What Are the Risks and Disadvantages of Eyhance?

My websearch discovered that Dr. LaHood is a paid consultant for Alcon (maker of Clareon) and Zeiss. Among other things, he's affiliated with something called the Alcon Experience Academy.

As for refracting eyes with Eyhance IOLs, JnJ receommends a well-established methodology that"s well-known to optometrists, ophthalmologists, etc.

You pays your money, you takes your choice.

Good to get that information!

Thanks for clarifying that!

ha ha. u r now coping.

I.m not suggesting he;s a shill. But it does present a conflict of interest that, for example, would have to be disclosed in a journal article. Especially when a paid consultant is endorsing a product from the business that pays him (and even more so when he says it's the best such product), I'd like to see reasons that, at least in principle, can be checked against other, ideally independent sources.

I think that is a good idea. The more checking you do, the better but does take a lot of work!

If you Google "Europe Ophthalmology Times Dr Ben LaHood" it will take you to a number of journal articles he has written. Next to his name it says he is a consultant to Zeiss and Alcon.

I was able to get into the Alcon Experience Academy. It has many technical articles about refractive surgery, retinal repair. glaucoma, dry eye disease, etc., for eye care professionals. Johnson and Johnson has something similar with their jnjvision.pro

Dr LaHood and I exchanged several emails, and I surprised that he did that. He knew I was an American and would not be a patient of his in Australia, but he was kind enough to reply to me.

I also got some email replies from cataract surgeons at medical schools here in the U.S. Doctors don't like to give medical advice online, but I carefully worded my emails to assure them I was only seeking their personal experiences with IOLs. Some favored the Eyhance, some favored the Clareon. Others said they thought that essentially they both were fine IOLs. One said he preferred IOLs that had already been on the market for years, such as the Arysof or the Tecnis 1. Another reason I chose the Tecnis 1.

"premium" isn't really a factor there. a lens with altering power from the edges to the center is probably not optically the simplest thing to correct if you need to?

One question I have is how much more close up vision does eyhance give compared to Clareon in choosing the distance focal point? I have had different people recommend either Eyhance or Clareon since both have advantages.

How have you liked Eyhance and how long have you had it? What focal point did you target?

Eyhance is not treated as a Premium lens at my health plan and is free since it is a monofocal. My doctor has recommended it for distance for me as she has seen good results but then I would like a blue light filter since I have AMD. Can be hard to decide but don't like wearing glasses for close up so that is a factor also.

I gather that you think Eyhance is hard to correct which is what you also indicated in a prior post. I conveyed that to my doctor and will discuss it with her on Tuesday. Have you chosen a lens yet?

I'm scheduled for an eyhance but i can also still swap for a regular monofocal. I'm quite torn because the intermediate vision isn't guaranteed anycase, so if it doesn't succeed, the image quality of a pure monofocal is just better. And a regular lens with no shenanigans is definitely a more flexible choice if you want to get custom prescription lenses using automated measuring devices. The central power shift of the eyhance means you cannot use autorefactors at all.

I have Eyhance. Ive had it for 6 months. I don't understand why anyone would say it is "hard to correct". It's not. I have glasses that I use for a few things and they all work amazingly well.

Interesting comments. I am torn also but somehow feel better about Clareon, all in all. Also, I prefer blue light filtering for the AMD I have. I guess you are choosing Eyhance as you think you are likely to get better intermediate vision which is of course something I want....but alas as you say...NO guarantees! March 2 is my surgery date and I am getting pressure to decide! Still doing research and hopefully some good posts will appear on a new discussion posted today!

I think the more accurate wording would be "harder to correct". As @Spoo says, the autorefractor will not get it right due to the varying power of the lens. However, an optometrist that is skilled in using the phoropter and knows how to deal with an Eyhance should still be able to do it.

If blue light is important to you then you can't go wrong with the Alcon lens. It's an extremely popular lens. With Eyhance you might get another 8 or 10 inches closer focus or maybe even a foot without glasses but honestly it is very very hard to say. Everyone is different.

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Also I've learned that focus distance is profoundly dependent on available light. I can read J1 at 14" with my Eyhance eye (other eye isn't done yet) in FULL BRIGHT sunshine. But not in normal room lighting. I can read my iPad fairly well at maybe 18". Although even at 6 months this is still changing. Post surgery my Eyhance near vision was spectacular and now it's more in line with the trial data. But in bed at night with the lights out and the screen dimmed I absolutely need readers.

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Its a mixed bag. Every IOL is a mixed bag. And whatever you end up with (assuming a good outcome, no bad side effects or complications), you will get used to and adjust your life around and eventually not even think about. But ya it is a scary decision as you can't try before you buy and you can't really do it over again.

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About blue light, honestly I can't tell any difference in greens and blues between my Eyhance lens and human lens. I can see a difference with whites. There is definitely a yellow cast in the un-operated eye. BUT I used to notice a strong yellowing BEFORE surgery when my eyes were dilated after an exam. So I think some (or a lot) of that might just be the cataract. But what I will say is, I don't find the world looks "cold" with my Eyhance lens. I think any colour temperature difference is probably very subtle. If you're worried about retina damage that's another issue. If you're young and expect to have this lens for 30+ years maybe the macular degeneration / blue light thing is a consideration. Something to discuss with your doctor.

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And as for focus distance, you should be able to see your dashboard sharply which might not be the case for a standard monofocal. And you might even get a better near result but no one can promise that. Again about the glasses, I got some for computer (because my other eye still is -4 and presbyopic and my Eyhance eye does better on the computer with a +1… I can read without it but with the +1 the computer is AMAZING… plus the computer glasses correct some residual astigmatism which gets rid of some subtle ghosting at close distances… and all I can say is… these glasses work insanely well for computer. The computer looks incredible with them on. Spectacular. I haven't tried a progressive lens with the Eyhance eye though. Again I'm between surgeries and dont want to spent too much on glasses. But I see absolutely no reason why progressives wouldn't work just fine since readers (when needed) work amazing.

Hey Ron. All I can talk about for sure is my personal experience with an Eyhance IOL. I visited my Optometrist in November and she didn't even know what kind of implant I had. It was a non-issue. She has no issues at all determining a prescription for distance and near. She knew I had an implant but that's it.

