment on it. It does leave you not totally certain what power will be used ahead of time. So, you have to have an agreement with the surgeon ahead of time what the acceptable range of outcomes are for you.

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After you get a refraction outcome on your first eye in writing then take it with you for preop consult before the second eye is done. Then ask for a copy of the IOL Calculation sheet with the target set at -1.0 D. This will show you the power closest to that and will include the one that leaves you closer to -1.25 D as well. At that consult would be the best time to discuss and agree on the actual target for the second eye You will be prepared ahead of time with the Hill-RBF and Barrett projections, so you should not be surprised with the surgeon's data. It is then just a matter of determining how much differential between the eyes that you are willing to risk. My differential based on post surgery refraction is the differential between -0.25 and -1.40 D so 1.15 D. I have no issue with that amount. I would prefer to be slightly more myopic in the near eye at -1.50 D, but it is good enough. As you know there will not be exact -1.0 or -1.25 D choices, but there is likely one within that range. That should work well for you with the Eyhance. I need more differential as I have monofocals.

On your attempts to get more information from the surgeon, I am not sure there is much more to get. You have all the measurements to use the various IOL power calculation formulas. About all I can think of is the ORA measurements. Not sure how helpful that would be other than that would likely be the last outcome prediction. @karbonbee may be able to fill you in more on what use that data may be.

Thanks for explaining that about the ORA - it is what I paid for but I haven't been given the information. It seems ORA was a good investment -$150 per eye. I'm not clear if the surgeon chose +21.5 ahead of time or is it possible he chose it at the time of surgery? If he didn't choose it ahead of surgery then the surgery center would have to have more lenses available at the time of surgery which I do not think they do as they told me they have to order the lens one week before surgery. So if the ORA gave a different measurement and they didn't have the lens on hand - what would happen?

Their refusal to give me my chart and requested surgery notes has me very suspicious. I've never had a doctor simply not respond to a chart request and certainly not 4 requests. They know it's a violation.

Now I really want to know what the ORA measurement was and will demand my chart on Monday. I didn't have much time to do research before the first surgery but was convinced ORA was more accurate and for the cost, I decided I could spend money on a lot less important things.

I will request a pre surgery consult after I receive the refraction - great suggestion. Anyway, they want the payment up front a week before surgery so it's a good reason to insist on a consult before the next surgery.

Mine didn't respond well initially. He got kinda snotty and was pushing me towards plano and -0.25D which I rejected and had to insist on what I wanted. He warmed up over time, especially after seeing the results from the initial test on the "near" eye which I had done first.

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I don't understand what is going on with the clinic you used at all! You paid for these tests, they are legally yours! Mine looked it up from the ORA scan that was done during the surgery after the old lens was removed. I asked him if he remembered what he thought he had it on the first eye while he was prepping for the second eye. He hesitated then went and looked it up for me. After he was done with the second eye, he told me right off. As others have mentioned here though, those aren't necessarily the final outcomes, just what the computer told him he had hit.

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Do they not tell you the results of the eye tests they've done on you? That does not make sense. I don't know, how arrogantly stupid are these people? Although those results will change after the eye heals, but still. I really think you need to make the trip there and get it. While you're there you can try to insist that they do a test to see how the eye has healed and what it's prescription is. Once again, I don't know what is wrong with those people. Are they trying to lose business by creating a bad reputation for themselves?

Is the print small on what they gave you, or did you try to scan and print it out yourself? If it's from your end, when you choose to print, try to enlarge the "zoom" before printing. You should also have an option to save the file as a pdf from the print menu. Once again, you can increase the zoom so the print is larger.

They didn't give me a printout of the ORA, just the Lenstar pre-op scan, though that is all I asked for. As you know, they do the ORA scan during the surgery after they remove the old lens, so they have better understanding of what is happening inside the eye, then choose the lens, etc and work from there. For example, after the pre-op tests, it looked like I would only need a Toric lens for my left eye, but when he used ORA on my right eye during surgery after removing the old lens, it showed that there was still astigmatism internally so he inserted a Toric into that eye also. The only other insight I have into using the ORA is that when I asked the surgeon what target he thought he had gotten with the first eye, he went over to the computer post surgery and pulled up the results of the ORA, I presume, and told me what it said. Then after he finished the second "distance" eye, he said all he'd be able to reach for that eye was -0.36D, not the -0.50D I had asked for, which was fine with me, although I appreciated his concern over it. As he remarked prior to surgery on either eye, "this is not an exact science" -- even when they don't do it manually but use the laser. I had been very clear that I did not want to end up on the positive side of plano, and he assured me that I wouldn't, so I'm assuming that if I had requested plano, like Analytica's surgeon, he would have chosen the more myopic version of the lens to use also. Though she still doesn't know exactly what target her surgeon did hit, even during surgery, which makes it hard for her to choose a power for her second eye.

"I'm not clear if the surgeon chose +21.5 ahead of time or is it possible he chose it at the time of surgery? If he didn't choose it ahead of surgery then the surgery center would have to have more lenses available at the time of surgery which I do not think they do as they told me they have to order the lens one week before surgery. So if the ORA gave a different measurement and they didn't have the lens on hand - what would happen?"

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They would have had a variety of suitable lenses on hand prior to the surgery based upon the pre-op scans and the targets chosen, as they won't know exactly which is the best option until they remove the old lens then run the ORA scan on the now open eye and have a clearer picture of what your eye needs (do you remember the surgeon telling you to look at a red dot during the surgery?).

I have also wondered about how many lenses the clinic has on hand. I would think larger clinics where you are using the lenses that they specialize in will have a supply of all the powers. It may get a little more tricky if you need a toric as that multiplies the number of lenses that they have to have on hand.

Yes. I remember the red dot. I remember almost everything from the surgery.

If they have a variety of lenses on hand, it doesn't makes sense that the staff said they have to order the lens one week before surgery, right? I'm pretty sure the Eyhance lens is the least used at this practice and wonder if they do keep extras. Did you receive any written results from the ORA?

Some transparency on their part would make things much easier.

You answered my question here, but if your surgeon can pull the ORA scan up on his computer, then they should also be able to send it to you, although It's a bit moot for you now. I am going to ask for mine. Thanks.

That's interesting that in your case, the ORA seems to have made a big difference.

ORA is something that wasn't presented to me as an option but when I researched it and asked, the surgeon said, "Yes, we have it." "We can do it." And that was all.

And that is pretty much all I have been told by this surgeon and staff.

It was all in one attachment, only the calculation sheet was less than a half page so I think I would have to increase the font on the entire attachment.

Because it was small, I didn't even read it initially.... Now I understand what it is, I can read it with glasses or on the screen. It was sent to me in a format like it was just fine print.

You know all those forms you have to sign pre-surgery? Did they explain them to you? Because I was rushed through those after a two and half hour appointment and I wonder what I signed. I usually am so careful about signing anything but...

One thing I remember asking the surgeon about Panoptix was if there was any guarantee and he said "no."

It sounds like your target in your first eye may land at about the same place as mine. I'll be interested to hear how your vision is overall as it is where I want mine to be, I think. I didn't need toric lenses but the surgeon "corrected a minor astigmatism" at the time of surgery. Now I understand that was most likely a "limbal relaxing incision" - it's exhausting though, knowing what questions to ask. Now I know to ask if I can ever get in to see him, "Was that a limbal relaxing incision you did?"

