My Vivity Experience
Posted , 16 users are following.
Today is day 2 following cataract surgery in my non-dominant (left) eye. A Vivity Toric IOL was implanted targeting -0.75D. I'm scheduled for cataract surgery in my dominant eye in two weeks. Yesterday, my optometrist checked my eye pressure and the condition of the cornea. The incisions are healing nicely, and the Vivity lens is centered perfectly.
My pupil is still enlarged, but getting smaller slowly. I’ve noticed that vision in my Vivity eye is improving as the pupil returns to normal size. I still cannot see my cell phone clearly, even at arm’s length. I also see the ghosting of letters. My optometrist said my vision will improve as healing progresses. My Vivity eye is giving me good distance and fairly good intermediate vision. I’m relying on my myopic dominant (right) eye for near vision, however.
I’m currently going without glasses all day. I’m effectively doing monovision (a.k.a, blended vision) and it seems to be working for me. With my very myopic dominant eye, I can focus on objects 6” away which allows me to see clearly to put on eye makeup and pluck my eyebrows. I would hate to lose that ability, but c'est la vie. I notice some interference from my myopic eye, but I have not experienced any headaches.
In the next 5 or 6 days, I have to decide what IOL to have implanted in my dominant eye. It will depend on what near vision acuity I get from the Vivity lens in my non-dominant eye. My plan was to have my dominant eye implanted with another Vivity lens at plano (optimized for distance) if the loss of contrast sensitivity isn't too severe. If it is, I would elect to go with an Acrysof monofocal toric at plano instead.I don’t notice any significant loss of contrast sensitivity in my Vivity eye compared to my right eye, in fact, it’s brighter than my natural lens. Of course, the cataract itself reduces contrast sensitivity.
Implanting a second Vivity is looking more and more feasible. I still have to check out my night driving, though.
I could have a second Vivity implanted in my dominant eye offset to match that in the non-dominant eye, i.e., offset the same -0.75D. Binocular vision with Vivity increases visual acuity over monocular vision with Vivity. I could get 20/32 (logMar 0.2) or better at 13" with only a slight decrease in distance acuity and no loss of depth perception.
An alternative, if the Vivity near vision is not good enough to go without glasses for reading, but gives good distance and intermediate vision, is monovision, implanting an Acrysof monofocal toric IOL in the right eye targeting -2.50D (my current right eye sphere is -3.00D). Whether or not this is a viable option depends on how I adapt to my current monovision in the next few days.
Another option is to have a Panoptix multifocal IOL implanted in my right eye. I’m still wary of doing so, however, because of the visual disturbances (halos and starbursts) that occur at night.
I'm probably over thinking this, but I have a tendency to do that (sigh). Any thoughts?
1 like, 86 replies
clara26552
Edited
I just returned from my optometrist. My Vivity Toric eye looks good at 8 days post-op. Eye pressure is good, and the cornea is healing well with only a bit of inflammation remaining. The IOL is still well-centered.
Distance vision in my left eye was measured at 20/20, and intermediate vision at 20/25. My optometrist said my left eye is under corrected by -0.6D (how did they measure that?). My ophthalmologist wrote in my chart that she targeted -0.5D, not the -0.75 that I requested. I’m not sure why she did that; maybe it was necessary given the half diopter steps available for the Vivity lens.
Anyway, with the Vivity lens in the left (non-dominant) eye I have good vision at distance to 20” (20/25 or better). My optometrist recommended targeting -0.5D in the right eye when I have the second Vivity lens implanted next week. We discussed the loss of contrast sensitivity with the Vivity lens. She said that it hasn’t been a problem for other patients. From my own experience, I don’t think it will be a problem for me either which is why I’ve decided to go with a Vivity lens for my second eye, too.
So it looks like I'll end up with both eyes matched at about -0.5D. It’s not the mini-monovision I was aiming for. But I'm not disappointed. I’m giving up one line of distance visual acuity to get one line of near visual acuity (20/30 at 16”).If all works as planned, I'll have good depth perception, no night driving dyphotopsias, and be glasses free except for reading in dim light.
clara26552
Edited
If I had to do it over, I would have had surgery on my distance eye done first as most people do. I chose to do my non-dominant eye first because I was concerned about the effect on night driving if I had Vivity lens in both eyes. That concern arose from information I read on the internet. At this point, having a Vivity lens implanted in one eye, I don't anticipate any problem implanting it in the other eye due to reduced contrast sensitivity. Others may disagree.
