Lens and monovision choice. Vivity, Eyhance, AtLara

Thanks for your reply.

I've been considering the lens choices for a while before I decide to go for vivity. So being told I can't achieve the targted diopter with Vivity threw me into disarray.

Do you think left -1.5D Eyehance right -0.75D with Eyehance will enable me to read my phone without glasses?

Indicatively, the average of ten Eyhance defocus curves, both binocular and monocular, shows 20/31 at 12.11" and 20/25 at both 14.31" and distance. Of course, hitting targets isn't guaranteed and biometric measurements fed into an IOL power calculator will determine what your surgeon can target. Also, the data I took from the defocus curves are all mean results. Even if the power calculation is spot on and your surgeon exactly hits the targets, you could end up with better or worse vision than the mean.

Apologies, I miscopied an data point. It should be 20/25 at 14.31" and 20/28 at distance.

Regardless of the lens you choose, your dominant eye should be set for best possible distance. I think -0.75 is too myopic for your distance eye. Results can vary but I'd target the distance eye for closer to -0.25 and then offset the near eye accordingly for your phone. I would also do one eye at a time not both at the same time.

Choosing refractive targets is complicated, even leaving aside whatever constraints on your choice result from running your biometric measurements through your an IOL power calculation formula.

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If you stick to monofocals--"pure" like the Clareon and Tecnis 1, or "plus" like the Eyhance--then you need to decide whether to prioritize distance, with a possible reach into intermediate via mini-monovision, or near/intermediate, also with the possibility of mini-monovision.

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Asking your surgeon to target the first available minus refraction makes sense if you're prioritizing distance. But some of us, especially those of us who have lived with significant myopia, decide to stay somewhat myopic, prioritizing near and intermediate vision. In that case, it may make sense, as my surgeon is suggesting for me, to begin with the non-dominant eye, see where you end up, and if satisfied with that result aim for 0.75 - 1.25 D less myopia in your dominant eye. This strategy may result in your needing glasses to drive or watch TV/movies. Different strokes for different folks.

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And even if you're prioritizing distance, you may want to target the second minus, both to make sure you don't end up hyperoptic and to give a titch more depth of focus. This is what my wife's surgeon did with the Eyhance, and she's very happy with the result. She sees well without glasses for distance and intermediate. She currently uses readers for close vision. To avoid having put them on and take them off when working at her computer, she soon will get "computer" glasses. Both the Shamir Workspace and Shamir Computer are very good; her surgeon and I both wear the Workspace. Hoya and Zeiss both make well-regarded versions of their own.

20/31 at 12.11" and 20/25 at both 14.31" and distance

Did you mean Eyhance is expected to give one this vision when set to plano?

I've been myopic since grade school so I guess it's what I am used to. That's why I would like to be a little myopic after the cataract. My expecation is: I can read my phone and computer without glasses, and put on glasses for driving, movies, and so on.

What I really want to avoid is: having to switch between two pairs of glasses, one for near, and another for distant. That would be a total disaster to me.

Not plano. I should have said explicitly that I was responding to your mentioning targets of -1.50 D and -0.75 D. I also shouldn't have responded hastily while eating breakfast. I see now that I copied from the wrong set of data points. With additional apologies, let me start over, more slowly and more carefully.

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I derived the following data by averaging ten Eyhance defocus curves, four binocular and six monocular. (I'm interested in mini-monovision and my working assumption is that the results for a difference between the eyes of 0.75 D - 1.25 D will be somewhere between the binocular and monocular defocus curves. So, I've just averaged them all together. I identified seven of the source studies for the data in a post yesterday in @Lynda111 's thread "Alcon Release New Study Comparing Eyhance monofocal with Clareon monofocal".)

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Assuming two Eyhance IOLs, one targeted to -0.75 D and the other targeted to -1.50 D, the average of the ten defocus curves for the better eye is:

12.11" 20/35

13.12" 20/31

14.31." 20/28

15.75" 20/25

4m 20/25

distance 20/28

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I don't know the distance from your eyes at which you hold your phone or what visual acuity you need to feel comfortable reading it. Bard tells me that, according to a University of Utah study, the average distance at which adults hold their smartphones is 10"-12" from their eyes. I tend to hold mine at a little over 14" from my eyes.

