Tecnis Eyhance or FineVision Trifocal

If anyone wants to read this, it covers what happened in more detail….

I’m 48, an IT consultant and use PCs a lot. Generally, when using a monitor, I’ll be sitting 75-85cm away. Up until around July last year, I had really good eyesight. I’ve never needed to wear glasses for any distance and could read small print on the back of packets and medication without a problem.

Having said that, towards the end of 2017, I noticed that I was seeing a few floaters which I hadn’t seen before. These weren’t the usual transparent type when looking at a bright sky, these were either long dark strands with clumps on them or less defined shadowy blobs and they would float in front of my central vision. I went for my first eye test since I was young to check and they said that as long as I haven’t been experiencing flashes of light or ‘curtains’ in my vision, I shouldn’t worry about them. They suggested that reading glasses might help when using a computer and when they got me to try some basic ones, (+1.0) I couldn’t believe how sharp everything looked. I realised that although I could see and read everything, it obviously wasn’t pin-sharp. I ended buying some but didn’t really use them as I kept forgetting.

Then, last June, I had to have a fluoroscopy, (video x-ray) which they said would expose me to the equivalent of around 2 years of natural radiation during the 15-20 minute procedure. I’m not sure if this accelerated something because a few weeks later, I noticed I couldn’t read small print, (particularly with my right eye) and this seemed to get worse really quickly. I thought that it had just come to the point where I need to use reading glasses but when I struggled to read bigger text on a computer screen with a white background, I realised that something wasn’t right.

I went back for an eye test at the end of August and struggled to read anything but the top 2 lines on the eye chart. He checked with a slit lamp and said I had a cataract and arranged for me to see a consultant a couple of months later, (the first available appointment). She confirmed that I had a really bad subcapsular cataract, (subcapsular thickening) and needed surgery. She said my left eye also had a cataract as well. She said that subcapsular cataracts are normally caused by trauma, steroid use, diabetes or radiation exposure. I’d had a blood test last year that showed I didn’t have diabetes. At the time I didn’t think to mention the fluoroscopy. She also said that the floaters might be PVD and gave me a leaflet.

We then had another lockdown in the middle of December and over the coming months, the vision in my right eye deteriorated further and despite an optician trying, couldn’t be fixed with glasses. I also noticed that with my left eye, I needed to hold anything I wanted to read, (tablets and phones) at almost arm’s length to read them. The reading glasses do fix this on the left eye though.

A couple of months ago, I went to another clinic and they did full measurements and an OCT scan on both eyes. The consultant confirmed the same thing with both eyes and said it looks like scarring at the back of the right eye is the cause for having such bad vision so quickly and I might find that after surgery, I’ll still need YAG laser treatment to sort this out but we won’t know for definite at this stage.

The vision in my right eye now isn’t yellow or brown because the cataract has been so quick to develop and affect vision. My near and intermediate vision is just out of focus and distance vision is almost double with heavy ghosting. It’s also like looking through steam all the time. If looking at a backlit screen, (computer monitor or tablet etc.), particularly with a white background, I can’t read anything at all, even with glasses and it’s really bad. Having said that, if I look from around 15cm away. I can actually read everything, (which I understand is ‘second sight’) although it’s still misty and affected by the floaters.

During lockdown and after researching medication that I’ve taken, I found that the hay fever treatment I’d been using for years, (a nasal spray) was a corticosteroid. The consultant said it’s very possible that may have caused the cataracts in both eyes and they’ve been forming for a while. He couldn’t say whether the fluoroscopy has caused the scarring/subcapsular thickening. He didn’t seem to think that my exposure to the sun would’ve been the cause as I’ve only ever done this when on holiday around a pool for a couple of weeks once a year. He said if that was the cause, thousands of young people would be seeing him because of getting cataracts.

He couldn’t confirm whether the floaters, (which are now quite bad) was definitely PVD and it could just be where the consistency of the vitreous is thinning and making them much more obvious. For me, I see a fair number of large black strands and shadowy blobs now, (I can’t count how many, but there are lots) and they’re really noticeable in a bright room or going outside on a grey cloudy day.

