Vivity and Light Adjustable Lens Combo Upcoming

That is an interesting plan and kind of the reverse of a more normal practice. But, you have some significant other issues to deal with so it probably makes sense. Normally one would put a monofocal in the dominant eye set for distance (-0.25 D target), and then use the EDOF lens in the non dominant eye to provide some monovision reading. A lens like the Vivity can use about -0.75 D of myopia to give better reading, without causing much of a distance vision loss.

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The big plus with the LAL is the ability to try different powers of correction. Lasik can make the power of the lens needed hard to calculate so that is important.

Last Wednesday (5 days ago) I had the Vivity Toric Lens implanted in my right eye. So far, it is a huge success. I was a bit nervous about the power since I have previously had LASIK. I made clear when some of my tests were repeated the morning of my surgery that if the power was missed that I hoped it would be on the myopic side. It was mentioned that two different machines that morning from different manufacturers had both come up with identical astigmatism readings which is unheard of that they agree that closely. And I was reassured that in the extremely unlikely event the power was significantly off there was a window of time to change out the lens. I was assured though that they didn't believe that would happen.

Anyway, the day after surgery I could see 20/20 for distance. Reading I could see at J2 (20/30 equivalent) which astonished me. I didn't expect it to be that good. My surgeon was very happy and said he thought it would likely only become sharper.

When I got home (I had gone out of town for surgery) I was able to test my vision at the computer. I have a set up with 3 monitors and being able to see without glasses at that distance is of primary importance to me.

So far, things are going well. My near vision has actually improved a bit. I can now read anything on my phone (I read Kindle books a lot) with no glasses. To be clear, that is a strain and I would not do it for extended time. I worse +3 reading glasses before. I bought a pair of +1.25 drugstore readers which are completely adequate. That is much better reading vision than I expected from a Vivity lens.

My computer vision is fine for things that aren't heavy reading. For example, I can easily play a video game or watch a video on my computer with no glasses. I can read web pages without glasses. But, if it is extended reading it is a slight strain. I might be able to alleviate some of that by monitor placement.

However, I will have my left eye done later this week with the light adjustable lens implanted. The hope is that the left eye will help with the computer vision. Right now, my left eye is a drag on my vision since my cataract in that eye is causing very blurry vision.

In short, I have gotten better intermediate and near vision from the Vivity lens than I expected. My distance vision is totally fine. I know that the Vivity lens is supposed to decrease contrast. But, honestly, I haven't noticed it. Maybe if I was driving at night I would. But, given I haven't done my left eye yet I am not driving at night. But, just looking around at night everything looks fine.

Of course, I know this is early in the recovery period so I guess things could change. But, for right now, things are going very well.

Oh -- one interesting thing to me. I did not expect that I would need a Toric Lens. Pre-Lasik (23 years ago) my astigmatism in that eye was -2. Most of the was corrected with LASIK. (I waited to have LASIK done until the laser that corrected astigmatism was approved in the US).

Since thing my astigmatism in that eye has varied from -.25 to -.5. I didn't think that would need a Toric Lens. However, when they do their tests they measure my astigmatism as it would be without the presence of my natural lens. Without it, my astigmatism would be -1. Since the natural lens was being replaced, they implanted the Vivity Toric lens.

So yesterday I had my left eye done with the light adjustable lens. It is hard to compare the two experiences since the situation for each was so different. A week after my Vivity lens I am still doing well, seeing 20/25+ at distance and J2 for near. It is nice that I can read anything on my phone without glasses although I want light readers for anything extended.

For me, though, ultimate success will for my overall vision really depends on the computer distance. If I can eventually spend several hours a day at my computer comfortably without glasses then I am happy. This is true even with needing light readers or even occasional glasses for some driving (say at night). The right eye alone doesn't quite get me there although almost. I am writing this on my computer without any glasses but it is a little bit of a strain.

