JUST HAD VIVITY LENS IMPLANTED 3 WEEKS

I have the vivity in both eyes - intermediate and distance is really great AT DAY TIME.

But I do have all the night vision problems there are. Feels like I have an multifocal.

I have bad vision in dim lightning, glares, starburst and the worst LIGHTSTREAKS across my whole vision.

Wouldn't recommend that to anyone that still wants to enjoy the night.

Daytime they are perfect and near vision is also good. But I'm 25 and still out at night so it's very very annoying and when I have the money I will get at least my dominat eye replaced with monofocal.

You will see TV perfectly with a monofocal IOL. That's crazy. Most people watch TV from 6 to 10 feet away! Maybe he's trying to push you towards Vivity?

You sound like you can deal with reading glasses and don't want to spend money for nothing.

I have the Vivity in both eyes laser assisted - cost me 8000€

I have to use reading glasses for my phone, intermediate is fine but I guess monofocals could do that too.

BUT I HATE THE GLARE/LIGHTSTREAKS/BAD VISION IN DIM LIGHTING/STARBURSTS

Trust me, take the monofocals and continue using reading glasses. This will be the safest route and I wish I did that too.

I do remember you struggling with your initial decision. So hard to deal with cataracts at 24.

Hindsight is always 20/20 Think long and hard about going ahead with an exchange - there is more risk to that surgery than straight cataract surgery. You have great day time vision as I understand it. The issue with night vision may not solely be the IOLs. At your age your pupils dilate more than a person of usual cataract age. It is possible your pupils dilating beyond the IOL at night may be the source of the issue and as pretty much all IOLs come in 6mm diameter so a monofocal may be problematic for you as well.

Anyways just encouraging you to really think about this. In some ways I am in same boat. I had cataract surgery with Symfony lenses at 53 but now have another eye condition that developed where I see lines all cur y - difficult to read. But surgery is risky and not recommend till vision is very poor. Thankfully my right eye is good and compensates.

Hey I also remember you 😃

Im not sure, since I've tried constricting pupil eyedrops and they didnt change anything. I will have to see I guess. Since night driving was my life back then and without it I miss life. I hope everything goes well for you tho! I really wish you lots of strength, you've always been very helpful ❤️

Sorry mister I just replied to your other post about pupil constricting drops - it appears you have tried them and they don't help. In a little way that helps as you know it is not your pupils dilating beyond IOL causing you these night vision disturbances.

If you are going ahead with en exchange find a surgeon exceptionally skilled at this. One who does a lot of them. Thinking a monofocal will counter balance the halos and glare. Exchange it for the IOL that sees the furthest - if you can get a hold of your records that will give whoever does your surgery that info - especially if pco is hiding which eye sees better.

I do know from personal experience that the brain is incredible at choosing the better 'view'

If I close my Right eye vision is rubbish. With both open I see fine. So for me on my current situation having EDPF lenses work well as i see from near to far no problem. Hoping right eye continues to see well for years

Thanks for posting your positive review. It makes sense based on what the claims for the Vivity are. I have looked at Vivity for a long time and my choice with it was to do the close eye at -0.75. I think now I am back to doing a monofocal AcrySof IQ at -1.25 D. This is based on my simulation of -1.25 with a contact lens.

I hope that goes well for you. RonAKA! Part of why I went with Vivity over monovision with monofocals was fear of decreased binocularity. Perhaps unfounded, but my experience is that my brain is making use of both eyes to see at all ranges rather then selecting one over the other. But the clear upside of monofocals is no visually aberrations. Best-wishes!

What I find with my simulated mini monovision of -1.25 D is that close and intermediate vision is fine, as well as distance vision. However at distance the -1.25 eye is not contributing much. If there is an problem area for me it seems to be at about 30 feet or so in a store. The eyes seem to fight over which one is right and until I concentrate on focusing I can have issues seeing signs and products in a store like Costco. But, I have crossed monovision with my dominant eye using the -1.25. That may be what is causing it. For anyone considering it, I would recommend sticking with the rule of using the dominant eye for distance.

