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I'm considering the Eyhance toric monofocal lenses versus Clareon toric monofocal lenses. Does anyone have any input? Many thanks!
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RonAKA judith93585
Posted
Neither of these lenses are a multifocal type lens. The Clareon is the standard monofocal from Alcon. The Eyhance is described as an enhanced monofocal from J&J. It is a mild extended depth of focus lens. It stretches the depth of focus a little bit and that costs a little bit on your distance visual acuity for doing that. The toric versions of these lenses will correct some of the astigmatism.
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If you get them in both eyes with the peak set for distance, neither is very likely to let you read comfortably without glasses, but the Eyhance will let you see at bit more of the intermediate range. The Clareon will give you the best distance vision. Set for distance you will need reading glasses for reading with either of these lenses.
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If you want to be without glasses for reading you will have to offset one of the lenses to make you mildly myopic in that one eye. This is called mini-monovision. The same lenses are used, but the non dominant eye is targeted for some myopia. The normal target for the Eyhance because it stretches the depth of focus some, is about -1.0 D to -1.25 D of myopia. The Clareon would have to be offset more to about -1.25 to -1.50 D. Readers may be needed for very small print in dimmer light, but for everyday purposes you should be eyeglasses free.
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If you are to consider mini-monovision it would be best to do a trial run of it with contact lenses first.
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Another option to consider if you want the best close vision without glasses is to target both eyes for -2.0 to -2.5 D of myopia. Then you will need prescription glasses for distance or progressive glasses.
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All the options have their pros and cons. If you tell us what your expectations and priorities for vision are, I could be a little more specific.
judith93585
Edited
Thanks RonAKA! Very helpuful information.
I became nearsighted and began wearing glasses for distance at 12. My vision quickly deteriorated and I soon needed glasses full time. Even wearing glasses, it is now difficult to read street signs when driving and the computer screen without increasing the font size. My uncorrected vision is currently clear only when reading very close to my face.
I had intended to choose monofocal lenses set to distance, but now I have second thoughts. I assume I would adapt to wearing glasses for reading and other close work, but I might prefer lenses set to near and wearing glasses for distance. Under those circumstances, it would be wonderful to be able to see intermediate distances such as a computer screen without glasses, but I'm not sure that would be possible without mini-monovision or perhaps an enhanced monofocal such as Eyhance. I think I could manage mini-monovision due to previous experience with glasses and briefly with contacts. That said, I wonder about a decrease in depth perception with mini-monovision with an increased risk of falling as I continue to age.
Researching enhanced monofocal IOLs, I came across Clareon which seemed to indicate that this along with Eyhance might provide a small amount of intermediate vision(?) I found 2 or 3 clinical trials comparing Clareon and Eyhance, but without published results.
In summary, I would love to manage without glasses for near and some intermediate activities and wear glasses for distance if that would be possible. My highest priority however is to avoid dysphotopsias and PCO as much as possible through carefully choosing the best lens for these concerns.
Any thoughts or suggestions would be greatly received!
Bookwoman judith93585
Edited
It is indeed possible! I have -2 monofocal lenses in both eyes, and my left eye wound up at -2.5. I can see very clearly from about 8" - 24", and well enough beyond that to be able to do just about anything around the house except watching TV. I wear progressive glasses when I go out, which give me very crisp vision at all distances.
For those of us who have been highly myopic since childhood, choosing close vision rather than distance is more in keeping with what our brains have been used to for so long, with the added advantage that intermediate and even distance vision is far, far better than, at least in my case, what I ever had before. Nearly 4 years after my surgeries, I'm still astonished at how good my vision is.
RonAKA judith93585
Posted
As @Bookwoman says, it is quite possible to have the lenses set to near vision and wear prescription glasses for distance. Either the Eyhance or Clareon would be suitable to do that. The standard near vision add with prescription progressive glasses is 2.5 D, so you could achieve that with a target of -2.5 D. Another option if you want a wider range of close vision would be to target the dominant eye for -1.5 D and the non dominant one for -2.5 D.