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Don't get me wrong. I know what you mean. Eyhance doesn't focus 100% of the light in exactly the same point so in theory it would be "harder" to determine a correction. But we are splitting the finest of hairs and in practice it's not an issue. It's certainly not something I would hinge an IOL decision upon unless I was an airline pilot. At the end of the day it's simple. If you want the absolute best possible image quality get a standard monofocal. But Eyhance peak focus image quality is probably about 98% as good.

Thanks for the detailed reply. I had read a very old post where you were just selecting Eyhance so I was very curious as to how you liked it. It is true about adapting to one's vision. I have been walking around for years with AMD, Cataracts, Myopia and Presbyopia. The only time I need glasses is for drivng on a very dark day. I live without glasses and am happy with my vision as I have adjusted over the years. I hope I don't go into shock when the cataracts are removed and I have really good vision!

Have a read of the "Maximum Plus Refraction" section of this article. It is near the end.

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orthopticscpd Unaided Intermediate Vision: A Paradigm Shift in Cataract Surgery?

I'm aware of the "pushing plus" method of refracting. It's something that is good for an optometrist to be aware of but it is not a reason for a patient to choose one IOL over another.

I see the author of that article prefers moni-monovision for patients with no ocular disease

And it is a bit of a moot point if the IOL has the correct power in the first place. It is essentially the same as targeting -0.25 D.

Yes, I think mini-monovision should always be considered. It is an often overlooked option. I feel sorry for my wife. Due to amblyopia she really only has vision in one eye which has a toric IOL set for distance. Mini-monovision was obviously not an option for her. Compared to me, with mini-monovision she has significantly compromised vision, and is always looking for reading glasses. She hates glasses and I can read her tablet from across the room as she always has the font size set very large so she does not have to use readers.

UV and blue light refer to different parts of the spectrum. Regarding blue light there's both disagreement regarding whether and which parts of the blue light frequencies are (most) harmful.

Almost all lenses including the Clareon and Eyhance have UV filtering. However, the standard on most Alcon lenses including the Clareon is to also have blue light filtering in addition to the UV filtering. The J&J lenses do not use blue light filtering, except for their latest Synergy lens. It has violet light filtering, which I would presume is between blue light and ultra violet light. So, it has almost blue light filtering.

Here is a graph of what a blue light filtering lens transmits compared to a traditional UV only blocking lens like the Eyhance. The graph shows how it compares to the natural eye lens at various ages.

What was your target focal point for your Eyhance eye and what will you target for the new IOL to be implanted?

I note that your vision was much better initially and has changed over 6 months and is not as good as it was initially. Is this true of all Monofocals or just Eyhance? I saw this in another post as well

after one year.

the alcon clareon lenses in the US come in both white and yellow. the white may not have the blue light filtering. something worth asking specifically for if you want it. for panoptix they are tfat and tfnt. one of the type is clear.

i made a note of that to ask my doctor.

Yes, I think around 2018 or so, Alcon came out with some clear lenses. Not sure how available they are. Myself and my wife were only offered blue light filtering lenses.

Thanks for providing this experience, it's really helpful.

Definitely the sight shifting in different lighting conditions has been discussed before. So essentially you are less dependent on glasses in daylight and need them more in poor lighting conditions.

Are you going to get a second eyhance based on your experience?

Someone has just given me a study posted here with results stating that Eyhance and Clareon are the same with distance and near vision. Eyhance proved much better in the intermediate range.

I was just reading some stuff about blue light filtering glasses, mainly for computer use, but some people like to wear them outside also. There were some comments about the glasses at least causing some level of loss focus and clarity with regards to colours and certain environmental situations, such as night driving, as it filters out portions of the spectrum. But you have said that you haven't really noticed much of a difference for yourself, right?

Spring1951, In reference to your AMD,, this article from Ophthalmic Professional,

"Update on IOLs-Ophthalmic Professional," says that both the Tecnis 1 and the Eyhance work well in patients with AMD:

Monofocal IOLs

Monofocal IOLs provide spherical correction for a single distance. These lenses do not address astigmatism or presbyopia – in other words, patients will require glasses for optimal vision after surgery. Patients can choose distance, intermediate, or near with these lenses but cannot have multiple distance in focus at once (unless they choose monovision). Monofocal IOLs provide excellent image clarity and contrast with minimal aberrations, such as glare and halos. These lenses are ideal for patients with ocular comorbidities, such as VF and contrast loss due to age-related macular degeneration (AMD) or glaucoma.

Many lenses discussed in this article are variations of the common monofocal IOL platforms offered by the major IOL manufacturers. Most current monofocal IOLs implanted, such as the Johnson & Johnson Vision (J&J) Tecnis (ZCB00), Alcon Acrysof (SA60WF), and Bausch + Lomb enVista (MX60E), are one-piece lenses made of hydrophobic acrylic. These lenses are foldable and are designed for placement in the capsular bag. J&J’s recently approved monofocal, Eyhance (ICB00), with a modified anterior surface sphericity to increase depth of focus and provide some range of vision, is an added benefit to current monofocal options

The Eyhance is not a monofocal. It is an EDOF lens that does not have enough EDOF to be advertised as an EDOF according to industry regulations.

You can't mix blue light filters for people with natural lenses in their eyes, and blue light filters in IOLs. The natural lens includes a significant blue light filter that increases with age. There is no need for people with natural lenses, and especially older people to wear blue light lenses. Getting an IOL with a blue light filter just restores the level of filtering that exists in the lens of a young person.

"results stating that Eyhance and Clareon are the same with distance and near vision. Eyhance proved much better in the intermediate range."

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Based on the defocus curves at distance the Clareon should have slightly better vision. At intermediate distances, depending on how it is defined, the Eyhance will be slightly better than the Clareon. At close distances the Eyhance should maintain vision slightly better.

Yes, that is true. The Doctor wouldn't even allow me to select multifocals.....only monofocals including Eyhance because of AMD. Thanks for the article!

Interesting!

If you were to choose monofocals again would you consider Eyhance or prefer Clareon?

Yes, the Eyhance is an EDOF, but in the above article the ophthalmologist who wrote lumped it under monofocals. And when cataract surgeons advise patients about monofocals, they tell them the Eyhance is a monofocal

"The Tecnis Eyhance is a breakthrough technology because, for the first time, a high-quality monofocal IOL offers extended depth of focus."

Review of Ophthalmology, March 12, 2021

I absolutely would choose Clareon with blue light filtering, and if I got a mulligan I would get a Clareon toric in my one eye that ended up with too much astigmatism.