None of it is an exact science, I heard an online surgeon describe that cataracts can actually change your prescription as your eyes struggle to focus and adapt. It's all fascinating really.

It seems the surgeons should have two sets of information, one for people who blindly trust the surgeon and another set for people like us who want to be have all the information to help make the best decision for our health. A doctor sees a body for such a short amount of time but we live in ours 24/7!

Before my first appointment the surgeon's office sent a series of five videos, via text, which in and of itself, is laughable, having to watch on a phone.

But I remember at the time, with the small amount of information I had, that the videos were really simplistic and were almost insulting to an intelligent person under 90. Then, a friend's father who is 90, has had a terrible time deciding about the lenses and he has medical training, so it set me off on a personal research trip at my computer to learn as much as possible. I hope to use all this information in the future to help other people who need cataract surgery. Your experience has been invaluable to me.

"If they have a variety of lenses on hand, it doesn't makes sense that the staff said they have to order the lens one week before surgery, right?"

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Oh, no, they do have to pre-order what they're going to use for you, especially if it's a lens they don't usually use. And they would only pre-order the specific lens they're using for you (ie Eyhance), and some variations on the powers specific to your eyes. They wouldn't have a huge variety on hand -- that would take up a lot of storage space and a lot of overhead money wise. They might keep some standard stuff on hand, but not necessarily what you need. Whatever they don't use for your surgery, they'd probably just return it and get refunded. They had to pre-order what they were going to use for my eyes also, even though that clinic offers the Eyhance in general.

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I didn't ask for a copy of the ORA scan as I didn't see any need for it, but yes, at least my surgeon was open to looking it up for me. If I hadn't asked and then saw him looking it up on the computer, I wouldn't have even known where he was getting the information from. And I'm assuming that he pulled my targets up from the ORA scan, cos that information isn't on the Lenstar printout, or in your case, the IOLMaster from the pre-op scans. Like Ron said, a test by the optometrist will give you a refraction of where your eyes are now, but I think it would help you to decide on what power you want to choose for your second eye, if you knew what the surgeon actually hit when inserting the new lens. Although, you could probably figure it out from what the optometrist tells you also.

I'm glad what I did helped you, as what other people did helped me make an informed decision. In general though I find that most doctors aren't that open to sharing anything but the basics. I too was wondering at the idea that they sent you a copy with such fine print on it, knowing that you probably wouldn't be able to read it, or at least they should have known, considering their field of work -- though maybe they did it on purpose, or they're just not very computer literate -- or really care about their clients. I kinda of laugh to myself when I go to web pages that are supposed to be giving helpful information to people with cataracts, and the fonts they use on their pages are really tiny. I'm thinking to myself, "ahhhh, have you thought this through at all, or gone to your own website to see what it looks like for your target audience", lol.

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"You know all those forms you have to sign pre-surgery? Did they explain them to you? Because I was rushed through those after a two and half hour appointment and I wonder what I signed. I usually am so careful about signing anything but..."

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At my first consult with the clinic, they did go through all of the forms you describe, and gave me copies to take home so I could look through them all at my leisure, then about a week before surgery when I did the pre-op, they went through each form again, and had me initial them, and then on the day of surgery, they read them each yet again, asked me if I understood or had any questions, and then had me sign them electronically on their computer, and then printed them out for me. I have to say that I never felt rushed at any point. I mean, obviously, they're running a business, so organization is important when scheduling people to do tests, etc, but I never felt like I was part of an assembly line. I did a little with the first clinic I went to a year ago, but they were still nice -- though they too gave me copies of the forms I would have to sign and answered what questions I had then about the different lenses in the booklet they'd given me in the waiting room. The booklet they gave everyone prior to their appointment was pretty good and they added a questionnaire in the booklet for you to fill out when waiting and then the surgeon went through it with you. I didn't have any real questions for them then anyway cos I hadn't a clue at that time of what was possible. I just assumed that if/when I agreed to do the surgery, I would look things up before and ask questions then. But little did I know at the time just how many questions I would end up wanting to ask them, lol.

Thanks. That makes sense. The ORA and Eyhance are not usual for them. So I must really be a pain in their elbow. Good thing I don't care about that and just want the best result I can get. 😊

It sounds like the surgeon may already know what target he hit... but isn't telling me. There is some weird secrecy around this that bothers me. It might just be western doctors in general, though. Although I think at this point, it's a HIPPA violation, 30 days after requesting my chart - so that's just bad service.

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Yeah, I don't understand why he doesn't want to let you know what target he hit with the first eye. It's like a dentist telling you that they're going to pull a tooth but there might be complications with it splitting during extraction, but then refusing to tell you whether they got the whole tooth or not. Have you made it clear to them that you understand that it's unlikely that he would hit the exact target? That you didn't expect him to hit it? That it's common for a surgeon to not hit it -- so you aren't looking for a way to criticize him -- you just want to know so you can figure out what the best target is for the second eye in order to achieve the best mini-monovision results.

I would not base the outcome on what the surgeon expects to hit. The gold standard is the refraction test by an optometrist, and ideally one independent from the surgeon's practice. Wait 6 weeks, get the refraction done, and get it in writing.

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The only value that I can see in getting what the surgeon expected to hit, would be if you go back to the same surgeon and you or they are willing to use the final error to adjust the A-Constant to get a better outcome on the second eye.

I was approaching it from the perspective of her having an idea of where her surgeon lands on his targets so she could decide which target/lens to choose for the second eye -- whether he lands above or below his targets. Though of course having a refraction by an optometrist would help her with that also.

Yes, that is a useful thing to do, if the surgeon will use that information to improve their accuracy on the second eye. However, my point is that the optometrist refraction once the eye is fully healed is the gold standard. That is where you end up, not where the surgeon predicts/hopes you MIGHT end up. So, all the other measurements have to be compared to the actual refraction outcome. And when you are calculating the differential between the eyes you want to use the actual refraction outcome of the IOL eye, not the predicted outcome. But of course you are stuck with using the predicted outcome for the non operated eye.

Jut got back from the office of a new optician. He was so nice. The surgeon was off on the target, the target was .34 and he hit .75. That's way off. I only have no reading glass vision at 30 inches. I am so upset. The other thing is --- I am left eye dominant so the surgeon didn't even check and put a 21.5 in my right eye so now I can't go with what I wanted for my left eye because now I just learned it's the dominant eye. I am going back in a week to try a contact in the left eye to see if I might be able to correct this mistake and get some semblance of intermediate vision.

The reason I have been getting headaches since the day after surgery s because I am left eye dominant and they operated on the right eye first.

Today's doctor was shocked that the surgeon wouldn't answer my questions or give me my chart.

I'm upset.

Jut got back from the office of a new optician from the big box store. He was good, and patient. .The surgeon was off on the target, the target was .34 and he hit .75. That's with the ORA. That's way off, I think. I only have no reading glass vision at 30 inches. And an uncorrected astigmatism in the operated eye. I am so upset. And 20/30 vision. The surgeon's office told me it was 20/20. How could it be that different? 20/20 one day aftre surgery and 20/30 at 2 months post surgery.

The other big thing is --- I am left eye dominant which the surgeon didn't even check and put a +21.5 in my right eye so now I can't go with what I wanted for my left eye because today I learned I am left eye dominant, clearly. I asked him to check twice and he did, it's obvious.

