My Vivity eyes
Posted , 11 users are following.
Hello, everyone. I've learned a lot from this forum so I thought I'd relate my experiences with Vivity IOLs. First eye was done on 1/26/2022, second eye is scheduled for 2/9/2022 with an excellent doctor here in the San Francisco Bay area.
Brief background: I've been myopic all my life and wore glasses since about age 8 (I'm now 63). I wore soft contacts for a while but gave them up around age 35. I don't have all my historical records, but my prescription around 2004 was about -3.0 in both eyes with very mild astigmatism. In the last 5 years or my prescription varied, seeming to get better both at distance and near. But there was some fluctuation also, and I'm not sure if that was due to different eye doctors (one of whom I doubted a bit), actual age-related changes, or the developing cataracts. Anyway, I first heard I had cataracts in 2019 when I changed to a new eye doctor. She didn't think they were bad enough to be treated then or in 2020. I had trouble driving at night, but that was easily avoided. But in mid 2021 I very nearly didn't pass my driver's license vision test so I had to do something. I saw the eye doctor, who referred me to an opthalmologist, and here I am.
During my consultation, the doctor and I discussed retaining good functional near vision, because that is what I have always been used to--being able to read and do things around the house without glasses. Yes, beyond 12 inches or so the vision was blurry, but good enough for many tasks. I wore progressive lens eyeglasses, but in recent years the reading part was more or less clear glass because my vision was sharp in the approx 6 to 12 inch range.
Now the first lens has been replaced. I was nervous about the procedure, but as others have noted, it truly is easier than it sounds. I had a little sensation of something in my eye for about 24 hours, but since then there is no discomfort at all.
My first impression was excitement about the color change, now that I can compare the two eyes. Wow, those cataracts sure put a dirty yellow cast on everything! This alone is worth the surgery. One of my hobbies is birding and seeing true color again is wonderful.
I have excellent near vision with the operated eye. I can read just about anything and good focus starts at about 7 inches. Computer screen distance is crystal clear. Beyond about 4 feet, the focus is less good, but still extremely functional for vision inside my home. The operated eye is better than the old eye at all distances -- but that's partly due to the cataract in the old eye making everything blurry anyway.
So right now, I'm in the state of having very mismatched eyes, with or without glasses. I dug out an old pair of glasses that sharpens the focus for my operated eye, and that works well for driving (but I'm being very careful in this time period). My brain seems not to mind the eye mismatch. I haven't tried driving at night.
I have a follow-up appointment in 4 days to evalute the results and discuss the second eye. I know that having the same lens in both eyes supposedly has some advantages. But I am thinking of asking the doctor to give me a little more distance focus with the second eye. I never tried monovision when I was wearing contacts years ago, but my current experience with mismatched eyes (as in, it doesn't bother me) makes me think that mini-monovision would work OK for me.
Anyway, I'd have to say that I am very happy so far. As some posters have pointed out, sometimes you gain so much improvement in something that was lost that you don't mind the tradeoffs. (Plus I'm an engineer, so I knew a little bit about optics and technical tradeoffs and I tried to keep my expectations realistic.)
Laurie
0 likes, 15 replies
RonAKA laurie30147
Posted
Interesting experience. I find your post helpful as I am considering a Vivity for my second eye. My main concern is the risk of halos and flare at night. If you do that, I would be very interested.
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I will be well over a year before my second eye is done, and I recommend using a contact in your non operated eye. It is more comfortable than using eyeglasses with one lens missing. I also recommend waiting 6 weeks minimum before proceeding with the second eye. Your operated eye will have stabilized by then and you will have an accurate read on how it ended up. I think the best indicator is an eyeglasses prescription refraction value. Based on your comment of being able to see down to 7" suggests to me that the surgeon may have missed on the power if the objective was distance vision, and has left you with some myopia. However your eyeglass prescription will tell you that. The normal target for distance vision is -0.25 D. However that is very unlikely to let you see down to 7" clearly.
