Tecnis Eyhance or FineVision Trifocal
Posted , 10 users are following.
Hi,
I’ve been reading various posts here for a few weeks now and found them really helpful. I’m due to have cataract surgery in around 5 weeks and need to let them know which lens I’ve chosen in the next couple of days, but still can’t decide between the two options I’ve been offered. I’d really appreciate any recommendations or feedback from experience if anyone has either of these lenses.
I apologise for the long post and to save time, I’ve put all of the other information underneath this post if anyone should want to read it but if not, to skip to the main questions:
The eye clinic offers two lens options – The Tecnis Eyhance Monofocal ‘Plus’ and the FineVision Pod F Trifocal. The consultant can’t recommend or offer advice on either apart from saying that intermediate and near vision with the Eyhance ‘will be blurred’. He said that I’m a suitable candidate for either lens and the choice has to be mine.
I’ve never had any eye or laser surgery before and apart from the cataracts, subcapsular thickening and floaters, the eyes are generally healthy.
I’m struggling to decide which lens to choose. I’m paying for the surgery either way and the difference in price to have the FineVision over the Tecnis Eyhance is £800.
My concerns over the trifocal are as follows:
1.The night-time issues, especially with driving. All I seem to read is that some people adapt over weeks or months and some don’t ever adapt and are unhappy with the results and don’t feel safe driving. Considering I’ve still got around 20 years of working life and I don’t know how much night time driving I’ll need to do, this might be a problem.
2.The issues with dim light. Does that mean that you can’t see very well overall in dim light on dark rooms or does this just affect reading in dim light?
3.The blue light filter on the trifocal means the IOL is yellow. Does this mean that everything looks slightly yellow like when you use blue-light blocking glasses for computer screens?
My concerns over the monofocal plus are:
1.The Eyhance is supposed to significantly improve intermediate distance vision which seems to be defined as anything from 60 or 80cm to 1.5m, 2m or 4m depending on which article you read. I can’t find out how much intermediate vision is covered by the Eyhance. Does it improve the end near to distance or does it cover right up to the 60-80cm range?
2.I can only seem to find marketing videos that attempt to show the difference between monofocal lenses and multifocal. These all show near and intermediate distance, (normally a book and a car dashboard) as being completely out of focus with a monofocal. Is that what it’s really like without glasses or are they exaggerating for the purpose of showing the difference with multifocals?
3.Does having a monofocal lens only really affect reading like I have at the moment, (where the letters are ghosted slightly without reading glasses or holding at arm’s length) or is everything, (objects, the ground, steps, looking at your own face in the mirror etc.) out of focus without glasses?
I don’t really mind if I have to have reading glasses for near vision, but would prefer not to have to wear glasses for intermediate, (60-80cm to distance). I’m concerned that with the Eyhance Monofocal Plus, if that’s not really possible, I’d just end up having to wear glasses all the time which defeats the object of paying for cataract surgery. That would make the trifocal a better option, but I worry about everything I’ve read from people who weren’t happy with the results.
The other thing I can’t find an answer to is that multifocal IOLs aren’t suitable for people with other eye conditions like ARMD, Glaucoma etc. What happens if someone has a multifocal IOL now when their eyes are healthy but develop one of those conditions later in life? I tried asking the consultant this question but he said he couldn’t say whether multifocals/trifocals would cause an issue if you develop a condition in the future.
I asked the consultant about mini-monovision and he said it would be possible but wouldn’t recommend it as I’ve never tested how I’d adapt by using contact lenses and it’s too late now with the stage of the cataract in my right eye.
I was also wondering if one lens over the other had an impact on how obvious/clearly I would see the floaters. The monofocal plus will let in more light compared to the trifocal and I don’t know whether either would help minimise their impact. All I know is that when my pupils are dilated for testing, I don’t see any at all and it’s amazing to be free of them for a short time!
I’m having the surgery on my bad eye, (right eye) done next month with a plan to leave the left eye until the cataract affects vision too much as it’s not bad at the moment apart from near vision without glasses. I can live with the starbursts and glare on this eye for a while once the other eye has had the surgery. I know that my eyesight still won’t be great afterwards due to all of the floaters but it’ll help a lot as I’ll be able to read again out of the operated eye so that when a floater goes across my central vision in my other eye, I’ll still be able to continue reading until it moves out of the way. When this happens at the moment, I have to move the floaters out of central vision to carry on reading.
If anyone has any thoughts, recommendations or experiences with the Tecnis Eyhance or FineVision Trifocals and how you’ve found them or have some answers to any of my questions above, I’d really appreciate the feedback.
Thanks very much for reading!
