Vivity IOL - 5 month results
Posted , 5 users are following.
Long post, I tried to give as much information as was relevant on my results with Vivity IOL cataract surgery.
So last year I was diagnosed with fast-developing cataracts. September 2021 checkup was fine with no cataracts showing (20/35 in one eye and 20/40 in the other), by March 2022 I was having issues with my left eye being very hazy, by May 2022 I couldn't really see anything but colors and shapes up close in my left eye. Right eye was comparatively fine (although the doctor said a cataract was developing in that eye as well).
All tests were done, conversations had, researched and decided on Vivity IOL’s (at a $4200 premium with insurance over monofocal lenses) for the replacement due to the doctor’s recommendation for the benefits (great distance/intermediate vision but may require reading glasses for up close vision). Was sold on the fact that I may not even need glasses after the surgery because my vision might be close to 20/20. “might be” being the key.
1st surgery was scheduled for 2nd week in October 2022 and the day of surgery everything went fine. (Acrysoft.IQ Vivity-Toric IOL +20.5 D) Expected results day of surgery (eye sensitive to light, scratchy/dry feeling, blurred vision).
1st Surgery Next day checkup was the same: eye sensitive to light, scratchy/dry feeling, blurred vision
Left Eye - 1 week checkup: scratchy/dry feeling, blurred vision, started to notice that during the exam I was seeing a double image in my left eye when reading the chart – doctor stated it was due to Posterior Capsular Opacification and could be corrected with laser post full recovery time.
2nd surgery was scheduled for 1st week in November 2022 and the day of surgery everything went fine. (Acrysoft.IQ Vivity IOL +20.5 D) Expected results day of surgery (eye sensitive to light, scratchy/dry feeling, blurred vision).
2nd Surgery Next day checkup was the same: Right eye: eye sensitive to light, scratchy/dry feeling, blurred vision
Left Eye – 2nd week: still having issues with double image, blurry beyond arm’s length.
2nd Surgery 1 week checkup - Right eye: scratchy/dry feeling, blurred vision, noticing close up vision is good (to about 24” but gets increasingly blurry the farther away)
Left Eye - 3rd week: Still double image and blurry, started noticing massive glare/halos at night which made it painful and scary to drive.
At this point the doctor reassured me that the blurriness would go away over time but that we still might need to do the laser for the posterior capsular opacification to get rid of the double image in the eye with the Toric IOL. Next checkup scheduled for March.
By the second week in December the blurriness in both eyes had not gotten any better with driving during the daytime being difficult and driving at night being dangerous due to the glare/halos/blurriness. Got an emergency appointment with the surgery doctor to check things out because my job requires me to drive on a regular basis. At the appointment they do all the tests again, dilation, scanning, chart, etc. and determine that my eyes are healing fine, everything looks perfect as far as the surgery went, the lenses are positioned properly and even though they are still healing I might want to get a pair of glasses to help with the blurriness for now (but don’t pay a lot for them cause my vision could still adjust).
Wait.. what happened to close to 20/20 with great distance and intermediate? Doctor – “Well, you are still healing, and things could and most likely will change over the next few months”. He gave me a prescription for new glasses based on the test done during that visit (very dialated eyes). I took that prescription to my normal eye doctors office, had him do a vision test (undialated), explained what was done and what I was experiencing and found that my new prescription was “worst then my last pre-surgery prescription”. Now my eyes are at 20/70 and 20/100. My regular doctor also verified that the lenses appeared to be positioned properly.
Now, I am going to say that I really do not understand the calculations they use to select which IOL ‘power’ they are going to implant or how that affects your vision as a whole, I am not an eye doctor and can only do so much research (which included ready a couple 100’s posts on this site) so I am limited to speaking on this topic with any certainty. But, when asked if the IOL’s used for my surgery were the correct power, the doctor stated that the calculations are computer controlled based on the size and shape of my eye and really could not be wrong.
So, my current vision is both better and worse than it was pre-surgery. Better due to the cataracts being gone, the haziness is gone and everything is very vivid, worse because I need a higher prescription corrective glasses to be able to see clearly.
Jump to March 2023 checkup: Everything looks perfect as far as the surgery recovery goes, new glasses work to correct the blurriness which in turn has gotten rid of the glare/halos (mostly) at night. I mentioned to the surgery doctor what my regular doctor said about my Prescription being worse then is was pre-surgery and he defensively said “I don’t know why he would say that, you couldn’t see before the surgery”. And again stated “everyone’s surgery goes a little different and if the glasses fix the issues then that’s the solution” although I may opt for Lasik down the road if I’m not satisfied. He also stated that if the glasses were doing a good job he would recommend holding off on the laser for the posterior capsular opacification.