He was shocked they told me that if I was right handed I was most likely right eye dominant. He said in 40 percent of cases -- that's false. I am in that 40 percent. I am going back in a week to try a contact in the left eye to see if I might be able to correct this mistake and get some semblance of intermediate vision.

The reason I have been getting headaches since the day after surgery is because I am left eye dominant and they operated on the right eye first. It's like I have been telling that office, my left eye is very stressed since the surgery. First the ye infection, headaches, etc.

Today's doctor was shocked that the surgeon wouldn't answer my questions or give me my chart.

I'm upset.

Today's doctor also said if I went with the lens in the incorrectly diagnosed left eye as planned, I would have most likely had neuro - adaptation problems. Which would have meant an iol exchange, etc. When I brought the headaches to the surgeon's office -- attention as I have never had a headache before in the left back side of my head, they just dismissed it as "not normal". With no explanation or inquiry.

Now I know why they wouldn't do the refraction too. But I think it may have been disastrous if I had gone ahead with the second surgery. Definitely not going back to that practice. 😒

A 0.34 target with a 0.75 result is a 0.41 absolute difference. Are these negative or positive numbers? While I understand being disappointed in that, ORA doesn't guarantee a perfect outcome - it just increases the accuracy. It likely would have been further off without ORA, and it was still within 0.5D. Seems like the surgeon could have chosen the adjacent power and had you closer to plano, but if your result and target are negative/myopic numbers, the other option would have also risked going hyperopic and left your intermediate vision worse. Even putting the same lens in the same eye two different times would very likely going to have two slightly different results due to shifting during healing.

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Eye dominance is a very complex and personal thing - I had my non-dominant eye operated on first: Eyhance, targeting distance. It was only a few days ago, but so far I'm having no issues adapting. There are multiple studies that have analyzed outcomes of conventional/crossed monovision, and all the ones I have seen concluded that there is no substantive difference for most people. There are always going to be exceptions to such conclusions. I heard a surgeon joke in a webinar once: "an issue is not rare when it's in your chair".

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I totally understand being frustrated, but I think everyone going through these surgeries needs to remember (reminding myself here, too): no result is going to be perfect, any one of us can be in the 20% or 5% or 1% or whatever who ends up with whatever less-than-ideal outcome, and, even with an imperfect outcome, many of us still end up less glasses/contact dependent than before surgery.

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When I am wondering if I could have gotten slightly better vision in one way or another, I also try to remind myself that I was blind in one eye less than 3 days ago.

Oh, that sucks. Once again, very surprised that the surgeon didn't check which was your dominant eye. He probably just assumed (again) that you were going to follow "what he was used to", and accept the targets he wanted to give you, not necessarily what was best for your lifestyle and needs. Although 20/30 isn't bad for distance vision though if the eye ended at -0.75D. Could it be though that your headaches have more to do with the discrepancy between the now clear vision in the operated eye and the bad vision in the cataract eye, rather than just right/left eye dominance? Especially since you've been used to good vision in both eyes all of your life, and even when you started to lose vision, it was probably pretty much equal in both eyes. Now one eye is seeing clear and the other one isn't -- that in itself is enough to cause headaches for some people. Though I don't know how good your vision is with the bad eye, so maybe not. After having my first eye done, the difference in vision between my eyes was enough to increase my headaches, granted I was really myopic in the unoperated eye, but still.

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Regarding the dominant eye, well I'm right handed but my left eye was my natural dominant eye for a very long time. When it's retina tried to detach a couple of decades ago though, I was left highly myopic and near sighted in that eye, and when my contact lenses or glasses were set for excellent distance vision in that eye, I would feel nauseous and disoriented when anyone or anything within three feet in front of me moved. So I ended having them back the prescription off in that eye by around +2.25D, which impaired my distance vision (but I wasn't nauseous anymore). And that meant that my right eye became my dominant eye, and has been for the last twenty years or so.

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Truthfully, I didn't really notice the difference. I might have had a bit of an adjustment period then, adjusting to the lack of clear distance vision in the left eye, but I don't remember it. If it happened, it didn't take very long or I would have noticed it cos I'm very prone to headaches caused by my vision. Maybe I didn't notice anything because I already had good distance (and near vision) in the non dominant eye, I don't know. My distance vision in the left eye used to be sharper than the right non dominant eye, but it's close vision wasn't as good, so there was distinct change in what each eye was used to seeing. And for my recent cataract surgery, I decided to make the left eye my dominant eye again for distance, and once again, not a big deal. I haven't noticed any difference from before -- nothing to adjust to at all, even though that eye hasn't been dominant for a very long time.

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If you're going to take the route of testing with a contact lens, then what I would suggest is to set the prescription of the contact to -1.0D and see if that does mess with your brain. if it doesn't then you know you could set the second eye for nearness, and just use glasses for driving if need be. And now since you know that the surgeon overshot his target, you know you can choose the stronger lens you and Ron were discussing, cos even if he overshoots that by a bit, you'll be on the myopic side of the target with a minimal difference between your eyes, with good near vision. If you use the same surgeon that is.

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I just had my five week check up with my optometrist, and overall she said I easily have 20/20 vision, with 20/20 in my "distance" eye that was targeted for -0.5D (and landed closer to -0.25 with her tests), and 20/40 in my "near" eye (targeted for -1.25D and rounded off by her as still that). Regarding the difference between what the surgeon's office said you initially had and what you are now, would have to do with the eye healing. My near eye was originally tested two days post surgery at 20/30 and now has landed 20/40 five weeks later.

First can you clarify some things? I gather it is your right eye that has been operated on? And, when you say your target was 0.34 and you ended up at 0.75 D, are these numbers actually positive, not negative? It makes no sense to target +0.34 as that means far sighted which is not good. And if you really ended up at +0.75 D that is not good at all. It will mean really poor near vision and poor distance vision. It could be corrected with eyeglasses or contacts but if your objective is to be eyeglasses/contacts free the only good solution at this point would be to get a lens exchange for the correct power.

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On the left and right eye dominance thing, that is not critical. I am right handed but left eye dominant. I have crossed monovision with my right eye the distance eye, and the left eye the near eye. It still works. Most do distance in the dominant eye, but some believe the crossed way is better.

I didn't add the negative. It's negative .75 in the right eye, the one that was operated on.

The target was negative .34, which would have been fine for the dominant eye. I am only reading at 30 inches -- and I have an uncorrected astigmatism in the eye that was operated on. So my vision is at 30 inches, and my main goal was to have laptop vision so I can continue writing. But I dont have it and I have been tryin g to get answers for two months. I think the headaches on the left side are an indication of the dominant eye being very stressed. I had 20/30 vision before surgery and today's testing is that I have 20/30 vision.

Well, I feel a bit relieved if some think that crossed monovision is better. I think the surgeon just made a mistake since it wasn't discussed with me and I was told by the surgery coordinator that I was most likely right eye dominant, without doing a simple test to determine if I was. I've done the test about 6 times now and I am most definitely left eye dominant in all ways.

How much cylinder do you have in the right eye?

If you are at -0.75 you should have reasonable reading vision at closer than 30 inches.

