first eye Vivity emmetropia, second eye?

Thank you RonAKA for your assessments!

The crucial question is: How do I gain more closeness? Either the 2nd Vivity on emmotropy and due to the better contrast Binocular a little more closeness - or a Minimonovision, which makes the 2nd eye a little more short-sighted, but gives a worse contrast overall....?

In good light, I am satisfied with the operated eye. Can shave me well etc, from 30cm distance. But in weaker light, the view within about 60cm is e.B. when cooking, taking medication, etc exhausting... and the view of ads bad.

If the 2nd Vivity on emmotropy slightly improves binocular vision nearby through better contrast, my choice is clear...

I think the binocular gain is quite small, and you will gain much more near vision by under correcting. The improvement in contrast sensitivity is a more minor effect than simply under correcting. The Vivity gives you a gain of 0.75 D nearer vision when set for emmetropia. If you under correct by 0.75 as well then the near vision gain is 1.5 D. The Eyhance has an emmetropia gain of about 0.5 D, so it needs a bit more under correction of about -1.0 D. The distance vision loss of the Eyhance will be a bit more than for the Vivity, as it has to be offset more.

.

Also keep in mind that contrast sensitivity is maximum at the optimum focus for the lens, and drops off quite rapidly as you focus closer. Offsetting the power moves the best contrast sensitivity closer. If you look at the Vivity Package Insert PDF you can see the defocus curves as well as the Contrast Sensitivity MTF curves.

Okay many thanks! If you are interested, my surgeon's report on my case has been described in an international journal, including my defocus curve after the operation: Google: unilateral implantation curschmann steinert

I looked at that report and you got unusually good close vision with a -2.0 D at a logMAR of 0.2. Notice that if that lens is under corrected by 0.75 D the logMar of 0.2 will be extended out to -2.75 D. And the distance vision logMAR will remain above 0.2 and will be close to 0.1 which is excellent about 20/25 or so. That is based on your second eye behaving like your first eye, which is a reasonable assumption. With your first eye better than 20/20, your binocular distance vision should easily be 20/20. And your close vision at logMAR 0.2 will be good down to 1 foot or so.

My 3 main focuses for the 2nd operation: 1. No strong optical phenomena, no risk of a failed neuroadaption. (which means that multifocal lenses are excreted)

bifocal lens will have photic phenomenon and they will be as bad as trifocal. however the vivity in the other eye will cancel a lot of it.

Thank you!

Is there not a single bifocal lens with as little/no phenomena as Vivity?

without rings they cannot give you near and far on the same lens. and if u r getting rings then might as well get the trifocal.

Thank you! Now I understand this detail!

I think the mildest lens after the Vivity would be the Symphony. There is a Su-An here that I recall has it in one eye and reports fairly mild optical effects like halo and flare at night. You should look at the defocus curve for the Symphony to see if it offers much over the Vivity. I suspect a Vivity with a 0.75 offset will likely do just as well, while maintaining excellent distance vision.

Have a look at this article, if you have not seen it.

.

A guide to the latest presbyopia-correcting IOLs October 27, 2021

.

It compares a few lenses including the Vivity and Symphony. I believe some suspect that the Vivity curve is overly optimistic, but it appears very close to what you achieved. And, it gives you nothing over what you got with the Vivity.

Thank you for your hints and the article. I will study this 😉 In order to avoid the danger of halos and co, it is probably clear that only the Vivity is suitable for me.

Or have you heard of WELL FUSION™ Systems and the Mini WELL PROXA®? Seems to me to work like Vivity with the Wavefront technology. Shouldn't this be compatible with my left eye?

@Ronaka: You always write from -0.75D. Surely you get closer with it. But I want to keep the mini-monovision as small as possible. Disturbing vision would be much worse for me than gaining a few centimeters more close. If my right eye had the same conditions as the left eye, then not even -0.5D would have to bring me a profit. What do you mean? (The cataract is too large to be tested with contact lenses)

I am suggesting an under correction of 0.75 D so you get good reading ability. Yes, 0.5 D might do it, but 0.75 has less risk of falling short. Keep in mind that regardless of all the sophisticated measuring methods the IOL only comes in steps of 0.5 D spherical power. For that reason you are highly unlikely to hit -0.5 D exactly. It is more practical to specify a range. Once you have the measurements of your eye, the surgeon should be able to tell you what the lens choice options that the steps will result in. My thoughts would be to target closer to -0.75 D than to -0.5 D.

.

Also keep in mind that anisometropia of 0.75 D is quite small. Full monovision can use up to 2.0 D. I simulate 1.25 D anisometropia with a contact and do not find it an issue at all. When it comes to getting my cataract surgery though I will ask for closer to -1.5 D with a monofocal. I am still considering using a Vivity, but in that case I would go for -0.75.

.

When you look at the defocus curves moving the Vivity to -0.75 D costs very little on distance vision. If I go with a monofocal at -1.5 D I will lose significant distance vision from that eye, and will depend much more on my 20/20 IOL eye.

.

