VIVTY CONTRAST BEST IF PLANO IN BOTH EYES
Posted , 4 users are following.
Hi l am considering Vivity and read it has a lower contrast then monofocal IOL's . l read on earlier posts on this forum that Vivity gives the best contrast level and quite good contrast if both eyes fitted with vivity are both set for Plano . But if they are adjusted for monovision or one eye adjusted for a different distance then the other eye then the overall contrast level is lower. Do you think this is correct and should l make sure l tell my surgeon to have both eyes plano set for distance
0 likes, 14 replies
RonAKA john20510
Posted
No, I don't think that is true. I think that overall contrast sensitivity is better if the dominant eye has a monofocal, like the Clareon, set for distance, while the Vivity lens is only used in the non dominant eye. The reason is that contrast sensitivity is much higher at distance with a monofocal compared to a Vivity. And at closer distances the Vivity will be better. But, a Vivity sells for a much higher price than a Clareon monofocal, so the surgeon may be resistant to doing that.
Guest john20510
Edited
Yes. I think that is true. I spoke to Ryan about that personally (the original poster) and it makes sense. Also that's what the trials both found. Peak contrast was low enough that it failed FDA minimums with one eye (loss of 2 lines on Pelli-Robson chart) but passed with both eyes thanks to binocular summation. In the US trial both eyes were set to first minus. In the international trial both eyes were set as close to plano as possible. Neither trial used an offset / monovision. In other words, the contrast issue was mitigated by setting both eyes the same.. There is no trial data (that I'm aware of) on a micromonovision setup.
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That said I know micromonovision is a very popular approach with Vivity… including with Catherine McCabe herself in her own practice (she led the US Study). So it is very commonly done and patients are happy. It would be great if someone did a trial of Vivity micromonovision.
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My guess is the contrast difference between using a 0.5D offset versus not is minimal though and likely only manifests in specific scenarios (distance viewing in low light / low visibility). For Ryan (who first posted about this a year ago) he found he couldn't clearly see his son playing indoor soccer (i.e. low/artificial/mesopic light at distance). And popping in a 0.5D contact lens in order to set both Vivity eyes to the same target (cancelling out his micromonovision) made a "night and day" difference according to him… for what that's worth (anecdotal evidence)
RonAKA Guest
Edited
I see it a little differently. The issue seems to start with the Vivity prescribing information that contains a warning about reduced contrast sensitivity. This is because when it is tested using one eye only, it is slightly under the recommended minimum for contrast sensitivity (MTF). But, then it goes on to say when the Vivity lens is used in both eyes (bilaterally), then it is OK. That makes some sense as the same vision with both eyes is better than one eye due to the summation of the two eyes.
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However, I find that to be a bit of deceptive equivocation on the part of Alcon. There is nothing factually wrong with what they are saying. It is what they are not saying that is an issue. They are not saying what contract sensitivity would be if you have a Vivity in one eye, and a monofocal in the other eye. My expectation is that bilateral contrast sensitivity would be significantly greater with a Vivity + monofocal than with two Vivity lenses because the monofocal lens gives a MTF that is nearly double that of the Vivity lens.
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Using an offset is a bit different. Yes, offsetting one Vivity with a Vivity in the other eye will reduce contrast sensitivity slightly at distance due to some loss of the summation effect. But, it will increase contrast sensitivity closer up. And, more importantly if you have a monofocal set for distance in the other eye, it is not going to affect contrast sensitivity at distance significantly. It will remain far better than with a Vivity in both eyes.
Pascal111 john20510
Edited
John, I think it's true, I had read this study too.
I myself have Vivity in both eyes and a mini monovision (l -0.09D, r -0.5D)
I wanted a little more closeness for reading and this worked out well. In good light I can already read at 30cm.
The subjective contrast is definitely much better, as with the cataracts. Therefore, I am very satisfied.
If I wanted to see a bird more closely in nature at a distance of 100 meters, I would keep my eyes both for Plano, but this is probably logical 😉
And even if the contrast would be worse than with a monofocal, you have a larger visual span and a better contrast nearby than with a monofocal
My vision values:
LE
Distance: 0.9-1.0
intermediate (70cm): 1.25
proximity (40cm): 0.4
RE
Distance: 0.8
intermediate: 1.25
proximity: 0.8
With both eyes:
distance 0.9
intermediate: 1.25
proximity: 0.8
According to my surgeon Ramin Khoramnia, the vision values are better than it would be physically possible
RonAKA Pascal111
Posted
Can you explain what those vision values mean? I've never seen vision measured with numbers like that before...
