Now with two Eyhanced eyes; mini-monovision; for me, so far a "wow" result.
Posted , 7 users are following.
Yesterday my second Eyhance IOL was implanted. This morning I had my one-day post-op check-up. For me, the initial results are spectacular, although my surgeon cautioned that, as I still have a little swelling, results may change between now and my four-week appointment with his optometrist. All going well, I won't see my surgeon again because, in addition to surgeries, he only provides continuing care in complicated cases.
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We started six weeks ago with my nondominant eye targeted primarily for near and secondarily for intermediate vision. Yesterday, my dominant eye was targeted to be slightly myopic, aiming primarily for intermediate vision with hopes of also being at least legal to drive.
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As of today, my hopes have been realized. My second eye tested at 20/25. My wife had driven me to the appointment; my surgeon approved my driving going forward, which at least in bright daylight just now I found very comfortable. Depending on how the eye settles, wearing glasses to drive at night and in bad weather may be a matter of comfort rather than necessity. Indeed, my distance vision is better than it was with the fully-corrected contact lens that I had worn to trial mini-monovision before the first surgery and continued wearing during the interim so I could function in the world. With the contact lens, I only had 20/30 with the difference between it and 20/20 being attributed to the cataract.
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With my nearer eye, I'm able comfortably to read my smartphone held at my normal distance of 12.5"-13". Holding a book as I normally would just above my lap, I can easily read 10 point Lyon Text. As for my computer monitor, which is a 27" Asus ProArt PA27QV monitor, 2560 x 1440 at 60 Hz., text is clear and comfortably readable at 32", where I had the monitor before the surgeries. For example, in Microsoft Word all the menu titles are clear and legible; I can make out four point Century Schoolbook text, easily read five point CS text, and read comfortably nine point CS text. Also, all the names in Windows Explorer in "Details" mode are easily and comfortably readable.
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The only untoward visual phenomenon I noticed is that while reading the eye chart letters appeared somewhat shadowed or doubled when viewed with one eye. Especially as the letters were clear and unshadowed when viewed with both eyes, my surgeon thinks this likely to resolve itself over time as my brain adjusts. Also, just now I don't see any doubling or shadowing when viewing this draft on my computer while covering one eye at a time.
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I realize that results can change over time and the optometrist examination in four weeks will provide more stable and comprehensive information about both visual acuities and mini-monovision. At the moment, however, I would call this a "wow" result.
2 likes, 23 replies
jo61855 RebDovid
Posted
My experience with contact lens was using monovision. One monofocal was for distance and the other monofocal was for near vision, and no need for eyeglasses. After retiring, I switched to progressive eyeglasses. First learned about mini-monovision from this discussion group and Ron's posts, around the time I had my first cataract surgery a month and a half ago.
The purpose of the mini is to extend the range of vision distance analogous to a EDOF lens, but using monofocals, which national health care, medicare, or HMOs would cover in cost. Is Eyhance lens a monofocal? My Vivity lenses preclude a mini-monovision definition, even though there is a small distance differential between the lenses.
RebDovid jo61855
Posted
Given the official categorization of IOLs, the Eyhance is a monofocal because it hasn't been shown to meet the criteria for an EDOF (extended depth of focus) IOL. Indeed, it's considered a monofocal for purposes of Medicare coverage and health insurance in the United States it's considered. Some refer to the Eyhance as a monofocal plus or extended range of vision monofocal because it has been shown to provide more depth of focus than a pure monofocal, such as the Tecnis 1 or Clareon monofocal.
Lynda111 RebDovid
Edited
The Eyhance has been favorably peer-reviewed. The Clareon has not been peer-reviewed yet. But I have had cataract surgeons tell me it has been over-hyped as the Alcon study was trying to reflect.
But bottom line, The Clareon, the Eyhance, the Tecnis 1 and even the Acrysof are all very fine IOLs.
RebDovid Lynda111
Edited
The Clareon monofocal IOL is included in the preprint I've mentioned that's currently undergoing peer review, namely, Rosa Giglio, et al., Visual Outcomes and Patient Satisfaction after Bilateral Implantation of an Enhanced Monofocal Intraocular Lens: A Single Blind Prospective Randomized Study. "The primary goal of the study was to evaluate and compare the clinical outcomes of three parallel groups of patients following bilateral implantation of the ICB00 IOL, ZCB00 IOL, or CNA0T0 IOL. Considering the modified optical profile of the ICB00, the primary outcome was the evaluation of intermediate-distance visual performance. The primary endpoint was to compare groups in terms of binocular DCIVA at 12 weeks after the second eye implant. Secondary endpoints included: UIVA, UDVA, CDVA, UNVA, CNVA, binocular defocus curves and the results of the Catquest-9SF questionnaire."
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Here are both monocular and binocular mean visual acuities. Monocular first:
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Mean UDVA (uncorrected distance visual acuity) was essentially the same for both IOLS: Eyhance, 0.003 ± 0.09 logMAR; Clareon, 0.003 ± 0.07 logMAR.
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Mean UIVA (uncorrected intermediate visual acuity) showed a substantial difference in favor of the Eyhance: 0.2 ± 0.13 logMAR, Eyhance; 0.34 ± 0.1 logMAR, Clareon.
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The Eyhance also came out substantially better for UNVA (uncorrected near visual acuity): Eyhance, 0.25 ± 0.13 logMAR; Clareon, 0.36 ± 0.12 logMAR.
