Recent cataract surgery - My experience with the Tecnis Eyhance
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Well, thanks to all of the advice and feedback on here from everyone, I had my first cataract surgery on my right, (non-dominant) eye last Thursday. I had the Tecnis Eyhance IOL with no particular request for a preferred near/intermediate/distance option and instead, left it to be the standard ‘distance’ option as I’d planned to use reading glasses for computer work if the ‘enhanced intermediate vision’ of the Eyhance didn’t work as well as expected.
Anyone who might’ve read some of my other posts will know that I’m in my late 40s and cataracts appeared out of nowhere around this time last year. My right eye was much worse than my left because there was also a lot of scarring for some reason. I’ve also suffered from a lot of large, dark stringy floaters from potential PVD in the last 3 years which is another reason for going with the Eyhance rather than a multifocal.
The surgery itself wasn’t painful but I didn’t like the feeling of pressure and I didn’t choose to have any kind of sedation or pill. The surgeon did explain that he had to use additional pressure for a longer period because he tried to get as much of the scarring off as possible in the hope I won’t need to have a follow-up YAG to help with the vision as the scarring would’ve made quite an impact to the end result. At some points during this extended polishing stage, the pressure felt so intense I remember tensing my whole body and pushing my head and fingers into the table until it was over…..at least I kept still though!
In the end, he said that the scarring was on both the back of the lens and also a fair amount on the capsular bag. With the extra polishing, he said that he’s been able to remove most of the scarring so it shouldn’t now impact my vision which was great news.
Strangely, my vision was really quite good shortly after coming out of surgery and my pupil didn’t stay dilated for very long at all. The eye was uncomfortable for the rest of the day of the surgery, (it was done at 9am) and didn’t feel nice to blink or move my eye around as the apart from the scratchy feeling, it also felt uncomfortable inside the eye which is most likely adjusting to the new IOL. Amazingly, the next day, my eye felt much better and looked normal which was great.
Now it’s been almost a week and my results haven’t changed at all since surgery so I suspect this might be how they’ll stay, I’ve found the following:
My intermediate vision is amazing. Everything on my computer monitor is pin sharp and I can even read the small font on my phone very clearly at 15”/38cm. I think the IOL calculation must’ve been wrong as it was supposed to be set for distance vision because, although I can see everything relatively clearly in the distance, it’s not sharp and distant text, (like subtitles on a 65” TV at around 10ft are just about readable but slightly ghosted). Strangely, if I try my son’s driving glasses on, they make everything in the distance pin-sharp, even the very far distance. His prescription is SPH:0.00, CYL: -1.25, Axis:95.0. I have an idea what these mean but I don’t understand how it makes so much difference to my distance vision.
From straight after surgery to now, I appear to have positive dyphotopsias which is disappointing. It’s a lot worse at night in a relatively dimly lit or dark room, a lot of light sources will have either a half-circular arc a fair distance above it. Some have a full thin halo, again a fair distance from the light source rather than right next to it. Some lights will also have light rays extending up to the arc like an open hand-held fan. In some cases I can move my eyes around the halo as if it’s actually there without it changing, (as long as I stand still). I believe that these are all caused by light bouncing of the back edge of the lens. I also have some strange effects in peripheral vision on the right-hand side of my operated eye during the day where objects that are very near to that side appear to have severe ghosting but, being in peripheral vision, I can’t really tell what they look like properly, I just know they’re not right.
The floaters are obviously still there and particularly noticeable in light environments or on a screen with a white background. However, they’re not quite as dark as before and I’m possibly seeing less of them which I’m putting down to the IOL letting in a lot more light than the cataract did.
It’s also made me realise just how quickly my cataracts got to an advanced stage. There were no signs of any at the beginning of last year and then from around late August, when I noticed my right eye was having strange issues and was referred to see someone a few weeks later, they said that the right-eye cataract was ‘significant’ and that my left eye had one too. Now that the surgery has been done on my right eye, my left eye, which started to show obvious symptoms around 3-4 months ago, is very obviously yellow/brown compared to the newly operated eye where everything is crisp and bright white. I know that the yellow/brown colour normally happens when a cataract is at an advanced stage, so this was quite a surprise in such a short space of time but is apparently common with posterior subcapsular cataracts.
