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If you main aim is for the best quality distance vision without glasses is the Eyhance the best IOL becauase it also gives you a bit of intermediate compared to other monofocal for things like reading the car dashboard , with almost none loss of contrast or distance vision quality or the side effects of EDOF nd mulitfocls have? If you want to go with a monofocal is Eyhance the best
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bob38868 john20510
Edited
I said I would never post here again due to the draconian censorship and the wonky interface but it has been almost a year now since I had both eyes implanted with Eyhance Toric lenses.
I love my vision and will quickly say my vision is the best I have experienced in my life. My vision was always nearsighted enough and with astigmatism to the point that I had to wear glasses for all normal activities except for working on electronic circuits and other tasks that were close up.
Both eyes have symmetrical bow tie shaped astigmatism that was easily corrected with the toric lens. I was the first "guinea pig patient" of my excellent surgeon to get Eyhance. His track record was impeccable and I consider the surgeon's skill to be one of the most important part of the equation. We discussed what to expect from the Eyhance lens before the final choice. Vivity was discussed however contrast sensitivity was a potential problem along with potential night driving issues ruled Vivity out. Monofocal lens would have given the absolute clearest vision at there peak points but being a EE and recognizing the defocus curves would be analogous to band-pass filter curves I'm used to working with the Eyhance looked like a better choice than mono focal as I did no want to do a lot of mono-vision to get some closer vision. I wanted to retain really good distance vision and stereo vision with the least work for my brain to sort out focal differences between eyes. Another consideration was what happens (I'm 70) as I get older and my eyes may degrade to a point where anything other than a mono-focal or enhanced mono-focal would degrade my vision.
I told and the surgeon agreed that the goal was to be able to have enough mid vision to see the dashboard of my car clearly. He said he could provide that. Since I was his first Eyhance patient he was working in uncharted sea as far as the calculations for lens choice. We agreed the optimum would be to hit my dominant eye plano and the other eye -.5 diopter. From our study of the MTF and defocus curves we felt the goal would be met. I felt comfortable with the choice as I printed out and drew my own defocus curves of the composite eyes and noted that unlike a standard mono-focal lens the Eyhance lens had a flatter curve so if the surgeon missed the mark a little in his calculations due to working with a new lens not completely familiar to him I would still have good vision.
The whole process went flawless. I had laser surgery "he said due to getting toric lens" and there were no complications except for a flickering affect in bright store lights that was annoying for the first 8 months. It has subsided mostly and I determined it to be a neurological twitch and not related to the implants. It could be related to the supplement I take that really ramps up all neurological and physiological functions. Not a problem now.
I ended up with no astigmatism in either eye and +.25 in the dominant and plano in the other eye. It is not what I was wanting however all vision from 3ft out is outstanding. Colors are true, distance vision is outstanding and night vision is fun again...like being a kid again roaming around in the woods at night. I would suspect the night vision is down about 3dB in sensitivity (subjectively) from when I was young however there are zero artifacts from oncoming car lights or other anomalies...regular night vision. The doctor noted my angle kapa was a little off on both eyes so the centerisation of the lens is not perfect. I can take my finger and pull my skin next to one eye back a little bit and get a sharper distance focus...nit picking. I don't need glasses for anything outside or driving my car.
I have a pair of .5 diopter German glass (very low distortion) glasses I wear in the house. The majority of the house duties feel very comfortable with those glasses and I wish the surgeon would have hit the mark we were hoping for. I got some .5, .75 and 1 diopter contact lenses to try in the non-dominant eye to see how mono-vision would work. .75 worked really well and it made me really functional such that I considered I might get PRK on that eye to set it permanent. I have not done it yet as I'm hesitant to have any more work done on my eyes. I wore glasses and had poor vision my whole life. I now have excellent vision and I tend to go by the rule "if it ain't broke don't fix it".
I wear 1.5 diopter glasses when I'm generally working on circuit boards. I have a pair of 2.5s also when I want to read the numbers on surface mount devices when the light is not so good.
Considering all I'm a happy camper.
RonAKA bob38868
Posted
It sounds like you had quite modest expectations for near vision and achieved them. There is always some risk of the surgeon not exactly hitting the power mark exactly. The statistics I have seen indicate that only 70% of cataract surgeries end up within +/- 0.5 D of the target, and 90% are within +/- 1.0 D. As you were the first Eyhance patient of your surgeon, the risk of a miss would be elevated. They typically develop their own personal database of A-constants, or surgeon factor for each lens design, and would not have that.