Yes, I know that some do, but I don't believe they are being honest with the patient.

Yes, and I think statements like this are sucking and blowing at the same time. A pure monofocal does not have an extended depth of focus.

Ok, but it's still not proved that it makes any differnce if you get more blue light or not. And I do know one person who had issues with blue light filtering IOL becasue it gives more yellow tinted temperature than a normal eye. If you go with bilateral implantation, there's no issue anymore. But think about those who has only unilateral surgery. As a young person I was strongly advised to go with a clear one (unilateral).

I would suggest you are getting bad information. The blue light filtering used by Alcon only restores the natural blue light filtering of a younger eye. If you are only doing one eye and use a clear lens you are most likely to see a more blue image than what you will see with a natural eye. The eyes will be unbalanced in colour balance. However, I have found that the brain deals with that. When I had one eye done with a blue light filter lens and the other with a mild cataract the difference between the eyes was quite noticeable. The natural eye was yellowish in comparison. However when you have both eyes open, the brain blends the colours.

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It is a common misunderstanding that blue light filtering in an Alcon IOL gives a more yellow tinted temperature than a normal eye. It just restores the natural eye profile. Because our eyes age and provide more and more blue light filtering (turn more yellow with age), the normal reaction to an IOL even with blue light filtering is that vision is all of a sudden more bright and bluish. This effect would be more noticeable with a clear lens.

Just read a study saying that no proof that IOLS with blue light filters have any effect on AMD.

That's what I was told by the majority of ophthalmologists.

Good. Glad to hear that as I have been leaning toward Clareon and will probably decide soon as the doctor is asking me now for a choice. It sounds like your main reason is you like the blue light filtering and because you chose monovision the extended depth of vision is not important to you.

There have been studies both ways. It certainly is not a conclusive situation. However when one is in a compromised situation already with AMD do you want to expose your eye to more blue light than it is getting now with your natural eye? Seems to me that with the uncertainly, the conservative approach is to maintain the blue light filtering that a natural eye has, and avoid exposing the retina to a much higher level of blue light than it has ever seen before in your lifetime. There certainly is no harm being done with blue light filtering, but there might be with a clear lens.

I chose the Clareon for the simplicity of the lens without any optical tricks to extend the depth of focus of the lens. My intent from the start was mini-monovison with my close eye targeted to -1.5 D of myopia. If I was to choose a Vivity which I considered, I could have targeted -1.0 D of myopia, instead of the -1.5 D. This would have preserved a little more distance vision with the close eye, but I really did not need it as at that point I had already had the other eye done and had 20/20+ distance vision with it. And my surgeon recommended against Vivity as he had me pegged as a perfectionist and was worried I was going to come back and complain. I didn't really consider the Eyhance as I prefer the Alcon lenses, but if I had I could have targeted -1.25 D myopia to get a similar effect. The benefit is so small that one has to consider that it is probably not worth the risk.

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My main reason for wanting the Alcon lens was to get blue light filtering to have a more natural colour balance. I do digital darkroom work using a calibrated monitor. I wanted to be sure that the colour balance I was seeing was the same as what a younger person with natural eyes would see. The other reason for selecting the Alcon lens was that there is some evidence that shows the risk of getting PCO and needing YAG is lower than with the Tecnis lenses. PCO is a real risk, and I wanted to keep it as low as possible. The limited information on the Clareon is that it has lower PCO risk than the AcrySof IQ material.

Yes, that makes sense. I would prefer not to get more blue light than I am getting now.

Thanks for that valuable information. That really sums up why you chose Clareon and that is something I was thinking of asking you....to elaborate ...as you just did. I am speaking with my doctor tomorrow and want to present her with my main reasons for choosing Clareon which overlap with the reasons that you just gave. I DO think those are some good reasons for making that choice!

Well, Ron, you are not an ophthalmologist. They are. I could have cited a dozen more websites where ophthalmologists called the Eyhance a monofocal. I think they know more about IOLs than you do. But believe what you want to believe.

What we know is that the Eyhance cannot be called an extended depth of focus lens because it falls short of the minimum extension of 0.5 D, with about 0.4 D actual. The Vivity just exceeds the minimum at about 0.6 D. But, does failing by a small amount to qualify for an EDOF designation make it a monofocal lens? Based on the defocus curves the Eyhance is significantly different than the true monofocal Tecnis 1. I would suggest the Eyhance is closer to being a EDOF lens than it is to being a monofocal.

Definitional arguments are often pointless. The Eyhance is not an extended depth of focus IOL because it doesn't meet the minimum criteria of the "American Academy of Ophthalmology Task Force Consensus Statement for Extended Depth of Focus Intraocular Lenses".

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But neither is it a pure monofocal because, like the Alcon Vivity, but only to an extent falling short of the Consensus Statement's criteria, it does provide an extended range of focus beyond that of a 'pure' monofocal. Some, therefore, call it a monofocal plus, because it shares many other characteristics of monofocal IOLs.

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Others, such as "Best Cataract Surgeons in America"--their claim, not mine--assimilate Eyhance to the EDOF category: "The Tecnis Eyhance lens implant, by Johnson & Johnson Surgical Vision (JJSV), utilizes extended depth of focus (EDOF) technology to deliver similar distance vision and better intermediate vision compared to a standard monofocal lens. The Eyhance IOL (intraocular lens implant) was approved as a monofocal intraocular lens by the Federal Drug Administration (FDA) in February 2021, and technically is not classified by the FDA as an EDOF lens because of the very specific criteria required for that designation, and clinical trial data that is required for a lens implant to have that designation by the FDA, however, it does provide patients with increased intermediate range vision compared to many other monofocal implants."

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Which is just to say, as I began, that the definitional argument is pointless. We should focus on what, according to clinical testing and the opinions of trusted sources, the Eyhance does and doesn't do. My own conclusion, FWIW, is that the Eyhance provides a modest increase in depth of focus over pure monofocals without the significant sacrifice in optical quality that some experience with multifocal IOLs and the Vivity.

"The Journal of Cataract and Refractive Surgery" is the leading journal for refractive surgery. It is a peer-reviewed journal. Here in 2022 they refer to the Eyhance as a monofocal lens with an "extended depth of focus." It is not a pure monofocal, but it is nevertheless classified by the FDA and referred to by cataract surgeons as a monofocal.

pubmed.ncbi.nim.nih.gov/34117177

So I think maybe we are on the same page.

