Help me choose a monofocal IOL
Posted , 13 users are following.
Some of you may have helped me previously here:
Dr's recommending EDoF/MF IOL.I'm not yet convinced,
I'm still waiting for elective surgeries to be rescheduled due to COVID-19. In the meantime I've settled on monofocal IOLs for distance, or possibly mini-mono vision. I've ruled out Acrysof lenses because of their propensity to develop glistenings. I'm aware that it hasn't been conclusively proven that glistenings affect vision, but why take the chance. Additionally, it has been shown that glistenings hinder an ophthalmologist view into the eye. So there's that. As I'm in the US, my choices are somewhat limited, and it seems the best options are the Tecnis ZC800 and the Bausch & Lomb enVista MX60E. I have my own pros and cons list for theses lenses, but I'm interested in other patients experiences and/or perspectives on these two IOLs, or any others you think I should consider. Thank you!
1 like, 50 replies
charles94562
Edited
Had post-op refraction Thursday (1-month post-surgery). Results are both eyes plano with a 1.75 add for reading. Not much to say except I can't believe how well this has all turned out. Makes me wonder if I was worried about nothing in the first place, but really glad I did the research and was able to benefit from all of yours as well. Thanks again everybody!
BrianCyberEyes charles94562
Posted
Hey Charles, I'm now basically in the same boat as you were in terms of IOL selection and am down to the ZCB00 and MX60E. Just as you, I would prefer to take glistening formation out of the equation and therefore discarded the AcrySof (even if the newest models show "only" 40 microvacuoles per mm2, while those from the 1990s were at 1600/mm2, why take the chance? I am in my 40s and who knows how many will accumulate on mine within 30 years? Plus I have RP and Glaucoma and don't want anything unusual to hinder my eye doc when looking into my eyes with a slit lamp). Also, as far as I'm aware, Alcon doesn't offer a clear color choice in their lenses, so I also left the Clareon out for me (though it would be a close 3rd option).
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Could you share your Pro and Cons list between the Tecnis and the enVista that you mentioned in your post?
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Did you find any studies that compared them directly by any chance? I only came across one comparing them both to a spherical IOL (AAB00), but can't really read from it what the difference is between the ZCB00 and enVista. And one that concluded that rotational stability is best in AcrySof, a bit worse in Tecnis and yet worse in enVista (though not sure how much that actually affects non Toric IOLs). Would be most interested in a contrast sensitivity comparison between the two if you ever came across such.
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Other than that I concluded that the biggest difference between the two is spherical correction of 0.0μm (neutral) in the enVista and -.27μm (full compensation of corneal SA) in the Tecnis, making the Tecnis probably perform slightly better (assuming perfect surgery), while the enVista should be very safe and consistent if any shift or tilt was ever introduced.
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Biggest issue with the enVista for me is its market share - I can probably find a surgeon who would order one, but their experience with it will be most likely far less than with the Tecnis.
RonAKA BrianCyberEyes
Posted
Alcon does offer AcrySof IQ monofocals in a clear version. However I am not aware of any disadvantage of having blue light filtering. Some believe it provides some longer term protection of the eye.
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If the lens is monofocal regardless of brand, I believe contrast sensitivity is a non issue.
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Spherical vs Aspherical is also another non issue. Some question the actual benefit of aspherical lenses though. These lenses assume a certain average in the population asphericity in the cornea, and they try to correct to this assumed amount. I would and did get aspheric lenses. But it is not a big factor.
BrianCyberEyes RonAKA
Edited
Good to know that Alcon is offering a clear option - is this true for the Clareon as well or just the AcrySof at this time?
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My thinking is that blocking visible blue light intentionally has to somewhat reduce the total amount of light entering the eye through that IOL, at least to a small degree. I've never bought into blue filters in eyewear and as far as I'm aware there isn't any consensus that blue light is harmful, so I'm not really keen on it and would rather take a few extra % photons reaching my (RP impaired) retina. I get that we are not talking orders of magnitude here but mere scraps. I guess every aspect compared in studies between similar IOLs comes down to error margins, be it rotation stability, PCO, contrast sensitivity, MTF, acuity, or DoF.
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As for spherical vs aspheric, I'm completely unclear how much if any benefit there is and how it actually manifests in real life. Going by a chart comparing the defocus curves of the Eyhance (ICB00) with the aspheric Tecnis monofocal (ZCB00) and the spherical counterpart (AAB00) the ZCB00 had the higher MTF values at the peak of its curve (Link).
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Similarily, there's also this study that claims a (statistically) significant difference in DCVA and contrast sensitivity between two aspheric IOLs (Tecnis ZCB00 and Envista MX60) compared with a spherical one (AAB00), though I admit that I am not nearly knowledgable enough to actually understand the findings and amount of difference between the 3 IOLs.