MY OPHTHALMOLOgist says Vivity IOL is the best

yes it $4500 each or $9000 for both, thats Australian dollars, that includes surgery and eveything , l dont have private health insurance. its alot of money but if it gives me good vision its worth it but lm worried he just wants me to go with the most expensive option and perhaps the eyehance or standard monfocal would be just as good and less side effects

I would argue that two basic monofocal lenses in a mini-monovision configuration actually meet all the points just as well or better than the Vivity. Or at least I hope that is true because that is what I am about to do!

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That said if there is a drawback to the mini-monovision approach it is that the surgeon and patient have to put more effort into getting the power selection right. And, if it is missed, then some post cataract surgery Lasik may be required to get it right. Some surgeons may not be prepared to put the extra effort in. And, I would include my surgeon in that category. They are used to recommending a lens, and the patient accepting it with no questions asked. Mini-monovision requires more effort than that.

Thanks so is the contrast and vision quality past arms lenght excellent and just as good as you expected? Can you see well close up with glasses on ? Vivity only promises distance and intermediate and not near , is it possible once both eyes have vivity in then the near vision could get a bit better , maybe they need both eyes working together to get best results

You can do what is called crossed monovision where the non-dominant eye is the distance eye. I have been simulating that with a contact lens for over a year and like it. The other thing you could consider is using the Vivity in your second eye, but ask for it to be targeted to leave you with -0.75 to -1.0 D of myopia. With the EDOF of the Vivity that should give you good close vision. Because the Vivity gives you closer focus this is less monovision than what you would need if you use a monofocal. For a monofocal -1.50 D of myopia is probably ideal for monovision.

Yes the far vision and intermediate vision are wonderful. And reading is good with +1 readers.

Yes I have read that suggestion elsewhere, re an 'underpowered' Vivity in the second eye, but I dont" really understand the science of that. I know the current one is 11.5 but 11.5 what I have no idea! At the moment I’m wearing a close-distance contact lens in my second eye and that’s great for near vision but there is a sacrifice with the far vision – not as clear as with the Vivity. It would be great if an underpowered Vivity in my second eye could improve the close vision without compromising the intermediate and far vision. Excellent news also about the dominant and non-dominant eyes. I have successfully used monovision contact lenses for decades.. Until I got cataracts.

Thank you.

I would not worry so much about the lens power calculation as this can be complicated factoring in Axial Length and other factors especially if you have short or long eyes.

In simple terms just think of this as the power to achieve optimal refractive outcome. Typically it is set to Plano or Emmetropia.So the incoming light is focused at the perfect spot.

Trying to keep that concept simple, it is about when you see that Snellen Chart 20 feet away your vision will be the best it can be.

But Plano might not be the best option for everyone.

As you mentioned Plano in both eye that have a monofocal IOL will not have good intermittent or close vision.

So one technique is monovision where typically the dominate eye is set to Plano or -0.25D and the other lens power is adjusted. What that adjustment is depends on what your goal is.

But with everything there are tradeoffs and everyones results will vary. If one could just do monovision and have Great distance, intermittent and close vision no one would get a diffractive IOL, which included me.

Full Monovision has been shown to have problems. The greater the monovision the greater the image difference being presented to the brain. So most people do mini or micro monovision.

I can tell you I see 20/20 and 20/20-2 out of each eye individually, yet bilaterally I see 20/15-2. So the 2 eyes work together to create a better image than each eye can individually. I would think monovision does degrade distance vision, again depends on how much monovision one gets.

Contacts are relatively cheap and you can test this out yourself by using contacts and setting them to achieve different refractivity. So whatever contact power gives you Plano reduce it by -0.50 and so forth in -0.5 steps and see how it effects your distance vision. And then you can determine what works best for you.

IOLs use a different power scale than glasses. They range in power from about 5.0 D to 30 D. A 5.0 D would be used for someone that is very myopic or short sighted and has a "long eye". A 30 D would be used for someone very far sighted. The "zero" of the IOL power range which would be used for someone with a catarct but not needing any power correction would be about a 19.0 D power. Your 11.5 power would indicate you were near sighted before the surgery. Perhaps about -7.5 D? Your second eye may be different, but your eyeglass prescription before surgery would be a clue.

