Need Advice on Cataract IOL

Good analysis. I had Eyhance toric done a month ago. Saw my optometrist today and will see him 2 months from now for a final post surgery exam. I have a slight residual astigmatism remaining but I see 20/15 now uncorrected. 2.5 adds in both eyes and OS +0.00 -0.50 x010 (left eye). Not worth filling a prescription. I have several reading glasses lying around the house. Yeah the toric worked out well. My astigmatism was bad enough prior to surgery that drugstore reading glasses was quite blurry.

If you got Eyhance in both eyes and set for distance exactly how much extra intermediate without glasses would you get compared to a standard monofocal , would it only be a tiny amount extra or quite a bit . Would for example you be able to read your mobile phone in your hand if you outstreched your arm or not need glasses for daily intermediate tasks like making a meal , reading car dashboard?

If you look at the graph in this article you can see that with a visual acuity of LogMAR 0.2 the Eyhance extends the curve out from about -1.1 D with the standard monofocal Tecnis to -1.5 D on the defocus curve. If you divide 1 meter (39.4") by the defocus D you get distance. So this works out to 36" as the limit of good vision with the standard Tecnis 1 monofocal, and 26" with the Eyhance. So it reduces the good vision distance by 10".

"Review of Ophthalmology PUBLISHED 15 APRIL 2021 IOL Review: 2021 Newcomers"

Ron,

I read the article you quoted from. On Page 4, Figure 2, under the defocus curve it says" Eyhance performed better at intermediate and near distances." On page 6, it says "Several studies have shown the modified Eyhance delivers superior intermediate distance compared to standard monfocals." On page 7, it says," Another independent study found Eyhance provided better visual acuity than the the ZCB00 across a greater range of defocus levels, including near vision.

This is why it is difficult to give accurate advice here as no one knows your particular eye health. My advice was based on having no other eye condition other than cataracts and have regular astigmatism that can be corrected.

When you say you have some issues that are making it difficult to get accurate readings that is another whole ball of wax.

My best advice is contact a Top Opthmalogist even if you have to fly there. I will PM you.

I am sorry to hear about your husband passing. That is very hard to deal with, and I can understand that you would be stressed. Cataract surgery options are almost endless and working your way through them is not easy. Sometimes ignorance is bliss, in not knowing what all the options are.

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The unfortunate reality is that we have "progressed" in the approach to cataract surgery, from the past times described well by one of your ophthalmologists. "He said just get a monofocal and wear eyeglasses." Many, many people get this option and don't even realize there are other options. They go without glasses most of the time and use over the counter readers for the times they can't see smaller print. My wife had undiagnosed lazy eye in childhood and as a result only has usable vision in one eye. She got a toric monofocal, and only uses readers when she needs to. Her current Rx after cataract surgery is 0.0 D sphere, and -0.5 D cylinder. She has a prescription for progressives and I keep suggesting she should get some, but she won't. Instead she has several pairs of readers. The point is that if you go for a monofocal toric you don't have to wear progressives if you don't want to. But, you will get the best vision by wearing them, as they will correct any residual error.

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This said I plan to eventually get progressives as well, but have not yet. I am still considering some touch up Lasik and don't want to buy them before that surgery if I have it. I can see quite well without progressives, but I will eventually likely buy them if for nothing else but night driving.

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My point about getting a monofocal lens over an Eyhance was if you are going to set them for close vision. I think the Eyhance would then be somewhat redundant, and you would get as good or better overall vision with basic Tecnis monofocals (toric if you want the best vision without glasses). The other situation would be if you were to consider mini-monovision. In that case it may make the best sense to get a Tecnis in the distance eye, and an Eyhance in the close eye. Both should be toric in this case as you will likely be able to go eyeglass free almost all the time.

Ron,

I appreciate your reply. Can you please explain to me why you think the Technis 1 is better than the Eyhance? As I quoted in my post from the "Review of Opthalmololgy" that you had referenced, in your post, that article clearly says in several places that the Eyhancd delivers better near and intermediate vision than does the Technis 1. Thanks

The Tecnis 1, as well as the AcrySof IQ, and Clareon in the Alcon lens line are aspheric IOLs. They are designed to as close as possible focus all light at one single point. This is good as it provides the clearest possible image.

