Lens and monovision choice. Vivity, Eyhance, AtLara
Posted , 9 users are following.
Long story short. I made an appointment with doc to do cataract surgey next week. I'm high myopic in both eyes, both around -10.D. Chose to take vivity, Left eye aimed at: -1.25D, right eye: -.5D. But I just got a call from the doc's office said vivity can only correct my vision to -1.5D according to their calculation. So here are all possible choices:
- both eyes target to -1.5D with Vivity
- left -1.5D vivity right -0.5D with Eyehance
- Or consider AtLara(Never heard of it).
But they also warned me that Vivity has a yellow tint while Eyehance is clear, so some people may have difficulty to adpapt to the difference.
I have been torn between these choices since the call.
What do you guys think? Any suggestions?
Thank you so much.
1 like, 67 replies
karin08666 johnson69762
Edited
You should read Karbonbee's experience with Eyhance. Search:
Definitely an Ey(en)hance for me!
Karbonee had eyhance put in both eyes and tells about the outcome.
johnson69762 karin08666
Posted
Am reading it, Karbonee and I are both high myopic(since high mypia may elongate eyeballs, so a sllight extended depth of focus is expected). His case would be very valuable to me.
Thanks for metioning it.
RonAKA johnson69762
Edited
I would not go with any of those options. The first thing you should do is ask the surgeon for a copy of the IOL Calculation sheet. IOLs come in fixed steps of 0.5 D for sphere power. Your IOL calculation sheet should show what your predicted outcome will be with each of those steps in the range of outcomes you are looking for. Almost always there will be a choice between two differenct powers and one is likely to be over what you want and the other under.
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All considered there is nothing wrong with doing mini-monovision with monofocal lenses only. I think that is the lowest risk option. That would mean a target of -1.5 D in your left eye, and I would also suggest using Clareon. The distance eye should be targeted to -0.25 D to give you the best distance vision.
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Last you do not mention it, but don't get both eyes done at the same time, or close together. I would do the distance eye (right?) first and be assured you get good distance vision, and wait 6 weeks minimum before doing the second eye. You can use this recovery time to simulate mini-monovision by using a contact in your left eye that leaves you at -1.5 D to ensure that you are OK with it. It also gives the surgeon an opportunity to refine the power calculation for the second eye based on the refraction outcome of the first eye.
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Given that you have high myopia, you may want to consider an optional process called Alcon ORA if your surgeon offers it. It is claimed to be more accurate in determining the final power to be used when the eye requires an extreme correction. @Karbonbee here had good success with it, while some others have not.
johnson69762 RonAKA
Posted
Lurking on this forum for a while, learned a lot from your replies. Thanks dude.
Will try to ask for a calculation sheet from the clinic, don't know if they will provide one.
You made a good guess, my dominant eye is right eye.
I agree with your comments on atLARA, haven't seen many real experience about it on this forum or anywhere, definitely gonna avoid it.
I'm inclining to do both eyes at the same time, because:
Don't know if they got Alcon ORA here but will check with them, thanks for that.
RonAKA johnson69762
Posted
Doing a vitrectomy at the same time is a major complication. So, it may be necessary to do the big bang all at once surgery. Risk is going to be high...
Guest RonAKA
Posted
I agree with Ron but one important thing to point out is that Vivity doesn't come in a power that will allow the original poster to target -1D. The best they can do is -1.5D. The available powers of the Vivity is pretty narrow.
RonAKA johnson69762
Edited
I would suggest delaying your decision on IOLs past next week. You should investigate the options much more carefully before jumping in. An IOL decision should be a once in a lifetime decision, and should not be rushed. As I suggested in my first post you should ask for the IOL calculation print outs for the IOLs you are considering. And you should spend a bit of time learning how to read them. Then you can have a good discussion with the surgeon as to what target and power is the best choice for you. To be frank, the options you have been given are "all over the map" and require significant refinement to get to something reasonable. Google this for a pdf on what the numbers on the IOL calculation sheet mean. See page 5 and 6 for non toric IOL examples. I would also insist on seeing how well the predictions match for at least a couple of the most recent and accurate formulas; Barrett Universal II, and the Hill-RBF version 3.0. With your high myopia you want to be sure the best methods are used to get the most accurate prediction of the correct power.