Pascal111 RonAKA
Posted
You can also give the numbers in percent, so like this:
LE
Distance: 0.9-1.0 (90-100%)
intermediate (70cm): 1.25 (125%)
proximity (40cm): 0.4 (40%)
RE
Distance: 0.8 (80%)
intermediate: 1.25 (125%)
proximity: 0.8 (80%)
With both eyes:
distance 0.9 (90%)
intermediate: 1.25 (125%)
proximity: 0.8 (80%)
RonAKA Pascal111
Posted
Interesting. I have only had my eyes tested at distance (20 feet or simulated 20 feet) and close up for reading.
john20510
Edited
Thanks so if l get vivity in both eyes and want best contrast for distance then Plano is the best way to go. But would a vivity in one eye and the other eye a monofocal set for distance a better option to get more contrast. Would in that case the intermediate seem a bit blurry because one eye is a monofocal distance?
My other question is the material the vivity is made out of the best quality compared to other IOL's. Also l think l read its not ' pre loaded' does that matter
RonAKA john20510
Edited
Yes, if you get Vivity in both eyes you will get the best distance contrast sensitivity if they are both targeted for distance.
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The very best distance contrast sensitivity is when both eyes have a monofocal lens, both targeted for distance. However both contrast sensitivity and vision will be more compromised at closer distances.
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But, yes with a monofocal in the distance eye and a Vivity in the closer eye, both targeted for distance will give you significantly better contrast sensitivity at distance, compared to both eyes having a Vivity. There will be no blurry intermediate distance because the Vivity eye will ensure you have good vision at the intermediate range. Your reading vision will be determined by the Vivity eye.
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The better Alcon material is Clareon. It is available in a monofocal, but I am not sure it is available in the Vivity lens yet. The Vivity is likely to have the AcrySof material. However, I don't believe that is a concern. The AcrySof material has been significantly improved over the years. I have an AcrySof material in one eye and a Clareon in the other. I don't notice any difference in brightness or clarity.
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Preloaded or not is a surgeon issue. If they are experienced with each type it will not make a difference. My surgeon says it does not matter to him. My Clareon lens was preloaded, and the AcrySof one was not.
john20510
Posted
l read somwhere recently that vivity in both eyes set for plano gives similar or close to the contrast level of a monofocal , do you think thats correct
kevin1951 john20510
Posted
John , I had vivity iols in both eyes last fall. I am an illustrator so the thought of loss of contrast was concerning. I find my contrast is good. Seems better than it was with my cataracts.
My optometrist insisted on plano. I visited her when I had 1 eye done and she told me to get the second eye done set the same way. The surgeon suggested going minimonovision on eye 2. He did say, however, it is not possible to get things exact. I told him to go plano and if he was off either way I'd prefer a bit more near vision in eye 2. I wonder if it was right decision, but by and large I am happy with my vision. My optometrist suggested that if the 2 eyes were not set plano I might need prescription glasses after the surgery.
Well, I came away with 20/25 vision mid and distance. I do have astigmatism which the surgeon thought might be not significant enough to warrant a toric lens. I also have a bit of strabismus , not noticable, but I am slightly cross-eyed. One surgeon told me I might need prism glasses. That did not happen. Everone's eyes are different, of course.
So now I wear over the counter readers for reading and drawing at close range. I got some glasses with progressive lenses that have magnification at the bottom and no magnification at top. These are slightly tinted as they are blue blocking. These glasses to effect my contrast sensitivity a bit. I don't need them to drive. The vivity lenses work fine for dashboard and road.
I am 70 , live in the US in Pennsylvania. My out-of-pocket cost was $2500 per eye. Best of luck with your surgery.
RonAKA kevin1951
Edited
"My optometrist suggested that if the 2 eyes were not set plano I might need prescription glasses after the surgery."
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I think it would be more correct to say that if both eyes are not set to plano then prescription glasses would bring them to plano for the very best distance vision (at a loss of close vision unless they are bifocals or progressives). However, the objective of mini-monovision and not setting both eyes to plano is to see well close and far without glasses. So if you go with mini-monovision you have two options for vision. No glasses to get very good vision close and far. And for the very best vision possibly at night for driving, you can wear glasses.
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I have had min-monovision now for over 3 months and still do not have a pair of prescription glasses to wear. I just go with no glasses.
john20510 kevin1951
Posted
Thanks for your post , so you are happy with vivity . How does your vision now and the contrast compare now to what it was like before you got cataracts ? do you feel like you your vision quality and contrast is back to what it was like before you got cataracts? You mentioned you now have 20/25 vision for mid and distance is that better/ worse or the same as before you had cataracts.
kevin1951 john20510
Edited
Yes, I would call myself happy. Prior to surgery my uncorrected mid and far vision was near the 20/40 range. Prior to surgery I was worried driving in fog or even on a clear dark night. My driving vision is much better now without glasses. My wife sometimes has to remind me to take off my readers in the car as before I could not drive well without glasses.
Contrast? A bit hard to be objective or really remember how I saw last year.
I printed out some contrast tests and my before and after contrast seem similar, but the paper seems whiter, leaning toward blue. Before page seemed to be ivory-colored, so I suppose my contrast perception has improved a tad. I definitely feel it did not get worse.