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Touch decision time for second eye: 3 ophthalmologists, 3 recommendations. Help!

Posted , 4 users are following.

RandallG
RandallG

Hello everyone. I am back since my first surgery some 4 months ago, and it's time for my second surgery as my right eye cataract is getting worse by the week.

I have Vivity in my left (dominant) eye. After a -0.5 miss (and a much longer than anticipated recovery time during which my vision was blurred), today I am relatively happy with my Vivity. Even with the 0.5 miss, I have 20/25 distance and I can work at the computer without glasses.

For the people who really understand this stuff (e.g., RonAKA ) I've uploaded the results from the trace measurements.

Nevertheless, I decided to talk to a couple of other surgeons and seek other opinions.

Here's what the 3 different ophthalmologists recommended:

#1 (original doctor): did not make any recommendation but said that both a monofocal set for distance or another Vivity (set for distance) would work fine. In other words, not very opinionated and wants me to make the decision because, I think, he does not want to be blamed if I am unhappy with the result—which I understand.

#2: Recommends another Vivity set for distance, said most patients prefer having the same lens and with another Vivity I'd be able to get close to 20/20 (given both eyes working together) and only need glasses for reading. This seems to match the chart that @RonAKA shared about the good results with two Vivity lenses.

#3: Recommended a Panoptics so I would not have to put reading glasses on/off when, say shopping and having to read small labels.

Any recommendations/ideas? Has anybody been in a similar situation and decided to mix and match Vivity with Panoptics or monofocals?

Thank you in advance for sharing your thoughts and experiences!

0 likes, 10 replies

10 Replies

  • RonAKA
    RonAKA RandallG

    Edited

    This is not the best situation to end up in, but it could be worse, and there are a couple of learnings to be had. Your outcome illustrates the downside of targeting -0.5 D of myopia. You end up with 20/25, less than crisp distance vision, and even with the EDOF of a Vivity you do not get good reading either. But on the other side of the coin it shows the benefit in deferring the second eye surgery until after the outcome from the first eye is fully known. You have the second eye to optimized based on where things fell short with the first eye. I do think you kind of have to make up your mind as to whether you want to improve on either your distance vision or your close reading vision. The odds of doing both are pretty limited. These would be my thoughts on alternatives:

    .

    Improve distance vision

    .

    1. Probably best is to target a monofocal for -0.25 to 0.0 D. This will improve your distance vision if the target is hit to 20/20+ with both eyes open. The much higher distance contrast sensitivity of the monofocal will also improve night vision significantly. The downside would be that it will do nothing for your overall close vision. You will get what you currently have.
    2. Use a Vivity in the second eye, but target it to the -0.25 to 0.0 D outcome. The odds of doing that should be better on the second eye. You may get up to 20/20 overall, but night time contrast sensitivity will not be improved much. The improvement to close vision is likely insignificant.
    3. Use a PanOptix in the second eye targeted to -0.25 to 0.0 D. Distance vision is likely to be similar to #2, but there should be some improvement in closer vision. However, I have a friend that has PanOptix in both eyes and still needs +1.75 readers, so you never know. And with this option you take on the very significant odds that you will get the halos, flare, and spiderweb effects at night. Probably the poorest choice for night time driving.

      .

      Improve close vision

      .

    4. Your could target a monofocal to -1.50 D, and you should get a significant improvement in close vision to pretty much eliminate the need for readers. Distance vision will not be improved, and contrast sensitivity at distance at night will not be improved. Contrast sensitivity closer up and with dimmer light should be improved.
    5. A Vivity could be used in the second eye but targeted to -1.0 D. This should give pretty good reading vision. However it will do very little for distance vision and will not improve night time contrast sensitivity.

      .

      I kind of think those are your choices, and it really is a matter of your priorities as to which one is best. In my view there is nothing magic about needing to use a Vivity in both eyes. It really is your choice based on what you want to achieve.

      .

      Hope that helps some,

    • RandallG
      RandallG RonAKA

      Edited

      Thank you, Ron. I knew I could count on your answer and I appreciate that very much.

      The PanOptix option is the least appealing to me. So it's a toss up between a monofocal and another Vivity.

      Night driving is the least important factor for me because I rarely need to drive at night. Also, even with the cataract in my right eye, I've been able to drive quite well and without eye fatigue with the Vivity—my left eye vision is 20/15 with Vivity + distance glasses—and I'm OK wearing glasses for night driving if necessary. I was actually quite surprised.

      I am really enjoying my very good intermediate vision without glasses since I spend most of my working time at a computer.

      The Vivity is also giving me suprisingly decent reading vision in good light. I would not want to plow through "War and Peace" from beginning to end without reading glasses, but it's quite workable for most short-term tasks and quick email checks on the iphone (for example.)

      Based on the numbers/% on chart you posted "Comparison on Binocular) Range of Vision Results between Vivity ...", I really like what I see (pun intended) in double Vivity column. So I am leaning in the direction of Vivity with a target of -0.25 to 0.0 D outcome (as you recommend) even though it's an extra $3,000 (not peanuts) ... but I am "only" 62 so it IS peanuts amortized over a couple of decades.