0 likes, 21 replies
bob38868 Matt22935
Edited
I had a follow up appointment with the eye doctor yesterday. The +.75 contact in the non dominant eye works well but not good enough for my liking. I was able to read J2 without a problem however that was in the bright lighting of the exam room.
The doctor gave me samples of +1 contacts to try. I have one in now and can read the small print on supplement bottles in lower room lighting. I notice the difference between the two eyes however it is not at all bothersome. I'm sure it would be even better if my dominant eye would have ended up plano rather than +.25 where it is now. Since I still have some of the trial +.5 contacts, I'm going to try also wearing one in my dominate eye for a day to see how that works out matched to the +1 in the non dominate eye.
I think the contrast deficiency I mentioned in a previous post was more of a defocus issue by the +.75 not providing enough focus for the text I was trying to read. I notice a major improvement with a +1.
I did a paper plot of the defocus curves for my eyes with the dominant eye at +.25 and the non dominate eye set at -1. The curves cross over at -.4 and touch the .1 LogMar line so the 78" out vision is still good.
I plan on a night jaunt in the car so that will give me a chance to test the vision on the road at night.
It looks like the Eyhance would still give .05 LogMar distance vision if it ended up -.25. I think that would be the optimum point for the dominant and would allow greater stretch back with the non dominant eye to give better near vision without the LogMar having a blur dip hole in the curve.
I could not tell a difference with the distance vision between +.25 and -.25 with the dominant eye so I think the peak is a lot flatter than one would get from a pure mono focal lens. At the doctors visit, I could not tell a difference as the doctor clicked lens through that range...including at plano.
I work in electronics so it is analogous to me of filter shape and bandwidth.
Matt22935 bob38868
Posted
Thanks for the update, it sounds like you're getting some interesting results, especially with the +1 being able to see such small print in lower light. Hopefully your night vision when driving will be good too.
I feel a bit better about choosing the Eyhance for my surgery next month. I had a day or two of doubts after making my decision wondering whether, at 48 and working in IT, I should've gone with the trifocal I was offered but seeing the possibility of having a slight adjustment with mini/micro monovision when I need surgery on the other eye, (probably in the next 6-12 months) gives me hope of getting some form of intermediate or even near vision....although I'm not expecting miracles.
I keep trying to prepare myself mentally to expect blurred near and intermediate vision after surgery so I won't be disappointed with my choice of a monofocal IOL. In the back of my mind though, I can't help but hope I might be one of the lucky ones and that by choosing the Eyhance, I'm giving myself an extra chance at getting some form of useable intermediate vision.
Having said that, I've read a number of posts from other people where they've had multifocal/trifocal IOLs and are unhappy with them, even after 6-12 months from surgery. It seems to be that some people are really happy with them but others aren't and the cost and risk involved with explanting makes me feel the Eyhance was the right choice.
Also, with David's earlier reply to me about the floater issue and not having multifocals, along with the study I found after reading his post that mentioned the same thing where, due to the light being split on a multifocal/trifocal in addition to the light scatter from floaters and PVD, (or possible PVD) it will just exacerbate the problem with the floaters. There are already too many in my central field of vision in both eyes without potentially making the problem worse. I asked my surgeon what his thoughts were on this and mentioned the study I found and he said he'd agree with their results.....that also made the Eyhance decision a lot easier.
bob38868 Matt22935
Edited
Matt, another consideration I made in my lens choice was having lens that would still likely perform well as I go through the regular ageing process. Even with good lifestyle choices and lucky genetics one can expect there will be problems in the visual system if we stick around long enough. As of now, lens exchange is a one and done procedure that becomes permanent with higher risk if modified at some later date. That may change however I went into the decision figuring it was my one chance to do it so there were a lot of issues that were studied. I credit this site for helping with my decision thus it is why I am sharing my one person's journey to help others with that thought process.
Night driving was OK with the 1 dipoter lens in my non dominant eye. Dysphotopsia was mostly unchanged as compared to my close-to-plano both eyes uncorrected state. I did not feel as relaxed and I had to work a little to make sure the dominant eye was doing the work outside the windshield and the non dominant eye was focusing inside the car. The navigation screen at center console was razor sharp and I could still read street signs...although with a little more effort. It seems to me the neural adaptation would be easier if the correction was permanent and one had a period of time to make it the "new normal". I don't perceive any defocus holes in the visual range at that setting however I suspect my vision might likely be better if I also correct my dominant eye from the current +.25 hyper to either plano or -.25. For what I would be giving up with super one eye distance vision I might gain that back with binocular vision eyes being closer in diopter to each other. That less differential between both eyes might also make the mono vision easier to adapt to. Since I have some of the Wally World generic +.5 torture devices left, I plan on trying a day (may pull it out after a short test if if proves to be as uncomfortable as the last time) with the .5 in the dominant and 1 in the non dominant. That would put me at -.25 dominant and -1 in the non dominant.
