Is Eyhance over rated

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Hi l suggested to my Surgeon l wanted Eyhance, he said he didnt think it was any better then any other monofocal and he said if l want both good distance and intermediate without glasses then vivity is the best choice and vivity is the lens he would go with himself. l think l read Eyhance only gives an extra 10cm of nearer vision compared to a standard monofocal , if thats the case then is Eyhance overrated

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  • Edited

    Trial data shows that Eyhance does offer an improved range of focus over the Tecnis 1. I'm not aware of any trial comparing it directly to the Acrysof monofocal. But it does have more range than the Tecnis 1. How much? Not a lot. I think the improvement is at least 20cm not 10 (I think Ron recently posted that he thinks it's a 10" improvement which may be where you got 10cm from). Regardless, it's true that doesn't sound like much… but intermediate / near vision is a game of inches. If you can just barely see your phone with your arm fully extended, elbow locked, then even a few inches is a lot. Yes near vision will be noticeably better with Vivity compared to Eyhance. No would argue with that. But every lens has pros and cons. If you understand the pros and cons and have realistic expectations then I don't think you'll be disappointed by any lens being "overrated".

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    • Edited

      Yes, to put some numbers on the difference between Eyhance and Vivity lets assume that comparing apples to apples, Eyhance gets you down to -1.4 D while Vivity gets you to -1.6 D at the 0.2 LogMar value of "good vision". That translates into 28" for a close distance for the Eyhance, and to 25" for the Vivity. In other words about 3" difference between the two. And a monofocal with an under correction of 0.5 D would do about the same - in the 26-27" range. Those distances are not really in the useful range for normal reading of 10 point text on paper. And for other things like seeing your dash the difference is not really significant. Either should work fine, and in fact my monofocal with no under correction lets me see my dash perfectly. In comparison if you go with a monofocal and an under correction of -1.5 D then vision goes down to about -2.5 D or 16". Based on my experience that gets you reading ability for 10 point text on paper.

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  • Edited

    Seems to me that your surgeon is splitting hairs. There is a standard on what degree of defocus addition is required as a minimum before it can be called an Extended Depth of Focus (EDOF) lens. With one eye vision testing, this minimum is 0.5 D. The reality is that from all the data I have seen, the Vivity is just over 0.5 D, while the Eyhance is just under 0.5 D. The difference between the two lenses is probably close to being trivial. The individual variation is likely greater than the difference. In other words some with an Eyhance may see closer than someone with a Vivity. On average, which is how they are tested, the Vivity people will see slightly closer. And, in commercial/technical terms the Vivity can be sold as an EDOF, while the Eyhance cannot.

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    My thoughts are that if you want to see 0.5 D closer, the simplest way of getting there is to ask for your non-dominant eye to be targeted to -0.5 D. Some might call that micro-monovision. It is not going to give you good reading vision, but it will let you see similar to an Eyhance or Vivity. And, there is no risk of optical side effects from an EDOF design lens.

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    I think the "problem" with that approach is that it is not a technology solution. "I got a new latest technology Vivity or Eyhance lens!". It is a procedure solution instead. All it involves is having a conversation with the surgeon and asking to be 0.5 D under corrected in your non dominant eye. However, the outcomes of the two approaches are quite similar. The technology approach sounds more sexy and since you pay more money for it, it has more "value" to some.

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  • Posted

    Overrated? Eyhance is doing exactly what it was designed to do. Hmm, let me reword that (as only time will tell if that statement is true); it is hoped to do exactly what it is designed to do.

    All IOLs come with tradeoffs. Nothing out there simulates the shape changing ability of the natural lens. Diffractive IOL try to provide distance, intermediate and close up, but come with much greater dysphotopsias than a monofocal IOL. So enters the new category of Premium Refractive IOLs such as Eyhance, Rayone EMV and Vivity. But just looking through this website you quickly see all the complaints about Vivity and in fact their own website states Vivity IOL will have contrast loss.

    So now we have Eyhance. The goal of this IOL is to provide the slightest EDOF, while having no more dystphotpsias than a monofocal. And from what I read, another goal, is to get insurance to cover this IOL cost the same way it covers a monofocal. Again only time will tell, but if this holds up; I would say the Eyhance IOL is a “Free Lunch” not “Overrated”; as it would be doing exactly what its design was meant to do.

    It is not like the old days where you just get a monofocal and then wear reading glasses. There are many options and all come with tradeoffs. My suggestion is just don’t listen to your doctor, as guess what many doctors do not keep up with all the new IOLs out there and their results. You have to do the research and learn the tradeoffs with each IOL and find the best fit for you.