I would also have sought out an ophthalmologist who has time to be more involved in selecting the best IOL configuration. Having to go through an assistant for all communications is not optimal. My surgeon is very skilled, but also very time limited. Cataract surgery has taken on a kind of mass production character. Don't expect a lot of guidance from the people providing this service.
The eye health professionals I interacted with seemed somewhat reluctant to pass along useful information without direct questioning from me, and even then answers were not very helpful. My ophthalmologist did take the time to make sure that I understood that the final outcome of my eye surgery could not be accurately predicted or guaranteed. I guess I came off as one of the dreaded "perfectionists" mentioned in the patient questionnaire.
Many of the people I've talked to who have had cataract surgery in the recent past often have little recollection of the details of their surgeries. Few could tell me their IOL brand, type, or correction. That's surprises me considering how important eyesight is all of us.
RonAKA clara26552
Posted
Keep in mind that if the lens used left you with -0.6 D, the next lens choice would leave you at -1.1 D. I would probably choose the -0.6 D for all around good vision. It is really an insignificant difference between that and -0.75 D. With the second eye, you could consider a target range of -0.5 to plano. For example if your second eye was identical to your first the next lens choice the other way would leave you at -0.1 D which would be ideal for a distance eye. It is best to discuss the lens power choice directly with the surgeon as they will know best where you are likely to end up.
clara26552 RonAKA
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Thanks for your response, Ron. You've been such a great help. Not just to me, but others as well.
I'm not overly concerned about my distance vision after having completed my first surgery and seeing at 20/20 in that eye. I was expecting it to be 20/25 targeting a slight under correction. It could deteriorate some as healing continues. My distance vision has never been particularly good with so much astigmatism and eyes that constantly needed stronger and stronger prescription lenses. I'm more concerned about squeezing out a little better near vision to limit my need for glasses in dim lighting situations.
My optometrist noted in my chart and promised to inform my ophthalmologist directly that she should target -0.5D in my dominant eye. Yes, that could end up -0.9D or -0.1D, given the variability of the factors that determine the final outcome.
I feel that the best chance I have of being able to read text on my phone at 16" is to have the EDOF Vivity lens implanted in my dominant eye at -0.5D, matching my non-dominant eye. Clinical trials and other studies seem to suggest my being able to achieve that goal.
I'm pretty sure I can live with any myopia in my distance eye between plano and -1.0D. If my surgeon hits -0.5D, that'll be great. If not, I'll benefit from either better near vision or better distance vision. It's a bit of a crap shoot, isn't it?
RonAKA clara26552
Edited
I am not convinced there is any need to match the -0.6 D in the other eye. If you were to end up plano then the anisometropia would be only 0.6 D, which is almost trivial. That said you do not want to go positive. There is no replacement to having a direct conversation with the surgeon with her estimate of outcome of the two lens powers that there will likely be to choose from. I am not so sure I would be comfortable working through an optometrist. The way it works where I am in Canada, your optometrist makes the referral to a surgeon, and after that you deal directly with the surgeon. The optometrist to my knowledge does not see the detailed eye measurements and calculations the surgeon makes. You don't see your optometrist again until 3 weeks after the surgery. The surgeon does the 24 hour post surgery exam themselves and gives recommendation as to when to see the optometrist.
clara26552 RonAKA
Posted
It's different in my case. The ophthalmologist is hard to schedule time with. She does up to ten eye surgeries a day. I'm assigned a patient coordinator that acts as a go between, but she never gets involved in actual eye examinations, and seems to act primarily as a buffer. My optometrist does have access to my surgery records, has access to the surgeon, and we have a history together. She's very knowledgeable and takes all the time I need to discuss matters with me. I trust her council.
clara26552
Edited
I had a second Vivity toric IOL implanted yesterday. This time it was for the right (dominant) eye. I now have a Vivity toric IOL in both eyes. The left eye is undercorrected by -0.6D, and the right eye is only slightly undercorrected (close to plano). I asked my ophthalmologist to target -0.5D, but she apparently didn't like the idea, choosing not to compromise my distance vision.
