Seeking feedback on EDoF lenses vis-a-vis monofocal (Eyhence)

which monofocal and how much near did you lose after the exchange?

It was a Tecnis Toric, don't remember the model. With the Symfony I had excellent intermediate but not as good near, so if I read for more than a minute or two I would still be using readers. Now I can barely read a text message on my phone, but not that good, so I prefer readers. I've used glasses all my life so that is fine.

how is your intermediate now?

No halos at all with monofocal?

You mentioned "a" monofocal. What abt the other eye? Natural eye?

OK except for tiny letters.

Natural. Cataract isn't yet a problem but when it is I'll do the same- mono focal for distance.

Hi. May I ask where you exchanged your iol? I had a cataract surgery in sep 24 th and I have lost all contrastvision and my noght vision is horrrible.

//evelina

Thank you Janus.

So, it looks like there are artifacts as well with monofocal? What are they? Presumably much less than multifocal? I thought only multifocal has them.

I read price charts on computer (example attached). I am therefore looking for lens that provides sharpness & causes minimal artifacts. Based on the scanty info I’ve gathered so far I am zeroing in on monofocals & EDoF both of which I thought give less artifacts than multifocals, be they bi-focal or tri-focal.

I wld very much prefer binocular vision to monocular to always share the load between the eyes. Between monofocal & EDoF I thought the latter gives better viewing range so I can do away with glasses. But if EDoF gives more serious artifacts than monofocal (yes, it is a subjective matter so some pictures wld serve as excellent illustrations for an objective comparison & judgment) I’d then have to go for monofocal, maybe Eyhance for enhanced intermediate vision as J&J claimed.

I’d then have two choices, (i) distance + intermediate or (ii) intermediate + near.

Views are most welcome.

I believe it is less commonly done but you could get both eyes done with monofocal but set for near distance. You would then of course need glasses for distance, and if you don't want to keep taking them off, then progressive prescriptions.

An added advantage of glasses for distance when outdoor is have them tinted to filter out UV light. 😃

I believe most IOLs filter out UV light, so that should not be a worry. Where they differ is in that some also filter out some blue light in addition to the UV. They have a yellow tint. While on first blush that may seem to be fooling with mother nature and giving the eye an unnatural view of the world. The facts are that the natural lens even without a cataract already does blue light filtering. The blue light filtering lenses are actually closer to a natural lens than a clear IOL is. Most of the AcrySof lenses and the PanOptic filter blue light, and I believe some of the newer Tecnis lenses also do. Here is an illustration of how the light transmission of a clear lens compares to blue light filtering lenses and the natural eye lens.

I think the big advantage of using glasses with IOLs is that any uncorrected refractive and astigmatism error can be corrected. It also give you the opportunity to get progressive lenses that let you see up close as well as in the distance. And if you really want the best computer vison you can get prescription computer glasses as well.

There is an important point you mention - residual astigmatism. I got residual astigmatism of -0.5 and I like to wear glasses to increase sharpness.

If residual astigmatism is a norm, then I would get eyhance and set it for -1 in both eyes. That should give me good intermediate and decent near. Then wear glasses. At -1 I would probably not require glasses indoors.

henry,

i have symfony edof and they give al the artifacts you talk about and my near vision is terrible from 24 inch in.

also distance+intermediate is safer than intermediate+near as more diopters are required for near so the range of near you get is small.

That part on IOLs filtering out UV as well as blue light is new info to me. Will bear it in mind. Thanks.

Thank you for sharing.

Choosing an IOL is difficult. There are trade-offs with every option.

The reason for first post in this thread, is that I wasn't sure why you were zeroing in on EDOF in the premium lens option, as tri-focals are newer and it seems based on not only articles but also from feedback on this forum, that trifocals are generally superior to EDOF at this point in time.

Assuming you are in the US, many have the cautionary articles about multi-focals are really about bi-focals . I was like you thinking I'd prefer EDOF, but found my clinic in Toronto had switched to tri-focals for 2+ years and while my surgeon used to discourage premium lens, she is very happy with outcomes with tri-focals. Tri-focals have less severe artifacts than older bi-focals, and it seems lower than EDOF. But tri-focals will still have artifacts. For most people they are quite mild and only show up at night.