I think all considered your safest option is an aspherical monofocal lens for distance with the target being -0.25 D. You do not want to over correct into the + side. A monofocal is going to give you significantly higher contrast sensitivity than the Vivity lens. The night time effects will be less with a monofocal. The Vivity is better than a MF or EDOF lens, but not as good as a monofocal. The cause of loss of contrast sensitivity is more with the design of the lens than it is caused by using monovision. Monovision will give you maximum contrast sensitivity but at the associated target distances. Not sure how far the instruments are away in a plane, but I can see my car and truck instruments perfectly well with my plano monofocal IOL. My eye starts to jam out under 18", but 24" may be more typical.

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Keep in mind that the cataract is likely responsible for the large increase in your required prescription. It along with the lens will be removed. The only correction that is needed to be addressed will be from error in the cornea.

Another option to maintain almost the same contrast as a monofocal with good uncorrected dashboard vision would be the Eyhance. Almost the same image quality as a monofocal (very close) but a bit more intermediate. Not as much intermediate as Vivity (an no neat vision) but for sure enough intermediate for good reading at dashboard distance and essentially no compromise on contrast.

Thanks Ron and David. Certainly the cataract is responsible for the rapid change in prescription. The retinal surgery may be responsible for a small increase in astigmatism.

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I think I continue to be confused about the intermediate vision of a monofocal lens. If I could see at dashboard distance (which is about the same as an airplane, and as what I use for computer distance, call it 69 cm or 27 in), then I think I would be quite happy with a monofocal. What I'm trying to avoid is needing progressives/bifocals for driving or flying, and ideally for my day job sitting at the computer. I'd like to be able to read my phone even if it's more like arm's length. I don't mind wearing readers for anything closer. It seems like some people can see quite close with a monofocal, while others can't. As I mentioned I'd rather avoid monovision, because I don't think I would tolerate it well based on past history.

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I have been looking at the Eyhance, too. I will look at it more closely (so to speak). Thanks again.

A reasonable strategy may be to do the dominant eye first for distance. It could be a monofocal, or for extra insurance in being able to see closer, then the Eyhance. Then when you have your actual outcome, the second eye decision becomes easier. Small amounts of under correction in the non dominant eye could be used to compensate if you need just a little more close vision. Or, if you are happy with the results in the first eye, then shoot for plano (just under) with it too. Just have a good discussion with the surgeon about what the choices for power are. The lenses only come in steps of 0.5 D. So, there will always be a choice of a little closer to plano or a little more under. If closer vision is important then a little more under is better. Going over or under plano does not impact the distance vision much. You are still likely to get 20/20 distance. However, going over is going to impact close vision a lot. That is why you always want to be under. Some residual astigmatism is likely to help too, and can be difficult to avoid in any case.

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As an example of the discussion with the surgeon, the one I had said that there were two lens powers to choose from. One he expected to give me just slightly over plano, and the other was going to give leave me -0.4 D. He went for the -0.4 D power, and my actual outcome for spherical correction was 0.0 D. It was bang on plano. In retrospect if he had used the next power I would have been 0.5 D over plano, and my reading ability would be significantly compromised. I am sure glad he chose the lower power. It also shows this is not an exact science. Measuring the cornea topography and predicting the exact power needed is not as exact as it could be.

I got the results of my biometry back. My eye is insanely long - 28.5 mm, resulting in a 11 D IOL. Also my eyes differ from each other more than usual. As a result I'm having it redone just to be safe. Given hard data I talked to the head of ophthalmology at a major university, and he told me with my biometry I would be crazy to do a Vivity lens and would be unhappy with the results. Also, since I have mild glaucoma and might lose contrast sensitivity over the years, I don't want to start with a deficit. Given all that I have opted to go for the tried-and-true SN60WF. Since my IOP is controlled with drops and the Hydrus stent probability wouldn't eliminate my need for medicine, and since the Hydrus doesn't have long-term safety information yet, I've opted to forgo stent implantation. We can always put it in a decade from now if it's going to be useful. So in the end it's going to be a very conservative surgery. Dominant eye is scheduled for October 19, and other eye for 2.5 weeks later. My surgery center aims for -0.5 D; they say people are most happy with that choice. I'm going to wait for my second biometry to come back before making a final lens power and astigmatism choice.

I think the SN60WF is a good lens, and that is the one I have. You may want to ask about the newer Alcon Clareon version of this lens. It has a few small improvements including Alcon's assurance that it will remain free of glistenings. I don't think that is a really big deal but you are relatively young and it may last longer. My wife just had her first consult. We are in Canada and it will cost her $300 extra to get the Clareon version. The SN60WF would be fully covered by our government health care. I think we will go for it.