With both eyes I'm see 20/20 for distance, and 20/30 for reading. These results could change, for better or for worse, when healing is complete. At least for now I'm pleased with the results.
But that's not the whole story.
Immediately after the surgery, I had moderate pain in my right eye. I was able to see my ophthalmologist within a couple of hours. She administered a drop of yellow medicine to numb the eye and another drop designed to reduce pain by relaxing the iris. It worked. By evening I felt no discomfort. I noticed, however, the presence of floaters in my right eye, and everything looked darker compared to my left eye. None of these symptoms occurred after my first eye surgery.
I discussed the matter with my optometrist today. She measured the pupil of my right eye to be just 1 mm, and suggested that the darker vision was due to the pupil being constricted by the drug that was administered the previous day. When its effect wears off tomorrow she will dilate the eye, if necessary, to examine my retina for any sign of separation (floaters are a symptom of retinal detachment). She emphasized, however, that the presence of floaters is not uncommon after cataract surgery, so I shouldn't be overly concerned. I've never experienced floaters before, so she felt that examining the retina was a necessary precaution.
When my pupil regains normal function I will take a drive after dark to see how having a Vivity IOL in both eyes affects my ability to drive. Some loss of contrast sensitivity is expected. Hopefully, it will not be so much as to make night driving unsafe.
clara26552
Edited
Okay, so this sucks. My second cataract surgery has triggered PVD (posterior vitreous detachment). I now have a bunch of floaters making a mess of what would otherwise be a really good result from my Vivity lens. My eye doc took a set of retina photos, and when compared to the photos done a couple of years ago, it's obvious that a detachment around the optic nerve has occurred. The floaters are large and extremely annoying, especially in bright daylight. They refract the light creating blurred spots that move within my field of vision
On the positive side, I am not seeing flashes of light which often accompany PVD, and the retina exam did not show any problems with the retina itself. The thing is, retina problems often show up a few weeks after the initial PVD, so my optometrist is going to monitor it at each of the next several cataract follow up surgery exams.
I'm told that PVD is more likely for strongly myopic people, and that a PVD will likely happen in the other eye before long.
clara26552
Edited
My cataract surgery in both eyes is now complete with the final follow up examination today. I had Vivity toric lens implanted in both eyes taking a mini-monovision approach. The results have been most satisfactory from a visual acuity standpoint, but the quality of vision has been compromised by the development of a PVD Weiss Ring floater directly in my line of sight of my right (dominant) eye. It's most noticeable in bright light settings, and makes it seem like I'm looking through glasses that need a good cleaning. After a month since it appeared, it's still very annoying, and I have no reason to belief that I will adapt to its presence. I'm exploring the possibility of having vitreolysis using a YAG laser to have it removed.
My binocular distance vision is 20/20 and near vision 20/32. I have no problem reading text on a backlit computer screen or reading text on my Galaxy Note 9 phone at 16 to18 inches. I can read book text in good light as well without glasses. In poor light, I prefer to use +1.25 cheaters to avoid eye strain.
Night driving is fine. I do experience a small amount of glare, but no halos, starbursts, or spiders. The reduced contrast sensitivity of the Vivity lens has not affected my ability to drive at night.
So my only complaint is this large floater. My optometrist is encouraging me to be patient. She says many people find that it becomes less annoying in time as it moves to the side or as neuro adaption takes effect. Having spent so much money on these premium IOLs, it's hard to accept less than acceptable vision.
Has anyone had a similar post-op PVD resulting in the appearance of large floaters? Has anyone had them treated with vitreolysis? If so, were you happy with the results?
NeluG clara26552
Edited
Hello Clara,
I don't have an answer for you regarding the floaters and I hope I won't have one next week, when I'll have my second surgery, for the right (dominant eye).
Our cases are very similar though, with the exception of the fact that I didn't have a cataract to begin with. For me it was all just to get rid of glasses because I hated them.
First surgery was on November 3rd, for my left (non-dominant eye) and I went with Vivity lens set for minivision , at -0.5D-ish...
All went very smoothly for me, no pain, no floaters, no light sensitivity, nothing!
