My Vivity Experience

I think the best information you can find on the Vivity lens and how it compares to a standard monofocal lens can be found by googling this:

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Vivity P930014 Package Insert

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I believe this document is part of what is required to get FDA approval for the lens. In any case the critical information in the document to address the questions you are asking is the defocus curves. They are somewhat complex, but I will give you a brief explanation. The vertical scale is the visual acuity in LogMAR terms. 0.0 is about 20/20 vision, and 0.20 is about 20/32 and considered to be the limit of reasonably good vision. 0.0 D on the horizontal scale is a distance of infinity. To determine the other distances, you divide 1 meter by the defocus diopter. You will notice this scale is very non linear. 0.0 is infinity and 1 D is 1 meter. Even at 0.25 D you are at 4 meters. At that distance visual acuity is still very high even with a standard monofocal. It is at the closer distances where it gets more interesting. The monofocal lens has higher visual acuity until you hit about -0.75 D which is 1/0.75 or 1.3 meters. Then the Vivity starts to get a little better. But, the monofocal still has reasonably good vision at 1 meter. The Vivity on the other hand hits the LogMAR 0f 0.2 at about -1.5 D or 0.67 meter or about 2 feet. Unless you are using large monitors that is probably too far for computer work. Reading paper documents is likely to be difficult.

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If longer distance binocular vision is important to you, I think you would be best with standard monofocal lenses, and then accept using reading glasses or computer glasses for the closer stuff.

loss of sharpness is real with multifocal lenses. loss of accommodation is real with minofocal lenses. dysphotopsias are real. if i could start from scratch i would do one of the following:

option a

1. eyhance set for -0.5 to -0.75D
2. then after a month i would play around with a + contact lens in the operated eye and see if i can do another eyhance at -1.5.

option b

1. get a clareon panoptix.
2. if u like the sharpness and not bothered by dysphotopsias get another panoptix. if bothered then get a clareon monofocal or a sofport set for distance.

Thanks for the replies, I'll check the package insert carefully.

I've been looking at these info sheets for several days, but I'd love to hear someone who actually has the lens what their real-life experience is. Obviously everybody's eyes are different.

Sharpness is just one aspect of image quality over distance. Being able to function at near distance and having some kind of continuous vision is something that's also important for someone with eyes as good as mine. I will have to sacrifice something, but it's hard to understand what i'm sacrificing exactly with these lenses.

What is the edge of distance vision on vivity until it gets blurry again?

Are vivity's optics such that you can't get a sharp vision with glasses even?

Also the contrast sensitivity and color of the vivity should be superior to the panoptix and significantly less dysphotopsias. Having cataracts the night time dysfotopsias are already pretty bad for me.

I've seen folks with prior excellent vision generally have bad experiences with panoptix. But definitely internet is biased towards the complainers.

I've also considered that if i have to wear glasses anyway the benefits of the added range in vision are diminished, but at the same time there are many circumstances where you're not using glasses, like taking a shower etc. so there's benefit in being able to function with objects that are closer and not have a wall of impenetrable blur around you.

Ultimately my concern is even if the limitations of the optics, if i can make things sharp by using readers or alternatively increase my sharp distance using glasses when playing disc golf then that's an OK trade-off for closer continuous vision with better contrast / colors and less dysphotopsias.

The package insert / and the defocus curve does state that vivity should have equivalent distance vision to the monofocal, (with loss of contrast sensitivity). But generally you play disc golf outside and in good visual conditions and up here in northern europe, the sun barely goes down during the summer. I maybe okay there.

So the remaining question remains if near vision can is adequate and can be made sharp using readers, then this may still be the lens for me.

What readers essentially do is shift your vision from far to near. So you take that same quality of vision you have at distance in terms of sharpness and contrast and shift it to near. Yes readers would work.

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Also I'm not sure "an impenetrable wall of blur" is a good characterization. Even with monofocal IOLs set for distance, you'd be able to see your shampoo bottle in the shower, you just can't read the label. Defocus is gradual not an immediate switch from everything being sharp to everything being a total blur. Text will be the biggest challenge.

Some thoughts. First, if you look at the Vivity package insert document and Figure 5 you will see that distance vision, which is at the 0.0 defocus position, is better with the monofocal lens than the Vivity. The difference is not huge with the Vivity being just under the 0.0 LogMAR, and the AcrySof monofocal being just over. It is probably close to 20/15 with the monofocal and 20/20 with the Vivity. This is an average of many people in a study so individual results can vary from the average. The error bar gives an indication of variability.

