My Eyhance Experience

Not sure if xen42188 is still active on here but I private messaged him a couple months ago and he said yes, it essentially went away. Once the second eye was done his eyes started working better together and it was no longer noticeable (or went away). He said there was still some ghosting at the closest distance (near vision) but perhaps that's just how the Eyhance IOL works?

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I recently went through the same issue with Eyhance. I had a number of complications actually... dry eye, cystoid macular edema, and surgically induced astigmatism. When you're still healing and you have multiple issues going on it's hard to disentangle them all. I'm 12 weeks out now though and the CME has essentially cleared and I got some prescriptions glasses for the astigmatism and I'm pretty sure the dry eye has cleared up too (no more gritty feeling and when I yawn / blink both eyes are making the same amount of tears where as before the IOL eye wasn't making may tears)... and things are finally looking up for me.

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So where I'm at now is, there is zero ghosting at distance, with out without my astigmatism glasses. But the astigmatism glasses sharpen things up and even though it's subtle (I can see pretty good without them too... 20/20) the extra bit of sharpness is amazing. Distance vision is breathtakingly clear with the glasses on.

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I DO still have some subtle ghosting close up (like computer distance). It's only really noticeable with screens not printed material. And the ghost is only maybe 10% as opaque as the main image. And adding +1D dollar store readers (which cost me $1.25) make the ghosting go away. So I do think this IOL in my eye with my cornea and my brain tends to have some ghosting on defocus. I don't know if that's just my eye or the Eyhance or the Eyhance + Astigmatism or what... but it's not so bad.

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Anyway it's been a rough 12 weeks dealing with ghosting, fuzz, distortion, etc. at all distances in all lighting... but it's almost completely cleared up now (again except for some very slight ghosting when pushing the limits of the Eyhance... i.e. lit up high contrast text at 24 inch distance or less) and I'm pretty happy overall.

How much residual astigmatism cylinder did you end up with?

Cornal topography shows me going from -0.6D WTR pre-op to -1.1D WTR post-op (so 0.5D residual astigmatism as a result of the temporal incision which is pretty typical). But oddly my optometrist only prescribed -0.75D cyl… which is only a quarter more than my pre-op RX. Is the IOL somehow "correcting" some of it? Or maybe my optometrist didn't quite get it right? Don't know. I don't think the IOL should add or remove any Astigmatism (it's not a toric)

Seems to vary a bit over time too. I've gotten slightly different cylinder values for my right eye from optometrists. 1 month after the IOL was implanted it was -0.75D, 6 months after it was -1.00D and now after 4 years it was -1.25D. Sphere value also moved from +0.25D in the months after the surgery and now after 4 years my latest refraction it was +0.75D

I got a toric IOL since initially my right eye had around -3.00 cylinder astigmatism at near 180degrees. That appeared to be eliminated by the toric IOL but an additional astigmatism probably from the incision at a totally different angle around 107degrees was left as residual, around -0.75D to -1.00D initially. Even with that I get about 20/25 distance vision uncorrected and better than 20/20 with it corrected via eyeglasses.

Thanks for your helpful insight. I am being examined tomorrow and hoping this practice recommends Eyhance, as halos from my cataracts make things indistinguishable driving nights.

What did xen42188 mean by binocular vision?

I thought with Eyhance lenses , one was adjusted to distance and the other adjusted to up close for vision without glasses.

I also have astigmatism, so I take it that Eyhance lenses do not address it and that lasik surgery is not used in conjunction?

Good to hear that it is working out for you overall.

Binocular just means both eyes working together. So when he got the second surgery done things started working better overall.

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Eyhance is a monofocal but with a little more intermediate vision than a classic monofocal. It is not specifically designed for monovision (where you set one eye to a closer focus point) but like any monofocal IOL, it can certainly be used that way if you want.

