Eyhance or Tecnis Monofocal?

How would you compare Eyhance with Clareon in light of trying to be eyeglass free?

My thoughts are that without any offsets there would be an almost insignificant difference. But, yes in theory the Eyhance does give about 0.3 D more depth of focus. My thoughts are that it is not going to make much difference in needing reading glasses.

Ok. Thanks. I do like Clareon better from everything I have read.

you should really be comparing Clareon monofocal to Technis ZCB00.

I am not sure if my HMO stocks the Technis ZCB80 and don't know much about it? Why would that be that I should be comparing those two?

clareon monofocal and tecnis zcboo are the respective monofocal products from alcon and jnj.

tecnis eyhance is a monofocal plus. didn't quite make the edof requirements. comparable product from alcon is the vivity. but vivity makes the edof requirements but has a ring type center. tecnis has a diffractive edof called symfony which has many rings.

acon has the panoptix which is a trifocal. comparable tecnis product is the synergy. synergy is a edof with a strong near add.

The ZCB00 is the Tecnis 1.

Oh yes, I am already aware of that but my health plan stocks both Eyhance and Clareon, two products of which I have an interest for various reasons.

I know I have seen in a couple of your posts how to find a web site that helps you understand your IOL Calculation sheet. I can't find your post and am hoping you can let me know how to find it. I got my IOL Calculation sheet from my surgeon today and would like to interpret it a bit better. It looks like they have used something called Haigis, if that helps. Thanks.

Try googling this.

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IOLMaster 700 Quick Guide Printing Functions EN PDF

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These are the instructions for the IOLMaster 700 calculations.

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I have not had any experience with the Haigis formula, but perhaps I need to look on the Scottish websites! Unless you have very short eyes (far sighted), I think the best formula is the Hill RBF 3.0, and the Barrett Universal II as a check. Both the Hill and Barrett formulas are on line, and if you have the IOL calculation sheet there should be enough of the data to run those formulas as a check to see if they are coming up with the same results.

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If you need any help inputting the data perhaps start a new thread. Some of these threads are getting pretty long...

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I just checked back to your OP. You are only mildly myopic and the Hill and Barrett formulas should work just fine.

RonAKA I just wanted to say thanks for all your help. I got an unexpected call yesterday asking if I wanted my surgery done this Saturday. That's life with our Canadian health care system. Luckily I had just decided that morning what lens I was going with. I was really leaning towards the Eyhance, but after reading many posts on here and doing research, I just knew I do not have the type of personality that would deal well with a pupil dependent lens. I decided to go with the tried and true monofocal. My surgeon uses Tecnis, so that is what I will be going with. I am also not the type of person who could deal with monovision, so I will have to do exactly what I didn't want to do, put readers on or off a lot during the day. Oh well, I will also get use to this. One benefit is I will see distant things clearly, something I haven't been able to do for years.

Thanks again for all your help and information. This forum helps make a hard decision, if not easier, at least better informed. The things I learned were very interesting.

Karin I wish you all the best with your surgery. With all your preparation and worry, I suspect you will find it kind of anti-climatic as to how simple it is, and you will be very impressed with the cataract free vision.

Good choice with the Tecnis. It is tried and true. I will pray for you.

Thank you. It was a hard decision, but when I sat back and thought about it I think I made the right decision for me.

The Tecnis 1 monofocal IOL is an eminently reasonable choice. But if one's concern is pupil dependency, it's not clear that that should be a concern with the Eyhance. Gerd Auffarth and his colleagues report that, in considering the binocular defocus at one month for study subjects who were bilaterally implanted with the Eyhance IOL, "stratification by pupil size showed no pupil dependency of the enhanced monofocal IOL, compared with the standard monofocal (Tecnis 1) for pupils more than 2.5 mm. The sample size for pupils smaller than 2.5 mm was too small for between-group comparisons." Gerd U. Auffarth, et al., "Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract"m J. Cataract & Refractive Surgery 47(2):pp.184-191 (Feb. 2021) (open access copy available on-line).

