Eyhance IOL: Nine Days Post First Eye
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A week ago Tuesday, my surgeon implanted a 14 D Eyhance IOL in my left, nondominant eye targeted at -1.97D (according to the Barrett Universal II formula). The results thus far have exceeded my expectations. In August, unless something changes, the target for my right, dominant eye will be -0.68 D. A reasonable expectation appears to be not needing glasses except for driving at night or in bad weather. And as perhaps should be obvious from my intentionally myopic targeting, I would not regard having to wear glasses at all times to drive as a hardship.
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Uncorrected distance vision in my left eye currently is 20/60, correctible to 20/25. Near vision is J1, holding the Jaeger chart at the distance I normally hold my smartphone, about 14”. I can comfortably read 10-point Century Schoolbook text on my 27” Asus ProArt monitor (2560 x 1440), placed at its normal, that is, pre-op distance of 26” from my eyes, as well as printed matter on my desk c. 16” distant. (I easily can read 8-point CS text on my monitor, but I don’t think I’d enjoy having to do so for an extended time.) Without any correction to my now much more myopic right eye, I have quite functional vision both in the house and walking around the neighborhood. With a contact lens in my right eye, driving is no problem.
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So far, I haven’t experienced any visual phenomena. Occasionally at the end of the day my operated eye can feel somewhat gritty. For this, my surgeon suggested tears; his recommendation is Refresh Optive.
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Getting a little bit more into the weeds, my operated eye, with 1 cylinder of astigmatism, today measured -2.50 D in spherical equivalents. If the surgeon hits the -0.68 D target in my right eye, the result, with 0.75 CYL, will be -1.055 D. Averaging several Eyhance defocus curves indicates a mean distance visual acuity of 20/32 (logMAR 0.2). (That said, 20/60 for my left eye is much better visual acuity than the defocus curves suggested. If this holds up, it will underscore the importance of bearing in mind that defocus curves report mean results that are subject to standard deviations.)
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By way of background, I’m 73 and have worn glasses for myopia since third grade. My most recent eyeglasses prescription, which is a couple years old, was RE: -6.25 D, -0.75 CYL, Axis 180, ADD +2.50; LE: -7.75 D, -1.50 CYL, Axis 134, ADD +2.50. My right eye was correctible to 20/20 distance; my left eye to 20/30. Finally, my right pupil measures 2.3mm and my left pupil measures 2.17mm.
0 likes, 14 replies
maura04015 RebDovid
Edited
Thanks for this info. I'm glad it's worked so well for your first eye. Your report is helpful to me because I've been procrastinating about getting surgery over an inability to decide what I want, but increasingly I'm coming to the decision that what you're aiming for would be best for me.
RonAKA RebDovid
Edited
I am surprised that you are compromising your distance vision so much in both eyes. I guess each to their own, but I would not be comfortable driving with what your predicted refractions will be.
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One thing to keep in mind is that based on the Barrett Universal II formula that is on line, and the reports it produces, it does not work in sphere and cylinder. It combines them both into a spherical equivalent. So the target is set as a spherical equivalent and refraction for each lens power is predicted on a spherical equivalent basis as well. That said surgeons may have access to different versions of the formula that work differently.
RebDovid RonAKA
Edited
Considering my lifetime of myopia and never having been able to drive without glasses, I don't regard my targets as compromising my distance vision.
Lynda111 RebDovid
Posted
Now that I've had cataract surgery, I can drive without glasses, but I can see better with glasses, especially when it is very dark. I ran up on a curb at a parking lot last night that was not well-lit.
RebDovid Lynda111
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As mentioned, my surgeon thinks your situation is a reasonable expectation for me, which I would regard as a bonus. If I prioritized distance/driving vision, I would have adopted a different approach to my surgeries.
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What I think we need to keep in mind that what we may think of choices are at best reasonable expectations, even when the product of good information and reasoned consideration. The reasons include that (1) variance from the targeted refraction of up to 1 D is considered normal and (2) defocus curves, even assuming their accuracy, can deceive us if we take the dots on the curve as guarantees rather than the mean average of a range of results. Regarding the latter point, this means that even if the surgeon exactly hits the target the resulting visual acuity could be significantly better or worse than the single point shown on a defocus curve (and not all defocus curves show the standard deviations).