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  • Posted

    Cataract Coach has good summary of aspheric monofocal vs Eyhance vs Vivity. Google "1218: J&J Eyhance versus Alcon Vivity". From the site:

    A monofocal IOL has a defocus of about 0.5 diopters, the Eyhance is about 1.0 diopter, and the Vivity is about 2.0 diopters. This means that the Eyhance is about 0.5 diopters more range than the monofocal IOL and the Vivity is 1.5 diopters more range than the monofocal IOL.

    If you look at the defocus chart on his sight, remember to shift the curves to the right a bit because Plano is probably not a typical result. A slight minus is more typically preferred.

    The defocus ranges look to be reflected in the lens pricing. Through Public Health in Canada for example & depending on which Province you're in, an aspheric monofocal will cost $0 to $125, Eyhance will cost around $250 to $350 and Vivity will cost around $1,200. All are per eye non-toric prices and prices will change over time & might already be different than what I found when starting my research.

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    • Posted

      I am not sure where the "Cataract Coach" is getting this information. It does not match the Defocus Curves I see on line. But, then I don't really understand what he means by "defocus". The curves really only have meaning when you look at where they intersect the horizontal LogMAR of 0.2 - limit of good vision. What I see is that a monofocal intersects at about 1.0 D, the Eyhance at about 1.4 D, and the Vivity at slightly more than 1.5 D perhaps 1.6 D. That means there is a difference of about 0.2 D in the two lenses.

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      I have absolutely no idea how he could come to the conclusion that the Vivity has 1.5 D more range than a monofocal. If you look at the "Vivity Package Insert PDF", figure 5 the monofocal perhaps is very slightly under 1.0 D at LogMAR 0.2, and the Vivity perhaps is very slightly over 1.5 D. So I give it about 0.6 D over a monofocal at best.

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      I stick with my conclusion that the difference between Eyhance and Vivity is almost trivial, not huge like this guy is claiming. And one has to keep in mind that the lowest cost IOL available which is the spherical one has nearly as much defocus as the Eyhance. I rate them as best I can figure as:

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      Aspherical monofocal: 0.0 D

      Spherical monofocal: 0.25 D

      Eyhance: 0.40 D

      Vivity: 0.60 D

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    • Edited

      I don't put too much weight in Cataract Coach. I think he's just churning out content for marketing purposes. I saw a video once where he's pulled up completely the wrong data for some IOL he was talking about. I think he likes to hear himself speak / get views.

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    • Posted

      Thanks for pointing that out Ron. It might be that the source for some of the difference comes from Alcon's Vivity Clinical Science Compendium report. The note: "This study was financially supported by Alcon" appears 18 times in that document.

      The -2.0D defocus at 0.2 LogMAR shows up there. It's binocular visual acuity though and not monocular visual acuity as it is in the Vivity Package Insert PDF.

      I have not yet found support for 1.5D defocus at 0.2 LogMAR difference between the monofocal and the Vivity in that document. Instead, the difference appears to range from 0.5D to 1.0D so how the conclusion that the Vivity has 1.5 D more range than a monofocal remains a mystery. Binocular -2.5D defocus looks to come at around 20/50-ish like image quality so probably not very useful.

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  • Posted

    John

    Read the article in the Review of Opthalmology April 2021 titled "Review of 2021 Newcomers."

    Also read a comparison of the Eyhance vs the Technis 1 in "Indian JournaL Of Opthalmology" Dec.2020.

    If you just do a Google search of "Eyhance vs. Technis 1," it should take you to the article in the Indiana Journal of Opthalmology.

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  • Edited

    Thanks, so the view is eyehance is a good IOL with more intermediate then standard monofocals and better contrast then vivity , perhaps my surgeon just wants me to go with the more expensive vivity , if l have my non dominant eye targeted -0.5 with eyehance , that will give me better intermediate but would l notice any change in distance vision with that eye, would distance look slightly blurry or no difference. If l had Eyhance set for plano / distance in both eyes would that still give me uselful intermediate , for example read mobile phone on outstreched arm or car dashboard. If you were to compare vivity to eyhance with both set for Plano would vivity not give signifantly for intermediate , if thats the case then eyhance with higher contrast would be a better IOL

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    • Edited

      With two Eyhance IOLs both set for plano the best anyone can promise you is dashboard vision. With two Vivity IOLs both set for plano you have a very good chance of having "functional" iPhone vision… meaning not perfect but good enough to probably see who's calling, read a text, etc. But you'd most likely still want / need readers for prolonged reading and fine print / labels. I've opted for Eyhance personally (still waiting for surgery so I have no experience to report on) and depending on how the first eye goes I may (likely will) ask for the second eye to target second minus. That means distance in that eye won't be razor sharp but with binocular summation distance vision should still be good and possibly still 20/20.

