Posted , 6 users are following.
Im seriously contemplating having vivity lenses fitted. Current contact lenses i wear +3.25 in dominant eye and +1.5 in other. I would like good near vision and best distance i can achieve. Does the mini monovision solution with vivity able to achieve this ?
0 likes, 14 replies
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Guest carlspaced1969
Edited
Yes it's a very common but "off label" (i.e. no trials or data on that configuration) approach. Typically just a 0.5D offset.
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Anecdotally I spoke to one person that got this and didn't like it. Specifically he said it was hard to watch his son play indoor soccer (so distance viewing in artificial light). He also said popping in a 0.5D contact to undo the slight monovision noticeably improved things in this very specific scenario. I suspect that's due to the contact lens shifting the peak focus of his near vision eye to distance, thus making full use of Vivity's limited contrast sensitivity.
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But this is again, a very specific scenario. From what I've read and heard from surgeons the overwhelming majority of Vivity patients are thrilled with Vivity in a 0.5D offset.
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You don't mention having cataracts? I would not recommend lens replacement surgery to anyone that doesn't actually need it (if that's the case).
RonAKA Guest
Edited
My thoughts are that only offsetting the Vivity by 0.5 D would leave you short of reading ability in the near eye. I would offset it by 1.0 D if I was doing it. The Vivity EDOF technology gives you about 0.5 D over a monofocal and you need about -1.5 D for decent reading ability. If you come up short on reading you will end up in the boat of having to carry around reading glasses to see the smaller print especially when the light levels are lower.
Guest RonAKA
Posted
I have not heard of any surgeons doing a 1D offset with Vivity. You're right that 0.5D probably won't give you perfect reading distance but that's not the idea. The idea is just to make the quick glances (see a text message for instance) more functional / usable so your day to day stuff is mostly glasses free. You still would likely still want readers to sit down and read a book. You could ask for 1D of course but I think more surgeons would not do it.
RonAKA Guest
Edited
It seems very foolish to me to spend the extra money on a Vivity lens and then be disappointed in not being able to read without reading glasses. All you have to do is look at the defocus curves and see what you get with a 0.5 D offset on a Vivity. At a logMAR of 0.2 it only gets you down to -2.0 D or about 19". From my personal experience a monofocal with a -1.5 D offset works just fine for almost all conditions. I never take glasses with me when leaving home, and days will go by at home without me getting the readers out of the drawer.
Guest RonAKA
Edited
I don't disagree Ron I'm just saying I haven't heard of any surgeons using Vivity in that way. A 0.5D offset between eyes is a very common approach with Vivity but not a 1D offset. If you 100% really need perfect glasses-free reading go multifocal or traditional monovision with monofocals. Or maybe Vivity with a 0.5D offset and slight under-correction as laurie mentioned below (although I'm not sure if that was planned or just luck). In any case always good to go first minus I think vs. trying to hit emmetropy bang on.
RonAKA Guest
Posted
@laurie30147 ended up at -1.0 D with the Vivity lens and it seems to work well and can see down to 8". It is not about the offset between eyes, it is about where the close eye lands on an absolute basis.
Guest RonAKA
Posted
Her offset is still 0.5D though. Overall she ended up a little myopic in both eyes which is great but I doubt any surgeon would intentionally target 0.0 and -1.0 with Vivity.
RonAKA Guest
Posted
That is not the way I read it. A quote:
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"My right eye is my near-vision eye. At the quick post-cataract checkup two weeks after the procedure, the optometrist there said that eye was -1.5 D. However, at an appointment six weeks after surgery, my regular optometrist says it is -1.0 D. "
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Typically the surgeon uses auto refraction to measure the eye, while an optometrist uses manual refraction. "Which is better, A, or B?" If so the latter measurement will be the most accurate one. It indicates a -1.0 D offset. This combined with the built in -0.5 D offset of the Vivity EDOF gives a total myopia offset of -1.5 D which is ideal.