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Using Eyhance without monovision, the average of four binocular defocus curves indicates that having both IOLs at -1.50 D yields 20/30 at 12.11", 20/28 at 13.12", and 20/25 at 14.31". By the same token, they yield 20/35 at distance.

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If you try mini-monovision to get better distance vision, then you need more myopia in the "near" eye to get near vision results comparable to two -1.50 D IOLs. For example, the averages for -0.75 D and -1.75 D are: 20/31 at 12.11", 20/28 at 12.12", 20/25 at 14.31", and 20/28 at distance.

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It gets more complicated, however. You may not be able to ask your surgeon to target -0.25D and -0.25D, -0.75D and -1.75D, or any other pairing. As @RonAKA has mentioned, IOLs come in discrete powers, generally in increments of 0.5 D. Until your eyes are measured and the resulting biometric data run through an IOL power calculation formula using your surgeon's "a constant" for a particular IOL, you can't know what refractive result it is predicated to achieve (assuming also that your surgeon hits the target exactly). For example, it might turn out that the calculation tells you that, in your dominant eye, the relevant powers of the IOL allow targeting -0.25 D, -0.57D, -0.9 D, etc. That's great if you want to target -0.25 D; not so bad if you want -0.57 D; but less than fully satisfactory if you want to target -0.75 D.

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I'm still thinking my way through the process. Assuming monofocal IOLs and mini-monovision, I suggest deciding what range of vision you want to prioritize. For me it's near and intermediate. I'm willing to need glasses to drive under some or all conditions. Others may prioritize excellent distance vision. Whatever you decide, I suggest asking your surgeon to operate first on the eye that will be primarily responsible for the range of vision you're prioritizing. Indeed, my surgeon spontaneously proposed doing my "near" eye first because of my prioritization. Five or six weeks post-op, you and your surgeon should have a pretty good idea where the first eye ended up. At that point, also knowing how close the surgeon came to the target for the first eye, you can decide on the target for the second eye. All going well and depending on what you and your surgeon decide about your degree of mini-monovision, you could aim to be, say, -0.75 D to -1.25 D less myopic. But if your first eye ends up less myopic than you want, you might decide to try for more myopia in the second eye. @Bookwoman has written extensively about myopia in both eyes.

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Good luck.

Right but if you want a myopic result why do an offset? Just set both to -1.5. The -0.75 target paired with -1.5 target doesn't make a lot of snese to me. The -0,75 probably isn't myopic enough for really good near but it's also not plano enough for good distance. An Eyhance at first minus will already give you good intermediate.

It all depends how ambitious you want to be. Intrigued by the greater range of focus available through mini-monovision, I discussed it with each of three surgeons, all of whom were receptive (one whom, for other reasons, I'm not using, told me he has contact lens-based monovision). I also tried it with contact lenses (never having worn them before). I was comfortable with 1.50 D of difference between the two eyes, from which I conclude that a 1.0 D difference with IOLs is reasonable for me. (I want to leave a margin for my surgeon not hitting the target. I understand that up to a 0.50 D difference plus or minus is regarded as a reasonable result.)

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My eyes need to be measured again following an in-office procedure to remove a Saltzmann's nodule that my current surgeon found (and the two prior surgeons missed). Based on pre-procedure measurements and his a constant of 119.4 for the Eyhance IOL, we could have targeted, for example, -1.23 D and - 2.2 D or -0.9 D and -1.86 D. Were the targets hit exactly and were my visual acuity to match the defocus curve averages (both somewhat heroic assumptions, which is why in choosing a target for my first (near) eye I'm also thinking about path dependencies depending on the actual result), then the former choice would produce 20/35 at distance and 20/29 at 11.25" (20/24 at 13.12"). For the latter choice, using results for -1.0 D and -1.75 D, but trying to keep in mind the lesser myopia of the "far" eye and the greater myopia of the "near" eye, the averages are c. 20/32 at distance and c. 20/30 at 11.25" (c. 20/25 at 13.12").