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And now binocular mean visual acuities, which replicate the monocular pattern of essential equality for uncorrected distance and advantage Eyhance for uncorrected intermediate and near:
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Mean UDVA: Eyhance, -0.03 ± 0.07 logMAR; Clareon, -0.03 ± 0.06 logMAR.
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Mean UIVA: Eyhance, 0.17 ± 0.12, logMAR; Clareon, 0.31 ± 0.09 logMAR
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Mean UNVA: Eyhance, 0.23 ± 0.11 logMAR; Clareon, 0.33 ± 0.12 logMAR
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Finally, because @RonAKA says he's of the belief that Eyhance studies often are biased in its favor for intermediate and near vision because they intentionally under correct the refractive targets, the authors report: "We found a postoperative subjective SE close to 0 and similar between groups, with slightly higher variability in the ZCB00 (neither Eyhance nor Clareon) group, although the mean values were not significantly different." Also, "pupil size was not significantly different between the three groups."
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The authors also state: "It's remarkable to underline that our study was a prospective study. Moreover, to our knowledge, there is no other scientific work in literature that compares the ICB00 IOL performance to two groups of standard monofocal IOLs (the ZCB00 and the CNA0T0). In our study, we observed a statistically significant difference in the age of the three groups, with older patients in the CNA0T0 group. This difference should be kept into consideration when analysing the results and might represent a limitation of the current study...."
Lynda111 RebDovid
Posted
This Aug 2023 study from the Journal of American Society of Cataract and Refractive Surgery published in PubMed may have already been cited here, but it compares two Johnson and Johnson IOLs, the Eyhance and the Tecnis 1 piece and finds the Eyhance provides one extra line of intermediate visual acuity
https://pubmed.ncbi.nlm.nih.gov/37232418/
RonAKA Lynda111
Edited
The issue is that the Tecnis 1 with the -0.27 um of asphericity offsets the positive asphericity in the eye to zero, at least in theory. As a result the Tecnis 1 probably has the least depth of focus of all monofocals. Short of a spherical lens the B+L enVista probably has the most depth of focus with the neutral asphericity approach which leaves the residual at +0.27 um. The AcrySof and Clareon lenses offset less of asphericity and result in a depth of focus that is not far off what is claimed for the Eyhance. That is probably why a comparison of the Clareon to the Eyhance does not show a significant difference. The difference from the Tecnis 1 is more significant.
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The other issue I have with the Eyhance is that they claim to suffer no loss in visual acuity. When you stretch the focus point of the lens that is simply not possible. There is a price to be paid for stretching the focus point. It may not be large and for those who believe the increased depth of focus is of some benefit, the tradeoff may be worth it. There is another thread here where the OP is unhappy with the distance vision and colour saturation of the Vivity. That probably is the result of this tradeoff of depth of focus for visual acuity and contrast sensitivity. There is no free lunch!
Lynda111 RonAKA
Posted
Good points. I'm sure there will be more studies to come and more IOLs to come. But as I said in an earlier post, all the main monofocals seem to work well, assuming someone has a healthy eye, good measurements, and a good cataract surgeon. And even with all that, the refractive outcome can vary from patient to patient.
RebDovid RonAKA
Posted
It is difficult to have a reasoned discussion with someone who fails to respond to evidence that calls his assertions into question. Rather than repeat here the evidence, or more precisely the publications providing and supporting the evidence, to which @RonAKA fail to respond, I'll simply (1) note that references are available elsewhere in this thread and (2) summarize three sets of facts that he hasn't addressed.
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First, the comparison between the Clareon monofocal and Eyhance relied on by @RonAKA was funded by Alcon, undertaken by a paid Alcon consultant who regularly appears in promotional articles for Alcon IOLs, and has not, or at least not yet, been published in a journal.
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Second, the comparison appears to have been rigged in favor of the Clareon monofocal. As can be seen at the timings in the Alcon video that I've noted elsewhere in this thread, the supposedly non-significant differences in intermediate and near uncorrected visual acuities result from the Eyhance having been targeted at plano and the Clareon monofocal at -0.25 D. This means that by the Alcon presentation's own data, the Eyhance has (at least) a 0.25 D advantage over the Clareon monofocal. There may be other reasons to prefer the Alcon IOL, but the Alcon video doesn't identify them.
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Third, a study by independent investigators that's been published as a preprint and is undergoing peer review reports (1) substantially better uncorrected intermediate and near visual acuities for patients implanted with the Eyhance vs. patients implanted with the Clareon monofocal and (2) no significant difference in distance visual acuity. Again, there's more to choosing an IOL than visual acuities as shown by defocus curves. But that "more" also should pay attention to the evidence in reputable studies.
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Finally, @RonAKA repeatedly asserts that it's "simply not possible" for there to be "no loss in visual acuity" with the Eyhance. Obviously, all designs have trade-offs. But the proof of this pudding lies in the visual acuities found through bench testing and examinations of actual patients. And for us as patients it also requires comparison with other IOLs. After all, as patients we don't care how close a particular IOL comes to an ideal. We care how well it meets our needs in comparison with other available IOLs. If one wants to argue that IOL Model abc is better than IOL Model xyz, let's see the data presented and then discussed in terms of the priorities and needs one wants the IOL to meet.