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Having good vision now is a good thing in some respects but there are a couple of issues with younger eyes. Look at Figure 7. That shows the impact of pupil size on near vision. The larger the pupil size the poorer the near vision. A younger person is more likely to have a larger pupil than an older person. Now look at Figure 8. It shows the impact of pupil size on near vision. There is much less of an impact. The Vivity with the EDOF is still better though, but it loses some of the advantage.

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The other issue with a larger pupil is the possibility you will see the edge of the IOL. Virtually all IOLs are 6 mm in diameter, and the large majority are implanted in older people that have smaller pupils. Seeing the edge of the lens or the light reflected off the edge is a cause of dysphotopsias.

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Yes, reading glasses can help with some issues in closer vision. But, keep in mind that lenses like the Vivity or PanOptix introduce focus errors that reading glasses cannot correct. For the sharpest vision you want all the light to focus at one sharp point. The lens that does that the best is a full aspheric corrected lens. Google aspheric vs spherical iol and then click on the images. You will see what I am talking about. Now, the Vivity and other EDOF lenses are not just simple spherical lenses and are more refined, but it is the same principal. They spread out the focus point instead of bringing all light to one point. That is the compromise you make when selecting one of these lenses. And it cannot be corrected with reading or even prescription glasses. That said, it is a trade off that some people make and are quite happy with it. If your objective is the sharpest possible vision then you may not be happy with these lenses. If you are happy with good or acceptable vision you may be happy with the extended range of focus.

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Do you wear eyeglasses and before cataracts what was your eyeglass prescription like? Do you still have good vision in the daytime now with the cataracts?

i was 41 when one sunday afternoon after waking up from a nap my vision felt out of whack. welcome PSC. i was a low myope at -2. my presbyopia had hardly begun . at 42 i got one eye done with symfony. other eye was holding up but had begun with light distortions. i am 47 now. i cannot tell you about vivity but i understand it does have dysphotopsias. your current sharpness and quality are going to be hard to beat. immediately after the surgery you are going to feel ecstatic with distortions gone but you will soon find that its not as good as the natural eye. loss of contrast means things will be fainter. dim situations will be dimmer. circles and halos are manageable. if you never had glasses i wud keep a trifocal in one eye and monofocal in other to balance out the quality and sharpness.

thats a good point about large pupil for younger patients. i have large pupils. i have no near vision with symfony and see lens edge in dark environments. that is probably the worst side effect of my own experience.

Here are a couple of options you might want to consider given your priorities:

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1. Get both eyes corrected for distance with a monofocal like the Clareon. This will leave you needing reading glasses for reading. There are computer versions which may work for you when doing intensive computer work. Or you could get progressive glasses. The advantage of progressive glasses is that there will almost always be some residual sphere and cylinder error after surgery. Prescription progressive glasses will correct those errors to give you the best possible distance and close vision.
2. Get your dominant eye corrected for distance with a monofocal. And for your non dominant eye get it corrected to leave you at -1.5 D myopic. This shifts the defocus curve 1.5 D to the right and gives very good close vision. But, the myopia will significantly reduce your distance vision. For most purposes the dominant eye will take care of distance, and probably 95% of your vision needs will be achieved without glasses. For the best distance vision it would be best to get progressive glasses. They would correct any residual errors from surgery as in option 1, and they would correct the -1.5 D myopia in the non dominant eye. Since the IOL is a monofocal there are no EDOF issues to correct. A simple -1.5 D sphere correction gives full distance vision in the near eye. This option gives you two choice for vision; eyeglasses free, and prescription eyeglasses. You can choose which one you want based on the vision need of the day. Not sure if you would benefit from the glasses for your golf activity or not. But, you can try it both ways and use the way you like best.

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   About 90% or more people choose option 1 when getting cataract surgery. I have selected option 2 which is called mini-monovision. I like it a lot. I use some mild readers occasionally. And when I remember I use my progressives for night driving in the country.

My daytime vision and watching bright objects / content on a white background on my screen is compromised severely by halos because my pupils get small and the light is forced through the cloudy parts of the lens and causes scatter.