I have what is called mini-monovision with about -0.375 D in my distance eye, and -1.60 D in my close eye. Both are monofocal lenses. This lets me read from about 8" out, and overall good vision goes from 8" to the moon. I essentially don't use glasses for exactly the same reason as you have. I don't want to carry even one pair of glasses and don't.

I agree and while some may be willing to do both eyes at -1.50 D, it is going to require eyeglasses to see distance and to be legal to drive.

I think you are reading way more precision into the predictability of outcomes than is realistic. Think in increments of half a foot for precision, not half an inch. Then take a look at the error bars on defocus curves, and remember that almost nobody is "average" which is what the curve represents.

Respectfully, I'm well aware of the imprecision involved, including, as I often note, that defocus curves report mean results, so that individual results can be better or worse, that missing the targeted refraction by up to 0.50 D is regarded as unexceptionable, etc. That's why, in my reply to @david98963 I referred to "somewhat heroic assumptions" and "path dependencies depending on the actual result" of the first eye. (Also, the increments I mention are directly from the defocus curves: divide 1 by the diopter, so -0.25 D defocus is 4m; -4.00 D is 25 cm. I simply translated from metric to inches.)

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Even so, defocus curves, IOL power calculations, and the like provide information that when used with a keen awareness of the imprecision can help inform the decisions of those of us who want to do more than unthinkingly go along with whatever our surgeon recommends. (We may, of course, end up going along thinkingly.)

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For example, you mention that you have "overall good vision goes from 8" to the moon." I don't know what you consider good vision, but with the Eyhance , and, therefore, I presume with the Tecnis 1 and Clareon, can't come close to getting the average person that with the mini-monovision set-up you have. Based on the defocus curves I've found, the average (mean) result with -2.25 D in both eyes is only 20/30 (logMAR 0.181) at 9.85". I haven't calculated your offset of -0.375 D and -1.60 D, but looking at the (more favorable) binocular averages (mean) for -1.50 D, that is assuming, your eyes enjoy the same binocular summation as both eyes at -1.50, results in only 20/43 at 9.85" (25 cm). You are very lucky indeed.

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Indeed, you are so lucky--at least based on the defocus curves--that it's not a result that I feel comfortable using in thinking about my own situation. I'll feel fortunate to achieve the mean results, anything better will be an uncounted-on bonus. And in making my decision for my first eye, I'll also be thinking about the implications of the target for that eye in the event that the refractive result is worse than predicted by the IOL calculator or my vision is worse than suggested by the defocus curves.

I am talking about reading normal 10 point text on a computer monitor with my near eye. At 8" I get zero out of my distance eye - it is a blur. It starts to give me readable computer vision at about 20", but I don't have a large enough monitor to work at that distance. I typically work at about 12-14".

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To be realistic start thinking in feet. With my near eye, I can start to see well at just under a foot, and can see well on a large screen 4K TV with it at 8-10 feet, and then it starts to fade. My distance eye sees well at just under 2 feet and that is probably helped by my astigmatism, and gets real good at 3 feet out to infinity.

I agree that targeting one eye to -1.50 D (which is good) and the other to -0.75 D (not so good) does not make sense. Too much distance vision will be lost. The standard target for the distance eye is -0.25 D.

"I was comfortable with 1.50 D of difference between the two eyes [with contacts], from which I conclude that a 1.0 D difference with IOLs is reasonable for me."

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Keep in mind that a natural lens eye with contact lenses still has some significant accommodation. Based on my experience with testing on a normal eye and one having an IOL, I found I could get away with -1.25 D for reading when using a contact in a non IOL eye. But, I found I needed -1.50 D to get the equivalent reading ability (based on the Jaeger chart) with an IOL eye. I attribute the difference to accommodation.

To comfortably read 10 point text that is 8 inches away, one needs visual acuity of 20/25 or better. I've only derived defocus curves to -4.00 D, which corresponds to 25 cm or 9.85". Binocular defocus curves for the Eyhance show that, with a -2.50 D refraction in both eyes, the mean visual acuity at 9.85" (-4.00 D) is 0.181 logMAR or 20/30. At 8", the mean visual acuity would be worse.