Due to the cataracts, I’m also getting glare when outside that takes away from the clarity of vision that my left eye still has and the starbursts in both eyes are about the same. LED lights are particularly bad and the size of the starburst compared to the light source is massive. I know people experience different types of starbursts, with mine I see hundreds of thin filament of light extending way out from the source and some have rainbow colours in them and seem to move slightly. It has only got to this level since the cataracts got bad last year. I don’t see halos around lights though.

At the moment and apart from the irritating floaters, the vision in my left eye is still great for distance, intermediate and near, (just not for reading unless at arm’s length as it’s slightly ghosted).

Sorry again for the long post and thanks for reading.

The dim light issue is common. With brighter light your pupil constricts and you get a wider depth of focus and generally can read easier. Since IOLs don't accommodate like a natural younger eye, it is one of the issues.

.

The blue light filter makes the colour balance similar to a young person's natural lens. The natural lens is slightly yellow as well. The lenses that do not have a blue light filter will provide a more blue colour balance than a natural eye. But, one gets used to it in any case.

.

The Eyhance only provides a very modest increase in depth of focus. It technically is not enough to be sold as an EDOF lens. However it does tend to be a bit better than a pure monofocal lens. What you need to do is find defocus curves for the lenses you are considering. That is the best way to estimate how close you will be able to see with them.

.

I only have one eye done with a Alcon AcrySof IQ Aspheric monofocal lens. It was set for distance and my eyeglass prescription for it now is 0.00 D Spherical, and -0.75 D Cylinder. I test out as a bit better than 20/20 for distance. On the closer end I can read text on a bright computer screen down to about 18". My car dash is crystal clear. Outcomes vary with different individuals and the surgeon's skill in getting the power right. What you don't want is for the surgeon to over correct and leave you with a + prescription requirement. Since the IOLs come in 0.5 D steps of power, they cannot hit an exact to the 0.25 D power. I would discuss that with the surgeon and tell them you would like to end up in the -0.25 D to -0.50 D myopic condition. This is standard practice. This will not compromise your distance vision significantly, but will significantly improve your close vision.

.

A monofocal IOL is very similar to an older eye with presbyopia. I can read fine, but my arms are too short! The alternative to a multifocal lens is mini-monovision. That is when the non dominant eye is under corrected by about -1.25 D to -1.50 D. The idea is to let the non dominant eye do the reading and the dominant eye corrected for distance to do the distance vision. Some like it and some don't. Ideally you should simulate it by using a contact. Again ideally the best is to correct the distance eye first with and IOL, and then before you get the second eye done, simulate the monovision with a contact in the second eye. If you like it, then go ahead. If you don't then you have the option of getting full distance correction in the second eye too, and use reading glasses. Or, you could get a multifocal IOL in the second eye only. Options to discuss with your surgeon... I think it makes sense to wait at least 6 weeks between the first eye and the second eye. That gives the first eye enough time to fully recover so you know what you have for vision. And then based on that vision you have 6 weeks to decide what is best for the second eye. I look at it as a plan, rather than a one time up front decision.

.

FWIW I am currently simulating -1.25 D monovision with a contact in the near eye, and a distance IOL in the other eye. I like it a lot. I don't need glasses for driving, watching TV, reading my computer screen, or even reading my iPhone 8+. For smaller stuff especially in dimmer light I do need reading glasses. For me that is almost never. I am 95% eyeglass free and about the only time I wear progressives is when I am giving my natural eye a break from wearing the contact.

From what I've read on the new Tecnis Eyhance IOL, it gives about -0.5d more focus range than a standard monofocal.

For reference, I have a Tecnis monofocal toric IOL only in my right eye set for distance focus and I need about +1d eyeglasses correction for clear focus vision at computer monitor distance, thats in that 60-80cm (24-30") range. It also works OK for reading my large screen smartphone a bit closer than that too.

