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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328104/
This is a 6 page article. The conclusion is "The Clareon monofocal provides stable refraction,
excellent distant vision and functional intermediate vision."
1 like, 13 replies
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RonAKA Lynda111
Posted
This is an interesting study. Nothing surprising in the results as one would expect.
judith93585 Lynda111
Edited
Thanks Lynda! That's good news!
Believe it or not, I'm still wavering on my choice of focus.
I would choose distance if readers would only be needed for very near, but I read that some people need readers for both near and intermediate...! If I had to choose (and I do!) my choice would be intermediate, but I've been told that would be the worst choice because both readers and distance glasses would be required.
jimluck judith93585
Edited
Judith, no matter what, you need two different sets of glasses if you get a conventional monofocal IOL, and want peak acuity for every task, unless you have the type of corneas and/or the type of brain that gives you extended depth of field. Choose near for glasses free, and you need glasses for intermediate and different glasses for distant. Choose distance, and you need glasses for intermediate and different glasses for near. At least if you choose intermediate you get so-so distance and near and a chance at better than so-so if you have unusually high depth of field corneas and/or brain.
If you get a monofocal plus like the Eyhance, and target slight myopia, you should only need readers if you can settle for less than perfect distance vision.
I have not had surgery yet. I target -0.75 with my monofocal glasses and find little need for distance glasses or readers. I'm 73, so I doubt I have much accommodation ability.
Lynda111 judith93585
Edited
I will send you a Message
Bookwoman jimluck
Edited
Or just one pair of progressives. Perfect vision at all distances.
RebDovid Lynda111
Edited
I don't doubt that the Clareon monofocal can provide excellent distance vision. And I also expect, although I have not seen supporting studies, that in a mini-monovision configuration the Clareon monofocal can provide good or very good vision across two of the three visual fields: distance and intermediate or near and intermediate. But other monofocals, including the Eyhance and Tecnis 1, also provide excellent distance vision, and studies show that the Eyhance monofocal provides a modest but real and significant extended range of focus as compared to both the Clareon and Tecnis 1 monofocals.
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What I have not seen evidence for are claims that the Clareon monofocal provides meaningfully different distance visual acuity than, in particular, the Eyhance or that the Clareon monofocal provides as good intermediate vision as the Eyhance when both are targeted for distance (emmetropia/plano). The linked study by Drs. Clayton Blehm and Brad Hall is consistent with what I've just written. For Uncorrected Distance Visual Acuity (UDVA), it shows a mean of -0.01 LogMAR (20/19.5 Snellen) for the Clareon monofocal. By way of comparison, Dr. J. Morgan Micheletti, in his Alcon-sponsored video presentation, reports a mean Best Corrected Distance Visual Acuity (BCDVA) for the Clareon of 0.01 LogMAR (20/20.5 Snellen) and 0.02 LogMAR (20/21) for the Eyhance.
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Others have reported on the intermediate visual acuity with the Clareon monofocal. See Dr. Rosa Giglio and six co-authors, Visual Outcomes and Patient Satisfaction after Bilateral Implantation of an Enhanced Monofocal Intraocular Lens: A Single Blind Prospective Randomized Study (pre-print). This study compared the Clareon, Eyhance, and Tecnis 1 monofocal IOLs. For all three monofocals, mean monocular UDVA was 0.03 LogMAR (20/21.5); mean binocular UDVA was -0.05 LogMAR (20/18 Snellen) for the Tecnis 1 and -0.03 LogMAR (20/19 Snellen) for both the Clareon and Eyhance.
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Turning to intermediate vision, Drs. Blehm and Hall report mean Uncorrected Intermediate Visual Acuity (UIVA) for the Clareon monofocal of 0.24 LogMAR (Snellen 20/35) at 66 cm (-1.50 D) and 0.16 LogMAR (20/29 Snellen) at 80 cm (-1.25 D). Dr. Micheletti's video does not report UIVA, but it does report Distance Corrected Intermediate Vision for the Clareon monofocal with a mean of 0.24 LogMAR (Snellen 20/35) compared to a mean for the Eyhance of 0.19 LogMAR (20/31 Snellen). (So far as I can tell, Dr. Micheletti doesn't say at what distance he measured intermediate visual acuities.)
