VIVITY OR EYHANCE which to choose
Posted , 18 users are following.
l am 48 and having cataract surgery this year, My main aim is to have exellent distance vision for things like driving with enough intermediate for things like reading the car dashboard, l dont mind glasses for near reading. l have narrowed it down to either Vivity EDOF or Eyhance monofocal but l am having trouble deciding which one to go with. Which one do you think l should choose, is one a safer option then the other and less likely to have negative side effects or problems
0 likes, 44 replies
rwbil john20510
Edited
Everyone's results will be different. But in general from post here and the fact Vivity Website says one can suffer from contrast sensitivity loss, I think Eyhance is the less risky option, but simultaneously provides less EDOF.
So one suggestion would be micro monovision with dominate eye set to Plano or -.25D and the other eye set to .-75D. Micro to the fact you stated safest option.
But more important IMHO is to find a top Opthmalogist and maybe one who uses the ORA System as many miss the refractive mark. Also if you have astigmatism you want to correct for that to get the best vision possible.
RonAKA john20510
Edited
Actually for your requirements a monfocal lens should do it. I find my dashboard vision to be perfect with a monofocal. If you want to go with an extended focus then the Vivity will give you closer vision, but since your expectations are very modest the Eyhance may be the safer choice. The other option would be a micro-monovision using monofocals with a target of -0.75 to -1.0 D in the non dominant eye. That is not going to give great reading vision but should be equal or better than the Eyhance.
john20510
Edited
l just dont like the idea of monovision, l prefer both eyes set for disatance. Eyhance sounds like the best becasue it gives a bit of intermediate vision, if l had eyhance in both eyes for distance would l for example be able to read the car dashboard or read my mobile phone if l hold it to arms lenght and not be too reliant on glasses for intermdiate
RonAKA john20510
Edited
I have read your repeated statements about not liking the idea of monovision. I think the reality is that many people without knowing it have some degree of monovison. This may happen accidentally when the surgeon misses on the correct power needed for full distance vision, or it may happen somewhat intentionally. The surgeons do not want you to end up on the + side or with far vision. That negatively impacts close vision. So, they always target to be on the negative or myopic side of plano. If they do the first eye and get plano or close, they may target to be even a little more under that just to be safe, or if the patient complains about not being able to read as close. I suspect the large majority of people getting cataract surgery do not even get involved in the lens power selection process once they have decided on a monofocal lens. They just leave it all to the surgeon, and they will make these kind of decisions without even informing the patient.
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For the large majority of people they will see the dashboard of their car, or their golf ball on the tee, quite easily with monofocal lenses. This is not a big ask. But to read a mobile phone is a little tougher. Not very likely to comfortably read it without readers, but my wife seems to manage it. She unfortunately only has useable vision in one eye, and cannot do monovision.
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Matching the eyes and even the type of lenses used in each eye is not essential at all. The best way to look at cataract surgery is on a stepped plan basis. Do your dominant eye for distance first, let it heal, and see what you get. Then make a plan for the second eye. It is not necessary to make one big decision for both eyes, although some surgeons may try to push you into doing that. One step, one eye, at a time is the safest way to go.
zer33674 john20510
Edited
May I suggest something? Get a contact prescription for monovision. Try it out religiously for a solid month before you like it or lump it. It takes some time for your brain to neuro adapt, and if you take a day off you will have another small period of readjustment.
Then make the call whether you do or don't want IOL monovision.
I've been wearing monovision contacts for about 1.5 months now to make sure it's what I want for the rest of my life. I haven't worn prescription glasses, even reading glasses, during that time at all. Since I'm frequently on the computer, my close eye is set for more intermediate distance, and doing stuff like driving and looking between the windshield and the dashboard is flawless. I can read my phone and my smart watch perfectly. So now I know that monovision is what I want.
You've got many many years of using the IOLs. A month of experimentation beforehand seems a drop in the bucket!
kevin1951 john20510
Edited
John, I expect either will work well for you. I got 2 Vivity lenses last fall. I can increase font on my phone or ipad and manage for a few minutes without glasses. I wear readers if I pick up a book or magazine.
