Largest Mono Focal IOL on market
Posted , 4 users are following.
Hi all. I am only 37 with cataracts developing in both eyes and might need surgery soon. I have been reading the forums and decided against multifocas. I want excellent night vision. I also play Tennis, Squash, Golf and TableTennis so I want good depth perception after surgery. I am planning on targeting -0.25 to -0.5 D for both eyes and hope to get 6/6 for distance and then wear progressive glasses if I cannot see the dash of my car clearly.
Question1: Are both eyes set for plano the best option for excellent depth perseption? Anyone here with monofocals who plays ball sports?
Question2: What is the largest mono focal IOL on market? As I am young my pupil might dilate beyond the outer edge of the IOL. I assume choosing the IOL with the largest Diameter will thus be best.
Thanks
0 likes, 9 replies
RonAKA peterfox
Posted
I have not played any of these sports since getting a monofocal in one eye only. I have played table tennis previous with progressive glasses, and found them poor for depth perception. At least that is what I blamed the swishes on! Contacts for distance seem to work much better at table tennis. I can comment that with my monofocal IOL I can see reasonably close, and read at a distance of 20" or so. I would think they would be just fine for all the sports you listed. The outcome of my eye was 0.0 D spherical, and -0.75 D cylinder, so I may be getting a little extra near vision with the small remaining astigmatism.
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I am not aware of the specific lens but I believe there is a Zeiss or B+L lens that is larger in diameter. The whole issue of dysphotopsia is controversial and not all accept that lens size is a factor. Some point to the refractive index of the lens material, but that is controversial as well. Here is an article you can google to get some views on the issue.
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Review of Ophthalmology NOVEMBER 2017 Dysphotopsia: Not Just Black and White
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Depth perception or stereoacuity is impacted by having a difference between the two eyes, like in monovision. Here is an article that talks about it and shows the impact of a difference. I currently have my non IOL eye corrected to be -1.25 and don't notice any impact on depth perception.
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Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD
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Given your requirements it would seem reasonable to go with full distance monofocal lenses in both eyes. It is normal to target -0.25 under, because the lenses come in power steps, and they don't like to leave you with a + error. Other options you could consider are mini monovision if you want to be free of glasses most of the time. I would try it with contacts first though. It is normal to do distance in the dominant eye, and closer with the non dominant. Another option would be to consider a mild EDOF lens that is quite likely to be free from any of the dysphotopsia side effects. There is the AcrySof IQ Vivity, and Tecnis Eyhance in that category. They will not give you good reading ability with smaller print, but should give you intermediate without giving up on good distance.
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Hope that helps some,
peterfox RonAKA
Posted
Hi Ron .
would the Vivity and Eyehance not make clarity at night a little worse than normal Monofocal? And which one would you choose If you were in my shoes and wanted perfect night vision?
Appreciate the help!
RonAKA peterfox
Posted
Peter, I have not done a detailed comparison. I prefer the AcrySof brand over the Tecnis, and have looked more at the IQ Vivity. The short story is that the low light contrast sensitivity reduction in a binocular (both eyes) configuration is clinically insignificant. The Eyhance does not quite provide quite as much intermediate vision and I would guess has a little less contrast sensitivity reduction. I believe they both use the modification of asphericity method of getting some EDOF.
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The AcrySof IQ Vivity is on my list of possible lenses for my second eye. But, I have not dismissed a monofocal AcrySof IQ Aspheric under corrected by -1.25 D. That is what I am currently simulating with a contact in my non IOL eye. I have no issue with it in reading my computer screen at 12 inches or so.
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Probably the best information on the Vivity is a presentation by an Alcon consultant (so probably with some bias!). You can find it by googling this. There are some FDA documents as well which are more technical.
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Clinical Outcomes of a Novel Non-Diffractive Extended Vision IOL CATHLEEN MCCABE, MD pdf
Curious3123 RonAKA
Posted
why do you prefer the acrysof brand over tecnis?
RonAKA Curious3123
Posted
The AcrySof lens uses blue light filtering which more closely matches the natural lens for colour of vision. It also is said to improve contrast sensitivity at lower light levels, and improve night vision. The AcrySof material has a reputation for being more "sticky". It tends to stay in place better which is especially important for toric lenses. Studies have shown this material is more resistant to PCO. The AcrySof material is more susceptible to "glistenings" however. I considered that but decided it was a low risk compared to PCO.
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Just my thoughts. Others may come to different conclusions.
soks peterfox
Posted
humanoptics aspira-aXA is the only 7mm iol and it is available in Germany. i am 45 and my pupils expand beyond the iol at night. it is quite a light show.
with monofocal i would just go plano instead on -0.5 which is negligible benefit for distorting the distance. with monovision you would want one eye set for larger myopia -1.5 perhaps.
peterfox soks
Posted
Hi Soks.
I think going the Monovision route would make me loose some depth perception which is the most important outcome I aim for. I just wonder what level of depth perception I will get with both at plano? Is it anywhere as good as two natural eyes?
Thanks for the info regarding the humanoptics aspira-aXA. Do you know of anyone on the forum who has had this implant? I don't mind travelling to get the best possible lens to avoid any night vision problems. If this iol is 7mm, what is the standard size?
Thanks for the help!
soks peterfox
Posted
i do not know anyone who has got this lens. janus had mentioned it on the forum. standard size is 6mm diameter. yes!! 1mm makes that much difference. also i do not know many people who see the lens light up to form a circle of light like i do. i know it is because of pupil because it is fixed with pupil constricting drops.
at 37 a monofocal could be shock as you will have absolutely no accommodation. it is also possible that you may get good intermediate with the monofocal but that cannot be predicted.
RonAKA peterfox
Posted
With two monofocal lenses I would expect you would have no depth perception reduction at all in distances of 20+ inches. With mini-monovision the reduction would be minimal.