In dim environments and after sundown my sight is considerably improved because the pupil dilates and the light can go around the cloudy bits that are in my axis. But it's clear the condition is deteriorating since I'm still on cortisone medication, likely for life.

I only have +1 readers which are not necessary at all, but I've found that they sometimes help me see better when somebody shares content that isn't running in dark mode over zoom calls.

If i just use dark mode on my large ultra wide screen which is about half a meter away. With a bit of zoom on the character set, i can see them pretty sharp.

But you bring a lot of good points for me to consider. I've been apprehensive about doing monovision because my wife has that naturally and she has migraines fairly frequently that maybe attributed to the eye discrepancy.

I suppose the IOL edge photopsias in the dark cannot be avoided regardless of my lens choice if my pupil dilates beyond 6mm. Further, i've always had excellent vision in the dark, which may indicate that my pupils are larger than normal?

My screen is 600 nits in brightness by default so possibly the near / intermediate vision performance of EDOF lenses maybe better than otherwise in this scenario because of the pupil size. Still if the monofocals can give me the best corrected sharpness then that is also useful.

There are some hybrid lenses also on the market that are Trifocal + EDOF like the Finevision Triumf, but it's really difficult to find good material on it that is not marketing. Still, it maybe valuable to consider putting a monofocal into at least one of my eyes.

i've also tried looking at the symphony and compare it to the vivity. Can you give some kind of an overall experience using it and do you have sharp vision anwhere in the extended focus range that is actually useful? At least what i've been able to see is that the distance vision of symphony seems to be compromised.

I think if one is going to use an EDOF like the Vivity, they are best used with a monofocal for distance in the dominant eye, and then the Vivity in the non dominant eye. That mitigates to some degree the loss of contrast sensitivity with the Vivity. But, keep in mind the Vivity really only adds about 0.5 D of closer vision. If you offset a monofocal by 1.5 D you get much better close vision. And there is the option of offsetting the Vivity by 1 D. That is going to give about the same near vision as the monofocal offset by 1.5 D.

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If you consider mini-monovision I would suggest simulating it with contacts to see if you like it or not.

Thanks,

I'm starting to think that the added benefit of a lens like vivity is pretty minimal vs. the loss of vision quality, even though it has a less severe drop in the defocus curve towards near vision. I was just taking my meds and realized how critical it is to see what meds i'm taking, vivity won't help with that much unless i'm one of those people that manage to get a more functional near vision with it and i would likely need a set of glasses anyway. Though the more continuous nature of vision with some level of clarity in the vivity lens is appealing.

I'm still looking at the latest generation multifocals to help with the ability to function without glasses to potentially use in one eye. The cataracts are definitely more severe in my dominant eye. I suppose my brain will get used to the lack of accommodation. Having meds ruin your eyes with cataracts really sucks when there's nothing wrong with them otherwise.

I feel like having stable binocular vision would be less stressful for me. People with pre-existing visual issues likely tolerate the limitations of iols a lot more.

I've tried wearing sunglasses in the dark when i watch something on my home theater wall, but i'm sure the loss of contrast is not that bad with any iol.

stay away from symfony. there is loss of contrast. if there is loss of contrast and u r going to deal with rings and dysphotopsia then atleast get vision in all ranges with a panoptix. symfony distance vision is probably the best. synergy distance vision is what people have been having problems with.

i think vivity add about 1D over a monofocal. eyhance adds about 0.5D. setting vivity at -1D would give very good functional near vision. mix that with monofocal and overall vision should be good even for the younger large pupils.

that's why i would go with panoptix and monofocal. the monofocal will neutralize the panoptix dyphotopsia by 50%.

When I look at Figure 5 in the Vivity P930014 Package Insert the monofocal hits the LogMAR of 0.2 at -1.0 D, and the Vivity at 0.2 goes out to -1.5 D for an extension of 0.5 D. It is hard to get comparable curves, but I believe the Eyhance extends focus by about 0.35 D. It falls a little short of the 0.5 D required to qualify as a EDOF lens.

Thanks i'm seeing a surgeon next week to discuss the matter and all this has been very helpful.

I think because vivity exists and supposedly has comparable EDOF defocus performance to symphony even though the close range vision is more compromised i've kind of disregarded symphony altogether from the mix.