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If this operated eye gives you good close vision, you could consider getting a monofocal in the second eye set for full distance. I would suggest the Alcon Clareon, or AcrySof IQ Aspheric. Or, you could get another Vivity, and hope that the surgeon gets you better distance this time. Accuracy of power selection is always a risk, and is far from certain. I am also an engineer and have done some research on the methods surgeons use to measure the eye and calculate the required power. Surprisingly there are many different formulas to do it, and no clear consensus on what one is the best. I found this article listed below in my research and you may find it of interest. My conclusion is that I hope my surgeon uses the Barrett Universal II formula for my second eye. Not sure how I can diplomatically ask him, but will try it. I ended up at 0.0 D spherical for my distance eye, so I can't come across as being critical, and trying to tell him how to do his job!
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OPTIMIZING OUTCOMES WHEN THE TARGET IS LOW MYOPIA ANDREW M.J. TURNBULL, BM, PGDIPCRS, FRCOPHTH; WARREN E. HILL, MD; AND GRAHAM D. BARRETT, MB BCH SAF, FRACO, FRACS pdf
laurie30147 RonAKA
Edited
Actually, the target for my first eye was not distance, but for functional near vision, which is what I am used to. I think in 10 or 20 years the ease of reading and using a computer will be more important to me than distance vision. I am used to wearing glasses for distance vision, and in fact I am not used to going out in public without glasses. So I don't think the target for my second eye would be to have excellent (spectacle-free) distance vision, because that seems like it would be too much of a difference from my operated eye. But maybe a little change in target from my current eye would be beneficial.
I see the point about perhaps waiting before getting the second eye done. But now the view from the old eye looks so grungy and blurry (compared to the operated eye) that I kind of don't want to wait!
Bookwoman laurie30147
Posted
laurie, I have two monofocal IOLs set for near vision. They're both -2 lenses, but my left (non-dominant) eye wound up at -2.5, so I have micro-monovision. It's worked out very well for me - like you, I've been nearsighted basically my whole life and didn't want to lose my close vision, since I spend so much time reading books or on the computer. When I'm indoors I only put my progressive glasses on to watch TV, but always wear them when I leave the house. It still amazes me, 2+ years after the surgeries, that I can see so well without them.
In any event, it's nice to meet someone else who has prioritized close vision - we're in the minority!
RonAKA laurie30147
Edited
I did not expect that the target for the first eye was nearer vision. However, if you wanted nearer vision with the first eye, it looks like you got it. The purpose of waiting between surgeries is to get an accurate read on what vision you got. 3 weeks is kind of minimum and 6 weeks is better. That would let you know how much differential you will have between your eyes if you go for full distance vision with your second eye. Certainly -1.25 to -1.5 D in your close eye is not too much, and if you get the theoretically ideal distance eye outcome of -0.25 D that is even less of a differential between the eyes.
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You know you have good close vision now, and unless it is more than -1.5 D myopic I would not worry about the difference between the eyes. Remember that you will have two choice for vision after you are done. One will be with no glasses and the other with glasses. If you go with near for both eyes then you are stuck with wearing glasses for good distance vision and will need glasses very frequently. If you get the second eye done for distance, you are likely to not need glasses at all. I currently simulate -1.25 myopia with a contact and don't need glasses for anything other than really small print on a medicine bottle label.
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If you are significantly more than -1.5 D myopic in the first eye then it might start to be a problem. With a Vivity lens I would be surprised if you have that much. Based on the defocus curve for the Vivity -1.0 D is probably all you need for mini monovision. That is why you want to get your vision checked to see how myopic your first eye is.
Bookwoman RonAKA
Posted
If you go with near for both eyes then you are stuck with wearing glasses for good distance vision and will need glasses very frequently.