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Eyhance comes in a Toric version which can correct your existing Astigmatism. The surgery itself can also induce some added Astigmatism though. They call this residual Astigmatism. I had half a diopter of Astigmatism before surgery and i have a full diopter now. Not ideal.

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Astigmatism correction after surgery can be done with glasses, contacts, LASIK (although LASIK can't be done on people with thin corneas), PRK (an older laser process that works on thin corneas but is more invasive) or, if your Sphere is 0 (20/20 without glasses), Femtosecond Laser limbal relaxing incisions (LRI) can also work (least invasive laser option). If you have a fair amount of Astigmatism before surgery though it's of course best to try to treat that at the same time as the surgery with a Toric and/or LRI. LRI can also be planned in such a way as to avoid surgically induced residual Astigmatism.

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BTW, since my last post I did a little test with my computer vision… during a time of day when I was noticing the slight ghosting / double vision on the computer (it's barely noticeable in bright light) I tried stacking two glasses on top of each other… my Astigmatism glasses AND a +1 reader. This makes the monocular ghosting 100% disappear. No trace at all. And the screen looks amazing. So I do think the issue is the Astigmatism at near / intermediate in less than ideal light… not any issue with the IOL or the surgery. It seemed weird and concerning to me at first because I assumed defocus would be a soft blur, not ghosting / double vision. But that seems to be what happens (or can happen) in the presence of Astigmatism.

Sounds like you discovered the root cause as well as a doable solution. I asked today about my Astigmatism and it appears that it is not enough to adversely affect an anticipated good outcome from cataract surgery.

They normally use Clarion, but were open to doing Eyhance.. Not sure of the pros and cons, but a little reading tonight should lead me to an informed decision.

Surgery is set for January two weeks apart. Mini-monovision is their plan, with reading glasses for up close work (assuming Clarion) and I am alternatively guessing/hoping no glasses if they go with Eyhance.

I get measured next week. . .

Clareon is a monofocal, while Eyhance provides some modest extension in depth of focus of about 0.35 D. For mini-monovison you could use a Clareon in both eyes if you target 1.5 D in the near eye, and -0.25 D in the distance eye. You could use an Eyhance in the near eye, and in that case target -1.0 to -1.25 D. The only issue is that Clareon has blue light filtering and the Eyhance does not. It is a minor issue, but the colours viewed with each eye will be slightly different. Or you could go with a Tecnis 1 in the distance eye and Eyhance in the close eye so both will not have blue light filtering. All of these options should not require glasses except for very fine print.

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One thing to consider is that it may be best to go with the lens that the surgeon has

experience with.

Blue light filtering and its benefits was something I had forgotten to consider until you brought it up. Definitely pushes me in the direction of Clareon.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901063/#S0001title

And yes, I agree with your suggestion for a best outcome to go with the lens that my surgeon is experienced with, a win-win., particularly considering the overall outcomes of success in controlled studies closely mirroring my surgeon's direct experience with patient satisfaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068507/

I will mention the 1.5/-.25 combo on my next visit, thanks. PS How do you arrive at those numbers, or for that matter, any numbers?

I had my distance eye done first to 0.0 sphere with a AcrySof IQ lens, and then used a contact to simulate -1.5 and -1.25 D in the other eye with contacts. I went that way for about 18 months and liked it a lot. I also used some +1.25 and +1.50 reading glasses with the AcrySof eye to simulate what I could get for reading vision. The final decision was to go with the -1.5 D offset. And in the near eye Clareon had become available so I went with it. My final result was a sphere a bit lower than I wanted and cylinder a bit higher. The combined spherical equivalent is -1.40 D, and I can see very well with it. I am virtually independent of glasses, but I do have a pair of progressives that I can use, but almost never do. I also have some +1.25 readers left over from my trials and use them occasionally for fine print.

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EDIT - Oh, and the reason for targeting -0.25 on the distance eye is to minimize the possibility of going into the + zone. That reduces your near vision and is best avoided. There almost always will be a choice in lens powers with one predicting a slight plus to a perfect 0.00 D outcome, and one predicting a slight negative. Better to go with the negative one.