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IOLMaster 700 Quick Guide Printing Functions EN PDF
johnson69762 RonAKA
Posted
Definitely. I will contact the clinic tomorrow see if they would give me that calculation sheet.
Also one confusion I've got is:
I contacted Alcon in the US years ago, they literally replied they have the range of lens extend to -10D(exactly my prescription). But the clinic said every one's eyes are differently, base on their calculation, vivity can only get me to -1.5D at the best. Do you think it's possible?
RonAKA johnson69762
Posted
The IOL lens powers have no direct relationship to eyeglass correction powers. If your eyeglasses are in the range of -10 D, then you will likely need an IOL power in the range of about +5 to +7D. The package insert information I have seen on the Vivity suggests it only goes down to +15 D. That is not even close to what you need. The more myopic you are, the lower the power of IOL you need. Even if they have extended the powers to +10 that is still not enough. I am basing this on @karbonbee measurements which are in the range you are at. However, you are very close the end of the range of powers needed, and you need to be sure they are not compromising the power selection due to available powers of the model of lens they are offering.
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I think you should demand to see a printout of the IOL Calculation Data Sheet. They have to give it to you. There has been a supreme court ruling in both the US and Canada that says medical data belongs to the patient, not the surgeon.
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The Clareon goes down to +6 D and may work, depending on your specific measurements. The Eyhance goes to +5 D and could also work. Another option would be the Tecnis 1 (+5 D minimum), or B+L enVista (+6).
johnson69762 RonAKA
Posted
Contacted the clinic today asking for a copy of their power calculation sheet, got instantly refused. Said it is not part of my "medical record" and it shouldn't affect my decision of lens. Did you get your calculation sheet before your surgery?
But I guess my diopter is indeed out the range of vivity. I checked the forum. No one with more than 9D implanted Vivity found yet.
johnson69762 RonAKA
Posted
Do you toric or not will affect the range of IOL?
RonAKA johnson69762
Posted
I did not get my calculation sheets before my surgery but wish I had. I was not aware of how useful they are at that point in time. I have been helping my brother who is half way through having his eyes done, and he got calculation sheets for his eyes, and a few versions of them for different targets.
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The sheets have measurements of your eyes, so of course they are part of your medical record. They are obviously being difficult, or just can't be bothered to print them off. Legally you may have to provide the request to them in writing and potentially pay the cost of getting it printed off (which is nothing of course). That takes time, so if they want to be difficult they can be.
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Perhaps you should try to talk to the surgeon directly and tell them you concern, and that you want to see the predicted outcome for the various lens options. While my surgeon did not give me the calculation sheets (and I did not know enough to ask) he did give me the options with the predicted residual outcome. We ended up having the final discussion over the phone on what lens to go with.
RonAKA johnson69762
Posted
I should have gotten a toric in one eye but did not. If I had it to do over again, I would have gotten one. Depending on the lens you are looking at it is possible the range of powers will be less in the toric versions. Currently Alcon is trying to expand their Clareon material to the different lens types, and I suspect they are doing it on a gradual basis with the most popular ones first.
RebDovid johnson69762
Posted
Even if the calculation sheet doesn't count as a medical record, about which I'm ignorant, your biometric results should be. With those you can use an on-line calculator, the Barrett II Universal formal is available, for example. The only additional datum you should need is the a constant. While the maker's recommended a constant should be easily findable, what you really want is to ask your surgeon for her personal a constant, which well may differ.
Lynda111 johnson69762
Posted
I am not sure I would trust a cataract surgeon whose staff is making your life difficult.
I went to three cataract surgeons before I settled on the one I actually used. Have you thought about seeing another one?
johnson69762 RonAKA
Posted
The surgeon did strongly recommend using toric version. I have around 0.75D and 1.0D with-the-rule astigmatism respectively. I've visited other surgeons they were reluctant to use toric version, instead they suggested LRI(Limba relaxing incision).
johnson69762 Lynda111
Posted
I've been to other docs. But considering I need a vitrectomy, this doctor is one of the best in the world and quite famous one.
johnson69762 RebDovid
Posted
Yes, the staff said you would give me my examination results shortly if I want but no IOL calculation sheet.