My reply was to Ron,,notRebDovid

"Review of Ophthalmology. 2021"

Professor Peter Szurman, chief physician at the Sulzbach Eye Clinic of the Knappschaft Hospital Saar in Sulzbach, Germany, has implanted many of the Eyhance lenses since their approval in Europe about two years ago. (He has no financial ties to the lens or to Johnson & Johnson Vision.) “Until now, cataract patients have had to choose between a presbyopia-correcting multifocal IOL—with all its advantages and disadvantages—and a standard monofocal IOL with a limited focal range,” he notes. “The Tecnis Eyhance is a breakthrough technology because, for the first time, a high-quality monofocal IOL offers extended depth of focus. To me, the Eyhance is a high-quality option for ordinary cataract management.

It sounds good and my health plan does not charge extra for it but I am wondering if there might be an issue with AMD with the optical tricks of Eyhance and the stretcing of the 1mm central zone? I had one person recomend a basic monofocal like Clareon because of the AMD issue. Also, blue light filtering might be an asset but no proof of that.

I wonder how much extended depth of focus it actually offers compared to Clareo?. I have heard it might possibly be only a slight increase mainly in the intermediate area.

Unfortunately, I'm not aware of any studies directly comparing the Eyance and Clareon monofocal. But I did find a publicly-available study, "Vision outcomes with a monofocal IOL", in International Ophthalmology that compares the Eyhance and AcrySof. With the limitation, among others, that the comparison was only monocular, the authors report the following results:

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"CDVA, UDVA, CNVA, and UNVA values did not differ significantly between the study (Eyhance) and control (AcrySof) groups (0.02 ± 0.02 vs. 0.03 ± 0.02, p = 0.523; 0.05 ± 0.13 vs. 0.05 ± 0.15, p = 0.637; 0.46 ± 0.17 vs. 0.46 ± 0.15, p = 0.821; and 0.47 ± 0.21 vs. 0.49 ± 0.25, p = 0.612; respectively), whereas the study group showed significantly better results for CIVA (0.28 ± 0.12 vs. 0.38 ± 0.13, p = 0.001) and UIVA (0.31 ± 0.16 vs. 0.41 ± 0.12,

p = 0.001)."

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Also: "Rates of patient satisfaction with spectacle-free distance, intermediate, and near vision were 95.2% (n = 60), 90.4% (n = 57), and 55.5% (n = 35) for the Eyhance IOL and 95.3% (n = 62), 53.8% (n = 35), and 41.5% (n = 27) for the AcrySof IOL, respectively."

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The authors concluded: "The Eyhance IOL, which features a new optical design based on a continuous power profile, was determined to be superior to a classic monofocal IOL for intermediate visual acuity and not inferior for corrected and uncorrected distance and

near visual acuity."

Your have Intermediate AMD , which as you know usually progresses to Advanced AMD, and there is no cure for it. I personally would go for the simplest, purest monofocal you can find, such as the Tecnis 1 or the Clareon, even though you can you can find eye doctors who say AMD patients can wear other IOLs. But why take the chance? Be safe. Either one is a very fine lens and you can be sure they will have no effect whatsoever on your AMD.

Interesting since I know you like Eyhance. I just talked with my doctor and she likes Eyhance. I prefer to have a blue light filter (Clareon) in the event it is shown it has an effect on AMD. Someone else here recommended the basic monofocal for AMD because of light stretching with the central 1mm zone and optical tricks with Eyhance. Maybe the basic monofocal is the best and safest choice. I am inclined toward Clareon at this point. Thanks for the post.

As far as AMD goes, many have had good luck with sea 60. Change the sea to c and combine that with the number when you search. Put Bob in front of it too and you will get the proper search results. It has worked great for me for the past 5 years. That particular one is the best in my opinion although there are others...just not as effective. I'm not that Bob however he is reachable over the phone and is quite knowledgeable.

They have to refer to the Eyhance as a monofocal because legally it doesn't meet EDOF requirements. The current clinic I'm going to refers to it as a "Monofocal +" lens.

That is probably a fair way to describe it. It is not a true monofocal.

When I looked up AMD in reference to the Eyhance, I didn't see anything saying it wouldn't be a good choice. Both it and a standard monofocal came up as the best options.

It might be a good choice. I don't really know but have some information recently which has influenced me. As my doctor said yesterday both Clareon and Eyhance are good and would work well!

David getting your input here is super valuable.

Being an engineer i'm somewhat concerned that i end up looking for any visual artifacts / disturbances in the lens and i'm distracted by them forever if I spot them.

Is my concern completely without merit and the sight provided by the Eyhance is sharp and distortion free across the range of vision it can handle? I'm sure my brain will filter them out like they are filtering out my cataracts but I just wanted to understand what I can expect.

Ron here has been scaring me by talking about the eyhance smearing the focus point to stretch it for extended focus, which sorta makes sense considering the physics of it, but is that in practice in any way visually distinct or significant in your experience?

No need to be afraid. I have the best vision of my life now. I avoided doing surface mount device repair and build over the past years leading up to my surgery due to poor eyesight however I can now do micro soldering with ease. I no longer have to use my phone to take a photo of a micro part so I can magnify it to read the printing.

I wear 2.5 readers when I'm doing really small detail work and 1.5 for all other general bench work soldering.

"Ron here has been scaring me by talking about the eyhance smearing the focus point to stretch it for extended focus, which sorta makes sense considering the physics of it, but is that in practice in any way visually distinct or significant in your experience?"

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I did not intend to scare you out of using an Eyhance lens. I think it is a very good lens for the purpose it was designed for. It is the right lens for some people that want an extension of the depth of focus provided by the lens itself and are willing to trade a small amount of visual acuity for it. The only way to do this is to stretch or smear the focus point. It has benefits and compromises to the approach. You gain a small amount of depth of focus (about 0.35 D in my estimation). The other more drastic approach is to provide additional focus points (bifocal and trifocal) but they in effect add out of focus images that some are not willing to deal with. PanOptix and Synergy would be examples.