So now I’m left feeling like I was oversold on an upgrade to the cataract surgery that did not have the advertised results and a doctor who seems to get dismissive/defensive anytime I try to question if anything could have been done differently to achieve better results.
I know that at the rate the cataracts were developing by this time I could have been in much worse condition with my vision and even possibly to a point of not being able to drive so I am glad I had it done. I just wish that I would have been better informed of the potential for a result like I am having because being in the bottom 3% (based on the Vivity result stats on their page) of potential outcomes kind of sucks. I most likely would have saved the money and went with the $400 Monofocal IOL replacement instead.
And again, when asked I say my vision is Better and Worse than it was pre-surgery.
Paul
1 like, 17 replies
billy111 paul11962
Posted
I know a cardiologist at my hospital who went with the Vivity and he says he has the best vision of his life now at age 66. But overall, I think the simplest approach is best, i.e., a monofocal, one that is tried and true.
But in the coming years, many more newer and advanced IOLs will be on the market, and the way cataract surgery is done may also be different.
I see that on Feb 3, the small aperture Aphthera IC-8 IOL was first implanted in the USA.
RonAKA paul11962
Posted
Would you be able to share what your eyeglass prescription is from the optometrist that gives you the best corrected distance vision? That would be very telling as to what your issues may be.
paul11962
Edited
My current prescription from the optometrist (what my glasses are made to) is:
OD : -0.75
OS : PL : -150 : 75
RonAKA paul11962
Posted
"OD : -0.75
OS : PL : -150 : 75"
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So your right eye is myopic at -0.75 D with no astigmatism? And your left ey is plano with -1.50 D cylinder at 75 degrees? Not quite sure how to read your OS prescription so that is a bit of a guess.
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My comments based on this assumed prescription:
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Right eye: As it is -0.75 D that is pretty good with respect to providing some reading vision. Distance vision will be somewhat compromised though. Based on my consults for Lasik, this could probably very easily be corrected to give you plano, but I am not sure that is a good idea. If reading with it is good or satisfactory, I think I would leave it there.
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Left Eye: If my translation is correct this is quite a bit of astigmatism. If my read of the cylinder is correct, there had to be quite a bit of a miss with the toric power or angle. This may result in a double image effect in your vision. If it is a miss on the angle I don't know if it would be too late to try and rotate it back into position or not. If you leave the other eye at -0.75 D for reading, it would be good to get this eye back closer to plano overall. Lasik could possibly correct the astigmatism, but you would have to find out if they could reduce the astigmatism only and leave the sphere at plano.
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Hope that helps some. Let me know if my assumptions were wrong on the interpretation of your prescription numbers...
paul11962 RonAKA
Edited
Sorry.. I really don't understand much about vision stuff beyond 20/20, etc. but your assumptions were correct... I should have added the Sphere : Cylinder : Axis headings in the initial reply....
The weird thing about the Left Eye astigmatism was the surgery doctor never said he was putting a Toric lens in the left eye... and prior to the surgery I never saw a double image in that eye so I was a bit surprised at the results I was experiencing with the first surgery... on a vision chart I see V as a W as an example
If I go back farther to my 09/03/2021 (my last pre-cataract exam) yearly eye exam, my results from that time were:
OD: +1.50 sphere : -0.25 cylinder : 100 axis
OS: +1.00 sphere : -0.50 cylinder : 75 axis
RonAKA paul11962
Edited
That is too bad that you had such a miss. A miss of 0.25 D on sphere or cylinder is quite common and can be expected. A miss of 0.50 D happens, but is less likely. A miss of 0.75 D should not happen with the sophisticated measurement tools and formulas we have today.
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In any case if you are OK with the near vision of your right eye, then I think I would leave it alone. You may want to go for a Lasik consult for your left eye to see what they can do for the astigmatism. The other option would be to have the IOL taken out and replaced with a toric with a cylinder power that is correct. I think I would also suggest a toric monofocal instead of a Vivity for this eye. Your surgeon should really do it at no cost. But if they are uncooperative you should get a second opinion.
RonAKA paul11962
Posted
When you get the surgery done they should give you a card for each eye that specifies the model number, name, and serial number for the lens. It should also detail the Sphere power, and for a toric a cylinder power. I would be curious to know what cylinder power they used? It seems strange that cylinder should be so far off.
paul11962 RonAKA
Posted
Right: +20.5 D (#DFT015)
Left: +20.5 D : 1.50 Cylinder (#DFT315)
RonAKA paul11962
Posted
Astigmatism can be complex. The first issue is that your eyeglass cylinder prior to surgery is the sum of astigmatism in the cornea and in the lens. Your total prior to surgery at -0.5 D @ 75 deg is not very high. I would have expected your astigmatism to have come down even without a toric. However, in some cases the astigmatism in the cornea and in the lens can offset each other. The angular position can be opposite which neutralizes the astigmatism. This is basically what is done with Lasik on the cornea. You have not had Lasik prior to surgery have you?