So its possible the new Eyhance IOL could get a similar intermediate focus range result but with only perhaps 0.5d offset instead of 1.0d, which would still allow for decent distance vision possibly no worse than 20/25. Compared to the standard monofocal with a 1.0d+ offset would have a hard time getting even 20/40 at distance.

So whenever my left eye will need cataract surgery (probably not for several years) I would definitely consider the Eyhance IOL (I would need the toric version due to my +2d astigmatism) unless an even better IOL appears by then. Before the Eyhance appeared, I was considering either a standard monofocal toric or the Symfony toric, though the Symfony has artifacts that monofocals don't have like spiderweb like big circles around lights at night, etc.

I personally would not consider an expensive multifocal or trifocal IOL due to too many artifacts especially for night driving and the results are not guaranteed - I've read too many results where they didn't even get good reading focus due to the target was not reached, so they got no better than a monofocal but at much higher cost and extra artifacts! To correct that refractive error, an additional expensive Lasik operation would be needed and some people with dry eye or other conditions may not be able to do that anyway, so the person might still end up wearing eyeglasses or contacts in the end! Also with the expensive multifocals they often want to use the added more expensive laser cataract surgery. Monofocal or the new improved monofocal (Eyhance) IOL looks like the safest choice to me and can be done with standard no extra cost cataract surgery like I had.

I also like the Tecnis IOLs because they don't have the yellow filter that reduces blue/violet in the color spectrum. The IOLs with a yellow filter try to emulate the amount of that the natural lens in the eye around age 30, its not as strong as in blue blocker eyeglasses however. At an older age the natural eye lens gets even more yellowish/brown, so with any IOL for someone 60+ will notice a much better color spectrum and white balance than their old natural lens.. The Tecnis clear IOLs give a color spectrum and white balance probably closer to what a young child has in comparison. I remember my brain had to get used to the new color spectrum for a few weeks after I got my Tecnis monofocal toric IOL a few years ago, at first sunlight hitting the ground had a violet tint that was probably filtered out by the old yellow natural lens. I also remember my dad when he had cataract surgery at about age 80, he commented on the huge difference in color he saw too.

As far as dim light, I believe that effect happens with all IOLs, but multifocals split the light to two or more focus points so it makes that worse since less light is available at any one focus point. Reading close outdoors in bright sunlight is always easier in any case.

The results can vary with each individual as to how much focus range they will get with a monofocal too. Factors such as what your resulting refraction in your eye ends up affects that, such as how much residual astigmatism and how close you end up from the target. This is unpredictable due to how the eye incision heals and the 0.5d steps between available IOLs. Also dependent on how much your individual eye's pupil size varies. In my case my monofocal IOL eye set for distance (though it has almost 1.0d residual astigmatism) seems to get clear focus from 4-5feet and beyond but due to that little astigmatism I only get about 20/25 uncorrected - with eyeglasses it can get 20/15 or better though. At computer monitor distance (full arm's length away, close to 80cm) I can make out medium fonts like on this current webpage, but my eye is straining a bit without glasses so its a little blurry. Much clearer and easier with +1.0d intermediate reading glasses I use at the computer. But someone else may be fine without the glasses at that distance - impossible to predict that outcome though!

For me the distance focus monofocal IOL gives clear vision looking say at my feet at the ground and clear enough useful vision anything beyond full arm's length. Looking in the mirror closeup however is blurry, so I got a 7x magnifying mirror with suction cup to attach the main bathroom mirror and that works great for close up shaving, etc.

Going with mini monovision, one eye set for distance and the other set for intermediate vision (60-80cm) may be a good combination that could allow for extending overall clear vision to cover most cases without glasses except for close up fine print reading especially in dim light conditions. With the Eyhance IOL that may not require much more than a 0.5 to 0.75d difference between the eyes due to its wider focus range, compared to a monofocal that would need 1.0 to 1.25d difference to cover the same range.