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To have 20/25 or better vision at 8" makes you, as I said, very lucky indeed.

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Also, the question whether one pays more, less, or equal attention to inches vs. feet does not have a simple right or wrong answer. It depends, rather, on what range of vision one wants to prioritize. If it's distance, then, of course, feet are more important. But if it's intermediate or near vision, then inches take on greater importance. Unless, that is, one can count in advance of surgery on getting the same fantastic results you enjoy.

Depending on the difference between the two eyes, people can experience problems with monovision, for example, headaches and loss of binocular vision. Some studies and individuals suggest that a 1.50 D difference is the sweet spot for most people.

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The purpose of my experiment was to see whether I experienced any negative side-effects with a 1.50 D difference. Fortunately, I didn't.

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For me, targeting a 1.00 D difference makes sense because it allows 0.50 D margin for refractive surprise in the surgical result.

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As I wasn't trying to test anything else, the difference in accommodation pre-op and post-op was irrelevant for my purpose.

My point was that you seem to be paying so much attention to small details that you may miss the forest for the trees. To me monovision has two objectives. One is to see 20/20 or better at distance. The best way to achieve that is to use a lens that has maximum clarity at distance and to target it as accurately as possible for distance, but with some slight myopia to minimize the chance of going positive. But that said going 0.25 D positive along with some small amount of negative cylinder is not a bad outcome. Not ideal, but not a disaster either. It is worth checking outcomes with at least 2 or 3 power calculation formulas, before deciding on the power. Seeing the IOL Calculation sheets is essential to do this correctly, and you should be part of the final decision on IOL power.

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The close eye should be looked at separately after the landing point for the distance eye is determined. If one does land at -0.25 D or more then you have more margin for more myopia in the near eye. Differential ceases to be a concern, and one can then target full -1.5 D to ensure good near vision. One also gains the experience as to which formula was most accurate on the distance eye, and one can feel more comfortable in predicting the actual outcome.

It's not a question of missing the forest for the trees but rather of walking through the forest toward different goals. Yours were, first, to achieve 20/20 or better at distance and, second, ... well you don't actually say what your second goal was, except perhaps the undefined "good near vision." When it comes to good near vision, inches actually are important. Jaeger 1 visual acuity, for example, requires being able to read comfortably 6.5 pt font at a 14" reading distance. It equates to 20/20.

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Using the Eyhance defocus curves, and assuming complete binocular summation, the mean result at -0.25 D is 20/21 at distance. The mean result at plano is 20/19. As for 20/20 at 14", I haven't calculated average defocus curve results beyond -2.25 D, at that refraction, however, a mean result of 20/20 comes at 15.75" (40 cm). At the same refraction, it's 20/21 at 14.31" . To have very good vision at 8" with a -1.60 D refraction is very good indeed. Put simply, I don't think anyone reasonably can count on getting Jaeger 1 vision at 14" from monofocals targeted at plano or -0.25D in one eye and -1.50 D in the other eye.

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Some people will conclude that they need to choose between prioritizing distance vision and prioritizing near/intermediate vision. At present, I've decided to prioritize the latter, recognizing that I well may need glasses to drive. Inches become important to me here because, realizing that defocus curves report mean results, and I could end up more or less myopic, I want to target a refraction such that, even if my visual acuity is not as good as the mean, I'm still likely to be satisfied. And at the myopic end of the defocus curve, it's all about the inches.

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What I don't understand is your statement that there are circumstances in which, for the second eye, the differential ceases to be a concern. Wherever the first eye ends up, I wouldn't want so great a differential between it and the second eye that I suffer headaches or a serious reduction in steroptic vision. And unless I knew that my surgeon could hit the second eye target exactly, I wouldn't agree to a second eye target that didn't leave me at a 0.50 D margin. That's how I get from (what I regard as) a successful 1.50 D difference in my contact lens test to a 1.0 D targeted difference with IOLs.