One option you have is to go for distance in the left eye. You will have to get to the bottom of what went wrong with the power calculation in the right eye. According to the Hill and Barrett formulas a 21.5 D lens should have left you at about -0.30 D. You will want to show the measurements and your outcome to the new surgeon if that is the way you choose to go. You do not want to end up with poor distance vision in the other eye.

And the other problem is what do you do with the right eye. An explant and a correct power IOL would be one option.

Not the best situation to be left in. I am surprised that they missed by so much with the ORA.

Thanks. That's helpful. It's hard to tell what is causing the headaches, but I did immediately feel off balance after surgery. I always had very good distance vision before the cataracts, i think the surgeon made a mistake by not listening to what I was saying about my vision. Even a few days before surgery, I tried to ask why the right eye was being operated on first and got an uneducated answer from the surgery coordinator.

In the initial eye test the day after surgery, they would only tell me what my vision was for distance. they would not tell me my vision result for intermediate or near.

Maybe I am getting confused but if my right eye vision is at minus .75 and I wear a contact for minus 1 - isn't that only a .25 differential?

Yours seems to have landed at a solid 1.0 differential.

Maybe my dominant eye will switch as yours did, but I feel like it's a lot of unnecessary neuro-adaptation because they didn't bother to check it.

I remember you said your surgeon apologized for not hitting the target, but yours is a .25 miss in your dominant eye which put you closer to plano and explains why you have great distance vision. , whereas mine is almost a .5 miss in my nondominant eye and no one will even discuss it with me at that practice. Isn't that a lot?

The last I heard after continually asking is that the surgeon would do a .75 differential, but if he did that - wouldn't that be a minus 1.5 lens? If I am now at minus .75? That's what the new doctor was saying would be hard to neuro-adapt to because my left eye is clearly dominant. Was the surgeon planning on checking my eye first to see where it landed? I know he wasn't because they were trying to rush me through surgery again without a discussion. Unless he had the results and just wasn't telling me but i know he didn't have a six week post surgery test.... I'm understanding why they would not answer my questions, or give me my chart because if it was such a big miss, I would of course have more questions. I would not use the same surgeon.

The numbers should have been negative, sorry about that. My nondomiant eye landed at minus .75, It's a .72 differential from the plano target from the IOL calculation sheet. The surgeon chose the next step (minus .34) without discussing it with me, The O.D. today didn't mention crossed monovision. I will have to read about crossed monovision now. Today, I understood that the best non glasses vision i can expect is 30 inches. which is way off laptop vision and why I decided to opt for Eyhance. I never wore glasses.

I am an artist and scientist and writer and my vision is very important. I have not been treated well by the surgery practice. I feel if my dominant eye had been considered, I could have made the best decision for myself based on my needs and what i know about my own vision.

They did not even warn about glare and haloes when pushing the Panoptix lens on me. I had to research it.

I have a slight astigmatism in my right eye so now my distance vision is not where it could have been with due diligence. It seems it could have been corrected. This surgery practice is an assembly line.

I'm frustrated because the practice won't give me my chart and refused to do an eye refraction until both eyes were operated on. The six week eye exam in my case shows a much bigger differential and would be very helpful in determining the lens for the second eye. But they refused to do it. So I went to an independent O.D. today and was surprised to learn that everything I was saying and feeling was more or less correct, and with any diligence by the surgery practice, the surgery process could have been very different and so much less painful.

I'm glad to be able to see again too but that doesn't mean I don't want the best outcome. At age 58, I could still be using these lenses for quite some time. I hope so.

I thought about your situation a bit more and the fact that nearer vision without glasses seems to be a priority. One thing you could consider is doing both eyes for nearer vision with a split in the target to expand the range of near vision. What you could do now is use a contact in your right eye which had been operated on and is at -0.75 D. This would allow you to test different amounts of additional myopia to see what you want for near vision. For example if you use a +0.75 D contact in the right eye this would make your eye effectively at -1.50 D. Then if this works for you for the type of work you do then you could target -1.50 D in your left eye.

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This would leave you with -0.75 D in your right eye, and -1.50 D in your left eye, with a differential of 0.75 D between the eyes. With the Eyhance I would expect that should give you very good near vision and with your right eye some reasonable distance vision (20/30 as you say). For driving or other situations where you want the best distance vision you could get some progressives. That would correct both eyes for distance and for near.

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This could be a functional vision situation without having to explant the right eye lens. The other option of course is to explant the right eye lens and do it for near vision. Your test with contacts will tell you how much you want. And for the left dominant eye you could then go for full distance. I think either solution would work, but the explant would come with a bit more risk.

I just pulled the form from yesterday. The Hill calculation was -.29 for a 21.5 lens although he didn't discuss it with me). If I had known what my dominant eye was I would have made a different decision. The target he hit is -.75. That's a .46 difference. (-.75 minus -.29) That's pretty off, right? I am trying to find some research on this.

The form from yesterday, the spherical is written as pl and the axis is 165, cyl is -.75.

My left unoperated eye is: +.50 sph, -,25 cyl, and axis 80.

The O.D. yesterday seemed pretty concerned that they did a bad job, He didn't come right out and say it but he said I need a +2.25 prescription in both eyes. He suggested I wait and not get the eye done yet. I think he was saying - not with the same surgeon. The way he said it, scared me: "I've seen it like this before.... " but not common, is what I heard. He was pretty thorough and held the eye chart out at different distances for me. We both agreed I am seeing clearly only at 30 inches. And with a 20/30 outcome - the same vision as I had a few days before surgery.

I am wondering if they even implanted an Eyhance, because they had it on my chart wrong. That's why I have been asking for my chart. The IOL card they gave my daughter, said Eyhance, so I hope that is what I got. But this practice is secretive to the point that i feel like they are hiding something. I think they probably did get a refractive measurement ten days post op, so they may know it was a miss. That the surgeon wont talk to me, is a miss for me. I am so aggravated. 18 hours after surgery some optician I never met, peering into my eyes asked me if I was a missionary in a very weird way. It made me so uncomfortable. He treated me differently when I said no. He asked me really prying questions about my daughter and I don't know how he even knew I had a daughter, much less asking so many questions about her. . I'm just throwing up my hands here. I knew something wasn't quite right. It's pretty hard to write on the computer at all and I am struggling to find a good outcome.

I really don't want to do an explant. I am scheduled to try a contact in my unoperated eye next week, the O.D. was very receptive to the idea of trying it, he would have done it yesterday but I had my grandson with me and didn't feel right about driving with him with a contact for the first time. I will ask him about your suggestion next week. Thanks.

From my research, I didn't expect my surgeon or any surgeon to hit the exact target, so I chose my targets with that in mind. But at least my surgeon told me that he had under hit both targets when I asked so I had an idea of what to expect. Remember though as Ron said, the optometrist's results showing what your eyeglass prescription would be, have to be rounded out to increments of 0.25D, which wouldn't necessarily exactly reflect what the ORA scan showed, or your exact, exact target -- their machines just round it out to the closest quarter, as they don't make eyeglasses, etc in diopters like -0.34D, etc. For example although my optometrist said that according to my eyeglass prescription I landed at -0.25D in my distance eye. she did some extra scans and said that from what she saw, my surgeon actually hit -0.31D in that eye, but that of course has to be rounded out to quarter diopters cos that is what the standard is for eyeglass and contact lens prescriptions. Does that make sense to you?