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    • Edited

      That is a huge question and something that took me probably a year+ to arrive at but the short version is, I'm a perfectionist (to a fault) and I'm not willing to sacrifice anything in terms of vision quality. The long version is:

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      1. I'm not willing to sacrifice any image quality. Any sacrifice with Eyhance vs. Acrysof/Clarion IQ or Tecnis 1 will be very minimal from everything I've read.
      2. The contrast loss might be something I never even notice (or only in dim light or certain situation) but what really bothers me about it is that there's not really anything I'd be able to do about that since it would be "baked in" to the eye. If I have issues with focus range with Eyhance I can fix that with glasses. If I have issues with night vision with Vivity there'd be nothing I could really do with that. Get a stronger flashlight maybe? Dunno.
      3. Since finding out about my cataracts I switched to Progressive Glasses (which I should have done years ago, before I even had cataracts, as I'd been peeking under my single vision glasses for YEARS to read fine print) and found I like them, so the idea of possibly needing glasses afterwards doesn't bother me that much.
      4. Even with Vivity I suspect the tiny complications on my Apple Watch might still not be sharp without glasses. I'd be able to read the time for sure but the teeny tiny weather or calendar complications? Hard to say. But the complications WILL be sharp with Progressive glasses on. And that's how I've been using my watch now for over a year and it works great. So why not just get the best possible image quality IOL and if I need Progressives, so be it.
      5. I'm an outdoor enthusiast (think overnight backpacking in deep back-country areas) and a ground SAR volunteer so I want to maintain the best possible night vision.
      6. I'm targetting first minus in my dominant eye (-0.2 according to the IOL Master predictions) and my other eye is naturally 0.17D off from my dominant eye so my non-dominant eye will have a tiny offset towards near even if we do first minus again or a 0.5D offset if we do second minus which I'm hoping will improve intermediate / near without sacrificing too much distance acuity.
      7. Speaking of distance acuity, being a lifelong myope I've NEVER in my life had razor sharp 20/20 (or better distance). I only ever get that the day after a brand new prescription. You put on your new glasses and you're like… WOW! But within a few months or a year it's gotten soft again as my eyes change. And I'm used to that. So I don't think I need perfect razor sharp distance (meaning if we have to do an offset I'm ok with that).
      8. Vivity would have cost me $5600. Eyhance is only going to cost me $350 because it's a lens that public health uses so the surgery and part of the lens cost will be covered by public health. With Vivity I would have had to go private. That's not a HUGE deciding factor (it's my eyesight for the rest of my life after all so to a certain degree I don't care too much about cost) but it is a nice bonus. I'm not poor but I'm far from wealthy.

      To be honest I'm still not sure I'm making the right choice. I worry that I've made too big a deal of the contrast loss with Vivity and the convenience / lifestyle benefits of Vivity might far outweigh any image quality issues (which I may or may not even notice). But there's no way to "try before you buy". And again I'm a perfectionist so I don't like the idea of the contrast loss.

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      So I'm veering on the side of playing it as safe as possible but knowing that I'm still going to get a LITTLE bit of a bonus from Eyhance. And who knows, maybe more than a little if I'm lucky. Maybe it'll be awesome. Who knows. But I think I'd rather risk glasses than risk being unhappy with the overall image quality and not really being able to do anything about that. I did think of your approach too, Vivity first and then Acrysof IQ if I was unhappy with the contrast, but I guess I'm not super keen on the idea of mix and match either.

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  • Edited

    thanks , at this stage l am thinking vivity in one eye first and if l dont like the contrast go with Eyhance in the second eye instead of vivity and both eyes set for plano / distance , that way l get excellent distance contrast and enough intermediate to get by without glasses

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    • Posted

      You should be able to simulate distance monovision using contact lens, relatively inexpensively. And see what you think. The more the monovision the greater the 2 images presented to the brain is and the greater the problems can be. Again everyone is different.

      Also remember doctors miss the refractive mark so you can get monovision without even trying to it.

      I think most people will be fine with micro-monovision, but try it out for yourself. Using Eyhance and micro-monovision will probably get you decent vision down to at leas 2 feet or closer; depending on the amount of monovision.

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    • Posted

      I did a quick contact lens trial of a 1.5D offset and I was actually surprised at how well it worked. It was a little weird but I felt like if I was like that all the time I'd probably get used to it. I will say I wouldn't want a bigger offset than that. But it also it clear to me that there would be nothing to worry about with a tiny offset like 0.5D. It would soften distance vision slightly but there would be zero issues with adaptation.

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    • Posted

      I suspect many that get an IOL targeted for distance at -0.25 D end up at -0.5 D or perhaps even a bit more. It is well within the margin of error of power calculation and eye measurement. I recall only 75% or so get within +/- 0.5 D of the target.

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    • Posted

      Exactly. I imagine a LOT of people end up with "micro-monovision" without even trying as it's within the margin of error. Could also partly explain why some people do slightly better with near vision than others. It's not an exact science.

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