Vivity mini-monovision vs. LAL monovision? Trying to decide.
Posted , 9 users are following.
Dominant (R) eye scheduled for nine weeks out. Just enough time to second guess my choice and research.
Game plan is to get Vivity in both eyes, with mini-monovision. Left will be for close-up and Right will be for distance. I don't know if the left will be the equivalent of readers? That's what I would like, and trusting the brain will compensate better in this scenario than using LAL lenses for monovision.
I don't think I want multifocal lenses although I'd really love to have the full range of vision, because halos and glare might be drawbacks that make the Vivity lens superior. It is a bummer the Vivity only can correct 3/4 of the visual ranges. I'm hoping to get zones 1-3 out of the dominant eye and 2-4 from the other. It that too optimistic, I wonder?
I'm 49 and had terrible nearsighted vision most of my youth, then nearly 20 years of ideal vision corrected by Lasik. So the thought of pulling out readers or other glasses for the rest of my life from now on because I have developed cataracts sounds like a huge bummer.
Currently I have contacts with mid-range left and distance right. I've had that for a couple years now and don't prefer it but it's ok. I hate that I have to pull out glasses to read small print when without the contacts I can read small print. It is not ideal to think I'm about to spend so much money to recreate this inconvenience.
I stopped trying to wear because my vision was bad anyways so I have almost gotten used to just having bad vision overall. I own glasses set to distance and have to use readers very rarely for teensy tiny print or reading at night in low light. TBH I don't even use my distance glasses for driving sometimes, if it's daytime and I know where I'm going. I only use them for night driving, day driving on a road trip, movies/TV set which is about 25 feet away. This is because my close up and intermediate vision is far superior with no correction than with any other options at hand. Lately my phone is really hard to read and I had to increase the font size. I didn't know that may be because of the cataracts and assumed I was just aging and losing my near sight.
When I had Lasik 19 years ago ("microlasik" is what they called it, which was more expensive than "standard lasik" at the time), I also had astigmatism in both eyes so that ruled out a few of the choices for me now that I need to replace both lenses with IOL.
My surgeon is very excited about the LAL and it was news to me. I was predisposed from internet research before my consultation to want the Vivity lens. His enthusiasm about Light Adustment technology was somewhat contagious and we talked a lot about the benefits especially of getting that left eye just perfect for close-up reading. He does not think he can guarantee to achieve that level of really certain perfection of close-up nor astigmatism correction with the Vivity lens. But he definitely sees the downside of monovision vs. a deeper range of focus.
He did say most of his patients who choose mono-vision are at a more sedentary age than I am. Honestly, I have had a very active lifestyle but since all the shut-downs, my eyes developing cataracts and getting closer to 50, and beyond, I forsee that I will likely be less active. I already go out at night much less but have taken up early pre-sunrise hiking, which is totally fine for any level of vision. As I age, I would think I'll want to read more, sew, craft, etc. and use my close up vision a lot.
I've been reading on this forum about people who have had the Vivity in their dominant eye and an LAL in the other. I think one person had the opposite. I didn't think of that. The LAL was a very tempting option and I really didn't feel 100% confident selecting the Vivity over that option. I do like the fact that I won't have to wear the blockers for recovery and light treatments, mostly because I'm a performer and will have to take off work. Plus it makes me nervous overall to have something so important be that fragile.
I wonder why my surgeon didn't mention doing a combo?
What I want might not exist. I want to see great at distance, mid range and close up without halos and flares. I am probably more willing to compromise that both eyes aren't the same than compromise overall clarity or using glasses. I really don't want to need glasses! That would be awesome and totally worth 9k to me. I could live with a little glare but not so much that I can't drive at night or read signs.
Any thoughts are welcome. Thanks, everyone 😃
0 likes, 16 replies
RonAKA mviv
Posted
With your objective to read small print without reading glasses, your best bet would be to use a Vivity set for distance in your right eye, and closer to full monovision with another Vivity set to -1.5 D myopia in the left eye. With a Vivity in the distance eye, there should not be a "hole" in the intermediate vision zone.
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Your main risk is the prior Lasik. That makes it hard to measure your eye accurately to get the correct IOL power. Some formulas are better for calculations when there is prior Lasik. Best to discuss this with the surgeon to feel how confident he/she is in getting the power selection correct.
