Posted , 20 users are following.
l am 48 and need cataract surgery this year my ophthalmologist says the vivity lens is the best IOL to go with, he says it has the most range of vision with the least side effects, do you agree? anyone here had positive or negative experience with it
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RonAKA john20510
Edited
There are lots of different lenses to choose from. Each has their pros and cons. A Vivity will let you focus a little closer, but not much. A standard monofocal should give good vision down to 2 feet. A Vivity reduces that to about 1.5 feet.
john20510 RonAKA
Posted
If l was going to go with a standard monofocal would you consider Eyhance the best, would that give me a bit more near vision then the average monofocal
RonAKA john20510
Posted
The issue with the Eyhance is that it varies the power of the lens from the outside to the middle of the lens. It is not a aspheric design which is intended to provide a sharp focus at a single point. It smears the focus point to give the extended depth of focus. As a result the quality of vision at the optimum point is lower. Have a look at figure 10 in the article below. The monofocal Tecnis 1 (black line) peaks higher in visual acuity, at about at nearly -0.1 which is better than 20/20. The Eyhance is flatter but does not provide as high of a peak acuity level.
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Mivision Education Unaided Intermediate Vision: A Paradigm Shift in Cataract Surgery?
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These curves assume that the lens power is perfect for the eye with the peak occuring at the point for maximum distance vision. However in actual practice it never ends up that way as the IOLs come in steps of 0.5 D power. There is always a compromise. So the typical target for a monofocal (black line) is at -0.25 to -0.5 D. That shifts the black line to the right by those amounts and pretty much closes the gap between the monofocal and the Eyhance. If you read the article further, some surgeons move the Ehyance the opposite way to the left to take advantage of the flatter landing zone. but that reduces the vision closer up.
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This is what drives me to think that monovision is a better solution than these EDOF (or mini EDOF like the Eyhance) lenses. Just visualize the black line moved to the right by 1 D in the non dominant eye, and 0.25 D to the right in the dominant eye. The distance zone covered is much wider and better than two matched Eyhance lenses.
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And I am not sure what the cost of an Eyhance lens is. I recently got my second eye done and was given a price list of the Alcon lenses. The basic monofocal in our system is $0, but the extra charge for Vivity and the PanOptix are $2175. Both the same. Not sure if the same applies in the J&J lenses.
rhett20790 RonAKA
Posted
im thinking of monovision at -1.5d
good idea?
RonAKA rhett20790
Posted
Yes, I think mini-monovision with a monofocal like the Clareon at -1.50 D is a good idea. Ideally you should try it first by using a contact in your non operated eye to simulate -1.50 D on a total spherical equivalent basis. Same with targeting with an IOL. Target based on spherical equivalent which is the sphere plus 50% of the cylinder.
rwbil john20510
Posted
There is no best IOL as they all come with tradeoffs and each person has to determine which tradeoff is best for them. In addition you have crazy folks like me who do a mix and match IOL. I would also add, some people have other eye conditions, which eliminates them from getting diffractive IOLs.
Vivity falls into the NEW category of Premium Monofocals, which also includes Eyhance and RayOne EMV.
Vivity will give you only a slight EDOF of about .5D, this will basically give you 1 additional line on an eye chart for intermittent and close vision. I should add it is important to realize, Vivity also comes with Contrast Sensitivity loss.
Vivity will not be at high risk of dysphotopsias like a diffractive IOL, but, in general, it is not going to give you great close-up vision. Heck people get the Symfony IOL with 1.5D of EDOF and they complain they do no get great close vision. You could also do micro monovision with Vivity to boost your close vision.
My suggestion is pull out the defocus curve for the Vivity IOL as it will show you the average Visual Acuity across the distances and you can see if it is a good fit for you.
john20510
Edited
l dont mind glasses for reading close up, what l want is good distance and fairly good intermediate for example reading car dashboard making a meal without glasses , you mentioned lower contrast , would it be noticable or much less contrast compared to standard monofocal . l read a few bad reviews here from people who got the Vivity, would going with Eyhance be safer
rwbil john20510
Posted
I have diffractive IOL which have greater contrast loss than Vivity, so I am not the best judge.
