Is Eyhance the best Monofocal

IF Eyhance is an EDOF lens would you consider it to have the best quality of distance vision and contrast level of all the EDOF lens but not as good near vision as all the other EDOF lens.

Yes, of the lenses in the J&J and Alcon line I would agree. The Eyhance has the least amount of EDOF so it has the least negative impact from the EDOF technology.

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The issue I have with the Eyhance is that it would not give me the close vision I want unless it was set to be significantly myopic. I want to read normal sized text and my computer monitor text without glasses. I really do not want to be stuck with carrying reading glasses with me everywhere I go in the house and out of the home. I am willing to have a pair around for really close work in my shop or to read the ultra small print on a medicine bottle, but not for everyday reading. What I really detest is having reading glasses on and then needing to take them off to look up and across the room.

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I am not so sure this contrast sensitivity thing is as big a deal as it is made out to be. People assume that contrast sensitivity is determined by the lens you choose. For example a monofocal has the best and something like a Vivity is the worst. However if you look at the MTF curves for each lens, for sure the contast sensitivity is the best for the monofocal at distance. But, closer up the Vivity has better contrast sensitivity. Just google "Vivity package insert pdf", and you will find MTF graphs which show this.

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My thoughts for your needs would be to take it one step at a time. In your case I would get an aspheric monofocal in your dominant eye first with it set for distance (-0.25 D). Let it heal for 6 weeks and see what you get. I would be surprised if you did not see your car dash instruments very clearly. Driving should be no problem with a distance monofocal. And then you will also find out how close you can see and how much you need reading glasses. Assuming your reading needs are not met then consider an EDOF lens for the non dominant eye. You can kind of pick your poison. An Eyhance will give you a very modest gain with a Vivity giving you a little more. And on this eye you do not have to be aggressive in getting real close to plano vision by targeting -0.25 D. You can relax that back to targeting -0.5 to -0.75 D with either the Vivity or Eyhance. You don't have to worry about contrast sensitivity at distance as you will already have it with the first eye. And the EDOF lenses will give you MORE contrast sensitivity closer up, especially if you target them for slight myopia. Your surgeon should be able to help you with the amount of myopia to target with either the Eyhance or Vivity, based on your expectations for closer vision.

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I would not be hung up on targeting both lenses for full distance or on having the same lens in both eyes. You are better to optimize each eye for slightly different needs. Your brain is smart enough to take advantage of the benefits of each eye while ignoring the shortcomings of the other eye. I currently have a 0.0 D distance monofocal in one eye, and about -1.25 to - 1.50 D in the other eye. When I watch TV at 6-7 feet on a large screen the 0.0 D eye is slightly better than the other eye. But with both eyes open the image is better still.

But, closer up the Vivity has better contrast sensitivity

Without glasses. With glasses on (which is how monofocals are used for close up) the contrast sensitivity of a monofocal close up is far better than Vivity without glasses (which is how its mostly meant / hoped to be used).

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Basically the very high image quality of a monofocal is available at all focus distances WITH the use of glasses. Granted that's a big "with" condition as the goal of most of us is to get rid of glasses.

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With Eyhance you should expect to need glasses for reading but not for your dashboard. Yes it sacrifices some image quality compared to a pure monofocal but is a very very slight compromise.

I can see my dashboard perfectly with a standard monofocal. I have no need for an EDOF for driving. That is why I suggest a stepped approach to getting cataract surgery. Do the distance eye first. Then see what you get, and make up for any shortfall in your second (non dominant) eye. A standard monofocal also assures high contrast sensitivity at distance. When you get one distance monofocal distance vision and contrast sensitivity is "in the bank". Then you are free to "experiment" with the second eye.

I agree that the use of reading glasses would increase contrast sensitivity at closer distance, but as you say the idea is to get good vision without glasses. I was originally concerned about using reading glasses with one monofocal set for distance and the other eye with -1.50 D myopia. Would I need custom reading glasses with +1.0 D in one eye and +2.5 in the other eye? What I have found is that a standard pair off the shelf readers with +1.25 D power work just fine. The issue remains of course that when you look up and across the room everything is still out of focus. That is the big issue with using readers.

The best clearest distance vision will be with a monofocal where all the light is focused at specific point.

Vivity even says it will have contrast sensitivity loss.

It is all about tradeoffs and what is best for you. And on top of that everyone is different. Your results might be completely different than my results.