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LAL would help in getting the power correct, but you would sacrifice the wider depth of focus of the EDOF Vivity and risk not covering the whole range from fine print to distance.
RonAKA
Posted
One other option to consider is a Alcon Clareon or AcrySof IQ monofocal in your distance eye, and a Vivity set to -1.0 D myopia in the close eye. The knock on Vivity is that it has lower contrast sensitivity than a monofocal. If you use a monofocal that offsets this effect to some degree. However, you cannot go as far with the myopia or you may leave an intermediate "hole". But within the range of vision which should include reading an iPhone, the quality of vision may be better than two Vivity lenses.
rwbil mviv
Edited
First, I recommend you research this forum for both Vivity and LAL as there have been many threads regarding these 2 IOLs and include both advantages and disadvantages. I would add even though some have had issues with Vivity, overall from what I have read it has been a very successful IOL for most people.
Sounds like you are already experimenting using different contact settings to simulate monovision, which is good thinking. Just keep in mind your natural adaptive lens is providing a close vision boost. Of course that adaptability decreases as you get older; presbyopia.
The Vivity will give you a .5D EDOF, which means you will not have to do as large a monovision as you would have to do with the LAL set to monofocal vision to achieve the same close vision. For example instead of shooting for -1.5D monovision you can just do a -1.0D.
The advantage of the LAL is you would not have contrast sensitivity loss and if you are not happy with your monovision results you can try a few more setting post op (not sure how many adjustments you can get). I read they have a new LAL with UV light filter built-in which might reduce the need for the UV blocking glasses; something to ask your doctor about.
Depending on how one defines Great Close Vision, it can be hard to obtain with a refractive IOL. This is one reason I have the Synergy IOL, dysphotopsias and all. The greater you make the monovision the greater the difference in images being presented to the brain, which is why I recommend micro monovision, but everyone is different and handles it differently. For me personally I need great distance vision from both eyes. And one thing I have learned is the 2 eyes work together to produce a superior vision over a single eye. For me, each eye individually I see 20/20 but together I can see 20/15 -2. I would imagine, though I could be wrong you will lose this with monovision.Something to check into when making a decision.
Lastly the only IOL that I know of that can achieve great vision at all ranges without dysphotopias is the experimental Juvene IOL, which last I heard has been given the green light to go into clinical trials. If you live in the US you could contact Dr. Chang, one of the top Ophthalmologist in the world, about this IOL. Keep in mind even though there have been clinical trials in other countries, only a hand full of individuals have had this IOL implanted and you would definitely have to be an high risk taker early adapter. This IOL has also been discussed on this forum, so search for it.
Lastly you did not state what your corrected vision with cataracts is. I see people that barely have a cataract get surgery right away. Again everyone is different, but I am a fan of procrastination as long as your vision quality is still acceptable. The reason is they are constantly coming up with new IOLs or having new ones approved in the US (if you live in the US). For example the PanOptic Clareon might be be available or another Trifocal might come available with less dysphotopais that might be acceptable to you.
robert80020 mviv
Posted
What country are you in?
laurie30147 mviv
Posted
Mini-monovision with Vivity is what I am planning. My right eye was done on Jan. 26 and ended up on target at -1.5D. My left eye is scheduled for Feb. 9, and the target is in the -1.0 to -0.75 D range. I'm a little nervous about it, because the decision seems so permanent, but I trust my doctor. I think that I will be OK with a conservative amount of monovision, because during this weird period between eye surgeries, the left eye is blurrier than the right eye at all distances, with or without glasses, and that doesn't seem to be bothering my brain at all. But I don't want to shoot for any more difference between the eyes than 0.75D, even if that means I will wear glasses to achieve the sharpest distance vision.
You can see my post under "My Vivity eyes," but basically I've been myopic all my life and I didn't want to lose the ability to read without glasses. My near vision with the operated eye is excellent and I am very happy with it. The optometrist at my follow-up appointment said that the operated eye would actually be legal for driving (California, if that matters), although the distance vision is not crystal clear. I have worn glasses or contacts for distance all my life, so I am used to the sharpness of corrected vision. Therefore I won't mind using some glasses for distance at times.
But I will post again after the second eye is done...