In anycase i think also monofocal + vivity slightly offset might give me the continuous vision that i'm looking for while retaining great distance vision and contrast / color.

The surgeon i went to didn't have any experience with eyhance, though had installed vivity many times, but the general gist i read between the lines was that these premium lenses are a lot of product marketing and of questionable value while having issues image quality and potential issues in correction with glasses due to funky optics. Doctors in my country, especially credible ones aren't really pushing products at all but trying to make sure the best outcomes.

Having spent a week going through material on them I have to agree to some extent especially for someone with no issues in eyesight except cataracts and very mild age related presbyopia. Though i'll have to deal with terminal presbyopia as a shock treatment rather than gradually easing myself to it through age.

I live in northern europe so it's dark here a huge chunk of the year too so stories about limited range of vision were also off putting. Equally, in the summer the sun doesn't go down much so it's a much more optimal time of year. Monofocals will work at any lighting condition.

Glasses and contacts suck, but making a permanent wrong decision with your eyes sucks even more. Maybe technology allows trying iols in the future and comparing them before buying based on personal experience, then the true competition comes into play and bad products go out of market faster since people see what they look like in real life and just give them a pass.

It's likely i'll get two J&J zcb00 monofocals configured identically to get flawless stereo vision and just deal with glasses. The risks and drawbacks of multifocals and edof hacks are probably not worth the additional risk and loss of image quality. Best of all, i can get these from the public health care for no cost and the surgeons in the university hospital are exceptional.

With clear lenses, i can then use contacts for creating various optical scenarios depending on the need and i can just remove them if I hate them rather than making those a permanent solution. That includes short term monovision etc.

Thanks everyone for giving me a lot of invaluable information here, i really appreciated. And I'm also happy for those that had a great success with Vivity. I was too concerned about the loss of contrast and permanent darkness during the winter to take the ultimate leap.

I would agree with most of your conclusions. I think that some approach the selection of an IOL with the thinking that some brand or model will do everything they want with no drawbacks. The current reality is that they all have strong points and weak points.

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My thoughts are that the best way to approach the selection decision is to think of it as a process and not a one time decision that has to be made up front. Here is an approach to consider, along with your conclusions to date.

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1. Use a monofocal in your first eye to correct for full distance. The normal target is -0.25 D.
2. While your first eye is healing and is fully healed, use a contact in your second eye to simulate your options for the second eye. One would be to correct it fully for distance. This will give you some idea as to what it is like to need readers for close vision.
3. The other alternative to trial with a contact is mini-monovison. I would suggest using a contact that corrects all astigmatism and leaves you at -1.50 D sphere. This will let you evaluate whether mini-monovision is an acceptable option for the second IOL or not. I really don't think doing it with a contact after both eyes are done is a good idea. The horse has already left the barn.
4. Based on your trials you can decide whether to go for distance or mini-monovision. For me the big advantage of min-monovision is that I don't have to carry around readers ever where I go within my house or where I go when I leave.

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   On lens selection the J&J Tecnis 1 is a good one. It is a clear lens and does not have blue light filtering like a natural young eye has. Some believe for younger people blue light filtering may be a good idea to prevent damage to the eye for the longer term. Other lenses to consider if they are available to you would be the Alcon Clareon, and the B+L enVista. The enVista is an interesting choice as it does not fully correct asphericity and gives a bit of extra depth of focus like the Eyhance. There does not seem to be a significant visual acuity loss to be paid for this extra depth of focus. My brother got one of these as it was the basic lens offered and fully covered by his public healthcare, and he tells me he has 20/15 vision in this eye. Each lens has their pros and cons...

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   Hope that helps some. It is not an easy choice, but I think it can be made easier if one does it in steps rather than all at one. For sure allow a minimum of 6 weeks between eyes. That gives your eye time to recover, and for you to make the decision on the second eye.

Thanks for those extra insights, i think in my case since this work will be done at the university hospital and the government health insurance the tecnis1 is the lens they provide and there are no alternatives unless i go to the private sector and make that choice myself and pay 1500€/eye for the operation.

Ultimately the difference between standard monofocals should be relatively small so the return of investment of selecting another lens is probably miniscule and i can spend that money on glasses instead, since i will have to wear them regardless of the lens i choose.