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I also found a letter to the same journal by Drs. Rita Mencucci and Eleonora Favuzza in which they explain their understanding of why the Eyhance "maintained the distance image quality of an aspheric monofocal IOL, independently of the pupil size". Their explanation:

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"The Tecnis Eyhance IOL increases depth of focus due to a higher-order aspheric anterior surface with a continuous and localized increase in power from the periphery to the center of the IOL. This is a fundamentally different approach than using SA to extend the depth of focus. Primarily, SA affects the power by a factor of r2, where r is the radius of the pupil. It is for this reason that the effects of primary SA are heavily noticeable for larger pupil sizes, with an increase in the depth of focus and decrease in distance vision quality. This was confirmed by a preclinical study based on clinically relevant metrics, which compared the outcomes provided by TECNIS Eyhance IOL with monofocal IOLs with different aspheric designs and different levels of SA and chromatic aberration.3,4 While TECNIS Eyhance IOL provided improvement in intermediate vision and maintained the distance image quality of an aspheric monofocal IOL, independently of the pupil size, the spherical IOL demonstrated a pupil-dependent behavior: it improved intermediate simulated vision and decreased distance image quality for large pupils, whereas, for small pupils, its performance was similar to an aspheric IOL." Journal of Cataract & Refractive Surgery 46(9):p 1326-1327, September 2020.

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Unfortunately, I could not get access to the original Mencucci and Favuzza, or to the letter to which the above quotations reply.

I'd be grateful if anyone can lead me to additional articles that either take a different view of the Eyhance and pupil size or that provide additional support for Mencucci and Favuzza.

I have my surgery tomorrow, I'm still not 100% sure which lens i'll pick. The minor add in intermediate is something i'd definitely want, but because i can't be sure it's still a concern. There's been many happy people with eyhance too. I'm feeling i might waste a good opportunity to have improved range and worrying over minor issues.

if your pupil is large eyhance wont aid as much.

But I'm also a personality that likes stable and 'sure' things, both lenses have their benefits for sure.

I'm aware of that, but it's a lot smaller in bright light and all these monofocal type edof lenses are light sensitive. Not sure how the iolmaster 700 does the pupil size measurement exactly. Still, it's not an easy choice.

A larger pupil size does not detract from the Eyhance's performance according to the article by Gerd Auffarth, et al., and the letter by Mencucci and Favuzza, both discussed with searchable citations provided in my recent post in this thread. As I'm scheduled for my first Eyhance implant in just under two weeks, I'd appreciate any articles or similarly-authoritative information contradicting their findings.

Even though I have made my decision, I am still wondering if it is the correct one. There are a lot of people very happy with the Eyhance and I too would love to get that little extra depth of focus it offers for some of the everyday things like reading your cell phone, using a self checkout at the store etc. without having to put reading glasses on. However, when my eyes started to change many years ago and I tried progressive lenses in my prescription glasses, my brain/eye could never figure it out. I couldn't see close up or intermediate, it was all a blur. Distance could be iffy and not great too. The Eyhance has a power change from the edge to the middle and my concern is my brain/eye once again won't be able to figure it out. Maybe I'm wrong and I am making too much out of that and I am giving up a good opportunity. As someone on this forum said "you can't try before you buy" and I think for me sticking with the monofocal is the best decision. Doesn't mean I can't second guess myself though.

Best wishes for your surgery. You will make the right choice for you. Please let us know how it goes and what you decided on.

If you search this "Enhanced aspheric optic: the ideal compromise for intermediate visual acuity" I think this is the letter you are looking for. Not positive though.

That article is from 2020 though when the lens was fairly new, there should be a lot more newer data on the issue over the last 3 years.

Another reason I decided against Eyhance is because my brain/eyes could never get used to progressive prescription eyeglasses. I could never see close to read, intermediate was blurry and distance was a hit or miss situation. Eyhance goes from one power at the edge of the lens and gradually changes to another power in the middle. As I had a bad experience with progressive glasses, I wasn't sure I wouldn't have the same outcome with the Eyhance. My surgeon told me I definitely wouldn't be able to use multifocals (not something I had even considered) because I had that experience with progressives. To me the changing of power from the edge to the middle of the Eyhance lens sounded too similar to progressive glasses.