The second goal is good reading vision. J1 at 14" is a sound objective. I can do it but I have -0.75 D of irregular astigmatism in my near eye which gives me a drop shadow on every letter. I think I could do better than J1 if I did not have that drop shadow.

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The amount of myopia that you have in your distance eye reduces the anisometropia. And your surgeon after considering the refraction outcome on your first eye should not miss on the second eye by 0.5 D, if they consider the first eye outcome and make any necessary adjustment. You should not have to allow for as much error on the second eye as the first.

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I thought you tried 1.5 D of anisometropia and were not bothered by it? If so why are you so concerned? Did you know that the original full monovision used up to 3.0 D of anisometropia? And of course you know you most likely cannot target -1.5 D exactly in the near eye. You may want to pick the power that puts you in the -1.25 to -1.5 D range. That is a realistic target and one your surgeon should be able to hit providing they are smart about it.

My Eyhance target was -0.21 and for the first few months at least, in excellent light (like bright sun) I could read J1 at 14". Probably not 20/20 but I didn't struggle. So your mileage real may vary… a lot. I also have -0.75D of astigmatism though so that helps.

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Unfortunately I've had a hyperopic shift since then. I started noticing this winter that my Apple Watch and iPhone were harder to see so i went for another refraction and it had shifted from 0 in October (8 weeks post op) to +0.25D now.

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Anyway the point is that results can vary wildly. And they can also change. So by all means do the calculations to get the best possible chance of getting the result you want, but understand that it might not pan out exactly as planned. I know you know that though. Just reiterating.

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One thing, it sounds like you want 20/20 at 8"? Bear in mind that EDOF lenses extend the range on the right side of the defocus curve. All lenses drop off pretty quickly to the left of the optimal focus point. So if you nail 8" 20/20 with Eyhance you wouldnt really be benefiting from the extended depth. I guess it does give you a bigger "landing zone" / margin of error.

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Anyway I'd be interested to hear what your surgeon suggests going forward now that it seems that Vivity is out and you're trying to formulate a new plan. I hate to say it (as I know they have drawbacks) but if really good 8" vision is a MUST have, your surest bet might be Panoptix.

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p.s. This was meant to be a reply to RebDovid of course

The PanOptix is no guarantee of close vision. I have friend that got PanOptix bilaterally about 3 years ago now. She needs to use +1.75 readers to read a book outdoors in sunlight. With my mini-monovision I can easily read a book outside with no readers. If one is to go with a MF lens targeted to plano, Synergy may be a better bet. It seems to favour close vision at the expense of some distant vision.

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I still think mini-monovision is the least risky way to independently assure good distance vision along with good close vision.

I mean… nothing is guaranteed of course. But 8" 20/20 is a big ask. If you're uncomfortable with the amount of offset that would be needed for monovision to achieve that, I think a Panoptix would give you the best chance. I wouldn't choose it myself as I'm a perfectionist but I'm sure a lot of people are happy with it (although you probably won't find them posting here).

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I think the drop off on the left of the defocus curve is an important consideration too. Not sure what the benefit of Eyhance would be if you're targetting 8" 20/20. Except maybe, as I say, a bigger "landing zone"

I would expect nobody would ever consider setting the peak visual acuity as close as 8". That would not make any sense, and is not necessary. Mini-monovision works on the basis of pushing the limit of the range of the depth of focus. Normally a LogMAR of 0.2 is considered a reasonable limit which I believe is about 20/32, but in practical terms it can go further than that. Targeting a monofocal to -1.5 provides peak visual acuity at about 2 feet, which is a long way off 8". LogMAR 0.2 vision runs out at about 15". But I can still do J1 at 14" in bright sunlight. In dimmer light it drops to J3 quite quickly.

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I think a computer monitor with black text on a white background is an easy test. The bright white background causes the pupil to close down and improves the depth of focus with the pinhole effect. Where I get into some trouble is with white text on a coloured or black background on my iPhone. That is more of a real issue. That said I can still read my phone without increasing font size even with a black background. My limit is best identified with the iPhone Stocks app. I use that to display my stocks with a % gain (green background) or loss (red background). The white on red I can see fairly easily, but dislike because it is a LOSS! But the white on green is a bit of a struggle to read. I have to get it at the optimum distance which I would estimate to be about a foot or so.