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Your comment that +1.0 D reading glasses gives you good reading vision would suggest that if you under correct the second eye by 1.0 D with another Vivity in the second eye you should get about equal reading vision was with using the reading glasses. As you have done monovision before with contacts, you will know there is a compromise of distance vision in the near eye. The upside of using a Vivity for the near eye in monovison is that less under correction is needed to get reading vision, so your distance vision is less compromised. As I mentioned before an under correction to leave you at about -0.75 to -1.0 D should be good. In my experience with monovison the brain does a good job of switching between eyes and determining which eye image to use. I frequently sit in front of my computer and have the TV on 15 feet away. I can easily switch between reading the computer at about 12" to seeing the TV clearly at 15' with no glasses on.

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If you are interested you should discuss with your surgeon. You obviously need the surgeon's approval as they will have to choose the right power of lens in the second eye to give you the -1.0 D myopia.

if 11.5 is plano then 12 would give you +0.35 closer vision. 13 would give you about +1 vision in the eye. you would need -1 glasses to make distance clear in that eye. of course your iol master would have these calculations. ask for a copy. also both eyes may not be similar so 11.5 may nit be plano for your other eye. use iol master multiple readings or ORA during surgery for accuracy.

With all your own reports, you also have to consider at which refractive value the surgeon ultimately landed. This allows the result to be better understood.

Reditor: At what refraction value did your surgeon end up? And which one had he targeted? (maybe you ended up at 0 or slightly in the plus. This would explain your visual acuity description)

My only concern with the vivity is that it has lower contrast then a standard monofocal , how much quality of distance vision contrast am l giving up to get better intermediate vision, will it be a noticable decline in contrast compared to a normal healthy eye?

I'm no expert but I am not aware of any lack of contrast. AFter having a cataract, the quality of distance vision with the VIvity seems great to my untrained eye.

I thought I would report back as I had my second cataract surgery 2 days ago. I had a Vivity lens put in just over a fortnight ago, and reported that in the days after, I was delighted with the distant and intermediate vision, but disappointed with the close vision. I can now report that the closeup vision IMPROVED A LOT over the next fortnight. To the point where, having weighed several options, I went for exactly the same Vivity lens in my second eye. It's early days, but I'm thrilled with the result. I can do pretty much everything without glasses, including computer use, the crossword in the paper, and reading my iPhone. Plus-1 reading glasses improve the focus if I want to do some extended reading, but for day to day I'm glasses free and delighted. Thanks everyone for their suggestions here.

It is good to hear that everything has turned out well for you.

Hi reditor, l'm still trying to decide between eyhance or vivity, my surgeon said vivity is better m you good results with the vivity makes me lean more to vivity, all l really want is good distance and intermediate without glasses and the vivity seem s to deliver that

The Vivity lenses are great for me, John, delivering everything you are after, but I have no experience with the Eyhance so I'm not much help to you there.

I haven't had surgery yet but I've done a ton of research and read many patient experiences and my conclusion is that in normal light with binocular vision you are highly unlikely to notice any contrast loss at all at any distance. But in challenging lighting like low light or low contrast (driving in fog for instance) things might not be ideal. In the case of reading, just add some light to the subject. In the case of challenging driving conditions, I really don't know… but the patient info insert simply says to "exercise caution".

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Personally I suspect too much has been made of the Vivity contrast issue (and I may be partly to blame… re: an old thread of mine about the issue).

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That said, I'm an incorrigible perfectionist (to a fault) and unwilling to accept any risk of a quality trade off at all… and I also volunteer with search & rescue and am an avid backcountry hiker / camper etc. so the best possible night vision matters to me… so I've decided to take my chances with Eyhance (and possibly a micromonovision offset). And I've accepted that making this decision means I might need progressives after surgery to make day to day stuff like quick watch / phone glances convenient. We'll see.