So, that’s my experience with the Tecnis Eyhance. I do have a couple of questions for the very helpful people on here with a lot more experience of things than me:
1.Did anyone else who experienced positive dysphotopsias ever find they went or even just subsided a bit? From most articles I’ve read, they doesn’t seem to get better with time but I’m wondering if anyone found it becoming less obvious over the first few weeks of healing?
2.When I have my left eye, (which is the dominant one) done in a few months, I’m wondering whether mini-monovision would allow me to get sharper distance vision and work well with what I currently have with my right eye. As I haven’t trialled anything due to the severity of the cataracts, my surgeon said half a diopter is generally well tolerated by everyone without much neuroadaption. From the card I was given, it looks like the Eyhance power is +21.0D. Would adding half a diopter for the IOL to be fitted in my left eye make much difference to the sharpness of distance vision or is that not enough?
Any feedback on the above or help with the last two questions would be very much appreciated. Thanks for reading!
0 likes, 14 replies
RonAKA Matt22935
Edited
I can offer a couple of comments. I think for the next eye, I would choose the IV sedation. I can't see any advantage in toughing it out with no sedation, unless you are allergic to the sedation drug. I had the IV with my first eye, and I will for sure do it again with the second eye.
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It is early but it sounds like your first eye was under corrected some. You should wait and see by how much when your eye fully recovers at 6 weeks or so. Then you may want to use it for the closer reading eye, and let the surgeon try again with the second eye for a full distance correction. It is best to have the distance eye as the dominant one as well.
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SPH:0.00, CYL: -1.25, Axis:95.0. - This is a correction for astigmatism only and it is not a good indicator of what you need. Wait until you get your eyes tested at 6 weeks to be sure where you are at. The rule of thumb is that it may be equal to about -0.75 spherical, but that is rough. It does suggest you may be somewhat under corrected.
Matt22935 RonAKA
Posted
Thanks for the feedback Ron. I actually thought I was going to be given sedation as I remember seeing it ticked on my form. What I didn’t realise was, when the surgeon saw me about 15-20 minutes before the operation to see how I was and asked if I’d like a pill to help, that must’ve been it but I thought he was offering one in case I was feeling anxious and so I said ‘No’… I’ll know for next time!
I agree that it’s likely the eye has been under corrected as it’s exactly the same just over a week later and I can’t see that it would change dramatically during the rest of the healing process. Having said that, for me it’s ideal because I’m an IT consultant and really wanted some form of intermediate vision, (which was one of the reasons for choosing the Eyhance). I didn’t want to risk asking for a correction for more intermediate vision before surgery in case this ended up being too far under corrected and giving me just near vision. As it turns out, leaving it at full distance and being inadvertently under corrected has worked out well. As you say, if the surgeon can get the calculation spot on for the other eye set to distance and the diopter difference isn’t too much to adapt to, I should end up with really good vision from both eyes together.
It’s interesting you mentioned my son’s glasses are set to correct astigmatism only because I checked my last 3 eye test prescriptions for the eye that’s been operated on and the one in October 2018 was C: -1.00, A: 80.0, in February 2020 it was C: -1.25, A: 84.0 and in September 2020 it was C: -1.00, A: 90.0, so I obviously have an astigmatism too. I wasn’t offered a TORIC lens so I’m assuming my astigmatism was too mild although I won’t know what it is now the surgery has been done for a few weeks.
RonAKA Matt22935
Edited
" I checked my last 3 eye test prescriptions for the eye that’s been operated on and the one in October 2018 was C: -1.00, A: 80.0, in February 2020 it was C: -1.25, A: 84.0 and in September 2020 it was C: -1.00, A: 90.0"
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It seems by coincidence that your pre-surgery astigmatism was very similar to that of your son. There are some wild cards in this to consider before coming to any firm conclusions. One is that the eyeglass astigmatism is the sum of the astigmatism in the cornea and the astigmatism in the natural lens. When the natural lens is removed in the cataract surgery that contribution to the total astigmatism is gone, and only the cornea astigmatism remains. If the cornea astigmatism is low, your post surgery astigmatism may also be low. The need for a toric lens is based on the cornea astigmatism only. If you ask the surgeon they should be able to tell you what it is. Anything less than 1 D is not usually corrected because the minimum correction power for cylinder in an IOL is 1.5 D.