I also went through this online contrast sensitivity test and the results are pretty good. I'll try to attach them here.
john42375 clara26552
Edited
Hi Clara - Yes, I have had a post-op PVD resulting in the appearance of floaters and lightning flashes. It was explained to me that PVD is the normal part of the aging process. In my situation, it was worst because it came about acutely and caused a retinal detachment. My retina surgeon fixed the problem. 6 months later the same thing happened in the other eye and I had to have surgery in that eye. The Weiss ring is normal with PVD. I had to learn to get used to it. After having so many problems with the PVD and my retina, I am grateful to still have my sight.
Quasimodem clara26552
Posted
Originally they had me with one toric lens and the other not. The surgeon said that looking at the myriad of tests that a toric lens was not necessary. I asked why and it was explained that the tests there were far superior to my optometrist.
All I can say is wow!!!
Quasimodem clara26552
Edited
I had both my eyes done yesterday, actually less than 24 hours ago, both with the Vivity!!!
i'm responding on my ipad which is about 10 inches away. i do have the ipad pro 12.5 inch.
i'm shocked at how well I can see. i had to reduce the brightness on both my phone and ipad to almost minimum, it was at a maximum and strangely everything seems more 3 dimensional. The only thing i can't see would be writing on a pill bottle. I could read a book with a bit of effort. My walls look whiter than I thought. My sight started to return within 6 hours so i am able to comment on how my streetlights look at night.
They looked like 19 lights bunched together before with a wide halo. Last night it was a solid circle easily 1/4 of the size.
I play tennis so that is why I chose this option. indoor tennis has bright overhead lights and i didn't want to deal with the halo effects of the other premium option.
I am in shock.
susan03345 Quasimodem
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Did you get toric lenses? And were you very nearsighted before the implants were done?
susan03345 clara26552
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What do you think about the Vivity lenses now that it has been awhile since you had them implanted? i was scheduled to get my first one a couple of weeks ago but had to cancel due to illness. I haven't rescheduled yet because, honestly, my dominant right eye still has pretty good vision (with glasses and the cataract in that eye is minor). I think my brain is relying on my dominant eye and ignoring the poorer vision in the other one. I would also need toric in both eyes. i have been very concerned about the loss of contrast sensitivity so am wondering if i should just go monofocal instead of Vivity. Your circumstances sound so similar to mine that i was curious what you think about it now. I too have worked with a patient counselor and haven't had much contact with the actual surgeon. I've been doing a ton of reading online, almost obsessively so. Also were you very myopic before the surgery? My surgeon did say that since i am quite nearsighted in my left eye the formulas they use might not be exact for the refraction and that I might still need glasses afterward. My contact lenses were monovision and i did great with that so i asked my "counselor" about mini monovision and all she said was "Oh he doesn't do that."
RonAKA susan03345
Edited
"My surgeon did say that since i am quite nearsighted in my left eye the formulas they use might not be exact for the refraction and that I might still need glasses afterward."
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You should ask about what formula is used. The Barrett Universal II formula is very good for near sighted eyes. The Hill RBF 3.0 is very good as well, if not better.
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As far as doing mini-monovision, any surgeon can do that using monofocal lenses. But, not all may be willing to do it with Vivity lenses. I would suspect the counselor may not know what mini-monovision is. I would ask to speak to the surgeon directly about it. There is nothing complicated about it.
susan03345 RonAKA
Edited
RonAKA, thank you. I will ask about the formulas. My neighbor is really unhappy with her vision. I believe she has monofocals set to distance but does not have good vision at any distance. Her surgery was several years ago. They have told her that her vision tests great. She said she wasn't counseled that she would lose her close vision. Her experience has made me hesitate to do anything at all. She did say her sister in Laguna Hills, CA had some sort of multifocals (her sister doesn't know the brand) which were implanted using the ORA system during surgery. It determines the refraction during the surgery after the cataract is removed. Her sister is very happy with her vision. It cost $4000 per eye however. I live in a different state and I don't think anyone uses ORA here.