There are so many people that are very happy with having Eyhance and I wish I knew for sure they would work for me because they do sound like getting a bit of something extra, like the prize at the end of the cataract experience. It is a very hard and personal decision to make, as we all do and experience different things in our life and we all have different things we can tolerate and adapt to. I was so set on Eyhance and it was extremely hard for me to come to the decision not to get it. However, I have to remind myself, if putting reading glasses on and off numerous times a day is my biggest problem, I am truly blessed.

Best wishes on your surgery and I know you will make the decision on which lens is best for you. This forum has so much valuable information and experiences, I am really glad I found it.

Thank you. That's the letter to which Mencucci and Favuzza replied.

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Trying to understand Vámosi and Németh, however, I don't see them arguing that visual acuities (VA) with the Eyhance are affected by pupil size. They try to make four points.

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First, they say that "the depth of focus of an optical system might be influenced by appropriate modification of spherical aberration (SA)." But their point isn't that spherical aberration in the Eyance, or pupil size, affects VA. Rather, it's that, because Mencucci and Favuzza did not evaluate their subjects' corneal SA and their "relatively small sample size, there is no guarantee that the average corneal SA was the same in the 2 groups of patients." That is, they're raising a question about the validity of the comparison between the Eyhance and the ZCB00, not the performance of the Eyhance as such.

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Second, they say that "aspheric IOLs with negative SA have presumably decreased depth of focus", and so "t would be better to compare the visual performance of the Eyhance ICB00 IOL also with an SA-free monofocal aspheric IOL" rather than the ZCB00 "(both with −0.27 μm SA at 6.0 mm pupil)". Again, this is a critique of comparing the Eyhance with the ZCB00, not a claim that Eyhance VA relate to pupil size.

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Third, they note that Mencucci and Favuzza "evaluated contrast sensitivity under photopic conditions at different spatial frequencies, but they did not examine it under mesopic conditions." Again, they do not say anything about pupil size.

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Fourth, they come to pupil size, but without asserting that Eyhance VA depend on pupil size. Rather, after acknowledging that "the optical quality parameters were analyzed correctly with the same pupil diameter," they say that "there were no data in the article whether the subjective VA (especially intermediate) was assessed with the same pupil size."

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It of course is possible, perhaps even likely, that I don't fully or correctly understand Vámosi and Németh. But they don't appear to be disagreeing with either the reasons for concluding that the Eyhance design does not make results depend on pupil size or study reports consistent with a lack of pupil-size dependence.

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On the other hand, Johnson & Johnson claims a pupil-size dependent effect on modulation transfer function, but not to the Eyhance's disadvantage. In a J&J supplement to The Ophthalmologist, Delivering Intermediate Vision: The New TECNIS Eyhance Monofocal IOL, J&J includes, as Figure 2, a bar graph illustrating their claim that "TECNIS Eyhance IOL has been shown

to provide a similar daytime contrast performance to other IOLs, but superior night-time contrast. In large pupils, image contrast is 31 percent better than with the Clareon® IOL, and 45 percent better than HOYA VivinexTM." The bar graph shows MTF results for 3 mm and 5 mm pupils.

You can get progressive contact lenses also, which are just going to be there, doing their thing when you look out of them, so there wouldn't be as much of the learning curve aspect. With glasses, you have to remember to look at a certain spot to utilize the progressed lens, but with the small contact on your eye, it's just there when you look down, it isn't an inch and a half or so below your pupil, and the contact moves with your eye -- at least that is how it's been described to me. If anyone else has another aspect, I'd be happy to hear it.

