Very disappointed with first Vivity lens result, need advice on what to do with for my other eyes
Posted , 5 users are following.
Hello everyone,
My first post here and I was thrilled to find this forum. Thank you Patient.info!
**TL;DR version: **One week after cataract surgery with Vivity IOL in my left eye, I have blurry intermediate distance vision and poor distance vision. I am wondering what to do with my other lens and would love to hear from other people who have had similar experiences. Should I go for a monofocal long-distance in my other eye? I would like to see clearly without glasses with at least one eye.
THE FULL STORY:
I am a 62 y.o. with cataracts in both eyes (well, ONE eye post surgery) and I would very much appreciate advice on my situations.
After much research and hand-wringing, I decided to have cataract surgery and opted for the Vivit multifocal lens despite the added cost because I read so many good things about it and $3000/30 years (give or take) is only $100/yr or $0.33/day ... worth it if I could see well without glasses.
My expectations were to get very good distance vision (my priority) and decent intermediate. Instead, I got blurry vision at all distances (I know that should improve with time) with best vision at the intermediate range (computer.)
I was scheduled to get another Vivity in my right eye, but I cancelled the surgery because, well, to say that I am not happy with the results in an understatement.
Do any of you end up with intermediate vision in one eye? What did you decide to do for the other eye?
Did any of you intentionally choose intermediate lenses over short or long distance ones?
Any advice or encouragement will be greatly appreciated.
Thank you!
RG
PS If I could go back, I'd probably go for long distance in both eyes, save some serious $$$ and at least see clearly at one distance and wear cheap glasses for near vision.
0 likes, 10 replies
Sue.An2 RandallG
Edited
Hi RandallG
Welcome to the most active forum. I see you too have the lovely gift of cataracts . The gift that keeps giving.
You should not be seeing blurry for all ranges with this IOL.
Have you had follow-up visits with the surgeon? What does he say regarding outcome? If you are at 6 or more beyond surgery maybe see your regular optometrist for a refraction test to see where you are. It is possible you have astigmatism or the surgeon miscalculated the power for IOL you'd need.
RandallG Sue.An2
Posted
Thank you, SueAn2.
Lovely gift indeed, but I am not complaning because I had decent vision for 50 years or so.
See, that's what puzzles me. I thought, and heard, that with cataract surgery you are in good shape probably for the rest of your life. All of my friends and family are very satisfied with their result. My mom is 83 and does not need glasses for anything after her surgery.
It was 8 days ago, so there is still hope—at least for the blurriness.
I had two followup visits and he says that the lens in placed correctly, centered and there are no issues. So, apparently, he miscalculated the power for the IOL ... and I did not know or even think that that was a possibility—I mean with all that high-tech equipment ...
He confirmed that my astigmatism was <0.5 and so he did not use a toric lens (two days ago I didn't even know what a toric lens was ...LOL).
Thank you again for your reply and I will keep this great forum posted ... hopefully my experience will help others in similar situations.
RonAKA RandallG
Posted
I seriously looked at Vivity for my second eye. My first eye got a distance monofocal. In the end my surgeon did not encourage me to do it, and I got another monofocal, but under corrected by about -1.4 to give me monovision. I think it could have been better if I had gotten a toric and 0.5 higher power number, but I am quite pleased with my eyglasses free result.
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My conclusion in my research of the Vivity is that it best to use in one eye, not both, and ideally in the non dominant eye. Vivity has some issues with loss of contrast sensitivity that are compensated by using a monofocal in the other eye.
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My thoughts would be to wait at least 6 weeks and get your eyeglasses prescription done. That will tell you where you stand with the first eye, and you will be able to make a better decision on the second eye. Hopefully you were left myopic, and not hyperopic. In any case if you are satisfied with the intermediate and nearer vision then yes, I would get a monofocal in the second eye. And the other thought is that if you have astigmatism greater than 0.7 D, then you should consider a toric lens if you want the best eyeglass free vision.
RandallG RonAKA
Posted
Thank you for your reply Ron,
I was myopic in the eye they operated on (left, dominant) +2.5/3.0 and getting worse by the week. I had a myopic shift according to the dr. I used to have great distance vision and in my 40s I began to need glasses, but in the last 3 years I can read without glasses but anything more than a foot or so is blurry.
Why did you say "HOPEFULLY you were left myopic"?
Thank you again for the education!
RonAKA RandallG
Posted
Myopic is also called being short sighted. It is when the light converges to a point short of the retina at the back of the eye. It is primarily caused by having an eye that is too long. If you are short sighted, your near vision tends to improve some. If you are far sighted, the light converges behind the retina, and is primarily caused by an eye that is too short. There is no good news with being far sighted or hyperopic. Your distance vision suffers as well as your near vision.
