Monofocal or Vivity for cataracts
Posted , 9 users are following.
My fiancé is torn. He has early onset cataracts and needs one eye done immediately. Of course the doctor is pushing for the $2500 Vivity lens. He is looking at that one or a monofocal lens set for distance. His question is, with monofocal set for distance, at what range does your sight kick in? He understood from his research that from 2-3 feet out he would have clear vision. However, his doctor said no it was more like 5-10 feet out. Does anyone have monofocal lenses? Can you see the dashboard of your car when you drive without glasses? At what distance does your sight kick in? Would you get the monofocal again or would you suggest the Vivity?
0 likes, 10 replies
susanlb kristin17941
Edited
I had cataract surgery left eye on 4/26/22 and right eye 5/10/22 with alcon lenses set to distance. I opted to pay out of pocket for the laser to correct astigmatism in both eyes, plus I heard it gives a more accurate result. I can easily see my dash without glasses..I just use my regular non prescription sunglasses. I need plus 150 readers to see my computer at an 18 inch distance, and plus 200 readers to read a book. I am in the process of buying progressive sunglasses so I can read under an umbrella at the beach. My distance vision is within 0.25 of 20/20 within both eyes, so that is a good result. I am a perfectionist, so I worried that if I got the vivity lens, I would have difficulty with contrast vision issues and that it wouldn't be perfect for either distance or near. I am really happy I got the alcon lens, which has been around for a long time. I won't lie and say it isn't a pain to constantly have to put on glasses to read well, but I definitely don't need prescription glasses to drive, unless I want to look closely at my phone. Hope this helps! Susan
RonAKA kristin17941
Posted
I have two monofocal IOLs. My first eye was done about a year and a half before the second one. In the first eye I had it set for distance, and I can easily see my car dash with it. On my computer I can see fairly good down to about 18", but based on the comments of others that seems a bit unusual. My distance vision in that eye is 20/20+ with an eyeglass correction of 0.0 D. Near vision with a distance set monofocal varies from person to person. It tends to be better in those who have a small pupil and also in those who are more myopic prior to having cataracts.
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According to the manufacturer's data the average good vision distance with a monofocal is about 26", and 20" with the Vivity.
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I would investigate mini-monovision. It is when the dominant eye is corrected to full distance with a monofocal, and the non-dominant eye is under corrected to leave you with -1.5 D myopia. It sounds like the surgeon uses Alcon lenses. In that line I would recommend the Clareon monofocal as it is a new material with longer expected life. Where I am the Vivity costs an extra $2100, and the Clareon $300 over the basic lens.
rwbil kristin17941
Posted
There are a lot of factors such as how is is overall eye health, does he have astigmatism and how accurately they are able to correct any astigmatism he has. And of course how well the doctor hits the refractive mark.
On top of all that everyone results will vary. The best option is to look at the defocus curve for the IOL you will be implanting. But that is an average curve. If you look at a curve that shows 1 standard deviation on it you can see just how much the results vary from person to person.
Also it depends on how you define Clear Vision.
I am just doing a quick look at a specific monofocal defocus curve, so double check my numbers. 2' out is about -1.5(D) and looking at the defocus curve it looks to me to be about 20/40 ish vision if you set the IOL for Plano.
Looking at Vivity it shows VA to be about 20/25 at that distance. Hmmm, that is better than I would have expected.
But keep in mind there is no free lunch and vivity comes with contrast senstivity loss.
Also the doctors said he would not have good vision until at least 5-10 feet out. I would bring in the defocus curve and he better be able to explain why he made such a statement or I would find another competent doctor.
Robken kristin17941
Posted
I am considering Vivity EOL. My only concern is how well it will be driving at night since the contrast is lower.
Guest kristin17941
Posted
Results can vary widely but on average with a monofocal you can expect usable vision (not razor sharp but good enough) to start at around 3 feet. But yes 5-10 feet will be sharper.