      In terms of doctors, even though one of the other doctors is quite well known (published quite a bit on the subject, and is #2 in the Newsweek ranking of ophthalmologists—if that means anything) I am leaning toward going back to the same doctor who did the first operation since I like him and the surgery went well. Plus, as you said in a past post, he might have learned something about better targeting for my other eye.

      I'll sleep on it for a week or so (and see if there are any other replies from people who've been in my boat) but you really helped me to think this through. So a BIG thank you!

      Randy

      image

    • RonAKA
      RonAKA RandallG

      Posted

      My thoughts would be if your main interest is better distance vision, and you are ok with your current reading, would be to go with a monofocal set to plano this time. If you go with a Vivity set to plano it should improve distance, but probably not quite as much as a monofocal, and because your first eye is a Vivity at -0.5 D, a second Vivity at plano is not likely to add any intermediate or close vision beyond what you have now. The Vivity at -0.5 is going to determine your intermediate and close vision limits. And the bonus of course with a monofocal is a lower price, and lower risk of optical side effects. Eyeglass needs should be reduced to occasional reading glasses.

      .

      I would agree that going with the first surgeon if they are able to explain why they missed on the first eye, and what they are going to do differently this time would be the best choice. They should have the best odds of hitting the target this time, whatever you choose it to be.

    • RandallG
      RandallG RonAKA

      Posted

      Thank you, Ron. Three quick final (I hope) questions regarding your recommendation.

      1. READING GLASSES: If I go with monofocal set to plano for my other eye, can I still use cheap drugstore (i.e., non-prescription) reading glasses? I ask because, I assume, that my left and right eye will need different powers for proper close vision.

      I am not talking about short-term reading (e.g., to read a label or a menu) but, say, 1-3 hours of reading a book. I assume that it would be more fatiguing if they eyes are not "aligned".

      1. Parallax/spatial issues at arm's length. Will it be more difficult to, say, thread a needle (not that I sew much) or perform other tasks where stereoscopic vision is important/helpful.

      2. Choice of monofocal lens. If I recall correctly from your previous posts (I try to read them all because I learn so much from you) you recommend paying a few $100s extra for the Cleareon monofocal, correct?

      Thank you again for all your help!

    • RonAKA
      RonAKA RandallG

      Posted

      First, I have probably overlooked one option. That would be to target -0.5 D with a Vivity, or essentially double down on what you have now. Due to the binocular effect you will gain about 1/2 to 1 line of visual acuity over the range of distances. That may be all you are looking for. It would come at the $3000 price tag though of course. You could get almost the same by targeting a monofocal to -0.5 D. It would give the same slight improvement for distance, but not quite as much for intermediate and close.

      .

      1. I am essentially plano in my right eye, and -1.5 D in my left eye. Ideally I would need +2.5 D in my right eye and +1.0 D in my left eye for reading. However, I find some off the shelf +1.25 D readers work just fine for me. I only use them for very fine print though, and depend on my -1.5 D for most of my reading.
      2. With my mini-monovision I have only found the loss of binocular vision significant at quite close distances of a foot or less.
      3. I paid an extra $300 for the Clareon because it was not 100% covered with our public health. The advantages would be having the very latest material for the glistenings issue (which I don't think are significant in the AcrySof IQ lens), as well as a somewhat increased light transmission, and potentially better resistance to PCO. The Clareon has slightly sharper edges on the lens. And, it may not be an issue for you, but choosing the Clareon let me jump the queue for surgery by several months. Where I am, it is done in a clinic, where at the time I would have had to wait for a spot in a hospital for the 100% covered AcrySof lens.
    • RandallG
      RandallG RonAKA

      Posted

      Thank you, Ron.

      First, I have probably overlooked one option.

      I am sure you have heard of The Paradox of Choice. It makes it difficult to choose between flavors of jams, imagine choosing the right lens for a lifetime 😃. So I appreciate your patience with my questions.

      The double-down (literally) option is interesting. I would definitely consider it.

      My only concern is that I've heard that EDOF lenses are more finicky about being well centered vs monofocals. Is that the case?

      PS Thank you for reassuring me about the binocular vision. One less issue to worry about unless I pick up sewing or making flies for flyfishing as a hobby—whihc is not likely.

    • RonAKA
      RonAKA RandallG

      Posted

      I am not sure that EDOF lenses are more finicky about being well centered. It may depend on how they specifically do it. The B+L enVista lens gets a modest extension of depth of focus by using asphericity. It achieves about as much extension as the Eyhance. If you google it, you will find their claims, but one of them is that the lens is more tolerant of being decentered, and it is more tolerant of less than perfect eyes.

    • RandallG
      RandallG RonAKA

      Edited

      Thank you, Ron. Is there anything about this subject you don't know 😃.

      Cheers.

  • indygeo
    indygeo RandallG

    Edited

    Randall,

    You might consider the Rayner EMV lens offset by 0.50 D. It is designed with a hyperopic "bump" where you gain a bit of distance vision over a standard monofocal set the same, plus an added depth of focus with the possibility of getting reading, or close to reading, distance. Do investigate it as you wish. It may or may not be offered in your area. I have it mixed, offset by 0.75D, with a monofocal for distance and love it. I feel I'm about 95% of my very good distance eye with the "near" EMV and I have excellent reading at 11 to 12 inches away.

    Indy G

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