1. Community
  2. Eyes
  3. Cataract

Lens Choices

Posted , 7 users are following.

doug53649
doug53649

So I've been reading through a lot of the posts in this group on lens choices and I wanted some feedback on my particular situation. I've actually worn glasses all of my life and I would be considered farsighted with astigmatism. On my latest visit to the optometrist he confirmed that I have cataracts in both eyes and recommended surgery. My prescription shows right eye +6.25 & -2.25 axis 71 left eye +6.75 & -1.5 axis 86 add = 2.25. My optometrist told me that I likely had two choices Monofocal or Vivity and his suggestion was Monofocal. I scheduled an appointment with the surgeon that my optometrist suggested and during that visit a couple of weeks ago he pretty much confirmed the two choices I had. The surgeon uses the Toric II & Vivity Toric but I'm sure they have others at their disposal as this is a very large facility. Monovision was not on the table at all, I assume because I have never worn contacts but at the time I didn't even know what Monovision, Mini-Monovision, or Microvision was so I didn't question it. The surgeon briefly went over the options and we scheduled surgery for the first of February but I did not make a choice on the lens. He said I have up to a week or so prior to surgery to decide. I hadn't really done much research at that time so I was not going to commit either way. Well then the research began and now I really don't know. I feel like the mono-focal will be the safer route and as I have always worn glasses not a huge deal. The surgeon I am seeing comes highly recommended and I feel that whatever I choose I will get the best quality from him. but..... so many questions.

With either lens I realize my far vision will be pretty decent but what about near vision? The Vivity obviously proposes to make the intermediate and near vision somewhat better but is it enough? I am trying to take the cost out of the equation mostly because this is obviously a one time thing and I don't have an issue with paying a little more if I get the results. Doing my research so far it seems like the contrast sensitivity seems to be the biggest issue with the Vivity and I have some sources in the industry that totally advise against the Vivity because of the low light contrast issue but yet others have nothing but good things to say. When I asked the surgeon about this he indicated they are not having any complaints. I wonder how much difference the actual procedure and the surgeon performing the procedure makes in the outcome? I of course reached out to Alcon and the documents they sent me barely touched on the contrast issue but yet their website specifically states significant contrast sensitivity loss. I just wonder if because peoples eyesight is so bad with cataracts and astigmatism that obviously anything will be an upgrade and there aren't as many complaints because they/we maybe don't know what we are missing.

One last thing, I guess I don't really mind wearing glasses mostly because I don't know anything else but it would be nice not to have to deal with them. Thanks

0 likes, 3 replies

3 Replies

  • RonAKA
    RonAKA doug53649

    Edited

    "My optometrist told me that I likely had two choices Monofocal or Vivity and his suggestion was Monofocal."

    .

    I think there is another choice worthy of consideration; Monofocal in your dominant eye, set for distance, and a Vivity in the non-dominant eye, set for mild myopia of -0.75 D. The monofocal in the distance eye can make up for the contrast sensitivity loss in the Vivity eye. And if you google this document "FDA Vivity Package Insert", you will see a graph that shows contrast sensitivity (MTF) varies with distance. The monofocal will give maximum MTF at distance but it decreases quite rapidly as you get closer. The Vivity on the other hand has reduced MTF at distance but it does not drop off as fast as you get closer. The combination of a Vivity and monofocal should give better across the distance range MTF than two monofocals or two Vivity lenses.

    .

    My suggestion would be to do your dominant eye first with a monofocal and see what you get for vision day and night. Between eyes you could test drive monovision with a contact lens in your non operated eye. Your optometrist should be able to help you with that. Then you have some options for your non dominant eye.

    .

    1. Get another monofocal set for distance if you don't like your monovision test drive. You will get maximum distance contrast sensitivity, but you will need reading glasses or progressive glasses.
    2. Get another monofocal but set for mini-monovision. Typically you target -1.5 D myopia. This will give you good reading ability without reading glasses, but distance vision will be somewhat compromised by the mild myopia without glasses.
    3. Get a Vivity in the second eye targeting distance. This will give you the best binocular distance vision, but probably will leave you short of good reading ability.
    4. Get a Vivity but targeted to -0.75 D myopia. This will give you good distance vision in that eye, and very good reading ability.

      .

      Keep in mind with these monovision solutions you get two ongoing options. One is eyeglass free good vision. The other is near perfect vision with progressive glasses. You probably will like the eyeglass free option and only use the progressive glasses for night driving, or reading very small print.

      .

      Hope that helps some. I have my first eye done with an AcrySof IQ Aspheric monofocal set for distance and see 20/20 quite easily. I am simulating mini-monovision with a contact that leaves me about -1.25 D myopic. I like it a lot and almost never wear glasses. I am now debating between option 2 and 4 for the second eye. I am leaning toward 2, but will ask the surgeon about his experience with Vivity, and if his advice is encouraging then I may do option 4.

      .

      Edit: I would suggest planning on an interval of 6 weeks minimum between eyes. This will allow the eye to fully heal so you know what you really have for vision. It also gives you time to test drive monovision and make a decision on what to do with the second eye.

  • redbirds
    redbirds doug53649

    Edited

    My eyeglass prescription was similar to yours: +6.5 both eyes with a 2.50 add, with some astigmatism, right 130, left 060. I wore monovision contact lenses for many years, so I chose monvision for IOL implant. Got Technis Eyhance toric for reading and Technis ZCB00 for distance. It's 3 weeks since 2nd eye, and see pretty much everything clearly.

  • Jennifer_Guess
    Jennifer_Guess doug53649

    Edited

    Hello,

    I highly recommend spending a few hours watching Shannon Wong's videos on YouTube (and I do believe he does one on Vivity). This has helped me tremendously! He does a great job of explaining the different lenses and their strengths and weaknesses - please note that most are geared towards the premium lenses, but he does also explain what the monofocal lens is and its strengths and weaknesses. He also discusses how much light enters the eye with each type of lens, which I find fascinating! So for example, the premium lenses (i.e., Panoptix) let less light in due to their design and/or material (so there are rings in these lenses that allow one to focus at different distances - and as a result, less light comes into the retina in order to form images in the eye). He also explains that as we age, less light enters the eye anyway, so some people may not notice much with regard to dimness if they are older - but potentially more so if you are younger.

    Watching his videos has helped me to better understand the recommendation my surgeon has made with regard to the Symfony in one eye (more light enters the eye with this one - so better visual distance and acuity) and the Synergy in the other (less light into the eye, but better up close/intermediate vision). A couple of people on this forum suggested that I focus on finding the best surgeon as the priority. That is what I did and I am seeing the most reputable one in my state. I am putting my trust in his expertise and recommendation. I will report back here once these new lenses are in. All the best to you 😃

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.