Many report they can get along quite well at a 1.5 diopter differential between eyes. I would think with regular mono focal lens there would be a resultant blur area in the LogMar as the defocus curves for those lens are a lot more peaked...like a narrower band pass filter. The Eyhance is flatter which fills that crossover area a little more. There are of course trade offs as the trials showed the MTF was not as good for the Eyhance as compared to a mono focal however it is better than the Vivity which was my original IOL of interest. There is no free lunch...trade offs with all.
Considering the super optical quality the Eyhance brings I am already quite happy even if I don't have the optimum balance between both eyes and have to wear reading glasses for close up electronic circuitry work. I can finally again read the print on the tiniest surface mount components without a magnifying glass...wearing +2.5 German glass reading glasses (rx-safety)...with no contacts. I suspect having my astigmatism fully corrected is helping.
I still wish the surgeon would have chosen both lens .5 diopter more nearsighted as I might not be going through this current process with that setting. The Eyhance is new to many surgeons in the USA and it would appear the spherical add to the lens may throw off some used constants by around .5 diopter. Finding a skilled surgeon who has implanted a number of the lens would likely get the patient a more predictable outcome as they would have had time to modify their constants from patient outcomes in their practice. My surgeon mostly got me what he thought the outcome would be. The toric calculation and placement was spot on and the power was to be within +/- .5 of plano both eyes.
Matt22935 bob38868
Posted
Hi Bob, sorry for the delayed response. Thanks for all of the info and your experiences with this, it's really helpful.
I absolutely agree with your thought process for choosing the lens type. Apart from being concerned about adapting to a multifocal and the potential issues with driving at night, I also chose the Eyhance based on things I'd read about multifocals where they're not being recommended with certain eye conditions due to the reduced contrast on that type of IOL. My thinking was that we don't know what might happen with our eyes in the future and as I already have lots of floaters and potential PVD that'll already be reducing contrast, a monofocal lens seems like the best option for me.
Like you, I'm very grateful to everyone here for taking the time to share their experiences and advice as that has really helped to make the final decision. Also, the testing you're doing at the moment is helping me to understand what might be possible with mini-monovision when I get the other done.
My surgery for the first eye is in less than 2 weeks now. The surgeon only offers two IOLs - the Eyhance and the FineVision Trifocal and I know he's been implanting the FineVision for years and the Eyhance shortly after it was available here in the UK, so he would've seen the results from a fair few Eyhance implants.
The only thing I'm worried about now is that I inadvertently read something yesterday that said my type of cataract, (Posterior Subcapsular Cataract) is meant to be more complicated when you're 50 or under, (I'm 48) because the natural lens is still very soft and there's generally some level of accommodation left. It said that standard methods of removal like phaco don't work very well. I'm hoping that, as my surgeon also deals with complex case cataract surgeries, he's likely to have dealt with a few younger patients with PSCs.
CoffeeJmk Matt22935
Posted
I'm 47 and had the Eyehance IOL put in my right eye for mono distance vision on Thursday. It's Monday now.
Although the doctor said that my vision is now "objectively terrific", we disagree on criteria. I see individual letters in a dark room as long as the individual letters are separated and you are testing my eyes at the eye doctors office. What I couldn't do was read words the next day...or the clock across the room or SEE anything within ten feet. I was in tears .
Thankfully, it does appear to be getting MUCH better. I can now read billboards. I can now see objects at 6 feet or farther. I still can’t read anything within 6 feet, but I am hopeful that will improve as everything else does. I’m supposed to be able to read at 2 1/2 feet or farther.
From what I am (trying to) read (on this forum with my other eye), it seems like the Eyehance might need more time to settle in your eye...or brain...or whatever is going on. Cutting into your eye is eye trauma.
My real challenges are driving and working. I only had one eye done and you CANNOT just pop out one lens from your glasses. I tried that and got so dizzy that I almost fell over. I have been told by the doctor to give it a month and so I am trying to do that. Right now I'm sitting three feet away from a 45" tv as computer monitor, but keep in mind that my OTHER eye is still a -5.5...and no glasses at present. What is too close now for the IOL eye is too far for the natural eye .
Really drill your doctor on detailed expectations. How will you drive if you have to see both far away and the odometer in your car which is close? How will you work on the computer and read and see the projection in a meeting? What sort of glasses would achieve that? How long MIGHT it take for your etc to adjust? etc
I had no idea I would be in that much pain during the surgery nor that Versed would be used (I would have requested something else). I had been told about halos, etc on the multifocal so I chose a monofocal...and then I had all of those multifocal side effects the first two days. The halos have mostly gone away and I only am seeing blinding rainbows now under certain circumstances. I haven't gone about at night.