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I suggested that if you were going with the same surgeon, that you probably would want to go with a -1.0D because according to the results with your first eye, he overshoots his targets. Thus there's a good chance that you would end up on the negative side of -1.0D, closer to -1.25D which would give you good near vision. But yes, I should have suggested that you try a -1.25D contact lens, not the higher one. I forgot to translate what I was considering the surgeon's skills to be into the actual contact lens power. Actually, reading what RonAKA just wrote about translating minus IOL targets into contact lens prescriptions, my suggestion of using -1.25D contact lens probably wouldn't work, and I don't know how to do that math, so whatever he said, lol.

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You definitely do not need to go as high as -1.50D with an Eyhance lens -- that would be overkill. And you'd lose far too much distance vision -- would probably end up around 20/60 and even for me, that would make my brain confused. Ending up at -1.25D with my "near" eye is giving me J1 and better at 14" (from my eyes, not my body -- body distance would be less), good phone, etc, vision and the same with my 15" screen laptop with the text zoomed down to 92% when sitting at a regular distance away. No eye strain (even for the distance eye), even if I don't take a break, no tiredness, no need for glasses for anything but the tiniest print on boxes and pill bottles. Your surgeon was making that suggestion based up assuming he'd hit a lower target with the first eye. You don't have to go to specific difference between the eyes, just what will give you what you want as long as it's less than recommended for mini-monovision. If it's less than 0.75D in difference, that isn't going to hurt you, it will just enhance your binocular vision. But if you do decide to not risk it and go for distance with the second though, remember that you will always have to wear glasses for reading, computer stuff, heck even to put eye makeup, tweeze your eyebrows, etc if you do such things. I know it's a hard decision to make and not one because of your own choices, but unfortunately, it is the situation you have to work with.

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I would try the contact lenses for a bit in the unoperated eye, before deciding that your headaches are caused by eye dominance, and not by the fact that one eye is now seeing clearly and the other one is not. I'm someone who used to get constant and severe migraine headaches when having to constantly wear eyeglasses because I was so myopic that it was a strain on my eyes (and thus my brain) to just look through the eyeglass lenses which were only less than two inches away from my eyes. But once I was allowed to wear contact lenses, those migraine headaches disappeared immediately. But if I wore my eyeglasses again for extended periods of time, they would return. So don't dismiss what most likely now is a significant difference in the vision between your eyes. Just the strain of looking through the one clouded lens while the other eye is clear is a big adjustment for your brain. I'm betting that that is real problem, not eye dominance.

You may be right about the headaches because the unoperated eye is bothering me a lot.

I misread something, the target was actually -.29 so if they rounded up, that would be .5 right? But since yesterday the refraction was at -.75 , that's almost 2 steps, right

I definitely don't want to need glasses all the time, that's why I decided on Eyhance. I guess I will just have to try and find a new surgeon, someone who will express interest in getting a good outcome for me.

I rechecked my calculation sheet and it was a .29 target with a -.75 on yesterday's refraction, which is why i guess I was rounding up to .5 difference. My laptop vision is not good and I keep making mistakes. I had really hoped for a different outcome. I am wondering if PCO is starting to become a problem already.

"This surgery practice is an assembly line."

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That is what I felt about the first clinic I went to. The surgeon I met with was nice enough and answered what questions I had, but overall, when sitting in the overcrowded waiting room waiting for my appointment, I felt strongly that we all were just cattle, and that it would be very easy to get lost in the process. There's being efficient, and then there's the above. The second clinic I went to, was very efficient and organized, but I didn't feel like I was being herded through a process.

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So are you ready now to write a bad review about that practice and save some other hapless soul from going through what you have? At the very least, I'd report them to the medical board. I wonder how your surgeon got such good reviews? Maybe they were "padded", or maybe written by patients who just didn't know any better -- didn't know that whatever little crumb that practice was throwing their way wasn't even close to how could their surgery results could or should have been.

Unfortunately the refractive outcome of cataract surgery cannot promise a great degree of accuracy. You end result can be off by as much as plus or minus half a diopter. Sounds like you ended up half a diopter under target, which is within the margin of error. My target was -0.21 and I ended up at +0.25.

Yes, that is a huge difference. And probably a good idea to find another surgeon, although more work and even worry for you, though I don't know if I would trust the previous surgeon at this point. Too much water under that bridge, and you don't know if he would try to do a better job second time around, or be even more lax to punish you for questioning him. I know that latter part sounds somewhat extreme, but trust me, I've seen it happen. And what would your recourse be if your next eye turned out worse? It's accepted that implanting IOLs is not an "exact" science so he could hide behind that. I do highly recommend reporting him and his staff to the medical board, both statewise and federal. You have more than enough evidence to support your case. Not enough people know enough to even know that their surgeries weren't done as well as they could have been. They're just told, oh well, that's how it is, so they accept it.

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I think you trying contact lenses will give you a clearer picture overall of what you're experiencing now, and where you want to go. And if you decide to set the second eye for near vision, and your results for it end up even close to where mine did (20/40), you probably wouldn't find yourself even using glasses for distance much at all except maybe for driving in difficult situations like fog or bad weather. And once both eyes are done, you will notice a significant difference and clarity in your overall vision. Like I've said before, each of my eyes are doing great doing their individual thing, but when working together, they really are magical.

"The form from yesterday, the spherical is written as pl and the axis is 165, cyl is -.75."

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Whoa! Just a minute. That sounds like sphere is plano. And your cylinder (astigmatism) is -0.75 D. If so that is not all that bad. On a spherical equivalent basis that is 0.0 sphere + 50% of the -0.75 D cylinder for a total spherical equivalent of -0.375 D. That is exactly the same as what I have in my distance eye. I am surprised that you do not have 20/20 with a correction this low. Did you get a toric lens? If not, this is a pretty good outcome.

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If this is correct, I would proceed with getting your left eye done for near. With your SE of -0.375 and a differential of 1.0 D you could target -1.375 for the near eye. If astigmatism is expected to be a problem you could get a toric to keep the cylinder lower.

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On a spherical equivalent basis which is what most IOL power formulas use you are only 0.075 D off a target of -0.3 D. That is very good if not excellent for accuracy.

After your outcome, and assuming you ended up with plano sphere and -0.75 D, I went back and checked your power calculation using the Barrett Toric calculator to see if you would have benefited from a toric lens in the right eye. The answer is Yes, and No. You would have benefited from a toric lens with a cylinder power of -1.0 D (-0.66 at the cornea plane). Eyhance however is not available in that power. The minimum toric is -1.0 D. The only lens I am aware of with that low a toric cylinder power is the AcrySof IQ Toric. It is a true monofocal and while you would have gotten better distance vision, the near vision would not be as good. With the 21.5 D lens and -1.0 D cylinder you theoretically would end up at -0.24 D SE, and of that 0.28 would be cylinder (astigmatism). See this image for the detail. In my opinion it certainly would not be worth it to explant what you have and put in this AcrySof IQ.

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I also redid your left eye with the Barrett Toric calculator to see if it would benefit from a toric lens. It did not. Even with the minimum -1.0 D toric it would result in more astigmatism. The residual with a non toric would be -0.30 D cylinder. With a toric it would be higher at -0.39 D. It would also flip the axis of the astigmatism which most say is not good. Short story is that with an Eyhance it would be best to go with a 23.0 D non toric which would give you a -1.20 D spherical equivalent. The differential between the eyes would be 0.825 D and within your desired maximum differential of 1.0 D between the two eyes. Here is the detail on the left eye.