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The stretching of the focus point is not unique to the Eyhance and others like Bausch and Lomb do it as well with their enVista lens. I think B+L are a little more up front about it and explain the tradeoff of ultimate vision quality vs extension of focus. They also make claims that their approach is more tolerant of the lens being decentralized and more tolerant of eyes that are less than perfect. The provide a simple graph comparing the impact of spherical aberration, SA (a measure of how precise or non smeared the focus point is) on image quality. In theory the Tecnis 1 lens corrects all SA to zero. AcrySof IQ (and Clareon) correct a little less than all of it. The B+L enVista is to provide a neutral approach where there is no correction applied, and nothing added. It just leaves the natural SA of the cornea. I did an estimation of where I think the Eyhance lens would land on this B+L graph and put a red dot where I would expect it to be based on an extension of depth of focus of about 0.4 D over the Tecnis 1 lens.

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I would expect the outcome of an Eyhance lens and the B+L enVista to be very similar. I think they are both good lenses for the purpose they are designed for.

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I just got off the phone with the surgeon, i have both options available to still change my mind on the surgery day this friday, either take the eyhance or a regular tecnis1 monofocal.

This is good news so i'm not locked into choosing the eyhance if i still chicken out at the last minute. There's been many encouraging discussions here and the choice is still not easy to make.

I'm very interested in the benefits of eyhance, but i'm still scared of the lens irrational or not. Having a history of excellent vision i know i'm going to be more difficult to please as every outcome in terms of range of vision will be a downgrade even if distance vision will possibly be an upgrade for me considering my cataracts.

I may still decide to opt for the eyhance, but we'll see. It's difficult to get a good understanding of how your eyesight will be different with these two lenses. I can get the tecnis1 for free from the public sector, but I think i've committed to this private surgeon as she's reachable and easy to communicate with and allows me the flexibility i cannot get f rom the public hospital.

I am in the same circumstances. Leaning towards Eyhance, but may go with Tecnis 1. I really like the idea of Eyhance and that little better intermediate vision, but so many unanswered questions. Also, the outcome can be different for everyone. Having that better intermediate vision would be so helpful in a lot of our daily activities. My eyes/brain could never learn how to use progressive glasses, so one of my concerns is will the same thing happen with the change in power from the edge to the middle with Eyhance.

Good luck with your surgery. Please let us know how it goes for you.

Having doctors that are reachable is a very good thing. I have not heard from mine for 5 days and am going to have to call another division to see if they can get her to r respond!

Good luck, whatever IOL you choose. Please bear in mind, however, that a considerable degree of luck is involved. For example, even the best surgeons can't guaranty hitting the target. Defocus curves report mean visual acuities, which vary from article to article (and the text should provide standard deviation information). In other words, enjoy a good result, but don't beat yourself up if it falls short of your hopes/expectations.

Yeah i'm painfully aware of that. I think what is the biggest potential bothers for me is the reports that your distance vision maybe compromised when watching through the center of the lens that has the negative power shift. That can certainly be the case for smaller pupils but if it's any way visible for more normal sized pupils that's another question. Also obviously people's pupils will get smaller as you age, though i'm not quite sure if that affects the maximum dilation or also the size of the pupils as a whole.

My surgeon told me that even with the -0.5 D target I'm going for with my dominant eye with the Eyhance, that if I needed glasses or contacts for distance with driving for example, it's unlikely that I would need more than a 0.5 correction in them. I was surprised by that as he was really pushing me initially to target for plano for the dominant eye for great distance. For someone like me who has never had better than a -7.68 D prescription in either eye, that seems negligible.

David, can you comment on one of the things mentioned on this forum before where you see 'better' into the distance with your head tilted 30 degrees from where you are going because the periphery of the lens is more powerful (in bright conditions?) Is that really even a thing unless your pupils are very very small and if yes, is the difference so small it doesn't really distract from the visual experience?

If the surgeon targets -0.5 D and achieves it exactly, that is exactly what you will need as an eyeglass prescription. Getting an eyeglass prescription is the only accurate way of finding out where you actually landed. And, of course when you get glasses they will correct any residual astigmatism.

That is good information. I never wear glasses so have little info. on them. A good way to test where one has landed as you say.

What was your target focal point for your Eyhance eye and what will you target for the new IOL to be implanted?

Sorry I rarely visit this site anymore. The target for my first eye (dominant eye) was about -0.2. My prescription landed at 0 Sphere & -0.75 Cylinder. With glasses (to correct that astigmatism) it's 20/20 and amazing.

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The second eye will be done in the Spring. Also with Eyhance. The predictions are -0.04, -0.38, or -0.72. I'm undecided which target to choose. The -0.04 one is way too close to plano so I know my surgeon will recommend the -0.38 but they're open to going slightly myopic (something we discussed way back before any of the surgeries were done). I will discuss with my doctor when the time comes.

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To be honest I'm tempted to just play it safe and go with -0.38. I'm in glasses now anyway for the residual astigmatism and I don't mind it. I also noticed that sometimes one eye will get covered and that's weird when I go from clear vision to crap vision (from the cataract eye). Like I use a mirror and clippers to cut my own hair for instance and when I'm using the bathroom mirror plus a small mirror to do the back of my head my arm will sometimes block out the Eyhance eye and it's like... woah. So bad. That said -0.75-ish with an IOL would still be a million times better than what I have with my cataract eye now. But I don't know. I'm tempted to just keep them both targeted for distance. I'm not super keen on the idea of one eye having diminished distance.

I note that your vision was much better initially and has changed over 6 months and is not as good as it was initially. Is this true of all Monofocals or just Eyhance? I saw this in another post as well

That's impossible to say. Everyone is different. I suspect the prescription can still shift very slightly beyond 6 weeks but usually by 6 weeks it's pretty stable.

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As for me, I'm not testing my vision all the time now like I was in the weeks immediately after surgery. But in good light I can still read J1. But I do notice that the iPad isn't quite as good at 14-16" as it was in the weeks after surgery.

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Also my Astigmatism had a huge amount of variability in the months after surgery. That probably has a lot more to do with my slight changes in near vision than Eyhance. I had a number of topography scans done and the Astigmatism changed from November to January (surgery was September) from as high as -0.8 to as low as -0.3. I think the cornea keeps changing for awhile. It seems to have settled in at around -0.5 to -0.75 though.