So the Light Adjustable Lens in the left eye needs to pick up and help a little with that. The LAL is a monofocal lens that you can adjust the power after surgery. We plan to ultimately set the power of that lens where I can most clearly see at computer distance (with both eyes together). It is easier with the LAL to add power with adjustments rather than to remove power. So, the target was for the left eye to be at -1 D. the adjustments will be to increase that. Typically, I was told people can often see well at computer distance with it adjusted to -1.25 D. Of course, the idea of the LAL is that it can be adjusted after surgery to what works specifically for me.

I would say my first 24 hours after surgery was more difficult with the LAL. I had blurrier vision overall and everything seemed more hazy. The negative with the LAL is the need to wear UV blocking glasses except when sleeping. Well, most people can remove them showering. But, I have a skylight in my shower so will wear them even when showering.

At the post-op appointment, I was able to take off the UV blocking glasses for my exam. Some of the haziness went away and it was overall easier to see without them. Anyway, I was 20/40 with my left eye today. I was quite happy with that. First, I was 20/40 knowing that my target was -1 so 20/40 seems very reasonable.

Also I had a vitrectomy 3 months ago to peel a macular pucker. Before that surgery I was 20/60 in my left eye. A month after surgery I was 20/40 implying improvement from the peel. It is expected to improve for several months. But, then the cataract got bad so I couldn't see improvement. The fact I am now at 20/40 with the LAL supposedly targeted for -1 is a good sign.

And, it was stressed to me today that I still had a lot of swelling and it should get better. Right now, my combined computer vision is better than it was before the left eye was done.

I go back in a couple of weeks for a check. I don't have an adjustment set yet for my left eye. They expect I will have an adjustment in 3 to 4 weeks. I want to be very cautious with the adjustments since they can only be adjusted a limited number of times and I may have more vision changes due to the peel. I am not planning on locking in anything until the end of January which will be 6 months after the peel. Wearing the UV blocking glasses is a pain but I am willing to do that and be patient if it helps with the results.

thank you for updates on your vivity toric and LAL . i have vivity toric in non dominate eye but have been delayed to get second eye due to flu tuating vision, severe dry eye i am also RK patient 30 yeRs ago

dry eye specialist recommending LAL for right eye once my dry eye under control and i am concerned about having 2 different lenses and my depth perception might be off

i dont like the loss of contrast with vivity compared to my natural lens how is yours with LAL? i have great near vision with vivity but horrible distance i also must be able to drive.. both day and night as well as hike, play tennis etc..,, I have had a terrible time these past months with the fluctuation hoping your LAL is going well please update and thank you!

Inga

I appreciate your detailing your experiences getting a mix of Vivity and LAL together with a macular pucker peel.

I'm in an almost identical situation to you, facing how to approach my cataract surgeries.

Main difference is my puckered eye is on the right (20/60), my left eye has a cataract but is still 20/25 or so. I've always been myopic at -9D. I had been considering Vivity in my good left eye (for distance and intermediate vision) and a monofocal in my right puckered eye . Perhaps an LAL is a better choice, as you've done.

How has your experience evolved since you have now had both lenses replaced and the final LAL adjustments made? Did you do any adjustments of the LAL to move toward better distance vision, or were they all to improve closer vision?

They can do EDOF with LAL, by adjusting it to manipulate spherical aberrations. (I'm just parroting what I've read. i don't really know much about it. But 2 ophthalmologists here in Massachusetts have confirmed that to me). Have you explored that possibility?

Codet talks a lot about this on their website. But my docs said they too could do it.

l recently got vivity in both eyes , mini monovison, right dominant eye plano 19.5 and left eye slighly near 20.5 l find the right eye vision perfect but the left eye slightly too shortsighted, l regret not having both eyes plano, l will try to get used to it, but if l cannot what would be the best way to get the left eye adjusted to plano or distance, would that be a LASIK laser or some other type of laser or a piggyback lens where they put another lens over the top or another way