Ron, you say that like it's a negative. For some of us, wearing glasses is second nature and not bothersome at all. Plus, the right pair of glasses can add some zip to our aging faces, and in my case, there's less need for eye makeup to look put together. Just another perspective from the pro-glasses faction. 😉
RonAKA Bookwoman
Posted
I have worn glasses for over 60 years now, and I hear what you say. For the last 16 months or so after my first eye cataract surgery, and the use of a contact in my second eye, I have been essentially eyeglasses free. I love it. In the home I frequently sit in front of my computer and have the TV on at the same time. I love being able to read my computer monitor one second while being able to look up and see the TV clearly 10 feet away. No glasses needed. I ride a motorcycle in the summer and love being able to put my helmet on without having to struggle with getting my glasses inside the helmet. In my truck and car I can drive with distance vision as well as seeing my dash instruments clearly. And in the winter with COVID and the need to wear a mask indoors, glasses are a real pain as they fog up from the mask. I could go on and on, but everyone has different priorities and I am sure will see it differently.
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I feel sorry for my wife as she only has functional vision in one eye. That makes monovision impossible. We considered a Vivity or PanOptix, but with only one eye to work with that was too much risk to take on. She has had very good distance vision all her life and was needing reading glasses already so it was not much of a change for her to get a distance monofocal IOL. But, she has lost some close vision compared to her natural eye, and now she is more dependent on glasses. It seems she is always looking for them, putting them on, and taking them off. There is probably a dozen or more pairs spread around the house somewhere! And, she seems to dislike progressives, but I suspect she will eventually get a pair.
laurie30147 Bookwoman
Posted
Bookwoman, that is pretty much how I anticipate ending up, and that's OK with me! The clarity of distance vision in my operated eye is already exciting for me, even if it requires glasses to achieve it. It's so much better than I've been able to see for the last few years.
If the Vivity lenses and a small amount of monovision can provide a little extended depth of focus for me, that will be a bonus.
During my research, I was interested to read this article from 2008:
Intentionally Targeting Low Myopia After Cataract Surgery, Gary S. Schwartz MD, CRST (Cararact and Refractive SurgeryToday)
danielleb28 RonAKA
Posted
Hi Ron, currently you have one eye surgically corrected for distance and your other eye is under corrected with a contact correct? And when you have surgery on your other eye, you will plan to have it corrected the same way? I am very near sighted and only 48, I work on a computer and my phone all day but im also very active ... i have worn monovision contacts for years but i thought maybe i wanted my cataract surgery to correct both eyes for distance but Im rethinking that because everyone is saying they cant see their dinner plate or put make up on, i wouldn't be able to see the end of my fishing pole or something on my lap... now I'm considering under correcting one or both eyes... i could get away with not doing my right eye for a while but contacts don't come in my exact prescription so thats difficult as well...
RonAKA danielleb28
Posted
That is mostly correct, but my status changed 6 days ago. I got a Clareon monofocal targeted for -1.25 D myopia in my second eye. I originally wanted -1.5 D but the surgeon said he expected -1.0 D cylinder (astigmatism) so he suggested the target of -1.25 D instead. Six days out I can read the smallest No 1 print on a Jaeger reading test in bright sunlight. However in dimmer light I cannot do that. I am still struggling a bit with a shadow on letters which makes it harder to read quickly. I am hoping it is due to the eye still healing, but it may be due to the residual astigmatism.
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My general vision at all distances is very good though. I do not wear glasses except for smaller print on medicine bottles in dimmer light. I have no regrets going with monovision. I may have to get Lasik or similar if this shadow thing does not go away and is due to astigmatism. Will see the surgeon again on March 15, and see where it goes. I suspect I will have to wait months to be sure the eye is stable before going ahead with any touch up laser surgery.
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My distance eye tests at 0.0 D sphere, and 0.75 D cylinder. However with that amount of astigmatism, my distance vision is very good at 20/20+. I can see well down to about 20" or so. That may be due in part to the uncorrected astigmatism.
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If you go with monovision it is ideal to do the distance in the dominant eye, and closer vision in the non dominant eye. I would recommend a target of -1.50 D in the close eye, based on my experience so far.
laurie30147
Posted
Update: I had my second eye (left eye) surgery on Feb. 9 with a follow-up appointment today. My eyes feel great and the doctor says the lenses are perfectly centered.
I have Vivity lenses in both eyes. The right eye is -1.5 D and the left eye is -0.5 D (I think this is about 20/50). I was a little nervous about choosing monovision, but I am happy with the result and I think this is a good combination for me. I was nearsighted all my life and I wanted to retain the ability to read without glasses.