RonAKA carlspaced1969
Edited
Do you have cataracts that are affecting your vision currently? If you don't then I would not consider any IOL. But, if you do, but can still see reasonably well, the first thing I would do is simulate monovision with contacts. That would mean leaving your +3.25 D contact in the dominant eye. And, if I have my + and - thinking correct you would use a +3.0 D contact in the non dominant eye to leave you -1.5 D myopic. This should give you good reading in that eye. In fact you could even try just using one of your -3.25 D contacts in the non dominant eye too. That should leave you -1.75 D which is a bit much, but it will give you an idea what monovision looks like.
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With respect to using Vivity to do monovision, yes I think it can be done. However, I would not use a Vivity in both eyes. I would correct the dominant eye to plano distance with a monofocal like the Clareon, and only use the Vivity in the non dominant eye. It adds about -0.5 D so the target with a Vivity would be -1.0 D rather than -1.5 D. The knock on Vivity is that it reduces contrast sensitivity. But if you use a monofocal in the distance eye, this effect is minimized.
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You can of course do mini monovison with a monofocal in both eyes. Then you would just target -1.5 D in the non dominant eye. That is what I have done, and it works well for me. The advantage of using a Vivity in the close eye is that it gives you slightly better distance vision in that eye, because it only needs an offset of -1.0 D instead of -1.5 D.
Songirl RonAKA
Posted
I was thinking about doing the Vivity after hearing all the issues with Panoptix. I figured I would ask about mono vision but after reading this last comment I wondering if I would be better off doing a monofocal with offset as well. Do you think this is doable with someone who is very Myopic like me?
RonAKA Songirl
Posted
The advantage of using Vivity for the close eye with a -1.0 D offset is that you have better distance vision in that eye, compared to using a monofocal with a -1.5 D offset. My experience so far is that I really don't miss that extra distance vision in my close eye. I see very well with my distance eye. And at TV range I see very well with both eyes.
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The issue with monovision is that you have to hit the target power quite accurately. That will be a little more difficult with a high myopia eye. One option if available in your area is the Light Adjustable Lens. That way any error in selecting the power can be corrected after the lens is in your eye. Any you will get a chance to fine tune the amount of myopia depending on what you like.
john20510 carlspaced1969
Posted
l am getting cataract surgery later this year , l dont like the idea of mono vision , but thinking of getting vivity both eyes distance, only thing that worries me is vivity lower contrast, but l like the idea you mentioned of a monofocal in the dominat eye and vivity in the other,do you think Eyhance IOL would be a good choice in the non dominate eye
laurie30147 carlspaced1969
Edited
Vivity mini-monovision is exactly what I have. My cataract surgeries were in January and February of this year. My previous vision had been myopia with a prescription somewhere between -1.5 D and -3.0 D (it varied a lot in recent years due to the developing cataracts). Note that I wrote about it in an earlier post in this forum.
My right eye is my near-vision eye. At the quick post-cataract checkup two weeks after the procedure, the optometrist there said that eye was -1.5 D. However, at an appointment six weeks after surgery, my regular optometrist says it is -1.0 D. Whatever the actual number, I can focus well starting at about 8 inches. This makes for very comfortable reading without glasses, which is what I wanted (having been nearsighted all my life).
My left eye is my distance eye, and it is about -0.5 D. It provides better distance vision than I ever had in my life. I do take walks without glasses and I have taken safe drives (local grocery store) without glasses. It is exciting to me to be able to do that, and it provides a new level of confidence that if I lose or break my glasses (say, during travel), I will still be able to see. That said, I still wear glasses for night driving and for long or tricky drives. The glasses correct the vision in my right eye for distance and sharpen up the left eye clarity, resulting in good binocular vision.
I am very happy with the outcome. This amount of monovision is working well for me and my brain. Some folks might prefer having perfect distance vision in one eye, but from what I read, targeting 0 D is somewhat risky.
For what it's worth, I don't know which eye was dominant before and my opthalmologist didn't try to determine it, as far as I know.
RonAKA laurie30147
Edited
"However, at an appointment six weeks after surgery, my regular optometrist says it is -1.0 D. Whatever the actual number, I can focus well starting at about 8 inches."
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With a Vivity lens -1.0 D should be ideal.