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In any case prior to surgery they should have predicted what your residual cylinder would be post surgery with a non toric lens. That is one of the calculations that the computer does with the eye measurements. You could ask the surgeon for this IOL Calculation sheet which shows what was expected, and you could now compare it to what you got.
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The range of toric lenses is limited. In the Vivity I believe the minimum toric cylinder is the 1.5 D which is what you got. This produces a 1.03 correction at the corneal plane. It may have been too much. The AcrySof IQ toric is available with a 1.0 D cylinder which would be about 0.75 D at the cornea plane. It may have been more suitable for correction in your case. But that still does not explain all of the error.
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Another issue is that the incision itself can cause some astigmatism. This can be included in the calculation if the surgeon includes it. And some surgeons claim to be able to make the incision at a location which reduces astigmatism.
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My thoughts would be to try to get a copy of the IOL Calculation sheet, and then go to another surgeon for a second opinion as to what went wrong. Going from 0.5 D of cylinder before surgery to 1.5 D after surgery with a toric just does not add up.
paul11962 RonAKA
Posted
No I have never had any procedures done on my eyes prior to the cataract surgery in October.
That's kind of what I was thinking but I wasn't sure if I was overreacting and just happen to be part of the percentage of people who don't get the expected results.
Having results better than pre-surgery would have been great but i did not expect certain aspects to be worse post surgery.
RonAKA paul11962
Posted
Your expectations of an improvement from pre-surgery refraction is very reasonable. The miss on sphere in your right eye is higher than one would normally expect unless it was targeted to be under corrected. That actually may be a good thing as it should give you closer vision in that eye, while shifting the duty of distance vision to your left eye. But, your astigmatism outcome for your left eye especially considering a toric lens was used, is not acceptable in my opinion. Something must have gone wrong. I almost think that the toric may have been implanted with the angular orientation totally wrong. That is why I would suggest you get a copy of the IOL Calculation data sheet and get a second opinion. I believe there is a visible mark on the toric lens that can still be seen. Your would need the data sheet for a second surgeon to determine if it was oriented correctly or not.
indygeo paul11962
Edited
Hi Paul,
Sorry to hear about your experience. Your outcome doesn't sound optimal. With that said, and as you say, your current situation is better than being blind from cataracts, as many people throughout the world are. That you're able to get corrected vision with glasses is a good thing. On a scale of 1 to 10, 10 being overjoyed and 1 being completely miserable, where would you say you are with regards to your situation? Sounds to me that you're somewhere in the middle?
. Indy G
paul11962 indygeo
Edited
Probably in the 5-6 range, I feel like I would have been better off had I been more aware of the potential downsides vs the glitz/glamour of the marketing jargon.
And considering my glasses prescription is worst then pre-cataracts/surgery requiring substantially thicker lenses which due to the difference between left and right skew my visual image - looking at something the size of a phone or smaller - the right side of the phone looks larger than the left which makes the shape more of a trapezoid than a rectangle.
I also wonder if I would have been more 'satisfied' going with a monofocal lens replacement which from the beginning I would have known that I would require glasses at some level.
As far as the removal of the cataracts go I am 100% statisfied, colors are very vivid and crisp.
If everything beyond arms length wasnt so blurry (I cant recognize faces over 15ft away) I would probably be a lot happier overall. On a positive note, it is nice to be able to work at my desk without having to wear my glasses, especially when wearing headphones.
I also realize that if I wanted to I could have Lasik to correct my distance vision but I was really hoping for a bit better results than I have had at this point. I know from some of the other posts on this site that some people have had their vision change over the course of a year following surgery so things still may adjust some... but I doubt there will be any major changes at this point.
indygeo paul11962
Posted
Hi Paul,
Thanks for your reply. At a rating of 5 to 6 it seems like things aren't completely awful. It sounds like there's quite a bit of hope if you have the option of Lasik to get some more distance vision. From what I understand, the Lasik enhancement is a fairly reliable procedure. Don't lose hope. Get a couple of opinions and make sure you go to a good reputable doctor for the Lasik if you decide on that option. Hang in there and let us know if things improve over time.
Best wishes,
Indy G
paul11962 indygeo
Posted
Yeah the 5/6 is with glasses on... without my glasses I'm strongly in the 1/2 range with the blurriness/double vision
indygeo paul11962
Posted
Ah, I see. So are the docs optimistic for a reasonably good outcome with Lasik? What has he/she said in this regard?
Indy G