Mono-focals are much less likely to have issues with halos and glare.

Eyhance, based on marketing materials, promises low risk of artifacts like a mono-focal (because it is a mono-focal), but with wider range of vision than old mono-focals. J&J does not promise as great a range as Symfony, but better range, and less risk of artifacts like an EDOF.

Assuming you are in the US, the J&J Eyhance has not been approved in the US (only approved in Europe).So your choice is between PanOptix tri-focal, Symfony EDOF, or regular mono-focal.And if you are considering an premium lens, I think PanOptix is a clear improvement over the Symfony EDOF based on feedback of many on this forum.

I zeroed in on monofocal and EDoF because I thought both of them have less artifacts than multifocals. I didn’t know that new multifocal in the form of tri-focal is better than EDoF.

That leaves monofocal as the only choice, as I truly prefer minimal artifacts and don’t mind wearing glasses.

I live in Singapore. I picked up an Eyhance leaflet at the ophthalmologist clinic I went to. So I believe it is approved here, though the ophthalmologist didn’t mention it at all during my discussion with her. She recommended and came across as pushing for monofocals, distance + intermediate for the dominant right eye & intermediate + near for the left. I am hesitant to go along that line. I prefer harmonious vision between both eyes.

soks eyhance for both and set for -1 in both is best case for me i think after discovering all advice suggestions and experience in this forum. what is residual astigmatism? forty five yrs of great vision with contacts -5 to -5.75 re and le due to cataract small increase in script and first time eyeglasses in prep for pre visit measurements neither optician mentioned astigmatism. Yet cataract surgeon did and did not advise toric. i only know of toric etc thanks to this forum so i am basically clueless thanks for the eyhance advice from you As of today what did you choose and how is your vision

"eyhance for both and set for -1 in both is best case for me"

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I think you need to think about this a bit more. It makes no sense to get Eyhance in both eyes with a -1.0 D residual myopia. In your close vision, no dominant eye, perhaps, but not both eyes. All this will do is force you to wear glasses or contacts to see in the distance.

i am so much more clueless than i thought Ron. i thought if i choose monofocal distant that the final lens can somehow be then configured to allow me some near vision by choosing slight myopia. This forum explained that iol is a piece of plastic not like the natural adaptive eye i get that but just from reading about other forum postings about drs creating different variables in lens prescriptions i thought that i could go distance mono then shape it even more with myopia

so if i choose distance mono eyhance then the near vision is based on how uniquely my own eye adapts? why then leave lens slightly myopic advice instead of plano?

No, it is just the same as myopia in your natural eye. The trick to get full range of vision with monofocal lenses is to target about -1.25 D (mild myopia) in the non dominant eye only. That eye gets the job of seeing closer. The dominant eye should then be fully corrected to see distance. -0.25 is probably ideal.

"so if i choose distance mono eyhance then the near vision is based on how uniquely my own eye adapts? why then leave lens slightly myopic advice instead of plano?"

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Not sure if I follow this one. If you choose distance Eyhance then the design of the lens will let you see a little bit closer. Perhaps about a foot closer. You do not want to go too close to plano in the distance eye, because you may end up being far sighted at say +0.25. That costs you close vision.

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You can do a bit of a mini monovision with Eyhance if the surgeon is game. In this case you would target the Eyhance in the non dominant eye to be about -1.0 D. You will give up sharp distance vision in this eye to be able to see closer, and perhaps even read text or a iPhone. But, you still want to target full distance (-0.25) in the dominate eye so it can see sharp distance. Ideally the two eyes together then see sharp up closer plus sharp in the distance.

so i choose distance monofocal lens and set distance iol with -1.25 in one eye non dominant then i also choose distance monofocal in dominate eye same as non dominant only difference being -0.25 ? both eyes same monofocal distance with each eye having its own unique -?