I've been looking at progressive lenses now as you suggested and seems like i can get computer progressives for my desktop work and another pair for leisure. Varilux X seems to have some kind of extended depth of focus feature that looks really promising where you get 40-70cm of focus area, they call it "Xtend". not sure if it works as advertised. This is the first time i delve into glasses, if there are alternatives that are equally good i'm definitely up for suggestions.

Yes, what lens you can get will probably depend on the jurisdiction. I was initially offered the AcrySof IQ and I asked whether the Tecnis 1 was a choice. The surgeon said he preferred the AcrySof IQ but I could have the Tecnis 1 if I wanted it. He said it was a bit more expensive but the government covered it. In the end I selected the AcrySof IQ. On my second lens I paid an extra $300 to get the Clareon which is basically the AcrySof IQ but with an improved material. Where my brother is, the enVista was the only fully covered cost option.

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I used progressives for years for general purpose as well as computer work. The only significant issue is that you have to move your head up and down to see different parts of the screen. Now that I have glasses free monovision I have gotten used to just looking up and down and side to side with my eyes without moving my head. But, I never really noticed that need to keep moving my head until after I had monovision.

Yeah, the Varilux X Xtend is supposed to eliminate that head movement as every part of the lens has sharp focus 'everywhere' by default in the near-intermediate area. The lens is divided into extremely small bee-hive pattern with different magnifications which the eye supposedly cannot perceive.

The pro version is also customized to the person. They are pretty expensive, starting from ~900e a pair just for the lenses, but If it does what the packaging says I will spend that money. I'm going to see some optician this weekend to get some more factual info on how it works and performs.

I also have a 49" super ultra wide which is further away from me than a normal monitor would. I can take it even further with a monitor arm, but that will remove some of the immersion you get when gaming on this thing.

I have to say losing my natural near vision and accommodation is causing me anxiety, also for an engineer that is generally pretty pedantic on the 'hardware' i spend money on there's a lot of variables in play that are out of my control so I need to make sure where I land is well understood.

If you can get the monitor 24" away and still use it, a plain monofocal IOL will likely let you see it quite well. I can start to see my 24" monitor at about 18" and further with my distance monofocal eye. But at that distance normal sized text is too small to read comfortably, even though it is quite sharp.

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On progressives I used Costco Accolade Freedom HD lenses for many years. I believe they were just another name for Varilux, but not the X Xtend version you are talking about. What Costco does have that I see on line is what they call Intermediate lenses. You can find some information about them at Costco on line. In comparison to normal progressives they have a larger central intermediate vision range optimized for a computer screen. The is a smaller section at the top for distance, and a smaller section at the bottom for reading. Not sure they would be all that suitable for all around use, but probably work well on a computer. Their benefits are claimed to be:

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• Larger intermediate reading area
• Comfortable head posture while at the computer
• Reduces symptoms of Computer Vision Syndrome, including eye strain, tired eyes, and headaches
• Protection against blue light

Thanks,

We don't have Costco in northern europe (or europe in general).

I don't know if this is a thing but i've observed that a lot of folks that have had great near / intermediate experiences with monofocals or advanced monofocals have been somewhat strong myopes before tend to have better results with intermediate and near vision with lenses. I'm hoping this will also be true for my eyes.

In any case i'll likely get varilux X lenses for my daily drivers, i'm going to check a local optician that has also the pro-kit for them and chat about my issue.

I called the hospital to put me in the surgery queue, but I'm still making some calls on monday if there are any facilities that have experience with eyhance lenses.

... true for my "flawless" normal eyes i mean...

If you go to Costco dot CA and then the "Optical", then "Lenses" you will find a graphic on what this Multifunctional lens is supposed to do. Costco in my experience tends to sell brand name products but can put their own name (Kirkland) on them, but I suspect this lens they describe is available as a brand name. My guess would be Essilor. But, beyond that, no idea. From a computer use point of view, it probably would be very good.

I managed to find a very experienced (~20 years, also in the public sector) surgeon that does 'exotic' lenses. She's done many vivity surgeries etc. and it was great to talk to someone whom I had a good rapport with.

She also said she would probably have vivity put on her own eyes if it was a choice she had to make. She was doing monovision herself using contacts. I also shared some concerns about setting the vivity off-pair because of the lack of overlapping MTF curves causing severe drops in contrast like reported here.