My surgeon uses the Barrett II Universal formula, which as I understand it, accounts for the myopic impact of predicted residual astigmatism. All going well, therefore, any residual astigmatism should manifest itself, if at all, through blurry vision, double vision, etc. For purposes of defocus curve data, however, my understanding is that it's already accounted for.

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That's why I say that your having very good reading vision at 8" with your monofocal-based mini-monovision makes you very lucky indeed. And to clarify for @david98963, 8" is not my goal. I've only discussed it in the context of trying to explain why, prioritizing near and intermediate vision as I do, rather than distance, I am concerned with the results of defocus curves at refractions that differ by inches rather than feet, e.g., -3.25 D (12.11"), -3.00 D (13.12"), -2.75 D (14.31").

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Looking at the ten Eyhance defocus curves I've found, and recognizing that I can't count on equaling or bettering the mean results they report, were (1) my biometry fed into the Barrett II Universal formula with my surgeon's a constant to permit -2.00 D in the near eye and -1.00 D in the far eye, and (2) were my surgeon to hit the targets exactly, and (3) were I to achieve the mean result of the average of those ten defocus curves, then at least ex ante I think I'd regard the process as a success. To translate into visual acuities, that would mean 20/25 at 13.12" (and, therefore, not likely very good reading vision at 8") and 20/32 at distance (meaning I probably could drive in good conditions, but as I've said repeatedly I'm willing to need to wear glasses).

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Of course, I fully recognize the uncertainties involved, including that my preferred targets may not be available, my surgeon may not exactly reach whatever targets we agree, and my resulting vision may end up better or worse than the mean results shown on defocus curves. All of this also informs the degree of monovision at which I currently think I want to aim. Going back to my -1.00 D / -2.00 D construct, if my surgeon felt confident that targeting a 1.25 D difference he wouldn't exceed 1.50 D, then, were -2.00 achieved in the first (near) eye, I'd probably be willing to aim for -0.75 D in the second (far) eye. After all, 20/28 (the average of the mean results of the 10 Eyhance defocus curves) is better than 20/32. Then again, the downsides of excessive monovision appear to me so great that, given my willingness to wear glasses to drive, I still might choose the more convervative target of a 1.00 D difference. (And, yes, I am aware that the surgeon might miss, or the calculation might be off, on the more myopic side.)

"Looking at the ten Eyhance defocus curves I've found"

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Did you include the defocus curve in the video below, which found that there was no statistical difference between the Eyhance defocus curve and the Clareon monofocal defocus curve?

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Alcon Science Head-to-Head Comparison of Intermediate Vision of Two Monofocal Intraocular Lenses Posted: 8 May. 2023 Morgan Micheletti, MD

In the post immediately above yours in that thread, I gave some reasons for hesitating to give much weight to the Micheletti video presentation. Just now, I've started a thread on a preprint I just found that's now undergoing peer review for Springer's International Ophthalmology. The preprint reports on a study finding that the Eyhance gave statistically significant better intermediate and near vision than both the Clareon and ZCB00.

Strange. The curves in the Alcon report look essentially identical.

The striking similarity of the curves in the Alcon/Micheletti video presentation may focus attention of elements of the Micheletti study that may have biased the results in favor of Clareon. Here are some in the order in which they are presented in the video.

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First, Clareon patients only got the non-toric version; Eyhance patients got both. This, we're told, is because at the time of the study only the non-toric Clareon IOL was available. But we're not told why, in that case, the Eyhance group wasn't limited to patients receving the non-toric version. If I understand correctly, and all else being equal, not getting a toric Clareon, when a toric IOL was indicated, would have made the Clareon group somewhat more myopic than the Eyhance group, and that greater myopia would have resulted, all else being equal, in better intermediate vision for Clareon patients than otherwise similarly-situated Eyhance patients.