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A target of 0.5 is OK. Keep in mind that they cannot hit a specific number and only a range as the lenses come in steps of 0.5 D. What I prefer is a direct conversation with the doctor that has your specific measurements. Then you can have a discussion about what will probably come down to two different lens choices. For example it may be leaving you with -0.75 D or -0.25 D. I think I would choose the -0.25. Each eye is different and it is good to have that conversation.

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Are they recommending a toric in either eye? I think it is worth it if your estimated astigmatism is 1.0 or more.

Good point on the Clareon. I had forgotten about that with the focus on Vivity for so long. I'll read about it this weekend. With the SN60WF my current biometry is forecasting -0.45 / -0.43 D so it's pretty close to -0.5 on the "good" side. The defocus curves for the SN60WF shifted 0.5 D show pretty good distance vision and a good chance of being able to read at 66 cm as well, which would be great. The cornea measurements show 0.80 D and 0.99 D astigmatism. The computer is recommending SN60WF and SN6AT3, respectively, with residual astigmatism of 0.80 D and 0.13 D.

Yes, I would go for -0.45 over +0.05 or -0.95. However if your first dominant eye comes out at -0.45 and your distance vision is good, then I might be tempted to go for -0.95 on the second eye. This a very minimal or micro monovision and almost anyone should tolerate that. It would ensure you are going to see dash instruments.

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Yes, the 0.8 D is not worth correcting but the other one is. The 0.13 D residual might be a little optimistic though. The minimum step is 1.5 D for astigmatism. And unfortunately there is likely to be some astigmatism induced by the surgery. Some surgeons claim they can make the incision to minimize the amount, or even reduce existing astigmatism.

I asked my surgeon about astigmatism induced by the surgery, and he said that with the tiny modern incisions and a skilled surgeon it is no longer a big concern. They can also do specific relaxing incisions to change the astigmatism explicitly. We haven't yet decided how to go with that.

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I think it's important to realize that the IOL cylinder power is not the same as the corneal plane cylinder power. A toric IOL at 1.50 D is equal to a corneal plane adjustment of 0.98 D. My corneal astigmatism is 0.99 / 0.80, so correcting the 0.99 with a 1.50 toric lens really should get pretty close to 0.

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I've been reading up on the Clareon. It's really hard to find information. One big question I have is whether the A constant is the same as with the SN60WF. The Alcon online IOL power calculator doesn't even have the Clareon in its drop-down list, and I can't find the A constant written anywhere. I would hate to choose it and then have the power prediction be off. Do you know? Thanks!

What I can tell you is that the surgeon that did my IOL is a professor at the provincial university. He indicated my eye measured at 0 astigmatism by one method, and 0.4 D with another. He said I would not benefit from a toric. I had assume he was talking powers at the corneal plane, not the IOL, or eyeglass plane. That was an assumption on my part. In any case my outcome was 0.0 D spherical and 0.75 D cylinder at the eyeglass plane. This difference may have been just in where the numbers were referenced to, or there was some induced astigmatism by the surgery. You are correct. It is important to be specific and compare apples to apples. I noticed in the Alcon specification sheets they list both the corneal and IOL plane powers.

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My wife is likely to get toric Clareon lenses and I have been doing some research. The best information I have found is from the US FDA approval system. If you google Clareon Toric Aspheric IOL P190018 you should find it. See the Summary of Safety and Effectiveness Data (SSED) link at the bottom of that page. Not sure if that will contain the data you are looking for. The Clareon seems to come in two versions one. is with the new AutonoMe System for insertion. I believe this is a pressurized gas (CO2?) system to put the lens into the eye. One thing you would want to check into would be your surgeon's experience in using this system. I would be careful about not forcing a surgeon to use a system they have little to no experience with. With the new injection system I suspect the lens you are looking at is the CNA0T3, or CNW0T3 without it. Perhaps searching for the specific lens might get you more detail.