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It is probably too soon to decide how much of a miss there was and in what direction unless they have already done some refraction tests. In any case I would wait until the 3 week mark before making any big decision.
greg59 RandallG
Edited
RandallG,
Waiting till your vision in the first eye settles before deciding on the 2nd is a good idea. If you are still on steroid/NSAID drops, they will affect your vision, some more than others. The harder, thicker cataracts take more energy to remove and that will mean longer healing times.
Typically they'll refract your eye after a week or two at the surgeon's. Make sure you get the prescription they measure. Then you'll know how close they came to hitting the target.
If your vision can't be refracted so that you could see clearly with glasses, then it's possible that the surgery induced a macular edema or other eye condition that keeps you from seeing clearly. The surgeon will probably look for that when you are examined. Even in these cases, vision can often be fixed but it might take a few months before another procedure can be performed.
I targeted -1D with my first eye with Eyhance and the results were better than anyone expected. I get nearly 20/20 vision at distance, good intermediate, good phone, some reading in good light. Results varied a bit with lighting but overall, I was doing as well as they claimed I'd do with Vivity. At first, I'd planned to get the 2nd dominant eye targeted for distance but decided afterwards to improve my intermediate / near and targeted -1.3D. It's only been 5 days since the 2nd surgery but I'm happy. Night vision is excellent.
I I'd gone with a standard monofocal, I would have also targeted something closer to intermediate (-1D to -1.5D) than plano. You'd end up with decent distance vision, probably good enough to drive and fine for TV watching etc. You'd likely also have phone vision. If you were willing to tolerate a small amount of monovision, target one eye to -0.75D and the other to -1.5D to get better distance and near vision with a monofocal.
In my view, targeting plano with a monofocal is a mistake that throws away nearly half of the good vision available in the lens. Look at a typical defocus curve that plots visual acuity against distance. All of the vision in the + range is beyond infinity and unusable. You want the highest portions of the curve available at distances less than infinity (0D and negative values). Targeting small minus values typically shifts the curve so that more good vision is available at closer distances without much compromise in distance acuity. If the surgeon misses the plano target on the plus side, you'll be farsighted and have problems with both intermediate and near. A bad miss on the plus side and you might need glasses at all distances (something you could have experienced on your first eye.) As my optometrist says, "there are no happy hyperopes" because there are no advantages to being farsighted.
If the surgeon targets -1D and misses to the minus side, at least you'll have decent reading and intermediate and will need glasses for distance. This seems to me to be a much better "bad" outcome than the hyperopic miss.
RandallG greg59
Posted
Hi Greg,
First of all, thank you for taking the time to write such a thorough post. I need to digest and try to understand some of the terminology (I am new to this cataract/vision thing ... I just got prescription glasses and I was good before 😃).
Could you please explain the term "plano"? Does it mean infinite distance?'
BTW, given all the fancy measurements they took, how could they be so far off? I assumed that the new technology for determining the best lens needed was reliable. I was really surprised about the BIG MISS (lousy distance vision ... and blurriness--although it has been only one week.)
You sound like you really know your stuff and think not in just best outcome, but also possible misses ... and I am super appreciative. I want to make sure I don't make another mistake with my second eye.
greg59 RandallG
Posted
Plano means you have the best possible vision at very far distances, essentially infinity. -1D means you have the best possible vision at 1 meter and would need a -1D corrective lens to see optimally at distance. -2D means the best possible vision is set at 1/2 meter. Of course, with any lens, you get good vision within a diopter or so of where you target. At plano you'd get decent vision in the range of -1D to +1D, roughly anywhere beyond 1 meter. But you can't see any of the plus values that are beyond infinity. If you achieve -1D, you'd get decent vision in a range of roughly -2D to 0D, that is from 50cm to infinity. So you might see 20/32 or so at distance but you'd be able to read computer monitors and perhaps even be semi-functional with tablets and phones in good lighting.
The Vivity was designed so that by targeting/achieving plano you get decent vision more toward the minus side than with a monofocal. That's why it seems odd that you didn't get good vision at any distance with Vivity. Hopefully that will change as you heal and get off the drops.
RandallG greg59
Posted
Thank you for explaining "plano" to me Greg.
I just bought and tried some new drops, Systane UltraPF, because I read about some drops possibly having preservatives and I am getting DECENT vision at the computer with the screen about 50cm away, so I guess that currently I am at -2D (if I understand you correctly.)
Anyway, I don't want to take advantage of your kindness and take more of your time, but hopefully I can bring your expertise in again after my next visit and after I've learned more and thought more about my next step.
Thank you again!
greg59 RandallG
Posted
If you can see better at 50cm than any other distance, then you'd be at -2D. In that case your vision would would get noticeably blurrier as you look further away than 1 meter. But your vision would stay "decent" at 30cm and things would get noticeably blurrier as you got even closer.
If your best focus is at -2D (50cm) with Vivity, that would be an outlier that almost never occurs assuming your surgeon targeted plano as most do with two Vivity IOLs.