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"The O.D. today didn't mention crossed monovision. I will have to read about crossed monovision now. Today, I understood that the best non glasses vision i can expect is 30 inches."

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Here are some articles to read about crossed monovision. From the first one:

"Zhang et al present evidence that crossed monovision has higher satisfaction than conventional monovision. I have chosen to routinely offer mini-monovision for 20 years in thousands of patients using a choice of the dominant eye for near."

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JCRS Rationale for choosing crossed monovision Myers, William G. MD

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And here is another. This may be the study that Myers quoted (Zhang).

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Healio News November 16, 2016 Crossed monovision may be as effective as conventional monovision

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And another.

"The clinical results of the crossed monovision were not significantly different from the results of conventional monovision. Therefore, crossed monovision can also be a valuable option for correcting postoperative presbyopia in patients considering bilateral cataract surgery."

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pubmed Comparison of conventional versus crossed monovision in pseudophakia Jaeyoung Kim 1, Hyun Jin Shin 1, Hyung Chan Kim 1, Ki Cheul Shin 1

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Unfortunately a 30" near vision limit is probably not very far off the norm, even for the Eyhance, when the lens is set for distance like yours is. You will need to get the other eye done for near vision to be comfortable with a laptop without glasses. My suggestion would be to get a +0.75 D, +1.0 D, and +1.5 D contact sample and try them in your right eye to see how much closer the target should be set for. I would expect that a +1.0 D contact would provide good reading vision. This is better than trying to test with your un-operated eye, as you will be testing with the Eyhance lens in place instead of your natural lens with a cataract. You would add the contact lens power to your eye spherical equivalent for your right eye. Ideally you want to use a toric contact to reduce the astigmatism. Your optometrist should be able to help you sort out the math, to come up with a target for the left eye. On my quick look, I would suggest -1.25 D for a target in the left eye.

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I posted another response where I redid the calculation for both eyes with the Barrett Toric formula. It seems to be still in moderation. The short story is that you probably could have benefited with a toric lens with a 1.0 D cylinder correction in your right eye. Unfortunately this toric power is not available in a Eyhance. The minimum cylinder is -1.5 D which would be too much. There are other lenses available in the -1.0 D cylinder power, like the AcrySof IQ, but that would have required a change in the brand model from your desire to have an Eyhance. In the Eyhance line the surgeon chose the best lens (21.5 D non toric) for you.

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The left eye does not appear to benefit from a toric and you would be fine to go ahead with an Eyhance non toric. I provided more detail in the post with the Barrett formula results for each eye.

I'm trying to get my records first and the insurance company called them for me yesterday and left two messages, so that's the first step.

Funny, because one of the best reviews the surgeon had, was from friends of his, I found out.

The problem is my vision is only good at 30 inches. I understand with help from all of you) that my dominant eye may be able to adjust (or switch) , but since the surgery was done in my non-dominant eye first, I would have to target for near in my dominant eye, not something that sounds ideal to me.

I was told a toric lens was not an option for me. The new doctor seemed to think it was. I am supposed to see him again next week.

I am kind of confused at this point, I think I just need a different surgeon: one who will explain things to me.

My main issue is my vision just doesn't seem very good to me and the 20/30 with clear vision only at 30 inches from the doctor this week, confirmed for me what i am experiencing.

Thanks. I think I should have considered more options too (but was rushed into deciding) and am wondering if i should try a different lens altogether in my unoperated eye.

I posted some articles to read about crossed monovision. I don't think it is a big deal, and some even believe it is better. My situation is interestingly almost identical to yours. My left eye is dominant but since my cataract was worse in the right eye, I got it done first and the surgeon recommended distance. My outcome was identical to what I think you have; plano sphere and -0.75 D cylinder. However I have a monofocal and have 20/20 vision. Your 20/30 vision may have been a price of using an Eyhance. My left eye was done second for near and I am at about -1.6 D SE. It is not perfect near vision but is very good.

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Your doctor was correct in that an Eyhance toric would have not worked for you. The minimum cylinder power available is too much for you. An AcrySof IQ (monofocal) toric probably would have worked, but I don't know if that was considered.

If you were doing your right eye over again I would suggest considering an AcrySof IQ toric. However, while it would likely have given you better distance vision, it would not improve on your near vision with that eye, and in fact would likely be worse.

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In your left eye another Eyhance is probably your best bet. It will reduce the differential between the eyes compared to using a monofocal.

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There is more detail in the post that is waiting to be moderated.

"I'm trying to get my records first and the insurance company called them for me yesterday and left two messages, so that's the first step. Funny, because one of the best reviews the surgeon had, was from friends of his, I found out."

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Good idea to do first. Doesn't surprise me that his reviews are padded by friends and probably from anonymous accounts made up by the staff. Maybe ask the new optometrist for a recommendation for a new surgeon?

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"I think I should have considered more options too (but was rushed into deciding) and am wondering if i should try a different lens altogether in my unoperated eye."

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As Ron suggested, I don't think a monofocal set for nearness will help you here, in fact might cause more problems as it would cause more of differential between both eyes which for you, probably wouldn't be good. You'll get better near vision with the Eyhance yet lose less in distance with it. If you were going to have the right eye done again, set for nearness, which also can end up worse than before, then you could decide upon other lenses.

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@RonAKA re: "My suggestion would be to get a +0.75 D, +1.0 D, and +1.5 D contact sample and try them in your right eye to see how much closer the target should be set for. I would expect that a +1.0 D contact would provide good reading vision. This is better than trying to test with your un-operated eye, as you will be testing with the Eyhance lens in place instead of your natural lens with a cataract"

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I suggested that she try a contact lens set for nearness in the un-operated because she didn't think she could handle switching her dominant eye. Though of course the vision wouldn't be as good because of the cataract.

The reason I suggest doing testing with a contact in the operated eye, is because that eye has an IOL that has no accommodation and will give a more realistic view of what near vision will be like with no accommodation. It also has the Eyhance lens so it will be a better simulation of a second Eyhance lens. The only purpose of the test would be to determine what power is needed for expected near vision. It would be the most accurate way of doing it, especially if a toric contact is used to null out the astigmatism.

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Yes to simulate mini-monovision it would be best to use a contact in the non operated eye as well as a separate test. That would be a second stage after deciding what the target will be. The only downside is that the unoperated eye will have some accommodation which will deliver better near vision that the IOL will. I found I needed about 0.25 D more myopia with the IOL than with my natural eye.

you are not getting the range with eyhance. if you had hit plano your near visiin woukd be further out than 30 inches. reason could be you are young and with possibly larger pupils. you should go with panoptix. did you get the surgery in india?

"he said I need a +2.25 prescription in both eyes"

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You may want to get some +2.25 readers from a dollar store to tide you over until you get your second eye done.

I think she is saying she cannot see closer than 30". With an Eyhance I would have expected better than that, but it is in the tolerance range for a defocus curve.

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PanOptix have their own set of problems.

Hitting plano bang on with Eyhance should reliably give just about everyone good vision down to 70cm / 28"

Wow. Thanks for checking this. 23.0 was the lens I was trying to ask the surgeon about. I just wanted to know whether he would recommend a 22.5 or 23.0 so with the new refraction, it does seem like I could get better near vision with the 23.0 and with only a .825 differential, well within the mini mono-vision range, correct?