Night-Hawk kristin17941
Posted
The focus range you get from a monofocal IOL can vary between each person and also there is variability due to how the eye ends up healing after the operation. The end result could easily vary by 0.5D and if it went positive that would really hurt closer distance vision. It could also end up off negative would could improve closer range but slightly reduce distance vision sharpness. So its somewhat unpredictable.
I have had cataract surgery in just my right eye with a monofocal toric IOL, mostly corrects significant 3.0D astigmatism in that eye. I ended up with about -0.75D cylinder astigmatism residual and very close to plano (0D) sphere. That reduces my unaided distance vision a bit to 20/25 instead of 20/20 or better if I use a weak eyeglasses to correct that eye perfectly. I can read pretty well beyond arm's length unaided in that eye, so dashboard in the car is OK. Probably 4feet and out is very clear. 3feet is readable but takes a little concentration, so for using the computer monitor near that distance I prefer to use +1D custom glasses for that.
john20510 kristin17941
Edited
lm in the exact same boat as you, surgery in a few months choice vivity or monofocal, at this stage my plan is to go with vivity in one eye first and if l dont like it or dont like the contrast then l will go with a monofocal in the second eye which will make up for the lower contrast in the eye with vivity, if l like the first eye with vivity then l will get vivity in the second eye also. Maybe you could consider that idea. From the most of the reviews l read on vivity most people with vivity say they dont have an issue with contrast or its not something that bothers them , only a minority say contrast is a problem. AS my optomerist said the worse the cataract the happier the patient after surgery will be, if you have bad cataracts you are going to be happy with the vivity contrast as it will be far better then your cataract vision
RonAKA john20510
Edited
My thoughts would be almost exactly opposite. In your case, I would go with a Clareon monofocal in the dominant eye first, and then see what you get for intermediate vision. Your requirements are modest and your chances are good you will get good intermediate vision for most needs such as car dash instruments. If you do get good results then get another Clareon in the non-dominant eye. And if you want better closer vision, get the Vivity in the second eye. The Clareon lens in the first eye will make up for any loss of contrast sensitivity from the Vivity eye.
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This is the same approach as you are thinking, but in the reverse order.
john20510 RonAKA
Posted
Thanks do you mean clareon monofocal set for distance , would that still give me some intemediate vision even though its set for distance? Why clareon, does it give a bit more intermediate then other monofocals, what about eyhance instead of clareon
RonAKA john20510
Edited
My thoughts are that you have very modest expectations for closer vision. I think you said you wanted to be able to see the dash instruments of your car and to be able to shave without glasses for example. You have about a 90% chance that you will get that with a standard monofocal lens. With a monofocal there is very low risk of optical side effects like halos and significant flare. I would do a monofocal in your dominant eye first with it set for full distance correction, and then see what you get for closer vision. If you are happy with it, then you could get another monofocal set for distance in the second eye. Overall this is the most risk free outcome - two monofocals. But of course you will need reading glasses for closer vision in the 12-14" range.
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There is a small risk you will not be happy with your close vision with the first monofocal. If that is the case then you could put a Vivity lens in your second (non dominant eye). That should easily assure you of closer vision. And because you will have a monofocal lens in the first eye it will make up for any loss of contrast sensitivity with the Vivity eye. You could also likely use an Eyhance. It would not provide as much close vision as the Vivity, but is probably going to be enough. A third option would be to just use another monofocal in the second eye and ask the surgeon to target to leave you at about -0.75 D myopic. This will assure closer vision, but you will still need reading glasses. You likely also will with the Vivity, and Eyhance options too.
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My point is that if you go with a Vivity in the first eye, the option of two monofocal lens is off the table. If you go with a monofocal first then you have the option of two monofocal lens and also a monofocal combined with a Vivity. That is a decision you can make 6 weeks after the first eye is done and you have seen what you got.
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I mentioned Clareon as it is the latest material used by Alcon. It is an updated version of the very popular Alcon AcrySof IQ monofocal lens. You may pay a small premium for it, but I think it is worth it.