I am so grateful for this forum. My husband is patient but I can't use him for a sounding board as much as I'd like to. He thinks I overthink everything. I'm struggling a bit with Vivity vs. just monofocals set to distance. I can't grasp how much better the intermediate and near vision would be with Vivity. My brother has distance monofocals and never uses glasses except to read. He can see his dashboard when driving and use the computer without glasses, as long as he has the computer at a "higher power" (his words) and he moves closer. That result is surprising to me.
susan03345 RonAKA
Posted
By the way, I have read many of your posts throughout this forum and am amazed at your knowledge about cataract surgery!
susan03345 RonAKA
Posted
The counselor said they use both the Barrett and Hill formulas as well as several others and the surgeon looks at all of them. She has told me in the past that this surgeon "under promises and over delivers". I think he tries hard to manage patient expectations. He does have a good reputation. As far as the mini monovision with monofocals, that is possible but she was curious about what I expected to achieve with it. Since I have been successful with monovision contacts I could have monofocal iols set for distance and have a contact lens for close vision for the non-dominant eye. That way I'd have control over when I have monovision or not. She also said each patient differs in terms of healing and the desired target may not be achieved. Oh so much to understand!
RonAKA susan03345
Edited
I think if they get a power calculation based on both the Barrett and Hill RBF 3.0 that is in agreement your odds of getting the targeted correction is very good. The Hill formula is based on an artificial intelligence analysis of thousands of surgeries. It also has flags built into it that warn the surgeon that the eye measurements are outside of the confidence range of the formula. How myopic are you?
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The other issue is the measuring instruments used. I think the most reliable are the IOLMaster 700 for eye measurements and the Pentacam for cornea topography.
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Based on my experience with mini-monovision I can't see getting both eyes set for distance and then using a contact in the non dominant eye to get monovision as a reasonable solution. I think if you really want monovison you would end up having to wear a contact every day. It would be much better to do it the other way around. Get mini-monovision with the IOLs, and then wear a contact in the near eye to get distance vision when you want it. But, I suspect you would never do it if you are used to monovision.
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A better second vision option while having monovision with IOLs, is a pair of progressive glasses. No matter how skilled the surgeon is, there will almost always be some residual sphere and cylinder error. A pair of progressive glasses will correct all of that, as well as give you distance and close vision in both eyes. I have a pair but almost never use them. They are probably only of enough benefit to use them when driving at night in the country where there is no lighting. In the city I don't bother with them even at night.
susan03345 RonAKA
Posted
I believe from other posts I've read you have monofocals set for distance with mini-monovision? How close can you see/read?
My first reply to you is being moderated I see. Probably because i mentioned a couple of opthamologists whose videos i have watched online.
susan03345 RonAKA
Posted
Another thing the counselor mentioned was that some people who get monovision in their iols come to regret it if they develop balance issues, due to a lack of depth perception. I don't know if mini-monovision has the same effect.
RonAKA susan03345
Posted
With my distance eye, I can read a 24" computer monitor with standard text down to about 18". However, that is not a comfortable distance for me to work at with a 24" monitor. With my close eye I can read standard text down to about 10-12" before it starts to get blurry. I can easily read at 14" or so which where I would normally be. My limit on paper is probably about 6 point print in normal indoor light. In bright sunlight I can see better than that. This all happens with my close eye which is at about -1.40 D when corrected for astigmatism.
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As far as depth perception what you get you should have already seen if you are doing monovision with contacts. When you get under 18" (for me) you start to lose the binocular 3D effect. There are a few activities where this has caught me, such as pruning shrubs when they are closer than that. One can miss with the scissor cutters! I think if a person was sewing and doing cutting of cloth etc it would be good to use some mild readers or put on the progressive glasses.
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I don't recall any balance or dizzy feelings, other than a slight amount when I was wearing prescriptions glasses with one lens removed when I only had one eye done. I had one eye corrected with the IOL and the unoperated eye corrected with a prescription lens. That felt a bit odd... With a contact in my unoperated eye everything was fine though. And now both eyes are done with IOLs I have no balance or dizzyness effects. It is the same as when I was simulating monovision with contacts.
Guest susan03345
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I think you need to clarify what you and they mean by monovision. An extremely common approach with Vivity is to offset the second eye by just 0.5D. That plus the EDOF of the IOL is enough to give you some usable near vision… not perfect but usable for quick tasks. They might be assuming that you mean more like a 2.5D offset which is a whole other thing and they are right to be very cautious of that. But the typical 0.5D micro monovision Vivity offset is so slight that I think most surgeons would not be too concerned about it.
susan03345 RonAKA
Edited
I actually was not aware of any depth perception issues with my monovision contact lenses even though monovision supposedly affects depth perception. I think maybe the counselor was trying to make me think about future balance issues with aging where a lack of depth perception might become an issue.