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I would wait until 6 weeks and then get your eyes tested to see exactly where you are at. Keep in mind that a modest amount of negative astigmatism can help you read without compromising your distance much. For example -1.0 D cylinder is about equal to -0.5 D of spherical. That is enough to improve reading some if your measured spherical is actually plano at 0.0 D. My IOL eye is 0.0 D Spherical and -0.75 D Cylinder, and I can see down to about 18" quite clearly with it. This seems to be better than average for a monofocal IOL, and I attribute it to the residual astigmatism.
Matt22935 RonAKA
Posted
Thanks for the info Ron, that all makes sense now. I have my first follow-up appointment since the surgery in just over 2 weeks so I should know a bit more then.
I didn’t realise that having some negative astigmatism can help with reading if a distance IOL has been chosen. That might be what’s happened for me because I still can’t believe how clear my dashboard, computer monitor and phone is. I can clearly see the small text under my phone icons at around 43cm/17” and I can still read them at around 33cm/13” with a small amount of ghosting. Any nearer than this and the focus goes quickly but I never used to read anything that close to me anyway. Also, it’s only really text that’s noticeably ghosted at such a close range because if I look at an object that close, it’s only slightly out of focus so I’m getting very functional and useable vision at a range of distances. In fact, I haven’t needed to wear any reading or computer glasses since the surgery.
I agree that it’s still likely to have been under corrected but the only real compromise with my distance vision in that eye is when reading signs or text because it’s very slightly ghosted so it’s not always readable. Having said that, my distance and far distance for anything other than text is really quite clear. I can see individual leaves at the top of the trees in the back of our garden and individual bricks on the house opposite, it’s not pin-sharp without my son’s astigmatism correcting glasses but otherwise very good unless I want to read certain sizes of text in the distance.
It’s obviously not all perfect as I still see loads of floaters in the daytime or looking at a backlit screen and, since having surgery, I now have positive dysphotopsias in that eye, (large arcs above and halos around light sources) along with distortion and sometimes a small black arc in the very right of my peripheral vision and distortion to lights in the upper peripheral vision but overall, I’m really happy with the results I’m getting with the Eyhance and never expected that from a monofocal but, as you’ve said, it could all be down to an under correction and me having some negative astigmatism.
RonAKA Matt22935
Posted
I suspect that the negative astigmatism contribution helps with functional closer vision but not necessarily sharp closer vision. In my non IOL eye which I am using a contact lens for correction I have tried both toric and non toric lenses. The toric ones definitely provide sharper vision, but not necessarily higher visual acuity. I find them uncomfortable compared to the non toric lenses and prefer the non toric.
Matt22935 RonAKA
Posted
I think you're right. I did some more visual tests today and found that what I thought was pretty clear distance vision is actually quite a soft focus. When I tried my son's astigmatism correcting glasses on again, despite them not being quite right, it really made everything sharp and made me realise the difference.
So, it does look like it's more of an under correction that's giving me the clear intermediate vision. Thanks again for all of your advice and feedback. It'll be interesting to see your results after the various contact lenses you've been trying.
Night-Hawk Matt22935
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I had cataract surgery only in my right eye almost 3 years ago with a Tecnis toric monofocal IOL.
I also would see a partial thin arc of light around some lights at night and that was when the eye's pupil was at its largest size. I also saw the thinner spokes going out to the arc like on a wheel. If you reduce the pupil size by looking for awhile at a flashlight up close it would go away - there are drops that can reduce the pupil size too.
This can happen if you are relatively young (under age 60 or so) because the pupil can get a lot larger when you are younger and as you age it doesn't get as large in dark conditions. Now I don't think I see the light arc around lights anymore so I guess my pupil doesn't get as large anymore. But this was after a year or two, doesn't go away quickly and since you are younger could take a lot longer, so if it bothers you at night you might look into the eyedrops that can reduce the pupil size for several hours.
I believe the partial arc is because the IOL is very slightly off center of the pupil - if it was perfectly centered you will see a full circle of light. Indeed if my eye is artifically fully dilated (more than happens naturally) at the eye doctor, I see full circles around lights even in the daytime until the dilation eyedrops wore off after several hours.
Wait for the first eye to be completely healed and settled before getting the second eye done. If the first eye remains undercorrected for distance but good for intermediate/near, perhaps you could target the second eye for distance focus and they can adjust for any error from the first eye, maybe try to get them to use ORA to check it during the operation to get it more accurate.