Close and intermediate vision: I did some crude testing with a medication insert (fairly small print) and a tape measure. My right eye focuses well starting at about 8 inches, while my left eye focuses well starting at about 13 or 14 inches. The two eyes are both in good focus in the range of 14 to 30 inches. So this is great for computer work, kitchen work, playing cards, and so on.
For watching TV (a 32-inch screen about 9 feet away), the left eye is much superior, although two eyes are better than one, even when one is slightly blurry. In general, I don't feel the need to wear glasses for anything I do indoors.
Distance vision: My left eye is better for middle distances than either of my eyes ever were. The focus is good up to about 20 feet, but the far distance vision still feels comfortable enough for me to take a walk outside without glasses. I can read a license plate from about 50 feet away.
For driving, I will always wear glasses. I have an old pair of glasses that has 1.5 D of correction in both lenses, which is perfect for my right eye but a bit overcorrected for my left eye. However, it works great for driving now, until I get fitted for new glasses in a month or so. With the glasses, I am ecstatic about the brightness and clarity of my vision -- better than it has been for years.
Night vision: I did experiment a little with night driving with the glasses. It is such an improvement over the pre-surgery vision due to the enhanced brightness. Now I am not afraid of night driving. As for artifacts, I do see some stars around bright lights when I look without glasses, and the star is bigger for the near-vision eye (more out of focus). But using glasses to focus the image reduces the artifact size. Unfortunately, these old glasses have an astigmatism correction that I no longer need, which causes a weird vertical streak through bright lights. So I can't really evaluate how good it will be once I get better glasses.
General monovision: It seems to work OK for me. I have to think about mode switching sometimes, as in concentrating on one eye or the other until my brain resets. But it doesn't bother me and maybe my brain will get more used to it over time.
Overall impression: Very happy!
soks laurie30147
Posted
monovision with vivity was a great idea.
how is the quality of video on your phone at 14 inches?
laurie30147 soks
Posted
Well, I am not the right person to judge this. I use a small smartphone (3x6 inches) and I don't watch video on it. I think the clarity is pretty good, but it's not something that I do in general. I tried an ESPN video, which ended up being about 1.3 inches high on my phone (portrait mode). Stephen A Smith looked and sounded normal 😃 but the little crawler letters at the bottom of the screen were....little. However -- with my -1.5 D right eye I can hold the phone closer than 14 inches if I want to read those.
Your mileage may vary...
dabears26858 laurie30147
Posted
Following my Vivity surgery, I am slightly nearsighted, I use a 0.75 contact in my Vivity eye during the day which I take out in the evening when I am only doing close to medium tasks like reading and watching tv. For me it is the best of both worlds, Vision around the house is sharp without the contact lens and my Vivity eye by itself is 20/20 near. Without the contact lens, my far far distance is a little blurry. Intermediate is fine in either case (with or without the contact lens).
laurie30147 dabears26858
Posted
Thanks for the comment. I wore soft contacts when I was younger, but haven't worn them for many years. Maybe I could try a contact in my close vision eye for extended outdoor activity days.
On a positive note, my brain seems to be adjusting well to the monovision (admittely, my amount of monovision is only a 1 D difference between the eyes). I wake up and walk around the house feeling like I can see well without thinking about it. And today without thinking about it, I got in the car and drove to the grocery store without glasses! I didn't even realize it until I was halfway there (a very short, safe route). That is something I would never have been able to do in my entire life.
Of course, I prefer sharper, corrected vision for driving, and especially night driving. My distance eye is -0.5 D (it was targeted to be that and landed there), so it is not the eagle vision that some people achieve. Plus my license specifies to use corrective lenses (but that could include contacts). Anyway, I am delighted to have this backup ability available -- less worry about losing or breaking glasses when traveling, etc. And it makes me realize that for most driving in daylight, you don't actually need 20/20 vision.
dabears26858 laurie30147
Posted
I find that I have more visual distortion in my near sighted vivity eye at night without the contact lens I mentioned. Pretty big starburst without lens, small starburst and halo with contact lens.