Oh and as far as floaters, I had a few before my cataract surgery with the distance focus monofocal toric IOL and they have been much harder to notice with the IOL, perhaps since its focused at distance and not close to the eye where the floaters are. I also recently had the YAG procedure due to the cloudy membrane behind the lens and that can cause more floaters, but I fortunately haven't noticed them from that either!

I would suspect though with an IOL set to focus for near vision, like a multifocal, floaters would be seen much clearer and be more of an issue with that then a distance and/or intermediate focus range IOL.

If you have PVD do not get a multifocal IOL. Personally with all the floater issues and a potential PVD I would 100% stick with a monofocal or monofocal plus to get the maximum amount of light possible for your vision. Multifocals work by splitting up and/or spreading out the incoming light over various focus areas so each area of focus (distance, near, etc.) has a lot less light to work with. This is ok outdoors in bright light but indoors in dim light you will notice a difference.

.

With Eyhance you should expect to see you car dashboard clearly (assuming the surgery hits the distance target nicely) but reading a phone / tablet / book may (will likely) be a challenge. But your mileage may vary. I've heard of a lot of Eyhance patients being able to use the phone glasses free. But the lens cannot promise that.

.

I don't really think you need to trial monovision if the offset is tiny… like 0.75 or 0.5. That's such a small offset that anyone would be fine with it. And it might be just enough to make device use with Eyhance more comfortable / functional. Not 20/20 mind you but "good enough". This is probably what I'm going to do when the time comes.

I have the Eyhance torics as you can find from other posts. I did not want to have to deal with the visual artifacts of trifocals and don't mind wearing reading glasses for really close up work like electronics circuitry so I went with Eyhance.

They do have a flatter defocus curve so you still end up with good uncorrected distance vision if the surgeon puts you you slightly far sighted on a plano request. I've watched a number of eye surgeons on YouTube mention they would choose the Eyhance if they needed cataract surgery.

All that being said...my dentist (about the same age as me...old far+) had the Panoptic lens implanted and is very happy. I noticed at my last appointment he no longer wears the loupe glasses he used to need.

The Eyhance lens have very good contrast MTF . I will find out soon if I loose anything with a +1 mono vision contact lens trial.

Night vision and night driving have been great. I can't wait to go camping way out in the country where there is no light pollution to mask the stars. Sleeping in my Chevy Volt overnight with quiet A/C run off the battery...the wonders of modern electronics.

Thank you so much for all of your replies and for taking the time to explain things in detail, it really has helped to hear your experiences as well as thoughts on multifocal IOLs.

A few weeks ago, I was already around 90% sure that I'd go for the Eyhance because I was worried about halos, glare and what would happen if I never adapted to a multifocal. Then, after doing a lot of research, reading articles and watching videos, started to wonder whether the FineVision trifocal might be worth going for at my age with so many working years left, especially when the video examples show monofocal vision for near and intermediate being completely blurred or out of focus and then they show multifocals with perfect sharp clarity at all distances.

Having said that, the thing that stuck in my mind was that most articles would show that they were sponsored somewhere in the small print. Other websites and videos all seemed to be from the IOL manufacturers or eye clinics where they would obviously select a multifocal patient to interview that had been lucky enough to have had a very successful outcome, had adapted quickly and where they claim they hardly notice halos and glare, (if at all) and don't require glasses for any distance.

Although I'd thought about which IOL might help to reduce the visibility of floaters, (if possible), I'd never thought about how PVD, whether I do actually have that fully yet or not, would have such an impact when a multifocal IOL is used. After you mentioned that david98963, I searched for multifocals and PVD and found information on a trial where patients with floaters and possible PVD along with multifocals were undergoing a vitrectomy to try and improve their quality of vision. In their results they said that floater symptoms may be exacerbated by multifocal IOLs because PVD and those types of lenses, (due to their design) are known to be responsible for increasing light scattering. They also had a diagram showing how, after light was split between the focal points on the IOL, it then gets dispersed again when passing through the vitreous after PVD.