If you are in the US , Eyhance may be largely covered by insurance. Check with your doctors. I think Eyhance, too, will serve you well. I did much research and decided on the same 2 options you have, but it turned out my chosen clinic only does Alcon products. So I popped for the Vivity even though it cost me several thousand dollars.
I have no contrast loss that I notice. Best of luck.
todd65813 kevin1951
Posted
Did you do micro mono with a -0.5 in the non-dominant eye? Or were both eyes set to plano ?
kevin1951 todd65813
Posted
Hello Todd, sorry for tardy reply. Both eyes were set to plano. That was something my optometrist argued for forcefully. My non-dominant eye had a worse cataract, so it got the Vivity first. My surgeon suggested 'mini-mono' could still be done on my dominant eye. Ended up getting that iol about 6 weeks later. Set to plano. Because of delays, partly due to covid , my surgery was almost a year after the initial measurements. Seemed plano was safest bet. I do wear reader for work closer than 18 inches.
jenny85741 kevin1951
Posted
Hi Kevin, I'm very much interested in knowing what was your experience like, having one eye with Vivity and the other with your natural lens for one year.
I would like to do the same! I have a very reduced vision due to cataracts in my right eye, and a very good near and intermediate vision, (although not so good far vision) in the left one.
Moreover in the left one, my doctor discovered a pseudo hole (almost a hole but not a hole) in the macular membrane and he said there was some risk that undergoing cataracts surgery in that eye might cause the breakage. So my idea is to under go surgery for only one eye, the right one. And to wait for as much years as I could for the left one with the pseudo hole.
I'm between Vivity and Panoptix. I don't mind night lights halos and glasses independence I ist my goal. But the question of whether is it possible to neuro adjust with only one of those IOLs in one eye and no surgery in the other, is what makes my choose so difficult!
Thanks in advance for your reply
john20510
Edited
l read on johnson johnson website the Eyhance gives you vision from 33cm to distance, if thats true and it gives you near vision at 33cm and superior contrast to vivity then l think l will go with Eyhance
rwbil john20510
Edited
I guess it does give Vision. The question is the visual acuity or Quality of Vision. Eyhance is just a little bitty bit of EDOF. I think you might be referring to Tecnis Synergy, which I have that give high quality vision from 33cm to distance.
Just look at the Eyhance defocus curve at 33cm or 13 in. Just a quick look it looks around 20/80 vision. Unless you are a statistical anomaly you are not going to see worth a crap at 13".
john20510
Edited
yes l thought 33cm must be incorrect. Would you be able to read large print approx 65 cm with Eyhance
rwbil john20510
Edited
I would think so depending on one's definition of large print.
But there are just so many factors mostly related to overall eye health including astigmatism and what refractive mark you end up achieving.
If you can sacrifice just a little bitty bit on the distance shoot for -0.5D and that will help you pick up an extra line at the 24" mark. Just keep in mind what you shoot for and what you end up with is not always the same.
RonAKA john20510
Posted
The 0.2 logMAR for Eyhance is at -1.5 D or 66 cm. That is the typical good vision limit distance. However, there is a big difference between individuals. Those that are myopic before surgery, and have a smaller pupil size will typically be able to see closer. If you are older then pupil size tends to be smaller.
john20510
Edited
First experiences at the Svjetlost Eye Clinic, after 40 implanted Eyhance lenses, shows that more than 90% of the patients use glasses only for close proximity (30-40 cm). A positive and pleasant surprise is the fact that 25% of patients do not use glasses at all.
https://svjetlost.hr/news/tecnis-eyhance-intraocular-lens/7231
Myope_PSC john20510
Edited
They probably meant 10% of their Eyhance patients didn't use glasses at all. If 90% of their Eyhance patients use glasses for near vision then only 10% could possibly not use glasses at all.
Some patients have pseudophakic accomodation that can last up to a year or so from what I've read. Some patients have actual pseudoaccomodation.
We don't know what reading needs the 10% of that clinic's patients is or what their tolerance of blur is so you can't compare it to our needs or tolerance.
With emmetropia targeted, I think it's very reasonable to expect/hope for good vision from extended arm's length and beyond with the Eyhance and anything within that range would be a nice bonus.