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Depending upon the outcomes of my surgery next Monday, that is the route that I will explore first. Especially since learning of new soft contact lens tech courtesy of Ron that I might be able to wear. Once I get me a prescription, I'm heading down to Costco to get me some of them there free samples, lol. I've always had to wear gas permeable lenses, and although you can a progressive version of them, I never bothered. Also a gas permeable lens moves more around on your eye than a soft one does.

just relaying information from my Tuesday appointment. do you have large pupils?

i do and i have the exact same symptoms of lighted arcs as someone who has posted their eyhance experience here. doctor said its because if 4,9mm refractive surface that wont help me.

message me for doctor name and the eyhance experience link if you are interested.

he basically said the central 1mm wont benefit you.

I would be interested in reading the eyhance experience link. The eyhance was made the same as the Tecnis monofocal which I am getting, so would be interested in reading that.

That is very interesting, never thought of it that way. The things we learn on this forum.

Best wishes with your surgery on Monday. Keep us posted on how you are doing. If I remember correctly you are getting your eyes done on back to back days. Nice to get it over with all at once.

Thanks. Good luck on yours also on Saturday, I think you said? I will start a new discussion when I'm done. They had to cancel the Tuesday surgery for the second eye, and going to do it on the Wednesday instead. The surgeon seems a little happy cos he'll have at least a day in between to see how the first eye goes, but he's aware that with my prescription, waiting even that long is going to cause problems for me.

I've been worried in picking Clareon that I might miss a good opportunity with Eyhance also. You had mentioned something about it is hard to get an accurate prescription with Eyhance specially with the online companies?

I think clareon is a good choice. I now have tecnis1 in my right eye, because at the last moment I was worried eyhance won't give me either great clear distance at the chosen power nor useful near vision. I figured the worst outcome is that i need glasses for every use-case to see clearly. The tecnis1 image quality is pretty amazing. The peak acuity is fairly narrow on these aspheric monofocals so some extended depth could be useful when watching near, but i'll probably get something like varilux X glasses that should have the "depth of focus" effect in front of you for general use. But I'm surprised and relieved how functional I am even without glasses and walking around in +1 feels fine. On the eyhance prescription side I don't know about that much, you just can't use autorefactors with eyhance, but there's been several people reporting that there are no issues with getting glasses for it. I'm mostly parroting what Ron has said earlier but I don't have any first hand knowledge.

I am getting Tecnis 1 put in today, so hope you don't mind a few questions. What do you mean "the peak acuity is fairly narrow"? Are you saying the clear crisp vision drops off quickly? Sorry, not trying to put you on the spot, but trying to have an understanding of what to expect. I know it has only been 24 hours for you, but can you see clearly from 3 feet and out, or not that close?

There will be essentially no difference in depth of focus between the Tecnic 1, AcrySof IQ, and Clareon lenses. They are all aspheric monofocals. 3 feet for a minimum distance is quite reasonable to expect, but everyone is a bit different. I can see very well down to 2 feet with an AcrySof IQ. It is not reasonable to expect to read normal text on paper without reading glasses though.

It sounds like you are seeing very good image quality with Tecnis1? That is good to hear! Clareon seems a good product as long as the Alcon glistening problem checks out after being tested. Best of luck with your new monofocal!

I know you are very research oriented and seem careful about getting the correct information about various topics. Have you seen anything on AMD and monofocal choice (exclude multifocals).

I have been told that Eyhance might cause optical illusions which would be bad for AMD. Since my surgery has been postponed I am now wondering if that is correct information?

Clareon is what they're calling Alcon's line that uses a new polymer for their monofocal, Vivity and PanOptix . It is supposed to resist any form of glistening down the road.

With AMD they won't allow a multifocal.

The peak acuity of a monofocal isn't "wide", so especially on near vision the point in which the image is in focus is precise, but also glasses make a difference there i'm sure. Also my vision this morning was very clear and sharp. I could read license plates outside etc.

I've been using readers to use my computer and phone a lot of the day so at some point somehow during today my off-glasses vision isn't quite in focus, i see minor ghosting. Using cheap supermarket readers of any kind fix this condition completely. Not quite sure what's going on. I wonder if my brain somehow got warped by my extensive use of glasses on the second day of surgery or something else is afoot. I know it's only day two, has someone experienced this before?