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Giglio et al. measured intermediate vision at 70 cm. They report mean binocular UIVA as Clareon 0.31 LogMAR (20/41 Snellen); Eyhance 0.17 LogMAR (20/29.5 Snellen); and Tecnis 1 0.32 LogMAR (20/42 Snellen).
Lynda111 RebDovid
Edited
https://crstoday.com/articles/monofocal-iols-impact-of-optical-design-on-intermediate-vision/monofocal-iols-impact-of-optical-design-on-intermediate-vision-2
This an Aug. 16, 2023 article by Dr Micheletti commenting on intermediate vision with the Clareon and the Eyhance
Lynda111 RebDovid
Edited
Google "Monofocal IOLs Impact of Optical Design on Intermediate"
It's an Aug 16 2023 article by Dr Micheletti in CRST commenting on intermediate vision with the Eyhance and the Clareon
RonAKA Lynda111
Edited
That is an excellent article that summarizes the issues and options well. This statement is a key one in article:
"Additionally, it's crucial to underscore the importance of evaluating distance-corrected visual acuities at the relevant point of focus—distance, intermediate, or near—when comparing the visual performance of two IOLs. This approach allows us to rule out the influence of residual refractive error, ensuring a fair comparison
of the visual benefits each IOL provides."
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Some target significantly increased amounts of myopia in the distance eye and of course gain intermediate vision by doing so. Correcting that out, allows an apples to apples comparison.
RebDovid Lynda111
Edited
Thank you for the reference. I note, however, that Dr. Micheletti's article appears in a "Digital Supplement | Sponsored and Supplied by Alcon Global Medical Affairs" and that the publication, CRST Global | Europe Edition is not peer reviewed. As the "About" webpage states: "CRST Global | Europe Edition is a targeted, cost-effective vehicle through which industry can aim marketing and advertising messages to cataract and refractive surgeons. "
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It is helpful that the text tells us that intermediate visual acuity presented in the Alcon-Micheletti video, and reproduced here, was measured at 66 cm. At that distance, his report that the Clareon's mean DCIVA was LogMAR 0.24 corresponds to Blehm & Hall's report that, at 66 cm, Clareon's mean UIVA likewise was LogMar 0.24. As for the Eyhance, at 66 cm, Micheletti reports a mean biocular DCIVA of LogMAR 0.19. In Snellen, the difference is 20/31 (Eyhance) vs 20/35 (Clareon), which Micheletti interprets as proving Clareon's "Non-inferiority". We can judge for ourselves whether, all else being equal, we would rather have 20/31 or 20/35 binocular DCIVA.
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Notably, using Micheletti's data, the difference in mean BCDVA between the Clareon and Eyhance is only LogMar 0.01, in Snellen, 20/20.5 Clareon vs. 20/21 Eyhance. For what it's worth, Giglio and her co-authors, in the article to which I linked in another post in this thread, report that the Clareon and Eyhance had the same mean UDVA, namely, -0.03 LogMAR or Snellen 20/19.
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I'd also note that Micheletti's conclusion emphasizes the cost advantage to surgeons of using the Clareon rather than the Eyhance: "The Clareon monofocal IOL may be an equally suitable choice with a relatively lower cost for surgeons who want to provide patients with the potential of some intermediate vision after cataract surgery." The implication seems to be that the Eyhance costs surgeons more than the Clareon. But in markets where the cost to the patient is the same, such as the United States, this consideration has no force.
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The conclusions I suggest drawing from Micheletti, Blehm & Hall, Giglio et al., as reinforced by other articles I've read, are that, all else being equal, distance visual acuity for the Clareon and Eyhance is substantially the same and that the Eyhance provides a modest but noticeably greater depth of focus as compared to the Clareon.
Lynda111 RebDovid
Edited
I am sure there will be more studies to come. And because cataract surgery is a multi billion dollar market, I am sure in the next few years there will be monofocal
iols that are better than what exist today.
RebDovid Lynda111
Edited
Both your thoughts seem unreasonable. Indeed if you don't need or expect a substantial benefit from cataract surgery now, these are reasons to hold off.
RebDovid
Edited
I meant to write "reasonable". My apologies.