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However, when you focus all light at the same point you reduce the range of focus or smearing of the image to provide a range of focus. If you google "aspheric vs spherical IOLs" and look at the images you will find many images which show the difference. The Eyhance lens and the Vivity in the Alcon line do what the spherical lens does but perhaps in a more controlled manner to extend the depth of focus. There is a cost to this in clarity at distance. So the Tecnis 1 will be better than the Eyhance at distance, or in the case of selecting a power to give you close vision, they will provide clearer vision at that distance.

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At near and intermediate distance it is different of course. Because the Eyhance smears the image it provides a better image at those distances. But there is a cost at distance.

I started using progressives about 25 years ago. I did not find them hard to get used to at all. About the only big "learning" I had was to NOT look down through the bottom half of them when going down stairs. Don't look. "Use the force Luke"!

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Now that I have mini-monovision with near and far without glasses, I have become spoiled. When I last used my progressives, I found it annoying to have to hold my head up to look at the computer monitor. But, you do get used to it. I had never even thought about it until after I became spoiled.

Unfortunately most desks do not make it possible to get the monitor low enough for good vision. And, as monitors get bigger it becomes even more difficult. The last office I worked out of had a desk with a section in the middle that could be raised or lowered. I adjusted it as low as possible while still being able to get my knees underneath it. Often you will see information that says a monitor should be at eye level. I think it should be much lower than that.

Progressives would be for day to day around the house or out and about. I wouldn't use them for the computer. I have single vision lenses for the computer. You CAN get progressives customized in a ton of different ways though, so they're optimized for computer or near or general purpose etc… but really for the computer I think you're better off with single vision lenses. I got my computer glasses from Zenni for like, $30 and they're great. Just don't ever buy progressives from Zenni (or Costco). You will not like their progressives. For progressives go to a real glasses store / optometrist.

I have used progressives from Costco for about 15 years or so. For that time I used Accolade Freedom 3.0 HD Progressive Lenses that were high index, with the anti-reflective coating. They are made by Essilor and I believe they are the same as the top of the line Varilux HD Digital lenses sold under their brand name. For me they worked very well, but of course with the limitations of a progressive lens.

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The last pair of glasses I got was a temporary solution with a prescription for my IOL eye in one lens and for my natural eye with a mild cataract in the other. For that pair I spent a bit less money on the lenses and got the Kirkland Signature™ HD Progressive Lenses: Digital Progressive Lenses. Although I never really wore them much, I didn't notice any significant difference between them and the Accolade Freedom ones. The optical technician said the add section was not as wide, but I didn't notice it. I would prefer to get lenses without the coatings as they make them difficult to keep clean. But with Costco it is part of the package deal.

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My brother has used Zenni for progressives and he said they were poor. I have no personal experience.

Thanks for the extra details on Costco. I should clarify that that was just based on my Optometrist looking at the Zenni progressives (which were truly horrible for me, unusable) and she commented off the cuff that "yah they don't look great, very narrow channels, basically the same as you'd get from Costco or something". So that's all that was based on. I don't have any personal experience with Costco progressives.

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Regardless I think my point stands that overall, you're going to probably have much better luck going to an optometrist (and perhaps getting the "channels" customized to your own use cases) vs. going with some $80 pair online from Zenni.

I agree the cheap Zenni progressive glasses are poor quality, the best you can do with them is get a frame with a rather large height that gives more room for the narrow rogressive channels, I did that for a cheap backup progressive pair. But my main progressive pair I got from a high quality online site that uses high quality Essilor lenses and their own local lab, not Chinese labs like Zenni - that pair works very well and I also it with a titanium frame and polycarbonate lenses and they have survived with no damage drops on concrete!

I have used Zenni for cheap single focus Rx glasses like for a computer intermediate distance pair and also a reading glasses pair. Those work fine.

Yup. I got single vision computer glasses from Zenni for $30 and they're great. No issues at all.

Lynda,

I am going to try to give an answer based on listening very carefully to what YOU say is important to you and what you say is not important to you. I think what you have said about your preferences and values makes perfect sense and the solution should be tailored to your preferences and values. I think you have said:

• Becoming glasses free is not an important goal.
• Comfortable computer use is a very important goal.
• Avoiding unnecessary expense is an important goal.
• Avoiding and reducing stress is important
• You asked about using your phone so I presume that is important
• You're worried about adapting to progressives and not crazy about the idea of bifocals either, but they sound a little better.