RebDovid RonAKA
Posted
Regarding my targeted refraction, actual result, and the Barrett Universal II formula, it may be that I did not fully understand what my surgeon had to say. At any rate, one should bear in mind that a refraction done only nine days post-op well may not reflect the final result. Perhaps for this reason, the technician used an autorefractor without also doing a subjective refraction. As she explained, their practice is not to do a subjective refraction until at least a month after surgery.
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The auto-refractor reported two results for each eye. For my operated left eye, for example, it reported -2.00 D (with -1.00 CYL) and a -2.50 SE. According to my surgeon, if I understood him correctly, because the autorefractor does not accurately measure Eyhance refractions--which is why Johnson & Johnson recommends not relying on it for determining final results and, e.g., eyeglasses prescriptions--his experience is that in my case a -2.50 SE autorefraction most likely reflects a -2.00 result (understanding also that the autorefractor provides rounded results). We'll need more time and subjective refraction to get better information, at which time I can seek clarification regarding how close the results will have been to the targets.
RonAKA RebDovid
Posted
I guess my point is that it is important that you and the surgeon are talking the same measure. You are going to get a very significant surprise if you are thinking sphere but the surgeon is using spherical equivalent for a target. With 1.0 D cylinder the "surprise" could be 0.5 D in spherical equivalent.
lucy24197 RebDovid
Edited
Sounds like you got results that will make you happy--congratulations!
You can get a seat-of-the-pants guesstimate of where you ended up---take your Jaeger chart and tape it to the wall at eye level. Cover your unoperated eye, and move closer and farther from the chart until you get the best overall focus. Measure how far your eye is from the chart--that's approximately your focal distance. Diopter = 1/Focal Distance (divide by .0254 if you're using inches.) It's not exact by any means, but it's entertaining.
RebDovid RonAKA
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Rest assured, we are comparing apples to apples. Also, before surgery on my right eye, when we need to finalize the target, I expect to have the benefit of a subjective refraction.
RebDovid lucy24197
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Thank you. I didn't know that.
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In trying this, for which Jaeger line should I be seeking the best overall focus?
lucy24197 RebDovid
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I look at the whole chart--when I'm at the focal distance, everything is sharp and clear. This doesn't work for a distance eye (although I have used a Snellen chart for that, and since my focal distance is only about 6 1/2 feet on my distance eye, it's feasible to measure it.) It's a very subjective and rough order of magnitude measurement. It doesn't take in to consideration any of the dimensions of the eye, and you're just making a best guess at where things are in the best focus. Your optometrist might say it doesn't work. But the math supports it---the relationship between focal distance and diopter is very simple--- (Focal Distance) = (1/D). The rest is just converting between English and Metric, and Bob's your uncle. Before my retinas started going nuts, I had a very good correlation between what I measured at home and what the optometrist measured. With my edema acting up and giving me a lumpy retina, I get some crazy numbers from autorefraction. A couple of weeks ago when I had a lovely fluid-filled pocket under my macula, an autorefraction measured -2.75D on my near eye--and there is no way that's the case. That would put my focal distance at about 14", and things are definitely not in good focus at that distance. I figure that the lumps and bumps in my retina are causing the light from the autorefractor to bounce in unexpected ways and resulting in measurement errors. When my eyes are behaving and I measure at home with my taped-up eye chart, I typically measure in the -1.65 to -1.75D range--which is right where I'm supposed to be. The focal distance for a -2.0 eye would be about 19 3/4", and for -2.5 would be about 15 3/4", so it can give you a sanity check.
Lynda111 RebDovid
Posted
I would agree with Ron, but you both are optically very knowledgeable, so if you are satisfied with the outcome, that is all that matters.
soks RebDovid
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thanks for sharing and good luck to you. my -1 cylinder became -0.75 post op. it is helping your near.
RebDovid soks
Posted
So I understand.