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I assume you have cataracts now? If you can still see reasonably well you can simulate all of those options by using contacts. Contact lens companies give samples of contacts away for free. So, if you explain what you are trying to simulate to your optician they should be able to set you up with some trial lenses to see what it looks like.
judith93585 Bookwoman
Posted
Thanks so much Bookwoman! Did you have any experience with monovision before having the lenses implanted? What about any dysphotopsia? By the way, from your name, it sounds like you enjoy reading!
judith93585 RonAKA
Posted
Thanks RonAKA. Can you explain the meaning of standard near vision add with prescription progressive glasses is 2.5 D?
Actually no, my cataracts need to be replaced sooner rather than later.
On a related note, is there a reliable way to determine the best monofocal lenses for minimal dysphotopsias and PCO?
Bookwoman judith93585
Posted
I wore contact lenses for decades, but never tried monovision with them. As for dysphotopsias, I see slight halos around lights, but that's been the case my whole life. They got much, much worse with cataracts, and improved dramatically when I got my IOLs. I can drive at night (with glasses, of course) with no problems.
And yes, both for my job and for pleasure I spend much of my day reading (actual printed books!) That's why retaining my close vision was so important to me.
RonAKA judith93585
Posted
If you look at an eyeglass prescription for someone that is older and needs correction for presbyopia (can't see close) as well as distance correction it will look something like this:
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Sphere -3.0 D, Cylinder -1.0 D @ 90 deg, 2.5 D Add
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The last number is used for the lower portion of progressive glasses or the lower part of bifocals. It effectively is like wearing some +2.5 D readers.
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Pure monofocal lenses have the very least amount of dysphotopsia like halos, flare, glare. Pure monofocal examples would be the Tecnis 1, AcrySof IQ, Clareon, B+L enVista.
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The next group have some extension of depth of focus (EDOF). The Eyhance has the least amount and has so little that it can't technically be called an EDOF lens. So it also has the least amount of optical side effects. The Vivity is technically an EDOF, and does have some side effects, but some still like it.
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PCO can come with any type of lens. In general the Alcon lenses like the AcrySof have gained a reputation of having more resistance to PCO, although that is a subject of controversy. The more recent material development from Alcon is the Clareon, and it is claimed to have even more resistance to PCO. The edges of the lens are more sharply formed and that is thought to prevent PCO better.
judith93585 RonAKA
Posted
Thanks again RonAKA! Extremely helpful!
judith93585
Posted
Thanks so much BookWoman. Same here about contact lenses and reading! I hadn't considered IOLs set for near until recently. I'm glad to know it works for others with my type of vision.
karbonbee judith93585
Edited
Hi. I just had Eyhance "installed" a month ago in both eyes and am extremely happy with them. I too have been a high myopic since I was eight years old, usually floating around between -8.75D and -10.50D until the last year or so when my optometrist discovered that I had early onset cataracts that had pushed my prescription up to -12.50D and -13.00D. I always had to wear gas permeable contact lenses in order to drive a car because of the messed up depth perception while wearing glasses. After much thought (and research), I realized that I'd rather to have to wear glasses for distance things like driving if need be, and be able to be around my home (or even shopping) without having to put glasses on and off, whether fixing stuff or working out in the yard, going for a walk, or just watching the birds at my feeders. Other things contributing to my decision were seemingly simple ones like being able to see the dashboard in my car without glasses (hard to do if you have a monofocal targeted for distance), or just being able to see myself in a mirror if I wanted to use makeup (hard to do with glasses, lol)
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So I chose to go with mini-monovision, targeting one eye for near & intermediate vision at -1.25D and the other for intermediate and distance vision at -0.5D, with both eyes ending up a little short of those targets after surgery (it is not an exact science when the surgeon inserts in the new lens), but in a good way. I am not needing glasses for anything, near or far, except maybe for extremely tiny print, when I'm tired. No problems reading my phone at 11", or reading a book set on my chest in bed, no problems seeing the 15" screen of my laptop sitting at about 20" away (I have a bad tendency to lean in even if I don't have to). After the surgery, I ended up decreasing the size of fonts and the amount of zoom on my computer and mobile devices as I didn't need them as large as before. I can even read the small print on pill bottles or an eye-drop bottle held at arm's length. I was worried about not having good enough near and intermediate vision (cos you don't really know how it's going to turn out until you do it), so I asked to have the "distance" eye backed off also, but it is not really impacting my distance vision in any big way at all. Although I might end up getting some glasses to have on hand to really sharpen my distance vision when driving in bad conditions etc, right now, I'm not really needing anything extra in order to drive, or look up at the moon and the stars, or easily determine what is hanging from the hydro line over 200' away (a bird feeder shaped transformer), or see what's in the window of the house beside me about a hundred feet away. I won't know for sure til I see my optometrist next week, but the early checkups at the cataract clinic put my vision at 20/35 in the "near" eye, and 20/20 in the "distance" eye.
