J&J Eyhance vs Alcon Vivity?

I'm considering the eyhance, dropped vivity because of the contrast issues even though they have a bit more range. You need readers anyway.

You can fix near vision with glasses but you cannot fix contrast that are permanently limited in your eyes. I recommend checking the multiple eyhance discussions here, I have exactly similar questions but I haven't had a conclusive answer. Many seem to be happy with it. I'm still on the fence, even though I would prefer having better intermediate.

Many folks that have the eyhance have said they have sharp vision, but "sharp" is a subjective issue to a point. There is a minor contrast loss with the eyhance but nothing to the magnitude of Vivity and the optic chances power as your pupil dilates and constricts as it is progressively changing power as you move to the center to the outer rim. There's a lot of interesting content in the "eyhance defocus curve and landing zone" conversation a bit further down the cataract section.

If your ultimate priority is razor sharp distance and you are ok with wearing glasses for near vision then two monofocal lenses set for full distance is your best option. When you get into the extended depth of focus lenses like the Eyhance and Vivity there are compromises. They spread the focus point and the ultimate distance vision has to suffer because all the light is not coming to the same focal point. The Eyhance extends the depth of focus by about 0.3 D, while the Vivity extends it by 0.5 D. So the gain of closer vision and loss of distance acuity is slightly more with the Vivity, but I suspect they are both capable of 20/20 vision at distance if the power selection is right on 0.0 D and there are no other eye issues. Some of the the Eyhance defocus curves show no loss of distance vision which I believe is misleading. See the curve that I think is realistic for the Eyhance in my original post in this thread.

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https://patient.info/forums/discuss/eyhance-defocus-curve-and-landing-zone-791445

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My thoughts on the Eyhance is that the losses over a monofocal are minor, but so are the gains.

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The other option that is often overlooked is setting the target outcome for the two eyes to be different. You set the dominant eye to full distance, and then set the other eye for slight myopia. To get Eyhance depth of focus benefits you probably only have to offset the second monofocal by about 0.25 D (the very minimum step) to get the same thing. If you want to get good reading without glasses you would have to target the second eye to about -1.5 D which is mini-monovision. Yes, there is a very slight loss in distance vision, but you gain eyeglasses free reading. My lenses are set this way and with both eyes I test at 20/20 plus about half the 20/15 line. I would expect if both eyes were set for full distance I would get 20/15.

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Also keep in mind that monofocal lens do not drop off a cliff for near vision. It is a gradual decrease. With my distance monofocal I can easily see my car dash instruments clearly. I seem to have a bit better than average near vision, but it is reasonable to expect good vision starting to fade at 2-3 feet. With my near eye set at about -1.5 D vision starts to drop off at about 10". With both eyes open I can see very well from 10" out to infinity. Close vision can be sensitive to lighting levels though. I do occasionally need some +1.25 D readers for very fine print in dimmer light.

I can't answer your questions but there are some on here who might be able to though....... but I DO sympathize with your frustration at the ABSURD LACK OF INFORMATION that is being given to a lot of patients. I am with a HMO and now realizing how hard it is for me to make a good lens choice since I HAVE HARDLY SPOKEN TO MY DOCTOR FOR ANY LENGTH OF TIME. I have been "hustling" on my own for every bit of info and it has not been easy! I just wrote the doc and said they should give information packets with COMPLETE INFO. ABOUT LENS AND OTHER IMPORTANT ISSUES so that people don't make the wrong choices! I have run into people who did make hasty bad choices based on scant info. and are living with bad eyes and regret! Hang in there and know that you are not alone. Also, I would pressure your doctor to give you the information that you need!!

Posted a moment ago

One thing I want to add. in doing the test to target different distances in each eye, generally, you try a contact lenes trial. I just returned from the Optometrist who was NOT able to get the contacts in my eyes since I have no prior experience with them and it was very traumatic to have someone put something in my eye. She was quite good at her job but said not everyone can do it at an advanced age with no prior experience. So I had to give up on the contact lenses trial! Just a warning and note of caution for you! It is a good idea to have a trial first since some do not like mini-monovision and can be risky as a result without a trial.

Good idea. The problem is I never wear the glasses I am supposed other than for driving....so when I put them on for distance when walking around i get very dizzy anyway. I would probably adjust over weeks of time possibly? I would think that the same thing would happen with mini-monovision?

I can address your distance question about the Eyhance IOL in two ways. Qualitatively, my wife recently had two Eyhance non-toric IOLs implanted, supposedly targeted at -0.50 D each, which I understand resulted in 20/25 distance vision. (The surgeon's choice.) She reports clear distance vision, is able to read/use her MacBook without glasses, but uses readers when looking down from her computer to papers at her desk. Her comfort level with her cellphone without glasses depends on how far out she holds it. An average of seven defocus curves that I found on-line in sources that either are freely available or were available through my library indicates that mean distance vision at -0.50 D is 20/24, so it looks like the surgeon came close to his target and my wife's results are within the standard deviation.