It sounds to me like you've gotten a very good result with your monofocal iol's!
You asked me how myopic I am and I don't have the figures. I can't actually find my last reading from my optomitrist. I know my left eye is worse than my right.
susan03345 Guest
Posted
Thank you. That's good to know.
RonAKA susan03345
Edited
The studies I have read show that loss of depth perception and 3D vision starts to become an issue when larger amounts of monovision, like -1.75 D or more. Having one eye at -1.50 and the other eye plano causes very minimal loss. A reasonable target is -1.25 to -1.50 D. They are never going to be right on the power due to the large (0.5 D) steps in the lens powers available, and it is more realistic to target a range rather than a specific exact power.
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You mentioned another that had what sounds like multifocal lenses and ORA. Mulifocals are now typically PanOptix or Synergy and they have mixed reviews. Some can adapt to the optical side effects of them and love them, while others dislike them to the point of wanting them removed. Have a read of the reviews on those lenses here. Vivity has fewer issues, but is not issue free either.
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As for ORA that is a method where they measure the effect of the lens once it is in place, and if they did make a mistake and put the wrong power lens in, they do a lens exchange right at the time. That means chopping up the first lens, removing it, and putting a new one in. That makes for a significantly more complex operation. But, perhaps if the power is wrong, it may be the best time to do a lens exchange. I think now with the improved power calculation formulas like the Hill RBF 3.0 there is much less risk of a miss on power selection.
susan03345 RonAKA
Posted
Thank you. I'm leaning toward putting off cataract surgery for now but when i do have it, I think monofocals set to distance with mini-monovision sounds like the best option. I would have my right eye (dominant eye) set to plano and the left eye -1.25 to -1.50 D, as you have suggested.
RonAKA susan03345
Posted
That is a good plan. I would continue to simulate that differential with contacts to prepare you for doing it with IOLs. My experience was that a differential of 1.25 D with contacts was about equal to 1.5 D with IOLs. The natural lens even with presbyopia still provides some accommodation. Surgeons should be happy to hear you have simulated mini-monovision prior to surgery as they will be confident you will not be surprised by the outcome.
soks RonAKA
Edited
ORA is done after the natural lens is removed and before the IOl is put in. the surgeon showed me the ORA screen and allowed to make a decision on how much myopia i wanted so he could put the iol accordingly.
RonAKA soks
Posted
Interesting. I thought it measured the effective power after the IOL was put in place. I wonder how they compensate for the actual position the lens takes in the eye, as I understand that is one of the critical factors in determining the achieved refractive power.
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I also gather it is a process that may only be justified when there is previous laser surgery, or in cases where there is extreme near or far sightedness or high amounts of astigmatism.
soks RonAKA
Edited
in most cases the iol within the bag can move only so much front to back.
in previous lasik the cornea has been shaved so it helps.! the real use is to take measurement after the opaque cataract is removed.
before my surgery the doctor handed me boxes of 15.5, 16, 16.5, 17 and 17.5. so he had them at hand as I wanted to make a decision after ORA readings. for example if ORA said -0.05 i wanted to be more myopic. if it said -0.35 i was going with that reading.
funnily i remember that part of the surgery very clearly than the rest.
susan03345 RonAKA
Edited
My glasses rx is:
Sph Cyl Axis Add
OD -4.50 -1.00 142 +2.50
OS -8.00 -1.75 004 +2.50
RonAKA susan03345
Edited
In a contact if you want to simulate mini-monovision this precription translates to the following in a contact:
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OD Sphere -4.25, Cylinder -0.75 at 140 deg
OS Sphere -7.50, Cylinder -1.25 at 180 deg
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Then for the eye you want near vision, reduce the sphere by 1.50. If your left eye is non-dominant and you want that to be the near eye, the sphere would reduce to -6.00 D.
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The contact lens fitter should be able to do this from your eyeglass prescription.
susan03345 RonAKA
Posted
Thanks!
RonAKA susan03345
Posted
As for measuring your eyes for an IOL, that prescription does not look troublesome. It is possible that when they do the measurement to predict residual astigmatism that you may not need a toric lens, especially in the right eye, and possibly in neither eye.