Tomorrow is Monday, so I am going to try calling now that my insurance company has left messages, maybe I will get some results in terms of communication. If not, I will start with a new team. Time is not on my side as I am trying to travel soon. These calculations are all really helpful and will help me a lot when I try to state my case. Do you think I could get the 23.0 without having to try contacts first? I am not too thrilled about having to try contacts.

The problem is that there are huge variations in outcomes between patients. I only have a monofocal and I can see a computer monitor well down to about 18". @Analytica has reported, if I understand the numbers she posted, that she only sees well at 30". People often look at defocus curves like they are a single line. In fact the single line most often displayed is an average of a large number of people. It is worthwhile looking at defocus curves which show the error bar associated with each data point. That gives a more realistic view of the range of possible outcomes. Google this article and have a look at Figure 2. Then look at the error bars. That unfortunately is the reality of the uncertainty when we implant these lenses. Everyone of course hopes they will be at the good end of the error bar, but unfortunately the statistics do not support that. When you consider the error bar range one can see that the standard monofocal can be better than the EDOF lens. Figure 4 shows the impact of different corneal profiles which would be one of the factors in person to person variability.

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AOS THESIS 2020 Static and Dynamic Factors Associated With

Extended Depth of Focus in Monofocal Intraocular Lenses KAROLINNE MAIA ROCHA, LARISSA GOUVEA, GEORGE ORAL WARING IV, AND JORGE HADDAD

just curious, maybe it has been discussed earlier in the thread: have you tried finding a surgeon that uses ORA? when ORA is available, there's no benefit to scrutinizing the pre-op calculations too much, since the data they get during surgery is the most accurate available.

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reading about your experience makes me feel very fortunate and thankful that my surgeon offers ORA as an option (included as part of any premium lens package, too) and that I trust him. I was happy to just make clear my goal outcome and let him make the power judgement himself during surgery...figuring that multiple decades of experience and tens of thousands of surgeries meant I'm better off letting him choose the best IOL power as long as he understood my goals. He aimed for plano to -0.5 (this is both what I wanted and what he was going to aim for given broader goal of "good distance vision" in this eye, not sure exactly what the exact ORA "target" refraction ended up being yet), and my result seems to be within that range. my eye is still adjusting, but I'm planning to get a preliminary refraction with my optometrist soon to start checking the result. in any case, I'm happy so far.

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I plan to use the exact same approach for my second eye eventually - same surgeon, using ORA even if I have to pay extra for it, and discussing my target range pre-op (which will be nearer next time).

Based on the measurements you provided earlier and the Barrett calculator the 23 D Eyhance in your left eye should give you a spherical equivalent of -1.20 D, and a 0.825 differential between the two eyes. That should be quite acceptable, but it would be best to simulate it with a contact before trying it. If you tell the optometrist that you went to that you want to simulate a spherical equivalent in your left eye of -1.20 D (or close to it) they should be able to do that.

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It would be also good to simulate what your vision would be like by using a contact in your right eye. But another option would be to use some dollar store readers to see what vision could be like. Some +1.0 D readers with your right eye may be a reasonable simulation. That is the route I went.

she is saying she aimed for -0.29 and her refraction is -0.75.

"But since yesterday the refraction was at -.75 , that's almost 2 steps, right"

if that is the case she is not getting enough near even after setting eyhance for -0.75. so a plan eyhance and her clear vision would start further out from 30 inches.

I believe @Analytica paid extra for the ORA. From what I can see her lens selection was not changed by using the ORA. @karbonbee also used ORA and her power selection did differ from the Hill and Barrett predicition. One difference is that I believe @Analytica was very mildly hyperopic before surgery, while @karbonbee was a myopic extreme at about -11.0 D if I recall correctly. Again if my memory is correct I recall recommending to @karbonbee that she find a clinic that does ORA as that much of a correction can be difficult to predict. I suggested a clinic that does it, and coincidentally she had already selected that clinic for a consult. It was obviously a good decision as her final power in at least one eye was significantly different what the formulas predicted.

I believe she later clarified this as:

"The form from yesterday, the spherical is written as pl and the axis is 165, cyl is -.75."

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I assume that "pl" is short for plano and is 0.0 D. That works out to a spherical equivalent of:

0.0 D sphere + 50% of -0.75 D cylinder = -0.375 D SE

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The formulas like the Barrett use SE in their calculation, so that is a miss of 0.85 D which is actually very good accuracy.

I researched and requested ORA on my own. It was a $150 charge per eye so I thought it was well worth it but it wasn't provided as an option until I asked, for some reason. I also think it was well worth it.

The surgery team would not let me get a refraction between eye surgeries, their optician even cancelled my appointment after saying it was a good idea, something very strange and secretive there. So, based on Ron's recommendation, I waited and received an independent refractive test. Now I see that that there is quite a bit of difference between target and outcome, and now understand it was because of the ORA so I am glad I asked for it.

I have not been able to get an appointment with the surgeon again so I am at a bit of a standstill and looking for a new surgeon.

My eyesight right now is not great. I'm struggling to see. I'm not happy right now so figuring out what to do.

Did you have Eyhance? My surgery center calls it Basic Plus, so I'm curious about your use of the word Premium which they reserve for Panoptix.

Correction to my previous post. The miss was 0.085 D, not 0.85 D!

is your distance vision good?

her astigmatism of -0.75 is minimal. she should have good vision from far to 30 inches.

I agree. My distance eye which has an AcrySof IQ monofocal has a current refraction of:

Sphere: 0.0 D, Cylinder: -0.75 D for a SE of 0.375 D

I can see down to 20" or so and have 20/20+ for distance, with a monofocal.

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I guess that shows how big the variation can be from person to person. People look at defocus curves and think they are exact. There are error bars associated with these curves, and sometimes they come back to bite you.

i was told by a surgeon recently not to get eyhance due to 6mm pupil size. the central 1mm will do nothing for me. he also said that the alcon lenses would be better for me as they are refractive for the entire diameter. the tecnis have a -0.55mm boundary that's not refractive.

My pupils are on the small size so I thought I would get closer range of vision than 30 inches. It's possible, having two eyes working together, maybe I could get lap top vision, but right now, I am even having trouble reading the burners on the stove: front and back - and that isn't functional at all for me. I am thinking to wait on the second eye surgery and have it in India. I tried to go with a different surgeon in the U.S. and the next appointment is in November. I finally got my chart from the surgeon, but under the brief description of PCO, it only says "active". So, I am wondering if I am already having blurring from the PCO.

I think I have every reader except +2.25.

Right after surgery, I bought +1.0 and +1.25 readers and they were working but now they are not. I think the PCO may already be causing blurring?

All services in my area are backlogged, but especially eye and dental. But HVAC, plumbers, carpentry - forget it. I guess it's in part post pandemic and people moving to more rural areas.

So distressful for you. So sorry you're going through this. Glad you got your chart finally though. Hey, if you wanted to come to Ottawa, Canada instead, lol, you could probably get an appointment within a couple of weeks at the clinic I went to. There is a Herzig clinic in Toronto also, and they have a good reputation also.

