Reasons Why a Basic Monofocal Such as Clareon is Better For Someone With Dry AMD?
Posted , 5 users are following.
A very few people responded to my query about Monofocal choice and AMD. I had originally thought about getting Eyhance but there were comments that with the optical tricks and stretching of the center of Eyhance that Clareon would be a safer bet for someone with Dry AMD, Intermediate. I would like to hear more about this and also where you might have come upon this information? My doctor had wanted me to choose Eyhance for distance as she has heard good reports from her patients but she also feels Clareon is a good choice as well. I feel I need more information and I have about 3 more weeks until my first LE surgery.
0 likes, 13 replies
Lynda111 Spring1951
Posted
I don't know why your dr would say the Eyhance is better for distance. It's EDOF feature is to "enhance"
your intermediate/near vision.
The Clareon is a pure monofocal and seems less likely to cause visual distortions, which those with AMD may have. But I am sure there are cataract surgeons who would feel comfortable using the Eyhance on someone with AMD.
Spring1951 Lynda111
Posted
I have not heard visual distortions linked with AMD. It is mainly a dimming in the central visual. I don't have a vast knowledge about AMD but that is mainly what I have heard about it and experience in a dark place.
Lynda111 Spring1951
Posted
You say you live in San Fran...there is a excellent eye hospital at UCSF but you are with Kaiser
Spring1951 Lynda111
Posted
No, I said I lived in San Francisco and now live in the Pacific Northwest.
soks Spring1951
Posted
your comparison is incorrect. you either choose clareon monofocal or tecnis1 (zcb00) or BnL sofport. if you are concerned with avoiding optical illusions due to AMD then before selecting clareon you should be convinced that glistening is resolved as per their promise. tecnis1 and BnL have not had glistening problem.
you have already returned from your surgery appointment so are you not decided on your choice?
wish you the very best in this very difficult decision for all of us.
Spring1951 soks
Posted
Oh, I guess you haven't seen my new discussion about how I had to reschedule the surgery to March 23.
You are the one I wanted to ask about the monofocal. I had chose Clareon as my HMO stocks Clareon as well as Eyhance. I don't understand why my comparison is incorrect and must choose among the several you listed?
I had actually given a statement to my doctor that Eyhance stretches the center and that is why it may be bad for AMD. She did not respond to this and I honestly don't know what that means? Why are optical illusions a problem for AMD? Where did you get this information so I can check it out?
Can you please explain further. I think Eyhance is a good product for what I am seeking. My doctor also recommended it for me. She also likes Clareon but prefers Eyhance for what I am seeking.
Also, could glistening be a problem for someone for AMD?
Let me know why Eyhance would not work for Intermediate Dry AMD? I have a few weeks now and really want to understand this. Thanks in advance for clarifying this!
soks Spring1951
Posted
why are you not considering clareon vivity if you are fine with eyhance? those two are somewhat valid comparison.
also, why aren't you considering zcb00 if you are fine with clareon monotocal.l? these two are validncomparison.
generally if you have any other eye condition you stick with standard monofocal so as to not to add to already blurred vision.
glistening is just another variable you add to the equation. among people without an eye condition, some are bothered by it and some aren't.
Spring1951 soks
Posted
Vivity is a multifocal and they don't allow those for those with AMD but they do allow Eyhance.
I don't know if my HMO stocks zcb00?
Well, that makes sense about the general rule of having an eye condition and sticking with a basic monofocal but I will probably have to probe this more since I do have an interest in Eyhance.
RonAKA Spring1951
Edited
I'm sure I have posted this many times before, but I would summarize the areas of concern as follows:
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AMD will result in poor central vision and a reduction in contrast sensitivity. For this reason you want to avoid any IOL that further reduces contrast sensitivity. That rules out multifocal lenses such as the PanOptix, Symfony, and Synergy. Vivity would also be a very poor choice due to significant contrast sensitivity loss. Eyhance could be a problem too as it like the Vivity extends the depth of focus, and as such it has to compromise contrast sensitivity to some degree. Perhaps not as much as the Vivity, but there will still be a reduction. It is the physics of light.
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You would be best to stick to a pure monofocal that does not try to extend the depth of focus and as such maintains the maximum amount of contrast sensitivity. Examples would be the Tecnis 1 and the Clareon.
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The other factor that reduces contrast sensitivity is distance. While the Tecnis 1 and Clareon will give you maximum contrast sensitivity at distance, the contrast sensitivity reduces as the distance reduces. For that reason to my mind it makes good sense to target one eye for distance, and then set the other eye for closer distances. Then when your distance eye is getting poorer for contrast sensitivity the closer targeted eye is getting better. Between the two eyes you should maintain good contrast sensitivity over a wide range of distances.
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And last the most controversial one is blue light filtering. A clear lens like the Tecnis 1 or Eyhance is going to allow a far higher level of blue light through to your retina than you had prior to surgery. The natural eye has a significant filter for blue light that you lose when your natural lens is removed during cataract surgery. A lens like the Clareon with blue light filtering will restore you natural eye level of filtering. While there is no consensus that this will slow the progression of AMD, it at least assures you that you will not be exposing your retina to far higher levels of blue light than it has seen before in your life. Further there is no harm done with a blue light filter. It simply restores the natural filtering of blue light that you have had all your life. It is the choice that makes sense to me, and I certainly would select it if I had AMD.
Lynda111 RonAKA
Edited
That was an excellent summary of the of benefits of the Clareron
Spring1951
Edited
You did not give this information previously as I think I would have written it down. I do remember you citing a discussion you had read where some doctors did not think an EDOF was a good idea for those with AMD but others disagreed.
The information that you just rendered about AMD and contrast sensitivity makes a lot of sense and yes it appears a basic Monofocal is the answer. That is the information I was looking for as I was still rather unclear about this issue.
The blue-light filter is an interesting topic and it does appear the natural lens has about 10 to 20% of blue light filter at birth. My HMO stocks them and it would be a special order taking longer for a clear filter. My doctor said either one is a good choice and she has a patient whot has a clear filter in one eye and a blue light filter in the other.
RebDovid Spring1951
Edited
If the issue is contrast sensitivity, then, applying whatever discount is appropriate to material coming from an IOL manufacturer, in this case, Johnson & Johnson, you might look at their publication "Delivering Intermediate Vision: The New TECNIS Eyhance Monofocal IOL", which was a sponsored supplement to The Ophthalmologist.
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J&J presents a bar graph comparing the modulation transfer function (MTF) for distance vision for 3 mm and 5 mm pupils at 50 cpmm. The accompanying text reads: "Furthermore, the TECNIS Eyhance IOL has been shown to provide a similar daytime contrast performance to other IOLs, but superior night-time contrast. In large pupils, image contrast is 31 percent better than with the Clareon® IOL, and 45 percent better than HOYA VivinexTM."
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Eyeballing the bar graph, it looks to me as though for 3 mm pupils the Eyhance and Alcon AcrySof IQ, SN60WF, are essential the same, and the Alcon Clareon is very, very slightly better than both. For 5 mm, as the text says, the Eyhance is markedly superior to the Clareon (and also to the AcrySof).
Spring1951
Posted
OK. I will try to digest that one! Thanks.