She mentioned that there's been good results in setting vivity lenses to -0.6. I wasn't quite sure what that means visually, but I have to put some trust in the surgeon about matters where i'm just a novice who spent 2 weeks reading about the basics, but she said she was quite impressed on how much i had prepared and understood about the basics so she could talk about these things on a more advanced level than a regular customer.

Are there any thoughts about the visual result of setting these lenses at -0.6. I have very good circular eyes, no astigmatism. No issues on the retinal imaging etc. 4,5mm pupil (she said it went down to ~3mm in the slit lamp examination without dilation). Right eye Visus 0.90, sf +0.75/cyl -1.75/ax 120 Tr14

Left eye Visus 0.70, sf -0.25/cyl +0.50/ax 115 Tr14

~3.6mm anterior chamber

I pretty much have three choices, to roll the dice on vivity and hopefully get a very good outcome, get eyhance lenses (also from this surgeon) or have the public sector do the monofocals for me.

If you are prepared to do mini-monovision, I would just stick to the Tecnis 1 monofocals. Yes, EDOF lenses can be used in mini-monovision, but I don't really think they are worth the extra cost and complication. Using monofocals makes any eyeglass correction down the road easier to fit. I think I would just ask for a Tecnis 1 targeted to -0.25 D in your dominant eye, and the same Tecnis 1 targeted to -1.50 D in the non dominant eye. It would be best to simulate it with contacts first though. There should be no extra cost to mini-monovison as it just uses standard monofocal lenses which it sounds like are fully covered.

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That eye prescription is in a different format than I am familiar with. If I have to guess, you do have significant astigmatism (cylinder) in your right eye, and more moderate in your left eye. I am assuming this is an eyeglass prescription, and the outcome after cataract surgery can be very different. But, with detailed pre-surgery measurements they should be able to tell you how much astigmatism you will have post surgery. Toric IOLs can be considered if it is over 0.75 D cylinder. If your plan is to wear glasses then there is an option to not correct astigmatism with a toric IOL and just correct it with eyeglasses.

I'm not looking for mini-monovision at all. Not sure if she meant that or that set both lenses at -0.6.

Also I have practically no astigmatism whatsoever, they've done pretty much every available measurement There are practically no irregularities in the eye so I won't need a toric IOL. Interesting that the notations maybe different, i wasn't aware of that.

But if there's +0.75/cyl that would imply there is some. At least the several doctors i've talked to said there's nothing to mention. I suppose that's what it means then... it's just at the threshold?

It may also be that this measurement comes from the autorefactor which can be off due to the cataracts, but they've done various imaging tests and those according to the surgeons don't show anything that would warrant a toric.

If I take your prescription and get rid of the Visis part which I don't understand and the Tr part which I also don't understand what is left is this:

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Right eye: sf +0.75/cyl -1.75/ax 120

Left eye: sf -0.25/cyl +0.50/ax 115

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If sf is sphere, then the +0.75 D indicates you are far sighted in the right eye, the cylinder is -1.75 D @ 120 degrees which is significant. The left eye is -0.25 which is very slightly myopic, and the +0.5 D at 115 Deg indicates some astigmatism, but not a lot. But if this was just measured with the autorefractor then this is your total astigmatism now. When you get cataract surgery all the astigmatism in your lens and what is caused by the cataract is gone. So, what is important is the predicted astigmatism after surgery. That is done by an IOLMaster 700 and a Pentacam. If you want to see the detailed measurements of your eye, then you should ask for a printout of the IOLMaster Calculation Sheet. Normally astigmatism is not corrected with a toric IOL lens unless the predicted residual is 0.75 D or more.

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If you get a Vivity set at -0.6 D then you are not going to get great distance vision and not great close vision. Peak vision will shift to 1 meter divided by 0.6 or 1.67 meters. If you get them set at -0.25 which would be standard, then distance vision should be very good, but close vision will not be very good.

The intermediate vision is more critical, i'm fine handling anything requiring detail at very close ranges with glasses. But i'm not 100% convinced that with my pupil sizes we necessarily get a huge bump in near overall.

Maybe over time when the pupil becomes smaller when aging, it maybe a different situation.

I'm still somewhat concerned if it's possible to achieve a defined / sharp image using glasses with eyhance / vivity or are those lenses doomed for somewhat soft vision (like when you have font smoothing enabled on your screen) because of their funky optics.