Each 0.25D should reduce distance vision by one line on the eye chart, so for example -0.75D should give about 20/40 distance vision expected. Though it could be a little better than that since I get 20/15 or even a bit better with my eyes corrected for plano.
Yes I too could see the big difference between my left eye (natural lens) vs the right eye (Tecnis clear IOL) regarding whites and colors. The natural eye as it ages gets more yellow/brown even at age 30 it has some yellow I've heard - thats why some IOL manufacturers have a slight yellow tint to try to match similar to the color/white seen around age 30. But I prefer the clear IOL that Tecnis does, thats why I chose it in fact. The clear IOL is probably close to that of a young child's natural lens color/white vision.
There can be some residual astigmatism due to the incision in the cornea, its unpredictable and after healing could produce that. I ended up with almost 1D astigmatism from that, though my right eye did get spot on at plano - so I get 20/25 or slightly better uncorrected distance vision in that eye because of that. With eyeglasses that correct the 1D astigmatism I can get 20/15. This is much better than I had in that eye prior to getting significant cataract, it had almost 3D astigmatism and a little nearsightness so it was 20/100 or worse back then so always needed glasses or contacts. Now I use glasses to correct my left eye (no IOL yet) but the right eye allows me to see pretty well without glasses at all a lot of the time.
You might have some residual astigmatism now that could reduce a lot after the eye heals over the next month or two. If so, that might improve your distance vision but reduce your near vision.
Matt22935 Night-Hawk
Posted
Thanks very much for all the info and your feedback Night-Hawk. I hadn’t thought about the IOL being off centre slightly and that my age might be a factor. I do see a full circle halo around some lights, but it’s more often a full semi-circular arc at the top. I’ve noticed that if I tilt my head fully back and look at the lights, the arcs tend to disappear.
I also read the article that RonAKA mentioned in another post about the Tecnis IOLs only providing a 4.9mm optical zone instead of the full 6mm if the power is over +21.0D and my lens is actually +21.0D so if that also only provides 4.9mm, that would explain the arcs and possibly the strange effects I’m seeing all the time in my peripheral vision, (mainly above and to the right) which seem a bit like seeing things underwater with ghosting at the extremes of my peripheral vision. I’m guessing it’s because I’m seeing the edge of the lens, particularly if it’s one of the 4.9mm optical zone ones. Having said all of that, the odd peripheral effects might be from the incisions as they’re mainly above and to the right so if I’m lucky, they might reduce as the eye continues to heal.
I agree with waiting before having the other eye done. I suspect that, given the speed the other cataract progressed, I’ll need it done within the next few months and I’ll definitely try and get them to set it correctly for distance vision. A couple of months ago, my surgeon said most people tolerate a 0.5D difference between eyes without needing to adapt. I’m not sure what level of power I’ll need for the other eye to be set to distance focus until my operated eye heals fully and how it ends up. Hopefully, it won’t require too much of a diopter difference which would reduce the need for a lot of neuroadaptation.
As I mentioned to Ron above, I already had some level of astigmatism before surgery and as you say, this might have been increased either temporarily or permanently. I wasn’t offered any TORIC lens options so I’m assuming that my original figures were mild, (I don’t really know what figures warrant the TORIC options).
RonAKA Matt22935
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I believe that article which shows the 4.9 mm effective area for the Tecnis is for the basic monofocal lens. You should ask your surgeon whether or not the same applies to the Eyhance model.
RonAKA Matt22935
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I am trialing monovision using a contact lens in my non operated eye. I have tried with it at -2.0 D under corrected (no contact), -1.5 D (+0.5 D contact), and -1.25 D (+0.75 D contact). I do not like the -2.0 D at all, but it is OK when I first get up in the morning for the basics. I like the -1.25 D the best. There is no "hole" in the vision and I can see close enough to read normal size text or a computer screen, or iPhone 8+. -1.5 D is OK though and gives me a little better reading. My plan is to use a monovision lens and ask for a -1.25 to -1.50 D under correction in the second (near) eye.
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With the Eyhance I would think you would be fine if you have good distance vision in the other eye to ask for a range of -0.75 to -0.50 D under correction. It is best to give the surgeon a range to improve your odds of them hitting it.