You want 20/20 vision, however, and you can get it with the Eyhance, if the surgeon targets and hits 0.0 D. But targeting 0.0 D isn't recommended because the standard deviation means that even with a good surgeon there's a reasonable chance of a result on the hyperopic (left) side of 0.0 D. My understanding is that most surgeons aim for -0.25 D. According to the average of the defocus curves, the mean result of hitting that target would be 20/21 distance vision. Mean intermediate vision would be 20/26 at 1 m and 20/29 at 66.67 cm. Of course, as has been suggested, you can get even better intermediate vision, and some near vision, with mini-monovision.

A review article in the January-February 2023 issue of the Asia-Pacific Journal of Ophthalmology, available on line by searching for Latest Developments in Extended Depth-of- Focus Introcular Lenses: An Update, contains both an interesting extended discussion of the topic generally (albeit one I only partially understand), and discussions of particular IOLs, including both the Eyhance and Vivity, both of which are classified as Type 5—Modified Central Optical Profile Lenses. Note that the article was published on an open access basis: "This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited."

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Here's what the authors--Elinor Megiddo-Barnir, MD, and Jorge L. Alió, MD, PhD, both from institutions in Spain and both stating that they "have no funding or conflicts of interest to declare"--have to say about these two IOLs (endnote references deleted).

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EyHance ICB00 Tecnis lens (Johnson & Johnson Vision): EyHance IOL is merchandized as enhanced monofocal IOL though it offers a smooth and continuous progression of its power from periphery to the center, with no demarcation line (Fig. 24). It aims to present the distance performance and minimum photic effects of the monofocal (ZCB00) while compensating for SAs in the cornea and providing intermediate vision at 66 cm. It is a single-piece, hydrophobic-acrylic IOL with a 360-degree posterior square edge and a tiny central plateau and thus a local change in power is applied to EyHance IOL to enable a local refractive change, whereas the basic anterior curvature is aberration correcting with negative primary SA. Clinically it leads to an improvement in intermediate distance vision when compared with monofocal IOLs. Regarding defocus, measurements indicate that the TECNIS EyHance IOL has a larger “landing zone” than the TECNIS Monofocal IOL and provides excellent (0.0 logMar) distance vision. The lens is pupil-dependent. No information is given about modified SA by the manufacturer. In a laboratory investigation of visual quality metrics and halo size by Auffarth et al, it was demonstrated that the mono-EDOF models had a clear advantage over the standard monofocal lens by expanded imaging capability beyond −0.50 D and that the ICB00’s halo profile was similar to that of the ZCB00, indicating their low potential to induce photic phenomena.

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Acrysof IQ Vivity DFT015 (Alcon): Vivity is a nondiffractive EDOF IOL with Alcon’s proprietary nondiffractive X-WAVE technology which stretches and shifts light without splitting it. A central plateau, similar to the one in the EyHance IOL but more pronounced small plateau of about 1 μm is used by Alcon’s X-Wave Technology (Fig. 27) to stretch the wavefront, combined with a discrete change in radial curvature in the central area of about 2 mm to produce a wavefront shift. The aspheric design of the Vivity corrects −0.20 μm of primary SA. According to the manufacturer, the Vivity has 2 transition elements in the central 2.20 mm range. The first transition element stretches the wavefront, creating a continuous focus area. The light is stretched in both directions, that is, in the myopic and hyperopic directions. The light in the hyperopic direction is located behind the retina and would not be usable. Therefore, the second transition element moves the wavefront forward, shifting the light from the hyperopic direction to the myopic direction so that the entire light energy is used. The Vivity IOL generates the extended depth of field by means of the aspherical front lens surface and a spherical rear surface.

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The lens optic is biconvex, aspheric, wavefront shape, made of a hydrophobic acrylate/ methacrylate copolymer with UV and blue light filter material. The lens is pupil independent. The index of refraction is 1.55. The optic diameter is 6.00 mm with an overall length of 13.00 mm, with a classic C-loop design. It is available in Europe at spherical power range from +10.00 to +30.00 D.

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Though EDOF IOLs are supposed to be less sensitive to optical quality degradation caused by IOL decentration compared with MF IOLs, the small central optical zone of the Vivity IOL seems to make the lens more susceptible to decentration and play an important role in achieving satisfactory intermediate and near visual acuity. A case report recently published by our group describes a patient with poor visual outcomes for intermediate and near vision due to poor centration of the central 2.2 mm optical zone of the Vivity IOL, in which IOL exchange solved the visual outcomes. In clinical trials, the lens was shown to deliver monofocal-quality distance vision with excellent intermediate and functional near vision, while maintaining a monofocal-like visual disturbance profile. In a prospective study of early real-world experience, Italian researchers confirmed that the lens provided excellent distance and intermediate, while patients needed some spectacle correction at 30 cm. The most complained postoperative visual discomfort were halos and glares, with that it was included in a score range of high satisfaction and tolerability of this IOL and the dysphotopsia profile is significantly better in the Vivity lens when compared with MFs. In a study performed by our research group, evaluating the quality of the retinal optical image following implantation of the Vivity EDOF IOL and compared with a monofocal and a trifocal IOL, it was found that although trifocal IOLs provided significantly better retinal image quality, this IOL also demonstrated to be the most sensitive to residual refractive errors. Both Vivity and monofocal IOLs showed a comparable retinal image quality.