As I review this list, the solution that makes sense to me is Eyhance set for computer distance. If you choose not to get the toric version, then you will wear glasses for the astigmatism correction. It is quite likely you will be able to see your phone comfortably and do your computer time comfortably with the same pair of glasses -- monofocal glasses, not bifocals, not progressives. Then, you would have different monofocal glasses for driving. Or you could have progressives for driving, but I suspect that would be an unnecessary added expense. It's quite likely with the Eyehance and your monofocal driving glasses that you would also have comfortable intermediate vision for the dashboard or the phone, though it won't be optimal phone vision.

If you get torics and they hit it right, then you should be glasses free for computer and phone and wear glasses only for driving and other distance needs. You would have intermediate and distance vision with the distance glasses on, probably.

As a fellow myope who spends a lot of time on the phone and computer, I think near is more important than far. I can anticipate my needs for far vision and have distance glasses at the ready for those needs -- I will leave a pair in the car, for example, and another pair by the TV. I cannot anticipate every time I am going to need near vision during the day and don't want to hunt up my reading glasses every time I suddenly and unexpectedly need to see near. If I have any glasses-free capability, let it be for near and intermediate. If I had to choose just one (say, if Eyhance didn't exist) I would choose near. I've always had glasses-free near vision (very near, and only in one eye -- but very valuable to me nevertheless) and it would feel absolutely creepy -- and stressful-- to give it up. I would not trade it for glasses-free distance vision.

The Eyhance has a little more depth of focus than a monofocal -- that means a little bit greater range of distances over which vision will be reasonably sharp. If it is set for intermediate, you also get near, probably. If it is set for distance, then you also get intermediate, probably. Whatever it is set for, you can shift that set point just by putting on the appropriate pair of cheap monofocal glasses. If it is set for distance, put on intermediate-distance glasses and now the combination of your IOL and glasses is set for intermediate. Wherever it is set -- and wherever you shift the set point to by donning glasses -- you get the next distance closer-in decently well too, probably. With a monofocal IOL, you don't, probably. I keep saying "probably" because eyes vary, unpredictably. Most people who get the Eyhance set for either distance or intermediate get the next closer-in range of vision in addition to the range it is set for. And, to repeat, you can shift the set point with glasses.

I have been wearing progressives for 30 years. I'm your same age, approximately. They are not a great solution. They are fine for distance and phone. Terrible for computer. Terrible for close work when I'm doing metal work or carpentry.

There are 3 distances -- near, intermediate and far. The simplest solution is get your eyes set for one of them with a monofocal IOL and have 2 pairs of glasses, one each for the other two distances. With a toric Eyhance, maybe you get two distances without glasses and need glasses for just one distance -- near or far, your choice. I would choose glasses for far.

I have 2.25 d of astigmatism in my left eye and 8d in my right . Yet, I don't need glasses to read my phone. I just close my right eye. I don't notice any issue with 2 d of astigmatism at very close distance. So, you might not need to correct your astigmatism for phone use. However, for comfortable computer use I want every last bit of astigmatism corrected as perfectly as possible. Unless you blow everything up to large font size on the computer, I expect you'll want either glasses or a toric IOL for the computer.

I want to be able to use my phone in bed. I don't want to wear glasses in bed -- they get in the way. So, I want my vision set for glasses-free vision at near. I believe by getting Eyhance set for intermediate, I will also have glasses-free near vision good enough to use my phone in bed.

Night driving is also very important to me. That requires good contrast sensitivity. According to J&J, the Eyhance gives 30% better contrast sensitivity than the conventional Technis monofocal. That seems important. I can always put on glasses for astigmatism or for a different focal point, but getting better contrast sensitivity is not so easy.

I've done a lot of research on this stuff for myself, but I'm not expert on this stuff. And I haven't had surgery yet. So double check with your doctor on any facts I have presented before you rely on them. If my summary of your preferences and values is correct, at least maybe that's of some help. Listen to yourself and stay with what is important to you. It's hard for anyone else to fully internalize your preferences and approach the decisions strictly from your frame of reference. But that's what I've tried to do, aided by the fact that your needs and preferences seem very similar to my own.

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