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I have no real problems with dysphotopsias -- there's a very small amount of glare around headlights, and street lights, mainly with the eye targeted for near vision, although that should improve over time especially after I'm finished with the prescription drops which dilate your pupils a little. Although even if it doesn't, it is quite minimal, and usually resolves itself as the car gets closer. I had far more trouble with halos and such prior to the surgery when wearing hard contact lenses. Overall, I'm finding that I'm less bothered by other car's headlights, especially when left on bright, then I ever have in my whole life of driving. No problems with loss of contrast even in dim light (unless I have been a really bright room for a while, then go into a darkened room, but it does resolve itself), and no problems driving down dark back-roads without any moonlight. Colours are bright and true. I find the accommodation excellent (changing your focus from near to distant, etc), though I realized that from wearing hard contact lenses for so long, my brain has had a lot of experience of "auto tuning" my visual accommodation anyway, as hard and gas perm contacts are small on the eye and have a tendency to move around on the eye as you blink or look around, so it can take a bit for something to come into focus. I'm thinking my brain right now is thinking that my current visual situation is a breeze compared to what it had to go through with the contact lenses.
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If you're not sure, and if you can, doing a trial for mini-monovision with contact lenses is a good idea. I didn't have any real experience with it, but I was careful to choose targets that would keep no more than 1.0D of power between the two eyes (it looks like I ended up with approx 0.85D difference), so the overlap in vision between both eyes is minimal (which can also affect your depth perception). In my case, it seems to have worked out very well, as my blended vision is pretty amazing. I'm not really aware of which eye is doing what job (ie near or distance), unless I choose to focus on it. I do have a lot of experience in dealing with depth perception adjustments from all of the years of switching from (thick) glasses to contacts, though after a while, I found that it didn't take that long to adapt from the change. Now though, with both eyes using blended vision, I'm not having any problems. It's great to have "real size" vision all the time without having to put contact lenses into my eyes. Hope that helps.
RebDovid karbonbee
Edited
Having been away from this forum for non-cataract-related reasons (and also having changed surgeons and consequently canceled by March 7 first-eye date), I've found much valuable new information on my return, especially from @karbonbee.
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I'm still planning on EyHance and mini-monovision. Although I'm inclined towards a 1.0 D difference to minimize loss of depth perception and promote some blended vision, I tested my response to mini-monovision by wearing contact lenses with a 1.5 D difference for about two weeks. Fortunately, I experienced no perceptible negative side-effects.
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My reason for trying with a 1.5 D difference stems from the inherent surgical uncertainty. I don't want to target a differential that, in the normal course of events, the surgeon might exceed without any fault on his or her part. Considering that coming within 0.25 D of the target is regarded as a very good result and a 0.50 D differential is regarded as normal, having successfully tried a 1.5 D difference with contact lenses gives me comfort in targeting a 1.0 D surgical difference.
avidpsychlist RebDovid
Edited
I'm about 10 days pre-op for my first eye and am leaning towards Eyhance with plans to do mini-mono once my second eye needs surgery. I found a very encouraging 2022 Eyhance mini-monovision (approx -1.0D near eye) study.