@RonAKA ^

I think the peak acuity of a monofocal is much wider than many people think. Correctly set for distance the typical depth of sharp focus is from 3 feet to the moon. That is a pretty wide range.

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But yes if you target it for closer vision the range of sharp focus is much less. With my closer eye (-1.40 D SE) good vision ranges from 8" to about 6 feet.

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I would not put much stock in what you are seeing in the early days post surgery. Your eye will still be swollen due to the trauma of the surgery, and may have elevated pressure. Three weeks post surgery will give you a pretty good idea of your future vision, and at 6 weeks it would be safe to get an eyeglass prescription that would be stable over the long term.

As I fortunately don't suffer from AMD, I haven't gone out of my way to research your question, and a brief web search just know--eyhance & amd; eyhance & contraindication--came up empty. What I can offer is that studies I have read report no significant difference between the Eyhance and Tecnis 1, on whose platform the Eyhance is built, regarding optical phenomena.

Yes, but the Clareon monofocal is also made of the new substance that resists glistening, hence it's name.

It is most likely that the glasses you're wearing is affecting your vision, especially since it's so close to the surgery. I became farsighted in just my left eye -- the right eye was still great even with contacts, and I started wearing cheap readers for the left eye, but then found after a while that my right eye was starting to become farsighted also, as if the glasses were kinda messing that eye up. And it wasn't like I was wearing them a lot, maybe three times a week for about thirty minutes at a time. So I stopped wearing them at all and started making my right eye do the work again, and it got clearer at near distances again. In general, when I'd take the readers off, my vision would be weird and distorted for a while until they readjusted. So I guess I'm saying that maybe you should work your eyes for a bit more each day until like you said, your brain catches up, and your eyes heal more.

I hope it indeed does but I have heard that many Opthamologists are waiting to see what happens with the test of time and won't offer it until then.

I think that claim of ophthalmologists waiting to see if the Clareon lens is good, is ridiculous. I suspect those ophthalmologists have never used Alcon lenses and are just looking for excuses to continue using J&J lenses.

That is uplifting to hear about the great image quality. I just lost my night driving license mainly because my left eye is 20/50 and also the cataract....AMD isn't helping either. My doctor thinks I will be able to reclaim the night driving license and if the image quality is really good for distance she might be right.

It is- good you are functional walking around with +1 glasses. I don't wear any glasses now and may not have to for walking around as I am walking around now needing about +1.25 and it doesn't bother me.

Good to hear your report as the Clareon would be similar allowing for differences in eyes.

How do I find the Eyhance experience link? Also. how are you doing on Da 2? Thanks!

Suspicion is not evidence. Why should we attribute nonmedical/nonscientific motives to ophthalmologists--far more expert than any of us--who have the temerity to be cautious?

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FWIW, my surgeon, as part of his office 'welcome' package when I first made an appointment, included brochures for both the Alcon PanOptix and the J&J Tecnis 1. He's one of the surgeon's recommending a wait-and-see attitude toward the Clareon because of past experience with AcrySof glistening, J&J representations that it had fixed the problem, but having failed to do so (at least to his satisfaction).

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Additionally, during the limited time that I was able to peruse the internal opthalmologist discussion at EyeConnect International, I read several posts from several different ophthalmologists--the name that sticks in my head is Steve Safran--advocating a wait-and-see attitude because their prior experience with AcrySof and Alcon over the years was not what they would have wanted.

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From material I've read, including some you've pointed us to, it well may be that this time Alcon has gotten it right. I hope so. The question is, what's lost by awaiting developments? For some people, Alcon's blue light filter may overcome concerns about glistening. And there are other differences between Alcon and other manufacturers. (It and J&J are not the only game in town.)

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As we try to learn about the choices we have to make regarding IOLs, please let's try to stick to facts that, at least in principle, are capable of being verified. And let's avoid evidence-free aspersions on the character of people, especially professionals in the field, with whom we happen to disagree.

Based on my research a "wait and see" approach to Clareon may well be the wisest way to go for many people!

Soks never sent it to me, so not sure. Sorry.