For what its worth I have Eyhance in one eye and I don't notice anything unnatural with colours. Colours don't look blue or cold compared to my un-operated eye. Greens and blues look identical. If I look at a white sheet of paper then yes the un-operated eye looks a little warmer but it's subtle and also, I suspect that may be the cataract more than anything else. Colour looks amazing to me with Eyhance. I think in terms of the impact on colour perception, blue filtering vs. not is probably extremely subtle, almost unnoticeable. For me at least. Of course it's impossible for me to compare to an Alcon IOL so I can't say for sure but for me anyway, the blue filter vs. not it a complete non-issue.

Agreed. As I said it is not a big issue, but some believe the blue light filter is more protective. I really have not researched it. When I got my first eye done I noticed a huge difference between my new IOL eye and my other eye which had a cataract forming. And, before my first eye was operated on, I noticed quite a difference in whites between the two eye. The first eye done had a much more advanced cataract.

I talked to two cataract surgeons about blue light filter on the IOL and both said they didn't think that was a idea because there was evidence that suggests it could impact your natural circadian rhythm.

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That makes sense to me. Although I might want to filter blue light during evening hours at the computer, i'd like to do that with glasses so i can make that choice.

That is the strangest reason I have ever heard for not using the blue light filter. I can't agree with that line of thinking. The blue light filter AcrySof (or Clareon) is a much closer replication of the colour spectrum of the natural human lens than a clear lens IOL. If there is something unnatural for the eye, it would be the clear IOL. It presents the retina with a much higher intensity of shorter wavelength (blue to violet) light. Most often there is some discussion about whether or not this exposure of shorter wavelength light is harmful to the eye or not. And those that favour clear lenses seem to conclude that IOLs are used later in life and there is less time left before death to do damage to the retina, so the extra light that is allowed offsets the risk of damage to the eye. There is some logic to that, if one can accept an unnatural colour spectrum of a clear lens. A person doing colour photography darkroom work, may not.

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If blue light filtering affects natural circadian rhythm, then just about everyone on earth that does not have a clear IOL will have an upset rhythm. See this graph on how the AcrySof blue light filter lens compares to a 25 year old, and 54 year old, and to a clear lens. The AcrySof lets in more blue light than that of the natural lens of a young person, but not nearly as much as a clear lens.

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Also as an alternative, on many screens, monitors and TVs, you can adjust the white balance and lower the blue level in the settings for those devices.

If you want to do some more research on the controversial issue of blue light, here is an article you may want to read.

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Canadian Association of Optometrists Blue Light: Is There a Risk of Harm? November 28, 2022

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My synopsis of the article is that there is some good and some bad in blue light. The bad portion seems to be the high energy part which ranges from 400 to 470 nm. The lower energy and lower risk portion is above that from 470 to 490 nm.

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When it comes to IOL filtering the clear UV only IOL lets virtually all of this light from 400 nm and up right through. The intensity is several times that of even a young natural eye. On the other hand the AcrySof/Clareon blue light filtering makes a significant reduction to the blue light range with most of the attenuation coming in the higher energy 400 to 470 range. While it is not an exact replication of a young natural eye, it is much closer than a clear UV only IOL.

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When reading this article it is worthwhile keeping in mind that the application of this information is with respect to the need for blue light filtering eyeglasses in people that do not have an IOL. So in other words their starting point is the 25 and 54 year old curves for natural eyes. Most articles I have read seem to conclude blue light filtering eyeglasses are not really needed for those with natural lenses in their eye.

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My thoughts on this when I was deciding for or against blue light filtering was the safe choice would be to replicate what the natural eye does for purposes of protecting the eye from long term blue light damage. A side benefit may be somewhat higher contract sensitivity in lower light conditions. The down side of course is a reduction in the overall light level.