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If you go ahead with laser I wouldn't mind hearing what you decide on. I just had my second eye done for mini-monovision and have not had refraction done yet, but am expecting that I have some modest residual astigmatism. Surgery was 2.5 weeks ago and the eye continues to improve. I can read the J-1 paragraph on a Jaeger reading test in brighter light, but am seeing a bit of a shadow on each letter which makes it harder to read comfortably. Depending on where the refraction comes out I am considering laser correction of the astigmatism. But, like you I would prefer not to do anything. And my astigmatism is probably irregular so I am not sure how that complicates things. I am still trying to figure out what is possible considering that complication and what the difference is between Topography guided, Wavefront guided, and Custom treatments. So far about all I have decided is that the SMILE process is probably not suitable, as the PRK and Lasik seem much more precise for small corrections. You may be interested in a document I found which compares PRK, Lasik, and SMILE.
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Bochner 3 Procedure Comparison 2019 PDF
lucy24197 john20510
Edited
One thing that can't be emphasized enough is that every person and every eye is different. Just because one person gets great near vision with a monofocal set for plano doesn't mean that you will--or your near vision might also be better than average. I have monofocals set for monovision, with my "distance" eye somewhat myopic at -0.5, no astigmatism, and my near vision isn't sharp and clear until I get out past 40-plus inches. Defocus curves are your friend--they will give you averages results obtained from a lot of eyes.
RonAKA lucy24197
Posted
It is true that the variance from person to person to person is quite large. If you look at defocus curves that include the high-low error bars it shows a good outcome with a monofocal may be better than an average or poor outcome with an EDOF lens.
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I found a summary of an interesting study which was done to determine what factors were most important in determining "good" close vision with a standard monofocal targeted for plano. "Good" was defined as J4 or better on the Jaeger test. Their conclusion was "small pupil size and short axial length predicted good near vision after phacoemulsification and monofocal IOL implantation".
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If one generalizes that a little more it would suggest an older person (pupil size decreases with age), that is short sighted before surgery (shorter axial length) is more likely to get better reading vision. I ended up with J3 reading in my 0.00 D distance eye, and makes sense for me as I have been myopic all my life and am now 72. Someone who is younger and far sighted may not fare so well.
RonAKA lucy24197
Posted
I intended to include the name of that study as it has a bit more detail. I would like to see the complete report but have not been able to find it. I would have thought that residual refraction would have been an important factor, but they kind of screened that one out, as they only included patients in the study that were within +/- 0.5 D of plano.
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Factors affecting near vision after monofocal intraocular lens implantation
Dong Hui Lim , Jong Chul Han, Myung Hun Kim, Eui-Sang Chung, Tae-Young Chung
allen43308 john20510
Edited
I had the Eyhance implanted in April 2021, almost a year ago. Prior to the surgery, my right eye was about -3.50 sph and about -1.50 cyl. Even though the surgeon used the ORA and laser-assisted equipment, he missed the target of plano. I ended up with +0.50 sph and -1.00 cyl (the IOL is non-toric). The LRI seems to have failed to correct my astigmatism, how common is this?
The result, closer than 4 feet everything is blurry. Distance vision without glasses is about 20/40. Contrast sensitivity is GREAT in low light conditions, but in bright sunlight everything is washed out as if too much light hits the retina.
RK correction isn't an option for me (my surgeon offered to pay for it) because I already have severe dry eyes and am afraid to aggravate it.
I've read of the new (experimental?) technology to use Femtosecond laser to either change the shape of existing implanted IOLs or alter their hydrophilic/hydrophobic properties to modify refraction power of the old implanted IOL, anyone has any info on that?
RonAKA allen43308
Posted
I asked my surgeon about LRI and he told me that he does not do it any longer. He said he could not get predictable results with the procedure. He said he could refer me to other surgeons that do it, but he would not do it himself. I guess that could be interpreted two ways. My surgeon is not skilled at LRI, or the LRI procedure is not a great one, and he simply does not want to be associated with the outcomes of it. I suspect the latter, and I have discounted using LRI now to correct the -0.75 D of cylinder that I have in one eye.
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You may want to investigate the use of Lasik or PRK to make a correction. They are capable of correcting both your cylinder error and sphere. I suspect the +0.5 D sphere is the biggest issue you have. I have just started to check out these procedures and have not seen a specialist about them yet. Some sources seem to suggest PRK would be the better choice if dry eyes is a problem. See this article. But, this is just my quick look at the issue so far. In the upcoming days I probably will book some pre-evaluation consults with two or three laser specialists.
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Kraff Eye Institute What Is Better, PRK, or LASIK For Dry Eyes? Dr. Colman Kraff March 2, 2022
RonAKA allen43308
Posted
Here is more detailed review which suggests PRK to be better than Lasik for Dry Eyes.
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Canadian Journal of Ophthalmology
Volume 55, Issue 2, April 2020, Pages 99-106
Canadian Journal of Ophthalmology
Review
Dry eye after refractive surgery: a meta-analysis