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Overall I think my vision now is about the same as it was right after surgery. Near is maybe ever so slightly worse. By for instance I can do the following with the Eyhance eye in good light:

• Read J1
• See small Apple Watch complications (but not super sharp)
• See my car dashboard perfectly
• Read iPad at 16" but not SUPER sharp and I 100% need readers in bed (dark room)
• Read iPhone but it's pretty fuzzy closer than 14-16" (was 10" after surgery)

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  And as for side effects:

• I developed starbursts 5 months AFTER surgery (which p****d me off greatly) but it's actually not that bothersome so I guess... oh well. I've been driving at night many times since this new development and it doesn't affect my night driving at all. It's fine. Annoying that it happened (oddly so long after surgery) but whatever.
• I have 2 streaks (maddox rods) as well but they have been there since day 1 after surgery. Not at all bothersome. A second ophthalmologist noticed a slight wrinkle in my capsule so that it almost certainly the cause of that. If I ever develop PCO and need to do YAG that might fix the maddox rods at the same time.
• Very sharp high contrast lines at any distance (like the lines around a cartoon character on TV or the text on a computer) can have some slight ghosting but that's my Astigmatism. Glasses fix this completely so I don't think it has anything to do with Eyhance

Definitely the sight shifting in different lighting conditions has been discussed before. So essentially you are less dependent on glasses in daylight and need them more in poor lighting conditions. Are you going to get a second eyhance based on your experience?

I'm wearing glasses all the time. I have my old -4SPH prescription in the cataract eye and a 0SPH / -.75CYL in my Eyhance eye. This does two things...

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1. it helps balance out my eyes a bit between surgeries so they are not so far off from each other as they are without glasses (and I've gotten used to the different images sizes I guess... not disorienting at all)
2. it cleans up the distance in the Eyhance eye. I can see fine in the Eyhance eye without anything but that little bit of cylinder takes it from great to OH MY GOD AMAZING super razor sharp distance.

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   It's funny, that Astigmatism correction is an objectively small improvement but it makes a huge subjective difference. It's that extra little bit of correction that gives me the "wow factor". I'm considering MAYBE doing a refractive procedure to fix the Astigmatism. Since my Sphere is Zero I'm hoping that Limbal Relaxing Incisions with a Femtosecond laser might be an option. I'm not a candidate for LASIK (very thin corneas) and PRK kind of scares me. This would make my near vision worse tho'. So if I go with the -.38 target in my second eye (mentioned in another reply) fixing the Astigmatism would almost certainly make me more dependant on glasses for day to day.

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   Yes I'm doing Eyhance in the second eye. I think it makes sense to match the eyes personally.

Someone has just given me a study posted here with results stating that Eyhance and Clareon are the same with distance and near vision. Eyhance proved much better in the intermediate range.

That sounds about right probably. For the average patient. Again is varies a LOT from person to person and Ron was fortunate enough to get a very good (out of the ordinary) good near result with Acrysof Monofocal but for the average patient my understanding is that they cannot promise dashboard vision (for instance) with a traditional monofocal.

Is my concern completely without merit and the sight provided by the Eyhance is sharp and distortion free across the range of vision it can handle?

It's been said a million times but I'll say it again, results vary from person to person. The IOL is only one factor in the entire visual system. So take everything I or anyone else says about their own personal experience with a large grain of salt, but my experience is that in good light I have good to excellent vision from somewhat relaxed arms length to infinity.

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If I'm reading in bed (dark room) I need readers. I still have one near sighted natural eye that hasn't been operated on so I can get away without the readers but it's not comfortable. With the readers in bed the iPad is AHHHH-MAZING. Super sharp.

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Computer is fine without glasses but with a slight bit of help (+1) it's insanely great. Super razor sharp. I also have a VERY very slight ghost on computer text in some light but I got computer glasses from Zenni for $35 with a +1SPH and -.75CYL for my Eyhance eye (old near prescription for my cataract eye) and with those on there is absolutely 100% ZERO ghosting and everything looks incredible. The ghosting isn't the Eyhance it's the corneal astigmatism. Or maybe that PLUS the defocus. Perhaps any defects (like the Astigmatism) will start to become much more obvious as the IOL reaches the limits of it's focusing capabilities. I suspect that after both eyes are done I may not bother with computer glasses at all.

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I got starburts after 5 months. Very very weird to me. No one has been able to explain it or can even be bothered to try to explain it. Ugg. It's not bothersome though.

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I have two maddox rods (streaks) that have been there since day 1. I think that is caused by a winkle in the bag / capsule which is actually very common. Again I'm sure this isn't the IOLs fault. Also no bothersome at all.

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There is no distortion but defocus does start to become quite evident closer than 16"

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No halos. No glare.

David, can you comment on one of the things mentioned on this forum before where you see 'better' into the distance with your head tilted 30 degrees from where you are going because the periphery of the lens is more powerful (in bright conditions?) Is that really even a thing unless your pupils are very very small and if yes, is the difference so small it doesn't really distract from the visual experience?

You'd have to share a link to the post I think. I actually don't know what I would have been talking about. I don't remember anything like that at all. And I don't experience that now. Maybe it was another David? LOL.

Your dominant distance eye at 0.0 D Sphere and -0.75 D cylinder is pretty good. That would work out to be -0.375 D on a spherical equivalent basis. It should give quite good distance vision without glasses. If you were to target -1.0 D to -1.25 D with your second eye Eyhance, you should get very good close vision with it. And, between the two eyes you should have very good vision across the range from 1 foot or so to infinity. Since you are willing to wear glasses, then you have two options for vision. Very good vision with no glasses, and excellent vision with.

I am in the same situation with my close eye. I have -0.75 D cylinder and only -1.0 D sphere. I am getting a significant amount of my reading ability with the astigmatism. Correcting it without increasing my sphere to -1.5 D would be a net loss for me. I thought I could reduce astigmatism and increase the sphere, but that turned out to not be possible with Lasik.

"I got starburts after 5 months. Very very weird to me. No one has been able to explain it or can even be bothered to try to explain it."

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One possible explanation is the early stages of PCO. You could ask your optometrist if they see any PCO.

Since you are willing to wear glasses, then you have two options for vision. Very good vision with no glasses, and excellent vision with.

Yes I'm somewhat torn. I feel like I may want to wear glasses full time anyway after all is said and done because although -0.75CYL isn't much objectively, I (a perfectionist) find it makes a big difference subjectively. When I correct that (with my glasses) distance in the Eyhance eye goes from being great to be OH MY GOD ("wow" factor).