Taking that into account as well as my other doubts about artifacts only reducing over time, (6 months to 1 year or possibly longer) and that they'll never go completely as you'll just get used to them along with the possibility of difficulties driving at night, the reliance on chance, the surgeon's ability and your own eyes as to whether you do end up being completely glasses free and happy with the compromises has put me back to being almost 100% sure on going for the Eyhance monofocal.

I expect there'll be a lot of people who have had multifocals/trifocals and are really happy with the results. It's just difficult to know whether that's the large majority that's claimed, (around 97% from marketing material). The consultant I saw told me that, in the nearly 12 years he's been fitting trifocals, he's never had to explant any and that should be a good indicator for me as to satisfaction rates on the FineVision.

I think the other reason I'd prefer the Eyhance is that, with nothing in the lens design to cause the usual artifacts and the main compromise being the need to use glasses for near and possibly intermediate vision, is that the you might be one of the lucky ones and only need glasses when reading within arms length and don't have to worry about it affecting eye conditions that might occur in the future whereas, with a multifocal/trifocal, if you really struggle to adapt, find it unsafe to drive at night or are generally unhappy with the results, it's an implant so your only choice is to live with it or have it explanted and replaced with another IOL along with the risks that procedure carries.

I've got less than 2 days to decide now and thanks to all of your help and feedback, the decision is becoming a lot easier.

My understanding regarding PVD is that it can dramatically reduce your eye's contrast sensitivity. That's why I say stay away from any light splitting or shaping IOL like multifocals. Your baseline contrast might already be compromised even before surgery.

Back from the eye doctor.

It would seem I ended up +.25 with the dominant eye and plano with the other eye so it is clear the surgeon can't guarantee the exact place you will end up. With that I really have not been working for the past 3 months with mono vision. It's no wonder my distance vision has been so good.

The doctor found I could tolerate +.75 mono vision with the non dominant eye without affecting the the distance vision.

I was given both +.5 and +.75 trial contacts to see how they would work. I have the +.75 in currently and I tested almost J1 reading with that setup. Having never put a contact into my eye I found that to be a little daunting at first. The contact is a daily and I don't notice it being in after 5 hours of wear.

I shopped at the grocery store and found I could now read all of the prices...although not the really fine package contents. At home with bright light I can read the package contents with no problem. Food prep and eating is very comfortable and the laptop is easy to use. I can read the small print on my phone although not the really tiny print on certain websites without two finger expanding them a little.

The doctor said it would take a week to get used to the mono vision and the vision should get a little better as the brain learns the suppression of the slightly blurry eye.

Daily contacts for one eye cost between 40-100 for a 90 day supply at Wally-World.

The interesting test will be to see if I still have good night vision with this set up.

I plan on trying a +.75 in the dominant eye tomorrow to see how that works. The doctor suggested it might possibly work as good or better as I don't seem to be highly dominant with one eye.

I've just made the final decision today on the IOL type thanks to everyone's help and have chosen the Tecnis Eyhance for my right eye. I'll then wait until my left eye becomes more of an issue before having surgery on that one, (it also has a cataract causing large starbursts and some glare but without the scarring of the other one so distance vision is still relatively good and glasses are still able to help with reading when needed).

I just wanted to thank you all again for your help as I was really struggling to decide before I posted and thinking about having cataract surgery at 48 was making things even more difficult. Your experiences and feedback have helped me to finally make a decision and I'm really grateful.

I tried one of the +.5 Wally Word generic contacts in my dominant eye to see how it would fair. I hope there is only a learning curve to inserting contacts as I had a lot of trouble...it took 5 eye pokes to finally get it in.

I found the distance vision to not be as good and there was not much improvement in intermediate vision. Those contacts are torture devices as it felt like it had edge ridges and it kept moving around as I blinked.

I think the Eyhance has a flattened peak that allows more error off plano without affecting distance vision much. That has been stated in other forums and it is what I see.

+.75 in the non dominate eyes looks like a good compromise even when the dominant is a little off. If the Eyhance has slightly less than .5 depth of field over a mono focal that .75 would be equivalent to a little less than 1.25 myopic that eye. That seems to match up with what I see. Previous post lists details.