Matt22935 RonAKA
Posted
Thanks Ron, I’ll check with the surgeon about the Eyhance although I suspect that it’s likely to be the same as the article you found. From everything I’ve read, the Eyhance is almost identical to standard Tecnis monofocal with the only difference being the additional power in the central 2mm zone. If the Eyhance does have a 4.9mm effective area like the standard Tecnis IOL, that could also explain why I’m seeing the dysphotopsias.
With the under correction and/or astigmatism giving me really good intermediate vision in the operated eye, I’ll look at getting the other eye set for standard distance so I’m not sure what level of correction that would need but I want to keep it within the accepted range of micro/mini monovision so it doesn’t involve too much neuroadaptation.
lucy24197 Matt22935
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I had my first eye done Tuesday and was also unable to trial different degrees of monovision because my cataracts are too bad. My unoperated eye is in the -2 to -2.25D range, so the doc says I'm doing my trial now. (My distance target was -0.5D.) If your eyes are now different enough, you might want to try going without glasses to see how it works for you. I'm noticing daily adjustments in how things look for my eyes working in combination-much better at 3 days out than the first couple of days. I'm throwing on some readers for reading a book in the evening, but otherwise I'm not wearing glasses at all. Contrast and focus have improved a great deal as my brain adapts, although neither is perfect. Some of it is probably the vision getting a little better in the eye with the iol, but some of it is definitely the vision blending better.
I had a pill (valium) during my surgery. I don't know that it does anything for the discomfort, but it did bring my blood pressure down significantly. I felt like I was all there mentally. There was some uncomfortable pressure a couple times, but nothing like the level you experienced. For me the worst part was that light shining in my eye the entire time--by the end I really, really wanted to close my eye to get a break from it.
Matt22935 lucy24197
Posted
Thanks for the feedback Lucy. Strangely, my vision in the operated eye hasn’t really changed at all since the day after surgery which was almost 2 weeks ago. I haven’t needed or used glasses for my phone or computer since the operation. It’s likely that I’ve been under corrected and as Ron said above, the slight negative astigmatism I had might be helping. Distance vision isn’t pin-sharp but is still very good and the overall range I’m getting at the moment is more than I could’ve ever expected from a monofocal. Did you have a monofocal or multifocal with your surgery?
I know what you mean about the bright light during surgery and I remember that at one point when the pressure was really intense, things started to go very distorted and then dark for a few seconds at which point, I was really worried about what was happening. After a few seconds, when the light started to come back, I could see multiple tiny specs of blue lights, (that possibly made up the bright LEDs they use) and it gradually turned back to a bright white light again. I don’t know what stage of the surgery that was or if it was when he was doing the heavy pressure part to try and get rid of the scarring on the back of the capsular bag but I was just pleased when I could see something at the end!
He did warn me during the surgery about the level of pressure being more significant than usual because of the scarring but thinking about it, the level of pressure must be subjective because they can’t put too much on to the capsular bag without damaging it.
lucy24197 Matt22935
Posted
Even if they can't use too much pressure, it can sure feel like a lot!
I had a monofocal put in. At first the doctor said he'd be using an Alcon lens, then when I talked to him a few days before the surgery he said he'd be using Tecnis--I've got a ZCB00 aspheric monofocal. Not toric--just had my one week checkup today, and the doc said no astigmatism, so the surgery may have fixed the little bit of astigmatism in this eye. Since this is my distance eye, I'm good with that.I'm expecting my "near" eye to have more of an astigmatism after surgery-hoping it will help a little with reading. I've seen an article that said side-to-side astigmatism can improve after surgery, and up/down tends to get a little worse. (It's called with the rule and against the rule, but I can't remember which is which.) At one week out my lens has landed between -0.5 and -0.25D. I'm pretty pleased with it so far. I was having some trouble with everything getting blurry the last couple of days, but it looks like that was mostly due to dryness, and there's still some inflammation. The near vision seems to been changing more than the far. I wasn't getting much near at first--when I first tried to look at a book right after the surgery, I couldn't even see words or paragraphs, just some faint smudges on the page.It's improved quite a bit--now I can make out words if I hold the book out at arm's length, possibly better depending on the font. My distance eye is definitely helping my near eye when I'm reading a book, too--contrast is MUCH better. I can read the computer monitor pretty well at about 30", but I can figure out words and letters at 8" out (I do have the text size dialed up a bit on my computer right now, so cheating a bit.)