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My distance eye ended up at -0.25D, and my near vision with it isn't much better than what you have. Distance is a solid 20/20 though, sharp and clear. I've been reading from other people though who ended up with PCO and they were finding their vision somewhat blurry also. Too bad the ass of a surgeon you had couldn't have given you a heads up so you at least knew what was going on.

Compared to the cataracts, it's great. Before the surgery, glare from light, sunlight, etc. was horrible, I had to put up heavy curtains and couldn't be outside for very long. I'm nervous about trying a contact though as my unoperated eye is very weepy. I don't have that problem in the operated eye.

I'm wondering if I should try a regular monofocal in the second eye as I don't seem to have much intermediate vision with the eyhance?

I think I'm too nervous to try contacts though because my unoperated eye feels irritated and is runny.

Assuming this is going to be your near vision eye, and considering that you have an Eyhance already in the other eye, I think I would stick with the Eyhance. In your close eye, this will allow you to have about 1/3 D less myopia, which will reduce the differential between the eyes by the same amount. If it was your distance eye, then it may make sense to use a monofocal.

I concur with Ron about putting another Eyhance in the other eye for near vision. You won't have to target as much myopia for your near vision and thus potentially won't lose as much distance vision in it also.

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Re the irritation in the unoperated eye, have you tried using lubricating drops in it? It wouldn't hurt both eyes actually. Dry eyes will cause your eye to "run" and feel very irritated. I experienced this for a long time, especially when wearing hard contact lenses -- my eyes were tearing up and running often, but still were dry overall. When your eyes aren't being lubricated properly they will get irritated and then will often get runny in response to the lack of proper wetting in them. In addition, I also found using a hot moist eye mask once or twice a day for ten to fifteen minutes at a time, helps with the dryness and the irritation. It helps to unblock the tear ducts and encourages the tears to move around the eyeball more efficiently. I started doing them about three weeks prior to, and right up until my surgery, but then stopped until last weekend when I was sure the eyes were healed enough to start up again. I was worried about the weight and the pressure up against my eyes, but the optometrist said it was okay to start using them again. I'm definitely feeling a difference already. I still use the lubricating drops three times a day in between, and overnight to supplement the mask.

I tried contacts and the Optometrist could not get it in the LE. After several tries as I kept shutting my eye despite all my strongest efforts not to, I had to give up. Someone on this site with a lot of contacts experience (I had none) said when you are older (I am 72) it can be difficult or impossible to get them in. I opted for Mini Monovision and decided to take the risk without the contact trial and it has worked out fine. I am used to being a bit dizzy to begin with so I haven't really noticed much difference when I am out walking. At least now I can see the pavement with my RE.

thanks. what was the diopter difference for your mini monovision? I am thinking that .84 difference will be ok too without trying contacts. I got cold feet about trying contacts. this is helpful. Ive been offline for a while with home repairs.

Glad that helped as the doctor never warned me that contacts can be impossible to get in at an older age until someone here clued me in on that essential piece of information. I ended up spending $65.00 and it was an unpleasant waste of time!

I don't have the final results on my two eyes. I will know on June 8 which is 6 weeks after the RE was completed. I targeted -.50 RE and -1.25 LE. It appears it has moved as much as .50 on both eyes! I may now have -1.75LE and -1.00 RE judging by my own measurements. At any rate, I have not had any more of a problem with dizziness or adjustment than I had with my original eyes of -1.00 LE and -1.25 RE and cataracts. I am glad I did opt for monovision as I would be very limited with the tecnis 1 monofocal which I chose because of AMD.

I currently don't wear glasses anywhere (except as required by law for driving) which is like before so I am happy about that. My near vision is super sharp also taking me back about 30 years when it was 20/20.

That's encouraging. I think I'm ready to try again for the second eye based on all the information I learned here. I'm glad I trusted my instinct, I didn't think I would be able to handle the contacts, with my current extenuating life circumstances: it just felt like too much.

I'm glad you are mostly glasses free. That's great!

Success! I went out of state for my second surgery to a university hospital with a top surgeon who is also a professor. 1.4 diopter difference in the second eye (Alcon monofocal) Eyhance in the first eye, right, and I can see great 3 days post op.

Discovered: U.S. University systems mainly use Alcon.

Interestingly, she said women adapt to monovision much better than men, going back to the hunter/gatherer brain.

She also offered an IOL replacement as one option, so 6 months after surgery, she wasn't that concerned about a replacement.

But I didn't have a lot of time, so went with the monofocal. She gave me contacts to try and I was immediately sold. Saw her on a Thursday and had surgery on Tuesday.

Surgeon actually suggested mini monovision and consulted with me about what lens I wanted! Night and day from the practice in Delaware. Oh, and they wanted to do a refraction, instead of denying me one like they did in Delaware. Top notch surgical team. 6 months between surgeries with loss of income and stress and depression from the other practice. So happy I kept advocating with your help. Thank you, thank you! We will see how everything lands in the next few weeks.

I'll wait for Ron to chime in, but I will add that yes, based on my experience and that of others, many US medical schools prefer Alcon. I admire your determination.

I am certainly glad that things worked well for you and you checked back in to update us. It is unfortunate that some clinics take a "Father knows best" approach and don't work with the patient. It sounds like you found a good one.

It is frustrating that people don't know they can have better eyesight than what is being offered. And that many doctors don't care enough to spend a little extra time for something as important as eyesight. Duke University Eye Center - about the best, I think. Learning about your experiences here helped me to advocate and find what I wanted. With the eyesight I have now, I don't know why I would fork over 6,000 dollars for multifocals. I guess that's just easier for the practitioners. Thanks again!

Thanks! It seems to be working really well, I could even thread a needle.

Respectfully, the point of the Eyhance for me is its slightly extended range of focus over a pure monofocal. This extended range can benefit patients with different visual priorities. In my case, based on my visual history and a comprehensive discussion with me, my ophthalmologist recommended implanting the Eyhance first on my nondominant eye, targeting for near/intermediate vision, and then on my dominant eye, targeted for intermediate/distance (but not best corrected distance) vision. As this lined up with my own interest in mini-monovision and my prioritizing the near and intermediate fields of vision over distance, it's what we did in late June and mid-August of this year.

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So far, the results exceed my expectations (albeit not my hopes). Holding reading matter at comfortable distances, I easily and comfortably can read the print on a medicine bottle and text at the default settings of my Pixel 7 Pro and iPad. Sitting at my customary c. 29-30" from my computer monitor, I can easily and comfortably read five and six point text in my preferred Century Schoolbook font, and could read four point text fluidly if I had to.

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As for distance, I'm legal to drive and do so comfortably. That said, at my upcoming one-month post-op exam I expect to come away with a prescription that better corrects distance vision to have a just-in-case pair of glasses, for example, when driving in unfamiliar areas or in bad weather. I'll discuss with the ophthalmologist employing mini-monovision here, too. I also want to be able to see information on the dashboard. As I don't need glasses for near vision, however, I'd like to avoid the compromises involved with progressive lenses.

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My ophthalmologist also suggested targeting both eyes for near/intermediate in the event I didn't want mini-monovision. And were mini-monovision ruled out, I well might have chosen it.

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My point is that not everyone prioritizes the best possible corrected distance vision. And there's nothing about the Eyhance, or any other monofocal IOL so far as I know, that makes such a priority the "best" use case. Rather, "best" can be different for different people.