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Second, according to Dr. Micheletti, in the distance-corrected comparison Clareon was "noninferior" to Eyhance for intermediate visual acuity because there was only a clinically non-significant 2.5 letter difference, which is unlikely to have a significant impact on a patient's ability to see clearly or perform every day activities. My understanding is that the minimal clinically important difference is typically considred to be three letters, in which case Dr. Micheletti's statement is correct. But for some patients, a difference so close to the border may matter, especially at intermediate or near.

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Third, with Clareon, the study target corrected to minus a quarter diopters and intermediate visual acuity was found to be non-inferior to the Eyhance group's distance-corrected intermediate acuity with a plano target. All else being equal, an additional 0.25 D of myopia in the Clareon group would provide slightly better visual acuity at intermediate distances.

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Fourth, and these are differences in results not in how the study was constructed, for DCIVA, 10.3% of Clareon patient had 20/25 or better; 25.2% had 42.6% or better. For Eyhance patients, it was 25.2% and 58.7%. For target-corrected intermediat acuity with a 0.25 D offset, 23.9% of Clareon patients had 20/25 or better and 55.5% had 20/30 or better. This leads to the question, however, whether it was the -0.25 D targeting offset results that they put in the Clareon defocus curve.

So did you use the defocus curve for the Eyhance that was determined by the study? Does it give you the results you want?

I'm not there yet. My current surgeon found a Saltzmann's Nodule that he removed, necessitating re-measuring in a few weeks.

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To avoid cherry-picking results, so far I've averaged together all the published defocus curves I can find whose results I can use. The "use" requirement so far prevents me from using including the defocus curve in the International Ophthalmology preprint. Because of the way the curve is presented I don't feel confident that I can read off particular data points with sufficient accuracy.

I would just check to see how close this curve is to what you are assuming to be correct. If they match then that is a good sign. If they don't then you have a problem to deal with. My thoughts after listening to that presentation is that to be conservative one should assume the Eyhance defocus curve is the same as a standard monofocal. If you get a bonus out of it, then all is good. If you count on the bonus, and then don't get it, then that can be not so good.

Hi there. I also am/was a high myopic (-12.5D and -13.50D). I had surgery with Eyhance in both eyes a couple of months ago, targeting -0.5D for my distance eye (ended up at -0.25D), and -1.25D for my near eye (ended up the same after refraction). I have a full range of vision from about 10" to whatever. I don't need glasses for anything, near nor far, whether it is reading a pill bottle, my phone, a book, to watching TV, driving, or being able to discern that someone is now standing in the window of a house almost two hundred feet away from me (they're not in sharp focus but I can see the outlines). The intermediate vision in particular is freaking amazing -- in some ways it's even better than the near vision. The print on small pill bottles, etc, held about 20" away are sharp and clear. No problems with light aberrations, depth perception, loss of colours, etc -- everything is sharp and bright and for the most part, even in dim light. No problems driving down dark roads on a moonless night, or even walking down those roads.

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After my five week post surgery checkup with my optometrist, she said that I have overall 20/20 vision, broken down to 20/20 in the "distance" eye and 20/40 in the "near" eye, reading J1 even in not so good light. She said if I wanted to get glasses for driving in difficult weather then I could, but it was completely up to me -- she saw no real need for them, based upon my current vision. Because the Eyhance does provide a small amount of EDOF (about .3), I don't think you need to go as high as -1.5D in your near eye to get good close vision. You'd lose a fair amount of distance vision and decrease the benefits of mini-monovision giving you full blended (3D) vision.

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I fix computers and many other small things and was worried that I wouldn't be to see as much post surgery, but for most things, I often don't even need cheap -1.50D readers to see what I need to see -- only when soddering really small circuit board type of things -- most of the disassembling I can do easily without any help. I don't know if you usually wear glasses, but mine with the high myopia made everything I saw out of them about a third of their "real" size, and I forgot that the computers, etc that I'm working on now with my new eyes are being seen in "real" size, so all of the parts are so much bigger now, lol. I used to be able to see about 4" clearly without my glasses so my pre-op eyes were like a built in microscope, but since everything I'm looking at now is so much larger, that ability isn't needed as much as before.