RayOne success story

Hello indygeo

I'm in the West of England. I found a good ophthalmologist locally who uses RayOne as the default for private patients.

Prior to the initial cataract procedure my contact lens prescription has been left (dominant) eye -3.75 used for distance vision and no prescription for the right eye which I use for near vision. I have had this for many years and it has worked fine. The ophthalmologist is confident that he can replicate this in my post-cataract lens configuration. However given that I only need a smidgeon more resolution for good near vision than the RayOne is already giving me in distance eye I'm wondering if I should be asking him to consider if a more modest offset would work just as well when I have the second procedure. (Subject to Ron's comment about waiting 6 weeks.) Any thoughts?

The standard myopia for the close eye with mini-monovision is -1.50 D on a spherical equivalent (SE) basis if there is astigmatism involved. On a SE basis I have -1.40 D and can read the computer standard size text down to about 8", but that is getting pretty close and the distance is helping. The computer screen is also bright. In dimmer light with very small print I do need to use some +1.25 D readers. I think that is a good tradeoff point. My vision in the close eye is compromised with -0.75 D of irregular astigmatism. I think my reading would be much better if it was a pure -1.50 D sphere. The irregular astigmatism gives me a bit of a drop shadow effect on letters. I can still read them, but it slows me down. As for distance, I can view a large screen TV at 7 feet or so quite clearly, but not quite as sharp as my distance eye. It gives me very sharp vision at that distance, and I can read a computer screen starting at about 18". It would not be comfortable to use a computer at that distance though, unless it was a very large monitor.

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Overall with both eyes open I do not see any gap in clear vision from 8" out to infinity.

For whatever it may be worth, Dr. Graham Barrett, who partnered with Rayner to develop and bring to market the RayOne EMV IOL, says he targets "about -1.25 D in the more myopic eye." Dr. Barrett writes that "In previous published studies, including my own, the overall satisfaction rate is well over 90 percent because the technique does not compromise the quality of vision. " The Ophthalmologist, Closing the Distance: How does modest monovision work as a strategy for balancing near and far vision?, Feb. 1, 2022.

Because the Rayone EMV is new to the U.S., I haven't considered it in making my IOL selection. I do see, however, that Rayner's binocular defocus curves for its new IOL and the Eyhance, which Rayner obviously sees as major competition, shows equal visual acuities at 0.0; better VA for the Eyhance from 0.0 to somewhat beyond +1.25 D; and slightly better VA for the Rayone EMV from 0.0 to -3.00 D. Eye Science, RayOne EMV and TECNIS Eyhance: A Comparative Clinical Defocus Curve

Allric,

I kind of figured you were in the UK. My doc (in the UK) was the first to implant the Rayner EMV so it seems to be catching on a bit faster there. In any case, given that you are having fairly good results with the EMV even in the near range with the distance eye, I personally would go no more than a 1.00 D offset with that lens. My doc actually targets from anywhere from as small as 0.30 D up to 1.00D offsets and feels good about the outcomes. My offset was about 0.75 D from a plano distance (non dominant) eye with a monofocal lens. I'm not telling you what YOU should do, I'm just telling you what I would do in your case if it was me, given what you've told me.

For me, I placed about equal weight to stereoscopic AND near vision needs. Thus, I wanted a fair degree of overlapping focus particularly at around a comfortable (but not super near) reading and computer distance... and distance if I could get it. What surprised me about the Rayner EMV lens was how good my distance vision is even if it's my "near" eye. In decent sunlight I feel its about 95% of the excellent vision I get with my monofocal distance lens. I expected maybe a 70% level. Given that you'll have two Rayner lenses I suspect your outcome overall will be at least as good or better than mine. I urge you to follow your own instincts and path under the guidance of your surgeon. I think it's highly likely you'll have a good outcome.

Indy G

The best reference I have found for optimizing monovision is this one below. Unfortunately they have taken down the full text version of the report. However there is still 3 figures and 2 tables from the report still on line. If you click on each one more information is displayed so you can pretty much piece together the full report.

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semantic scholar Optimal amount of anisometropia for pseudophakic monovision.

Ken Hayashi, Motoaki Yoshida, H. Hayashi Published 1 May 2011 Journal of refractive surgery

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All of the data is useful but Figure 2 is most useful as it shows the blended outcomes of 1.0 D, 1.5 D, and 2.0 D of monovision. The study chose 1.5 D of these fairly course steps to be the optimum. I spend a lot of time looking at this data, and to my eye with some interpolation, I decided that 1.25 D, a step not displayed, to potentially be the optimum. However when I got my first eye done for plano and simulated these steps with reading glasses, I decided that 1.5 D was probably better. The 1.25 D left me a little short of the reading I was expecting. But considering that one cannot hit expect to hit a target to the 0.25 D accuracy, I think a more reasonable target is to be between 1.25 D and 1.5 D.

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With respect to this RayOne EMV or enhanced monovision lens, the only aspect of it that I can see as an enhancement over a standard monofocal is that there is a very slight increase in the contrast sensitivity (MTF) to the left (hyperopic) side of the peak acuity point. This has no value in the distance eye set to plano as it will be at a distance beyond infinity. However in the close eye this small boost will be of some help in the distance between the peak point and full distance. However, since the boost is not on the myopic side, I would still target the monovision offset the same as a standard monofocal. So I would still stick with the 1.25 D to 1.5 D offset.

My Rayner EMV experience mirrors James70491's.

I've had Rayner EMV toric lenses implanted to replace a Vivity lenses in both eyes.

The vision quality in my "distance" eye is astoundingly clear, bright and precise - down to ~1.5m. That eye was done nearly 4 weeks ago, so has settled nicely.

My other eye was targeted for a bit more intermediate-to-near vision, but I fear they have missed the target significantly, being way too myopic for comfort, which is very annoying. But at one week since surgery I'm hoping that will change for the better.

Overall, and aside from targeting errors, I'd rate the quality of vision across all light conditions for the Rayner EMV at a solid 9 and the Vivity at 5. To me, the difference is stark.

A standard monofocal lens set for distance should provide good (20/32) vision down to 0.8 meters. But, individual results have a large variability.

"A standard monofocal lens set for distance should provide good (20/32) vision down to 0.8 meters."

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At 80 cm (-1.25 D), the mean binocular visual acuity of an Eyhance IOL with a -0.25 D refraction was 20/23 (LogMAR 0.069), averaging together defocus curve data from four published articles: Auffarth, et al., Clinical evaluation of a new monofocal with enhanced intermediate function in patients with cataract, J Cataract & Refract Surg, February, 2021; Nanavaty, et al., Visual Acuity, Wavefront Aberrations, and Defocus Curves With an Enhanced Monofocal and a Monofocal Intraocular Lens: A Prospective, Randomized Study, J Refract Surg, 2022, 38(1): 10-20; Park, et al., Visual outcomes, spectacle independence, and patient satisfaction of pseudophakic mii-monovision using a new monofocal intraocular lens, Scientific Reports (2022); and Choi, et al, Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population, BMC Ophthalmology (2023).

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Relying on the same sources, with a 0.0 D refraction, the mean binocular visual acuity of an Eyhance IOL at 80cm (-1.25 D) was 20/25 (LogMAR 0.104).

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Of course, individual results are likely to be better or worse than the mean.