RonAKA johnson69762
Edited
Getting a toric IOL in the small amount you need is a bit of an issue. That was part of the mess I got into with my near eye. The surgeon kept flip flopping on whether I would benefit from it or not. The issue in my case was that my astigmatism was irregular and the surgeon would not commit to saying whether or not it a toric would help. I the end I passed on it when he said I could fix any astigmatism after the surgery with Lasik. That turned out not to be true. On LRI he said that he will not do it any longer, because he could not get consistent results with the procedure.
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But, in your case if that astigmatism is regular and that is measured at the cornea plane than you should be able to get a toric. The choices in smaller amounts of cylinder that I am aware of are:
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Toric Lens - IOL Plane - Cornea Plane
enVista - 1.25 D - 0.90 D
AcrySof IQ - 1.0 D - 0.75 D
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It kind of limits your choice of lenses...
RonAKA johnson69762
Posted
If you can get your eye measurement you can run an on line toric calculator yourself. Google this to find it.
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Barrett Toric Calculator V2.0
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I found I had to use Microsoft Edge instead of Chrome to make it run.
johnson69762 RonAKA
Posted
Thnaks. I will try it once I get the examination results. But the problem is I don't know where to find the power ranges of Vivity lens, data on the internet might be outdated. Have you got any clue?
RonAKA johnson69762
Posted
You may want to call Alcon to see if they will tell you what the power availability is for the Vivity. I have searched a fair bit for it, but all I could find is a minimum of 15 D for power, which would not work for you. But in the end it is what the surgeon can get.
johnson69762 RonAKA
Posted
I've been told that Eyhance can cover my power range and astigmatism. In my opinion, whether it's toric or not won't make too much of a difference. LRI doesn't seem very reliable, but since my astigmatism is small, either option should work.
You mentioned that you have irregular astigmatism — is that due to HOAs? If so, you may need a wavefront-guided LASIK procedure, which not all eye doctors are capable of performing.
RonAKA johnson69762
Posted
I have investigated wavefront guided Lasik with two clinics. My issue seems to be two fold. One is that the cornea is too thin, and may be the reason for the irregular astigmatism pattern (it is pretty much all on one side), and the other is that it would reduce my reading vision as they can't make the sphere more myopic. It was a dead end.
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A toric will help some, if you can get it in the right cylinder power for your eye.
soks RonAKA
Posted
that they cannot make it myopic is in general of specific to your eye anatomy?
johnson69762 RonAKA
Posted
Used the online calculator with my parameters, it turned out to need a 10D IOL to target -1.D. I guess the clinic's calculation is correct. Then I'm gonna move on and consider Eyhance instead.
johnson69762 RonAKA
Posted
I apologize if this comes across as rude. Have you performed any cornea surgeries before? Typically, a touch-up procedure to correct HOA doesn't consume too much cornea thickness. LASIK can make you more "myopic", but it would use significantly more cornea than reducing your myopia.
You are correct that, precisely speaking, the toric version should be optimal. However, there is always some degree of inaccuracy involved. I will respect the surgeon's inclination on this.
RonAKA soks
Posted
No, it seems the Lasik process is very effective in reducing the steepness of the cornea (reducing myopia), but not predictable or effective in increasing the steepness of the cornea (increasing myopia). They use radial cuts to reduce steepness, but circumferential cuts to increase the steepness. My optometrist went on to tell me that another reason is that when they try to increase the steepness it may initially work, but over a year or two the increase can be lost
RonAKA johnson69762
Posted
If you are not calculating a toric lens, you could also try the Barrett Universal II calculator which will calculate a non toric solution. Probably and even better one however is the Hill-RBF V3.0 calculator. Another is the Kane calculator.
RonAKA johnson69762
Posted
I have gone to two different Lasik clinics and they have essentially both given me the same answer, which was also confirmed by my optometrist. Keep in mind I am looking for a very small amount of an increase in myopia of about 0.25 D.
Guest RonAKA
Edited
I also looking into getting me -0,75 Astigmatism corrected by laser (LASIK, PRK, or SMILE) and they basically said that that amount of correction is a little too close to the margin of error for these procedures… so probably not worth risk as the result could not be guaranteed and the benefit would be minimal.