Honestly I think a lot of it has to do on the age of the person, their vision quality before surgery and the personality trait (maybe not the best word to use) of the person.
Lets assume everything went perfect with implantation, IMHO you could give the same lens to 2 different people and their after results could be the same and one would be unhappy with the contrast loss and another would be fine with it.
Overall I think the Vivity is a Great IOL if you want to take the safest IOL option, but want to just boost your intermittent and close vision.
On Eyhance, I have not read it produces CS loss, but it also has less EDOF than Vivity. You might gain 1/2 a line of intermittent and close vision.
Again it all comes back to knowing the tradeoffs and deciding which one you would accept.
RonAKA john20510
Posted
Based on my experience I see my car dash perfectly with a standard monofocal. I would easily be able to make a meal if I did not have to read a recipe. My wife has a monofocal and she is the same. You have to think about what you want to read closer than two feet that you would read at 1.5 feet. That is all the Vivity gains you unless you offset it by -0.75 to -1.0 D in your non dominant eye. Then you will see normal text on paper fine, and read your iPhone fine, as well as see a computer monitor. Eyhance gives you a little less close vision than the Vivity. It will have loss of contrast sensitivity too, but a little less than the Vivity. You would have to offset the Eyhance by 0.25 more than the Vivity to see normal text on paper easily.
soks john20510
Posted
yes.
john20510
Edited
He said he can do the vivity or the eyhance , He said panoptix has too many problems. He said he has lots of experience with the vivity and lots of happy people with it and he said its the best one if l want good distance and intermediate, he said its $9,000. l dont know if he is just trying to sell me the most expensive one and l am worried after reading some bad reviews about vivity on this forum , but he has a good reputation and done 20,000 cataracts over 20 years. Here in Australia l could go with the public system and get a standard monofocal for free but the waiting list is a year and l have the fast growing posterier subcapular cataract so l cannot wait a year l have to pay to go private, l just need to decide vivity or eyhance , The most important thing for me is excellent distance vision and enough intermediate to not need glasses , dont mind glasses for reading. l am worried about making the wrong choice and ending up with bad vision for life as l am 48 and still have 40 years left
RonAKA john20510
Edited
For some comparison I am about to get my second eye done next week in Alberta, Canada. My first eye cost me $0 for the monofocal AcrySof IQ lens, consultations, and the procedure. My only cost was $70 for the eye drops and dark glasses. The options offered to me for my second eye are the monofocal AcrySof again for $0, an AcrySof IQ Toric for $1100, a Vivity for $2175, or PanOptix for $2175. The Vivity and PanOptix are non toric or toric for the same price. Of these choices I have selected the new monofocal Clareon for $300. My surgeon discouraged me from going with the Vivity. I had already decided I would not risk the PanOptix. And the surgeon kept flip flopping between whether or not I needed a toric. So I just went for the monofocal Clareon. I will use monovision so I don't need the extra depth of focus of the Vivity or PanOptix. These prices are incremental above the cost of the basic monofocal. I don't know what that costs here as it is fully covered by our public health, but I would guess it is in the $1200 a lens range. These are $ Canadian.
soks john20510
Posted
there is a debate on whether alcon has resolved the glistening (micro bubbles) in their iol material or not. glistening is time induced so it is a consideration for 40 years. without that vivity gives great range (more than eyhance) without diffractive rings.
aspen88 RonAKA
Posted
why did your surgeon discouraged you from using vivity?
RonAKA aspen88
Edited
I think he identified me as someone that had high expectations for vision and did not want to take a chance that I would be unhappy with the vision quality of the Vivity. When I asked him about his experience with the Vivity he said that he had another patient with similar expectations as me, and got the Vivity, and was disappointed.