Laurie
lejoniken laurie30147
Posted
Hello Laurie
How did your mini-monovision with Vivity work out? I'm here in California going nuts trying to make decisions about IOLs that won't take away my ability to read close-up (which I have now without eyeglasses) but I do want to see distance pretty well also.
Thanks for any info about your experience!
Marilyn
Pascal111 mviv
Posted
Hello mviv!
Maybe my experience can or will help you. I got the Vivity placed perfectly in the dominant eye (-0.09D). Wednesday in 9 days I have the 2nd operation. I get the Vivity again with the target refraction -0.5D. If this succeeds, I should have enough proximity for reading, although it is certainly better with reading glasses, but it should also work without it.
If you definitely don't want to reach for reading glasses at all, you have to go deeper into monovision, as RonAKA says. However, I would be a little more cautious and would aim for -0.1D in the extreme case. The greater the difference, the greater the contrast loss and possibly optical phenomena or inharmonious vision
I spoke to my surgeon on -0.5D to -0.75D. He advised to aim above -0.5D. Of course you can do this, ultimately it is a balancing act between the risks: Maybe sometimes need the reading glasses or get a certain risk for vision problems (Important: Possibly, can be, does not have to be)
My goal is similar to yours. I will then report, this is then 7 weeks before your operation.
RonAKA Pascal111
Posted
Keep in mind that the differential between the eyes does not cause the optical artifacts like flare and halos. That effect is a result of the optics of the lens itself, not the monovision differential. And also keep in mind that while the Vivity suffers a loss of contrast at the set distance, it actually gains in contrast sensitivity (compared to a monofocal) as the distance gets closer. The monovision split actually increases contrast sensitivity across the vision range.
RonAKA Pascal111
Posted
Did you mean to say -1.0 D for the extreme case, not -0.1 D?
Pascal111 RonAKA
Posted
Yes, sorry, -1,0D of course
Pascal111 RonAKA
Posted
the greater monovision reduces spatial vision. and if optical phenomena occur through your lens (not in my case), I think they are rather amplified by a larger monovision, or the perception of interference is thereby greater.
RonAKA Pascal111
Posted
There was a good article on the internet on the optimal amount of anisometropia (monovision offset). Unfortunately the full pdf version of it has been taken down. However there is a brief summary of it still up with the tables and figures. Click on the button to view all tables and figures. You can also click on each table and figure to see the text associated which is very helpful when you do not have the complete article. Their conclusion was that 1.50 D was the optimal offset or myopia in the near focus eye. They compared 1, 1.5, and 2 D of offset. The significant drop in stereoacuity occurred when you go from 1.5 to 2.0.
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Optimal amount of anisometropia for pseudophakic monovision Ken Hayashi, Motoaki Yoshida
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I saw my surgeon last week and his recommendation was a 1.50 D offset when using monofocals. We did not get to a full discussion on how much to use with Vivity. My thoughts are that 1.5 D is correct for monofocals, but the offset can be reduced to 1.0 D for Vivity, and 1.25 D for Eyhance. This is based on how much close vision the Vivity (0.5 D) and Eyhance (0.25 D) adds with their EDOF.
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One thing to keep in mind is that anisometropia is defined as the difference between the two eyes. However what really counts is the amount of myopia you have in the close eye. If the distance eye is plano (0.0 D), then you want -1.50 D in the near eye. If the distance eye turns out to be -0.50 D, then you still want -1.50 D in the close eye. Your anisometropia will only be 1.0 D in this case. You do not want to go to -2.0 D in the close eye.
Pascal111 mviv
Edited
mviv: Your surgeon will also have an opinion on this. I noticed with my potential surgeons that they already have their own views and habits. I think it is helpful if the surgeon feels comfortable with your project and considers it a suitable idea. If a surgeon is not convinced of this himself, I would not let him do it.
RonAKA Pascal111
Posted
I agree. If you have a choice go to a surgeon that is on board with what you want, rather than forcing the surgeon to go against their views. Fortunately my surgeon picked -1.5 D for the near eye using a monofocal, and that is exactly what I think too.
Ryyck mviv
Posted
Hello MVIV,
Would really appreciate if you could update us on the final IOL configuration and also what you found in terms of vision acuity, distance/closeness, contrast, halos etc. Waiting in anticipation... cheers Ryyck