My understanding is Clareon is a platform not a IOL per se. Much like Acrysof is a platform (i.e. Acrysof Monofocal, Acrysof Vivity, Acrysof Panoptics). The main difference between the Acrysof and Clareon platforms is the Clareon material is glistening-free and has improved clarity due do a new surface polishing process. Another aspect of the new platform in the new injector. Eventually all of Alcon's IOLs will switch over to the Clareon platform. So we'll have the Clareon Vivity for instance. It's just that the first lens to move to the Clareon platform is their monofocal IOL. All of that is to say that I think the specifications of the SN60WF are likely identical to the specifications of the Clarion Monofocal. I think it's essentially an SN60WF made from a new updated material. But I don't know for sure.

Here is a nice marketing document from Alcon that talks about the differences: https://anyflip.com/pffcb/woro/basic

As far as I can tell, there's really no clinical difference between the two. The glistenings are low in the modern Acrysof anyway, and the incidence of PCOs is about the same. The clarity of the lens itself may be slightly better with the Clareon. Offset that with a new insertion technology that my surgeon has never used, and a new A constant that hasn't been nailed down that might affect the accuracy of IOL power choice, and I wonder if the risk/reward tradeoff is worth it.

Right. I don't know where I saw this and probably couldn't find it again but experiments have shown the original Alcon lenses developing thousands of glistenings whereas current Alcon lenses have that down to maybe a couple hundred. So it's likely a non-issue now. Clareon develops only a handful of glistenings… similar to J&J lenses. So I guess it is objectively better but there's likely little to no clinical difference.

Thanks for posting the Alcon presentation on the Clareon. It was quite interesting. They seem to spend a lot of time making that point that the improvements were cosmetic and not a reflection on the quality of the AcrySof lenses. I recall they made a claim that the edge design had improved, so one would hope for decreased risk of PCO and dyphotopsia. The study data they presented did not seem to verify that point though. I noticed that they have an A constant stated of 119.1, but with the caution that the surgeon should further refine that based on their experience with the lens. There also was a suggestion that they may have further data available on request by the surgeons.

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Bottom line is that this all may be more of a marketing move than a true step up in lens performance. Tecnis loves to point out that they have fewer glistenings than Alcon. Alcon may want to put that one to rest. For my wife due to the clinic vs hospital option with the Clareon we are seeing the $300 extra as just the price of the shorter wait time, and well worth it for the 6 weeks for the Clareon vs 6 months plus for the AcrySof. Surgeries in the hospital are currently shut down due to COVID.

I wouldn't say it's just marketing. It takes a great deal of R&D to develop and test a new material, manufacturing process, injector system, etc. But it's definitely evolutionary as opposed to revolutionary.

Interesting that you get Clareon in the clinic but AcrySof in the hospital. I talked to my surgeon and he said that Clareon isn't readily available at our facility yet, and if I wanted it I'd need to switch to a different specialty surgeon and that would delay surgery by several months (the opposite of your case). So I'm going ahead with the normal AcrySof. I read the lab and clinical studies on Clareon, and I don't see a compelling reason to wait. The Clareon has a more perfect edge that might reduce dysphotopsias, but people don't complain about problems with the AcrySof that much as it is. A lab study showed similar rates of PCOs (in fact AcrySof was a little better). And while the glistenings are essentially zero for Clareon, those in modern AcrySof lenses are an order of magnitude below what's considered clinically significant anyway.

You can't go wrong with the tried and true Acrysof mono. I imagine millions have been implanted worldwide. It makes sense that the new Clareon lens isnt available through public health yet. The new lens likely costs more plus they may have a huge stockpile of the "old" Arcysof lenses. Public health will always be the last ones to get the "latest and greatest" monofocal IOLs.

It may be a case of Alcon giving out the lenses to their short list of preferred surgeons. I think that is common with a new product. The surgeon I had, and now my wife is seeing has done consulting work for Alcon so perhaps that is how he gets access. Here in Albera I suspect it is the politics and control around government health care that determines that the basic lenses get used in the public hospitals, while the more specialty lenses are done in private clinics. The subject of two tier health is a sensitive one here.

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I agree with you, the advantages of the Clareon are pretty subtle. and perhaps just cosmetic.

Yes it is a sensitive issue in Canada (2 tier health system). Still we can get cataract surgery completely covered and pay difference in pricing if choosing a different lens other than monofocal ehereas NHS in UK will only cover surgery with monofocal lens. You want something different you pay for entire procedure and lens. What's hard about that is even a toric monofocal id considered premium lens and not done on NHS