I think it comes down to how much do you want to risk needing reading glasses for a smart phone and text documents. I have some +1.25 readers that I use very occasionally. It is quite acceptable. However if I needed them all the time to read my iPhone I would not be happy at all. I think I would just wear progressives. That would not make me real happy either. I have gotten quite used to being eyeglass free virtually all the time.

I think it comes down to how much do you want to risk needing reading glasses for a smart phone and text documents. I have some +1.25 readers that I use very occasionally. It is quite acceptable. However if I needed them all the time to read my iPhone I would not be happy at all

That's the point! And with the 1st operation partly also succeeded. Putting on glasses for conscious reading (of a book, mobile phone) would not be so bad. But it would be annoying if I only needed glasses for a quick look at a label, price tag, time, etc. With the operated eye, I only need this in low light, small font or poor contrast. Otherwise not. If this would work for both eyes, or even better, I would be happy. For me, it is quality of life if I can consciously decide: "With reading glasses it is more comfortable, but it is also possible without"

However, the following subjective impression frightens me so far: I have supermarket glasses with -1.0D (The optician called me -1.5D for the operated eye): If the light is weak and the contrast of the writing is poor (newspapers), then I can not read even with the glasses.... 😭 Better light is then imperative. I hope this will work binocularly after the second OP. Because not being able to read small writing in low light even with glasses would be a problem...

Yes, the issue is light. When our pupils open up in dimmer light we lose the pinhole camera effect that allows a larger depth of focus. That is when the real range of focus is exposed.

Keep in mind that regardless of all the sophisticated measuring methods the IOL only comes in steps of 0.5 D spherical power. For that reason you are highly unlikely to hit -0.5 D exactly. It is more practical to specify a range. Once you have the measurements of your eye, the surgeon should be able to tell you what the lens choice options that the steps will result in. My thoughts would be to target closer to -0.75 D than to -0.5 D.

To understand this correctly, what would be the consequence if the doc reached, say, -0.48D instead of -0.5D? It is clear to me that there can be deviations, I suspect that with a good surgeon between 0.1-0.2D...? (The better the surgeon, the less likely the deviation, right?)

Thanks a lot for your help!

Unfortunately there are lots of opportunities for error in getting an IOL. First the surgeon has to measure the eye and ESTIMATE with the help of computer programs what power of lens you need to gain plano distance vision. This is not an exact process and there are different formulas that can be used depending on the specifics of your eye. You depend highly on the skill of the surgeon and the quality of his instruments in getting the power calculation right. The other aspect is that the surgery itself can change the shape of the eye and the power needed. This requires a further estimation in determining the needed power.

.

So lets say for an example with all this considered the power calculation comes out at 16.25 D. If you want to be under corrected by 0.5D, then you need an IOL with a 16.75 D power. The issue is that the Vivity IOL doesn't exist in that power. The closest choices would be 16.5 D and 17.0 D as they come in 0.5 D increments. These choices are going to give you a residual myopia of -0.25 D and -0.75 D. -0.5 D is not a choice because the lens (16.75 D) does not exist. The normal target for plano distance is -0.25 D, so what you really have is a choice between plano or -0.75 D myopia.

.

Yes you could get lucky and get to choose a -0.5D option exactly, but the odds are not with you. At the end of the day there will always be a choice between two lens powers. It is best to have that discussion with the surgeon as to what your expected outcomes will be with each of the two options. Then choose between them. For sure in that hypothetical example above I would choose the -0.75 D option over the -0.25 option, if your objective is to get good reading vision.

.

Hope that helps some,

lets say for an example with all this considered the power calculation comes out at 16.25 D. If you want to be under corrected by 0.5D, then you need an IOL with a 16.75 D power. The issue is that the Vivity IOL doesn't exist in that power. The closest choices would be 16.5 D and 17.0 D as they come in 0.5 D increments.>

Thank you very much! I think/hope I understood it a little better.... only if in the mentioned example the calculation comes out with 16.0, then and I want -0.5D, then I would need the Vivity with 16.5D power, which would be available....?

My main goal is to get closer, to be more independent of glasses nearby. Good reading vision without glasses would be great. However, I am looking for the best possible compromise in the balancing act: as close as possible - on the other hand, the risk as low as possible. Do you understand my thoughts? Or do I perhaps still have a thought error?

Yes, there is a get lucky possibility. Just remember that that lens is the lens, and your eye is your eye. You only have control in 0.5 D steps.

.

If you are overlooking something, it may be your vision with a -0.75 D under correction. If you look at your defocus curve in your published report the vision is about 0.1 logMAR at 0.75 D to the left of plano. That correlates to a Snellen vision of 20/25. That is very good vision. Combined with your -0.05 logMar in the other eye (20/18), you should have an easy 20/20 combined binocular vision at distance. In other words you are not compromising much if anything at distance by going to a -0.75 D myopia in one eye.

Yes I have Symfony actually in both eyes. Have very good vision. I rarely wear glasses - see from 11 inches.Only use my glasses for small print - for pill bottles. I do see concentric circles around certain lights at night. The outer rings are very faint - inner ones more vivid.

I don't find these too bothersome - do drive at night without problems. it was a trade off as I know mono focal lenses would not have the rings.