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So I kind of want to either keep wearing glasses OR get it fixed with Femto and LRI if possible (laser consult is next week). If I do a laser procedure on the first eye though I'd probably want to do more minus in my second eye to be potentially more glasses-free because I know the only reason I can read J1 (for instance) and see my Apple Watch ok / so-so... is because of that Astigmatism. When look at my watch with the 0SPH / -.75CYL spectate vs. without, it's noticeable.

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But then again on the other hand I've been back in glasses for the past 4 months anyway and I don't mind. And glasses are non-invasive and "reversible" (just take them off). Basically I'm not sure how much I care about being glasses free anymore because I've been back in them for 4 months anyway (to correct that astigmatism and to help out my cararact eye) and it's really not a big deal. Labels in the grocery store are a pain though because my cataract is really bad now and I have zero accommodation in that eye and also because the eyeglass lens I put in my frames for my Eyhance eye is just single vision (0SPH / -.75CYL) not progressive. I didn't want to spent big money on progressives of course. These glasses were less than $50 on Zenni.

One possible explanation is the early stages of PCO. You could ask your optometrist if they see any PCO.

A cornea specialist (which is an Ophthalmologist with a specialty) did notice a winkle in the bag. I'm thinking maybe it's that. But I have also had a maddox rod since day 1 so I think the winkle has been there since day 1. Or maybe the winkle is changing? Who knows. I guess the good thing is that as odd as it seems to have that come up so much later, it's not bothersome.

I think this was something mentioned by Greg59 in a different post, sorry for the confusion.

I occasionally feel like i should've picked eyhance afterall just for the intermediate benefit. In the end what happened was that the eyhance I had available for me was set to -0.25-0.3 for my dominant eye and i said to the doctor I would be disappointed if i need glasses for all distance use cases (because the eyhance distance vision isn't as strong as the tecnis1), then she ended up putting a tecnis1 to plano.

I have astigmatism currently 1,5 weeks out of surgery so my vision without glasses isn't sharp to any distance at the moment and there's minor ghosting visible. I'm hoping it will go away so I can enjoy my glasses-free vision also inside the apartment, at a longer distance it's not that bothersome.

I'm sure if the ghosting is fixed so i have sharp distance I will enjoy my vision a lot more. With glasses it's obviously excellent. Also I may end up wearing glasses most of the time anyway just to see my watch / phone with clarity. I also have an option of putting an eyhance in my non-dominant eye targeting it -0.25, do you have any opinion on that option?

I guess my point is that this is one of the rare situations where you can have your cake and eat it too. You can have the very best eyeglasses free vision, PLUS, have the very best vision with glasses. It is just as easy to correct monovision set eyes with eyeglasses as it is to correct distance set eyes.

Good to have dashboard vision but I went with a basic monofocal for various reasons.

One of the advantages of asking the surgeon for the IOL Calculation data sheet is that you can run a calculator yourself and see what the options are for lens powers and what the outcome will be. You then will be looking at what the surgeon is looking at, and the two of you can have a more productive conversation. For an example of what they are looking at, see my recent post with example images of a calculation outcome sheet, at this link.

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https://patient.info/forums/discuss/definitely-an-ey-en-hance-for-me--797638?order=oldest&page=2#topic-replies

I just had my eye refracted at a nearby optician, S +0.75, C -0.25 A 77, that looks pretty hyperopic to me. I hope this settles to something more reasonable, but may explain the ghosting / why nothing's really sharp at any range. The surgery is less than 2 weeks ago so fairly early.

I would hope it would settle closer to plano than +0.75. That will cost you both distance vision and near vision. It would also explain why some low power readers could give you better distance vision. The other issue is that it is that it is very difficult to correct hyperopia with Lasik. I consulted at two Lasik clinics and they both said no.

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Did they do a full Phoropter test or just do an auto refraction (house or hot air balloon on the horizon)? The auto refraction is less accurate.

Just a basic auto refraction with the house, so it's not necessarily fully accurate.

My far distance is MUCH better without glasses but I see some minor ghosting (is 0.25 cylinder enough to account for that?), but my vision inside the apartment isn't really sharp at any distance without glasses. I have the eye chart on the wall and with glasses it sharpens up. Is it common for the refraction to be this out of whack during healing?

If cylinder is only 0.25 D, then that is trivial and should have almost no impact on vision. I did not track my vision real closely and unfortunately did not get a written refraction until the 6 week mark. Subjectively though, I was generally getting better and better vision as the eye healed.

"I developed starbursts 5 months AFTER surgery (which p****d me off greatly) but it's actually not that bothersome so I guess... oh well. I've been driving at night many times since this new development and it doesn't affect my night driving at all. It's fine. Annoying that it happened (oddly so long after surgery) but whatever.">

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Oh, wow, that really sucks. I'm so sorry that you've gotten hit like that. That is the kind of thing that I'm worried about. No matter how great my vision is now, I'm very aware of potential negative results down the line. I'm almost the perfect text book description for a post surgery retinal tear, and to a lesser extent, PCO, and unfortunately there's no timeline of when it might happen if it does. There's not any great explanations either of what might trigger this stuff so you can try to avoid doing the wrong thing. It's like this annoying time bomb just waiting to jump off the shelf when you least expect it. So, I'm trying to just enjoy this lovely visual freedom I have right now, and not let the negative possibilities overwhelm me.

"When I correct that (with my glasses) distance in the Eyhance eye goes from being great to be OH MY GOD ("wow" factor)."

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I just had my five week checkup with Eyhance in both eyes, and came out at 20/20 for both eyes, with 20/20 vision in the "distance" eye (targeted for -0.5D -- optometrist rounded it down to -0.25D), and 20/40 in the "near" eye (targeted for -1.25D and rounded out to that also by the optometrist -- surgeon thought he had hit -1.21D). Reading J1 and just below that at around 15". And apparently no astigmatism left behind (thanks, Ron). The optometrist said I could get progressive glasses if I wanted to, if I felt I needed them, but she saw no real need from my tests. I probably will get a pair made up to have on hand.

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From my own perspective, I'm still finding my vision sharp and clear both near and far, with no concerns with contrast loss in dim light. Still not finding any problems driving down dark roads or wandering around in the dark in the backyard on a cloudy night for example, or other unlit areas. The night sky is still a wonder to see no matter where I am (backlit or cloudy). Happy to know that I can still see the night clouds in the sky, and the tops of the trees etched out up against them. Depth perception is also excellent, even in darker areas. My slingshot aim is even better than when I was wearing contact lenses -- I'm very happy -- the starlings... not so much, lol. And overall, just the ease of not having to fiddle with glasses or contact lenses in order to live.