Vivity gives you about .5D EDOF, so you are basically gaining a line on the chart. It is not a lot of EDOF. Don't expect to get close vision unless you are a statistical anomaly.

Eyhance from everything I have read has the least complaints regarding contrast senstivity loss, but it does not even qualify as an EDOF as it is <.05. You might gain 1/2 a line.

IMHO there are other factors that can actually be more important such as hitting the refractive mark and getting astigmatism corrected. This is the advantages of the LAL and being able to make adjustment post op.

My advice is first make sure you are dealing with a top doctor who has experience with all the different IOLs, use the latest IOL Master Machine and get more than one measurement on different days and preferable on different machines and make sure your readings are consistent. And make sure to deal with any Astigmatism issue you have. You might also find a doctor that uses the ORA System to help nail the refractive mark. I know you might think I sound crazy about how important hitting the refractive mark is, but what good is gaining .3D EDOF if you ended up +0.5D hyperbia.

Then if you want to take the least risk and still get just a tiny tiny bit of EDOF go with Eyhance.

But I am apparently more risky as I went with the highest or one of the highest risk IOL; Synergy.

thanks, my surgoen has about 20 years experience and done thousands of cataracts and he has experience with most of the IOL's but l have no idea what type of machines and measurements he uses. He says he has alot of experience with Vivity and his patients are happy with it and l should get vivity but just worried l would have lower contrast compared to Eyhance. assuming both eyes set for distance , in terms of cm or inches how far will l be able to see well close up without glasses with the Eyhace and how far with the vivity.? For example would it be 80cm with eyhance and 60cm with vivity?

Define see well. For one person that might be 20/20 and for another 20/40.

I would suggest you find the defocus curve for both IOLs. Sometimes the defocus curve will also show 1 standard deviation on them, as again everyone's results will vary.

But this will give you an idea of the expected visual acuity will be from distance to close.

I just pulled the first Vivity Defocus curve that came up on a search and it showed 20/25 ish at 66cm and about 20/32 ish at 50CM. Visual Acuity drops off pretty fast as you then get in closer. So you should have pretty good vision at least down to 2 feet.

l read lots of good things about eyhance, l have'nt read anycases of people being unhappy with it, makes me start to think eyhance would be better then vivty if it will give me enough intermdiate without glasses to do daily stuff like reading car dashboard, l found this on J & j website

"The results

were highly encouraging: significantly

more TECNIS Eyhance IOL recipients

reported no difficulty in walking on

uneven surfaces, as compared with the

TECNIS® Monofocal (3). Furthermore,

the great majority of TECNIS Eyhance

IOL patients could continue to engage

in activities requiring intermediate

vision: more than 93 percent were able

to perform handicraft or woodwork

with no difficulty (55 percent) or just

some difficulty (39 percent). Similarly,

100 percent of those implanted with the

TECNIS Eyhance IOL had no difficulty

(79 percent) or some difficulty (21

percent) with seeing to engage in an

activity/hobby that they are interested in

received the TECNIS

Eyhance IOL in one eye and a monofocal

TECNIS® ZCB00 in the other could clearly

see the difference in intermediate vision

with the TECNIS Eyhance IOL. This patient

exclaimed that she had “won the lottery”

with the new IOL.Bart Zijlmans confirmed the impressions

of previous speakers regarding reports of

improved visual acuity outcomes with the

TECNIS Eyhance IOL and gave the example

of patients who were able to use in-car

navigation or music systems without glasses. He commented on patients “gaining”

intermediate visual acuity, and asserted

that, for that reason, he would like to see

his current Monofocal IOL replaced with

the new TECNIS Eyhance IOL."

What you could do with very little risk is implant Eyhance in your dominate eye and shoot for Plano or -0.25D and then do micro monovision with Eyhance set to -0.75D in the other eye. I don't think bilaterally your distance vision will be effected much if at all and you will gain some more intermediate vision. Again you are not going to have great close vision.

IMHO Eyhance was designed for people who had the extra money to get very very close to monofocal vision quality and also get just a little bitty bit of extra intermediate vision.

If I personally was going to use a Premium Monofocal I would probably go with Vivity and monovision. And probably use the Clareon version.

you said you would go with vivity? would the lower contrast compared to monofocal concern you

No, but you have to remember I got 2 diffractive IOLs. The Tecnis MF that splits the light creating 2 foci point and the Synergy that elongates the light and splits it for a close-add, so contrast sensitivity loss was not my top concern.