Ron you and this forum so grateful thank you. I was diagnosed overnight with no symptoms and had few months to wait for procedure due to Summer vacations medical professions. No previous knowledge no clue at all about cataract procedure. I thought originally i just choose monofocal both eyes then set both for same slight myopia ex set both eyes -1. i thought that way i see distance i had no idea that both eyes are distance and i have to set to allow for some near vision. i thought i could correct any near loss of vision with contacts as i wear contacts now for loss of distance due to myopia

would the formula above using two different formulas for two different eyes make me dizzy or make my eyes fight with each other

Yes, that is basically it. Think about it as having one eye fully corrected with a contact, while the other eye is left slightly near sighted. Some people tolerate this well, and some do not. For that reason it is best to try it with contacts first, assuming you still see well enough to evaluate. You wear your normal contact in the dominant eye, but get a less powered lens for your non dominant eye. If your normal non dominant eye contact is -5.25 D, instead you would use a contact at 4.00 D. It is best to try it with contacts to see how you like it.

mary

instead of eyhance get vivity. set one vivity at -1 and other at plano.

my laptop keeps re typing and cursor jump and erase so im going to try again please excuse grammar would 4.25-4.50 in one eye and 5.75 to 6 be a good monovision trial? i have lenses in house already was trying all different scripts to perfect vision at onset of cataract

It depends on what you need to see plano now in both eyes. In the dominant eye you just want to keep your normal contact that lets you see plano at distance. Then in your non dominant eye you want to reduce your normal plano prescription by 1.25 D. Say it is normally -5.75, then a -4.50 would be the one to try. You could also try -4.25.

i see like 20/30 with contacts worse eye gained a diopeter due to cataract so i been playing with all contacts since diagnose being my own optician. will try but less diopeter in non dominant eye i will see blurry is that not a good candidate for monovison or mini ? is mino less diopeter difference?

Yes if you reduce the correction in the non dominant eye by 1.25 D you will see more blurry in the distance, but should see much better up close. The hope is that your brain will use the dominant eye for distance, and non-dominant for close up. There are no hard and fast rules for what full monovision, mini-monovision, and micro-monovision. But here is what I have seen mostly reported:

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Reduction from full correction:

1.0 to 0.75 D - micro monovision

1.25 to 1.50 D - mini monovision

1.75 to 2.5 D - full monovision

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Full monovision is seldom used. I would test at 1.0 D, 1.15 D, and 1.50 D to see what you like. Less gives you better distance, and more gives you better close up. It is a compromise. I find that 2.0 leaves a significant hole in the intermediate distance range of 12-14 inches.

Ron i dont think there direct way to message Doctor. What is an effective way to just ask for Eyhance? i keep reading such positive benefits compared to zcboo which is what he said he used when i asked about eyhance. he did say he uses it to me that bit of intermediate and maybe little better near as compared to zcboo is such a big advantage. im sure alot of us here share that same disconnect with dr. its not personal i get that. should i just say i will pay out pocket although i know insurance covers it same as zcboo?

thanks soks for the positive eyhance both set for distance -1 is what i want and without this forum it would have been dr choice since i had no explanations just premium or insurance covered. how do i communicate to dr i choose eyhance? dont want offend his choices.

It seems like the whole IOL process and cataract surgery varies a lot from area to area. We were provided with a phone number and e-mail to the surgeon's secretary, and so far have dealt through her to get our questions answered. For my wife, she arranged a phone call from the surgeon to answer questions about a need for a toric lens, and availability of the new Clareon material (it is not available as a toric in Canada yet).

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The other route you have would be through your optometrist, if you could get him or her to call the surgeon.

"although i know insurance covers it same as zcboo?"

Are you sure about that, I suggestion you double check on that one. Though I thought I read something about Medicare covering it, but not sure on that one.

As for contacting the doctor, I actual have my doctor's email, but I know that is rare and sad that it is rare. Can you not just call the office and ask for him to call you back. If that does not work, personally I might start to look for someone else, but I know my doctor has a person that is in charge of the cataract patients and ordering the IOLs and so forth (seperatre person from front office staff). Give that person a call.