So you ended up at -0.25 D in the distance eye, and -1.25 D in the near eye? Are those spherical equivalents? If so, that is an excellent mini-monovision outcome for Eyhance lenses. You must really appreciate that compared to where you were before cataract surgery.

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Progressives for night driving may be a good idea. I have a pair but almost never wear them. I just got an updated prescription with both eyes changing by 0.25 D, but I don't think I will bother to change the lenses in my glasses. I can't remember the last time I wore them.

Just reading this again about your +0.75D result Spoo and ondering where you are at now? That is a BIG miss if true. I thunk that would actually warrant an IOL exhange as that's a plano miss of at least 2 if nor 3 steps in power.

I should be getting my eye refracted again tomorrow when I visit the surgeon, but i'm not super optimistic as the eye has been pretty much in the same place for the past 3-4 weeks. Because it's too much off it's affecting my binocular acuity.

Yes, those are the spherical measurements -- that's what my glasses would be with a +2.25 add for near vision on both eyes. I haven't had a chance to scan it and add it to my surgery post yet. And yes, completely happy compared to even well before the cataracts started to mess my eyes! Just having vision this good without having to mess with hard contact lenses is amazing -- nothing to fiddle with or worry about losing if I blinked the wrong way at the wrong time. The optometrist said I am definitely experiencing binocular 3D vision after testing my eyes separately then together. So once again, thanks to those here and elsewhere, who tipped me off to the importance of paying attention to the distance between the targets of both eyes.

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I asked my optometrist about multifocal contact lenses in the brands/material you suggested and she said that if I wanted to go that route, that a just month supply would probably last me over a year since I wouldn't be wearing them regularly. She couldn't give me contact lens prescription though as she hadn't done a fitting for them, and she wasn't sure if Costco would charge me to do a fitting to get some free samples either. She did say though that if I wanted to, she would try and get me some free samples herself. She didn't have anything on hand that would fit me or she would have done it during my appointment. I will go ahead and get the glasses made up -- like you said, to have on hand, just in case, though so far I feel no need for any further enhancement to my vision in any circumstances I've tested them under. I haven't tried driving a dark road in fog or heavy mist though so the glasses would probably be helpful for situations like that.

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So was the change in your prescription a plus or a minus? The optometrist said that -0.25D was basically as good as plano in the majority of situations.

The change in my prescription was in the cylinder for my distance eye. It went from -0.5 D to -0.75 D. A little disappointing as the surgeon had predicted less than -0.4 D, and I have a had a couple of tests at -0.5 D previously. The sphere on my near eye went from -1.0 D to -1.25 D. This is a good thing, and not surprising as in my various visits for Lasik consultations they were getting -1.25 for sphere.

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How did you cylinder values turn out? I recall that the Barrett Toric formula was predicting a higher power toric than your surgeon used in one eye.

Okay, that is interesting, although disappointing with regards to your distance eye at least. I guess even with the new lenses, we're still prone to our vision deteriorating as we age.

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"How did you cylinder values turn out? I recall that the Barrett Toric formula was predicting a higher power toric than your surgeon used in one eye."

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I'm not sure that I understand what you mean? My eyeglass prescription is -1.25D in the near eye, and -0.25D in the distance eye. The optometrist did say that she thought that the surgeon hit closer to -0.31D for the distance eye (rounded down to -0.25D for a prescription, as you explained). but according to her tests, she thought that he hit a little above -1.25D in the near eye. I didn't ask any specifics about the other calculations, though she mentioned that I didn't have to worry about astigmatism any more.

The normal eyeglass prescription has 4 values for each eye (5 if there is prism):

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X.XX D Sphere, X.XX D Cylinder, Axis Angle, Add D (for bifocal or progressives)

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To calculate SE or Spherical Equivalent you add 50% of the Cylinder D to the Sphere D. But, if the prescription is written in ophthalmologist format with + Cylinder values you first have to convert the numbers to negative cylinder. It changes the Sphere and Axis. There are calculators on line to do that. The normal prescription for eyeglasses is written in optometrist formal with negative cylinder.

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It would be very unusual to have zero cylinder or astigmatism. And of you are getting glasses made it would be very important that they correct any residual astigmatism.

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If you google this you should find a good example of the ways it can be written in optometrist format.

"Zenni How do I read my prescription"

This is all she wrote...

That would appear to indicate there is zero astigmatism. Amazing!

Yeah, I guess the surgeon was correct in his choices. The optometrist kind of chortled that I needn't worry about "that" any more when I mentioned that the surgeon had used Toric lenses to correct internal astigmatism. I was only around one before the surgery, externally at least. I used to be a lot higher, but apparently decades of wearing hard/gas permeable contact lenses corrected most of it. Do you think that you would have ended up with the same near vision if they had corrected your astigmatism? Or did that happen post surgery?

Toric lenses some in such large steps that it is very unusual that the correction is perfect. My wife got the minimum 1.0 D cylinder toric which translates to 0.75 D effectively. That was about what she was predicted to have without a toric. So it should have been a good match. However she just got her eyes checked and she is 0.0 D sphere and -0.50 D cylinder. Not the greatest of outcomes for a toric. Not sure what I would have gotten as my astigmatism is irregular. But, I potentially could have used the same minimum -1.0 D cylinder toric. You are fortunate to be at zero cylinder. I hope it stays there.

im curious ron. is the distinction between edof and enhanced monofocal because edofs are always diffractive and enhanced are not in addition to a certain amount of edof for a lens to qualify?

I am not totally sure of the various methods used by manufacturers to gain EDOF. The industry definition of qualifying as an EDOF is a minimum extension of depth of focus of 0.5 D. The Vivity lens just qualifies, and if I read the technical spin they put on the method correctly, the lens has a slightly raise section in the middle of it. I presume this raised section has a slightly different power than the surrounding part. The two powers extend the depth of focus by about 0.6 D. The Eyhance says they vary the power of the lens from the outside to the middle. This is effectively the same as intentional asphericity. But, they don't call it that. Extension of depth of focus is about 0.3 D. The enVista probably extends focus depth a bit more than the Eyhance, but neither lens claims to be EDOF as they fall short of the minimum 0.5 EDOF extension definition.