Vivity Loss of Contrast Sensitivity
Posted , 11 users are following.
How critical is the following Alcon warning concerning Vivity IOL?
And, how important is contrast sensitivity?
"Most patients implanted with the Vivity IOL are likely to experience significant loss of contrast sensitivity as compared to a monofocal IOL. Therefore, it is essential that prospective patients be fully informed of this risk before giving their consent for implantation of the Vivity IOL. In addition, patients should be warned that they will need to exercise caution when engaging in activities that require good vision in dimly lit environments, such as driving at night or in poor visibility conditions, especially in the presence of oncoming traffic.”
0 likes, 12 replies
kevin1951 Keithred
Edited
Not an expert, but had VIvity iol implanted one month ago . It was implanted in my left eye, which is my weaker and non-dominant eye. Prior to the surgery I printed out a Pelli -Robson contrast test. You can find this online. My cataract was ranked a 3 on a scale of 5 by my eye doctors. I find using the chart that my contrast sensitivity seems to be no worse than when I had the cataract. I will be having another VIvity iol implanted in my other eye in a few weeks. From what I read, binocular implants will help maintain contrast sensitivity even more.
I am an illustrator so I was extremely concerned about this issue. Of course, results will vary, but I am satisfied that I chose the right iol. I had narrowed my decision to either Eyhance or Vivity . Turns out my clinic only does Alcon brand iols , so I went with the Vivity.
It is not easy to place links in this forum , but I learned a lot from a podcast. it is called Ophthalmology off the Grid. I listened on Apple podcasts. The date of the podcast was 2 /26/2021. The hosts interviewed a Dr. Carones from Milan, Italy who has a lot of experience with VIvity. He and other European Drs have had years of practice with Vivity and his review of the Vivity helped me make my decision.
A few days after my surgery I drove at night in an unfamiliar town. In truth, I found it difficult. However, since then I have driven at night and it seems no more difficult than prior to the surgery. Hope my experience is of interest. Good luck with your decision.
My surgeon told me that compared to my cataract the iol would improve my ability to perceive contrast. Not certain that happened , but it did not get noticeably worse. One final curious note, I haven't seen elsewhere: I do not see glare from lights at night except for blue lights. When I drive past a police car that has blue lights flashing the glare is astounding. Fortunately, no problems with red , green, or white street lights.
Ainhoa14814 kevin1951
Posted
Hi Kevin, I am trying to decide between Vivity and Eyhance. I am quite concerned about contrast sensitivity. I understand that in you case, after cataract surgery with Vivity, you got same contrast sensitivity as before operation when you had cataract ranked 3 out of 5? I heard that cataracts decrease the contract sensitivity. I would expect to improve contract sensitivity after surgery. Was not this your case?
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Do you feel that you need to increase the contrast in the computer or phone?
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And driving at night is similar as with cataracts?
thanks very much,
RonAKA Ainhoa14814
Edited
I think the ideal way to use a Vivity lens is to get a monofocal like the Clareon set for distance in the dominant eye, and then a Vivity in the non dominant eye. The Vivity can also be under corrected to leave you somewhat myopic for better close vision. The monofocal will make up for loss of contrast sensitivity in the Vivity eye.
RonAKA Keithred
Edited
No experience with the lens, but I considered it. I believe elsewhere Alcon say that the impact of contrast sensitivity loss is reduced if the lens is used in both eyes. I would also think if you used Vivity in one eye and a monofocal in the other eye the impact would be reduced even further. One strategy would be to use a monofocal AcrySof IQ lens in the dominant eye, and a Vivity in the non dominant eye. And if you wanted to push the ability to read further, the Vivity eye could be under corrected to leave you about -0.75 D myopic.
Eye33 Keithred
Edited
I got a vivity in my dominate right eye, while my left eye was natural but contact corrected. I could see no contrast difference between my natural eye and the vivity. During the day it was clear the vivity had much better whites and was brighter than my natural eye. I was also worried about this but did not see any noticable issue with the iol. i now have Panoptix in the left and still no concerns with contrast. Maybe if I was 21 instead of 51 I might notice a difference?
Guest Keithred
Edited
Vivity does "borrow" a great deal of light from the peak area of focus (distance assuming you aim for a plano target) to provide better close focus. But in normal lighting you don't need much light for distance and won't notice any difference. Where you may potentially notice the difference is in dim lighting or driving in poor visibility conditions etc. But yes I suspect most Vivity patient's won't notice much difference day to day. With both eyes set to the same target Vivity passes the minimum threshold for contrast loss as specified by the FDA (loss of no more than 1 triplet on the Pelli Robson chart). Monocular testing does fail however (loss of 2 triplets on the Pelli Robson). But we don't look at the world with one eye closed.
RonAKA Guest
Edited
It is worth keeping in mind that the contrast sensitivity and MTF is strongly influenced by distance. When the lens is set to plano at distance the MTF in a standard monofocal drops off quite rapidly as you view an object closer and closer. The Vivity while not as good as a monofocal at distance does not drop off as rapidly. For that reason the Vivity should provide better ability to read at intermediate distances (15" to 24") than the standard monofocal lens. Here is how the standard AcrySof IQ monofocal compares to the Vivity based on defocus position.
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It is my view that the impact of MTF loss can be mitigated by mixing the lenses and offsetting their correction by 0.75 D for example. This is what a plano monofocal combined with a 0.75 D offset Vivity looks like. This gives better distance MTF (albeit with one eye), and better close MTF than two Vivity lenses set to plano.
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And there is also the option of using two AcrySof IQ monofocals set with a near eye offset of 1.25 D. Across the defocus range this option provides higher peak MTF at two positions and pretty good coverage except for the really close distance.
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These graphs came from data I found in the Alcon Vivity package insert document (if I recall correctly). These graphs convinced me from a contrast sensitivity point of view going to a monofocal plus Vivity or two monofocals can minimize the loss. I have some similar graphs for visual acuity. They brought me to the same conclusion. Given the cost of the Vivity lens (based on what some have posted here) makes it hard to overlook a simple monofocal monovision solution.
RonAKA Guest
Posted
I posted a response, but it has some graphics so likely will take some time before it is moderated...
rwbil Keithred
Posted
"How critical is the following Alcon warning concerning Vivity IOL?"
I say pretty critical. I have read about this issue, but if Alcon itself is admitting it, it has to be serious. The problem is they were pushing these new Non-Diffractive IOLs as having all the benefits of a monofocal and still able to gain some EDOF. Well that clearly is not the case.
If RayOne EMS or Tecnis Eyhance does not suffer this CS loss, then they could become the dominate "Enhanced" Monofocaol.
john20510 Keithred
Edited
lm getting vivity next week, l asked my surgeon about the contrast, he said if you have healthy eyes apart from cataracts the contrast wont be an issue, he said most of his patients with vivity are happy with the contrast level. l hope his correct. My plan is if l am really not happy with the contrast of vivity in the first eye then l will go with a monofocal in the second eye which would make up for the lower contrast. You could do what lm doing go with a vivity in one eye first and if you dont like the contrast go with a monofocal in the second eye that will give you higher contrast. Also if you have cataracts you have already lost lots of contrast so vivity should give better contrast then what you have now
lisa50682 john20510
Posted
excellent thinking
how did it go?
soks lisa50682
Posted
he doesnt like the contrast in the second eye that he set for closer vision. the first eye was set for distance which he likes and provides better near vision with glasses. he would have gone with both vivity eyes for plano and then use glasses.
click on his name and you can see his posts.