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The key takeaways for me is that the mini-mono group had a pretty big improvement in binocular uncorrected near vision acuity compared to the emmetropic group (– 0.19 ± 0.18 D vs – 0.95 ± 0.19 D logMAR), and 80% of mini-mono patients were "glasses free" compared to only 20% of the control group.
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The whole study can found by searching:
RonAKA RebDovid
Edited
I am yet to be convinced that there is anything wrong with using standard monofocals with a target of -0.25 D in the distance eye, and -1.50 D in the near eye, for a differential of 1.25 D. If I had it to do all over again, that is exactly what I would do. The only change I would make is to use a toric to reduce my astigmatism so my SE had more sphere and less cylinder.
RebDovid avidpsychlist
Posted
Yes, I also found the article by Ella SeoYeon Park and her colleagues quite interesting. But it also exposed limitations in my understanding of defocus curves.
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According to the article, the mean postoperative spherical equivalent refraction for the control (emmetropria) group was -0.18 D +- 0.24 D, while the mean for the mini-monovision group was -0.19 D +- 0.18 D in the dominant eye and -0.95 D +- 0.19 D in the non-dominant eye. (So, the difference between the means was a mini-monovision of 0.76 D, very close to the study aim of 0.75 D.)
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The Park defocus curve depicts point results, with standard deviation bars, at half diopter intervals ranging from 2.0 to -4.0 D. Here are two things I don't understand about the possibility of using this defocus curve:
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What I don't understand is how, if it's possible, I can utilize the Park mini-monovision defocus curve to extrapolate results from differences of more or less than the 0.75 D differential it depicts.
RebDovid RonAKA
Edited
I don't think it's a question of right or wrong. From my reading and talking with now three surgeons, my understanding is that 1.0 D of mini-monovision using the EyHance should at at least equal in visual acuity 1.25 D of mini-monovision using a 'pure' monofocal. At the same time, the lesser degree of mini-monovision should result in greater binocular summation and a reduced likelihood of negative side-effects. On the other hand, using the Eyhance, with or without mini-monovision, may result in very slightly less contrast than using a 'pure' monofocal.
RonAKA avidpsychlist
Edited
I would suggest that a target of -1.25 D in the distance eye for Eyhance is ideal, and to be practical about it, a target in the range of -1.0 d to -1.25 D is fine. With a monofocal the target would be 0.25 D more for a target range of -1.25 D to -1.50 D. There are some very good graphs at this link which show what visual acuity one can expect using monofocal lenses. If you click on each graph there is a bit more explanation of each. The conclusion of the study was that -1.50 for a monofocal is best.
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Optimal amount of anisometropia for pseudophakic monovision. Ken Hayashi, Motoaki Yoshida, +1 author H. Hayashi Published 1 May 2011
Medicine Journal of refractive surgery
RonAKA avidpsychlist
Posted
My suggestion for getting the best results from mini-monovision would be as follows:
karbonbee RebDovid
Edited
Oh, thank you! I'm glad I could be of help. I hope it turns out well. I see my optometrist this week for a five week check up, so I'll have better idea then of where I am, but according to my surgeon, he hit -1.21D for my "near" eye (target was -1.25D), and -0.36D in my "distance" eye (target was -0.50D).
avidpsychlist RebDovid
Posted
strictly an amateur here, but I suspect that it is hard/impossible to extrapolate much reliable data regarding increased anisometropia from a single study, since changes to binocular summation seem to have a complex effect on acuity, contrast, etc.
RebDovid avidpsychlist
Edited
This makes sense. And because the results shown in binocular defocus curves presumably reflect the benefit of binocular summation, it also suggests that in considering mini-monovision a conservative approach to using defocus curves would be to use only monocular curves. This way, if the differential focus between the two eyes still permits some binocular summation, that improvement in visual acuity would be a bonus.