What Cataract lens will give me mobile device reading at 13-14" and intermediate and far?
Posted , 4 users are following.
I am scheduled for 2 Cataract surgeries and am told to get Vivity for near, intermediate and distance vision with minimal glare. But, I use many business apps on my cell phone 14 hours a day, so 13" is where I need to look and be able to type. I set one eye for distance, but the mono focal and Vivity may not work for 13" Does anyone know if that cab be achieved with either of those or another lens and if so, what is the night glare risk?
0 likes, 7 replies
RonAKA joseph54594
Edited
The Vivity option will work, but with some risk of halos and flare around lights at night. Contrast sensitivity will also be reduced. To get the near vision you want you will have to set the target for one eye closer than for distance. I would suggest a target of -1.0 D. The EDOF of -0.5 D that the Vivity adds together with the -1.0 D target should give you the near vision you desire. If you do this I would suggest a monofocal set for distance in the other eye. That will offset the negative effects of the Vivity to some degree.
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And the other option is mini-monovison using monofocals with the distance eye set to -0.25 D, and the near eye at -1.50 D.
joseph54594 RonAKA
Posted
@ronaka, thank you! Those were the two thoughts and you also gave measurements! I am thinking the mono focal for the distance, eye since those have few side effects, and the Vivity set for close in the other eye. Is mixing a Vivity with a mono, something Optamologist stay away from? I could do Vivity both eyes. The supposedly carry less risk of glare and halos. And, if each eye is set differently, I have never had contacts and read that some people do not adjust. Is that still a known issue?
joseph54594 RonAKA
Posted
@Ronaka, if I use two monofocal lenses, the way you suggest, is there a loss of intermediate vision vs using the Vivity for the close eye and a monofocal lens for the distance eye? My surgeon in Board Certified and my Optometrist has sent him patients for 20 years, but that he has not gone into this type of detail and seems to think that 13"target is not easy to target, I am nervous and feel like I don't have the time with him. His lens advisor is not medically trained and I have to get staff to send him my inquiries. Any tips on how I can ensure he is capable and experienced at the mini mono for my goals? thanks!
RonAKA joseph54594
Edited
Using an EDOF in one eye and a monofocal in the other is called hybrid monovision. I suspect most surgeons will do it, but perhaps not all. I saw one survey that showed only 50% of surgeons will put different lenses in each eye, so it is not a given.
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On the monovision with monofocal lenses it is all about picking the correct targets and the surgeon being able to hit them. I am convinced they are -1.5 D for the close eye, normally the non-dominant eye, and -0.25 D for the distance eye. Google the article below to see some figures that show what the various monofocal targets provide individually (Figure 1), and what they provide when combined (Figure 2). If you click on each figure it will expand and provide some more details about it. Their conclusion was the same as mine; -1.5 D in the near eye is ideal.
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Optimal amount of anisometropia for pseudophakic monovision. Ken Hayashi, Motoaki Yoshida, +1 author H. Hayashi Published 1 May 2011 Medicine Journal of refractive surgery
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My experience is that while these graphs show a bit of a drop in the combined visual acuity at about 2-3 feet, I do not notice it. I can see my car dash very clearly with either eye, and very well with both eyes open. The Vivity might provide a touch better vision in this range when it is used in the near eye, but I really don't think it is worth it. And, you may have difficulty convincing the surgeon to target the Vivity at -1.0 D.
RonAKA joseph54594
Posted
" Any tips on how I can ensure he [surgeon] is capable and experienced at the mini mono for my goals?"
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That is a valid concern. I'm sure all surgeons are trained in monovision and mini-monovision, but whether or not they are interested in doing it is another matter. I'm sure that many prefer a "technology" solution like the PanOptix or Synergy lens, as they get a pretty nice premium profit from doing those lenses. Monovision on the other hand can use standard monofocal lenses with no big profit built in, and in many cases are fully covered by the healthcare system or insurance. Doing a good job of monovision does require a bit extra effort on their part, for which they may not feel they are being adequately compensated for. So, probably the biggest tip would be to find a surgeon that is onboard with monovision and willing to spend the bit of extra time with you to get your desired results. What would that extra time be for? Well, one is to print off and show you the predicted outcome of the lenses to be used with the various powers in the range you may need. My experience is that not often do they offer this printout which is called an IOL Calculation sheet. It is just a click of the mouse to produce although it probably should be produced using at least a couple of formulas for calculation to optimize the result. Then they need to discuss the options for powers with you and allow you to be part of the decision as to which one to pick. Some surgeons are prepared to do that while others are not so much.
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So, I think it comes down to time they are willing to spend with you exploring the options for lens powers and formulas for calculation. A good screening question would be to ask them if they will provide the IOL calculation printout and explain it to you. Then you will quickly find how cooperative they are likely to be. You could also ask what instrument they use for eye measurement. The best one is likely the IOLMaster 700, followed by the Lenstar 900. A Pentacam is also typically used to measure cornea topography and is a second check on the amount of potential astigmatism.
indygeo joseph54594
Edited
I agree with Ron. As someone who is using a mixed lens strategy using a mono-focal for distance and an EDOF lens (the Rayner EMV) set ¨near¨ I find I am quite happy with my overall vision and contrast sensitivity. I might even go as far to say that I could have possibly been as happy, or maybe even happier, had I gone with two Rayner EMV´s offset by between 0.75D and 1.00D. I say this because although I don´t suffer in any way, it would have been a ¨nice to have¨ if I had a tad more near vision with my mono-focal lens. But it´s really splitting hairs here because then I might not have the bright sharp vision at distance that I have with that mono-focal. I strongly believe if you can dial in your distance eye first and achieve plano or -0.25D, then the other eye is low hanging fruit for a great outcome. The surgeon can hit a range of acceptable values at that point. We are extremely fortunate to be living in an age where medical science can effectively cure blindness caused by cataracts.
IndyG
RebDovid joseph54594
Posted
If you use mini-monovision, which if you're interested you should try with contact lenses before making a decision, then with the Eyhance monofocal plus IOL the mean visual acuities from averaging together ten binocular and monocular defocus curves are c. 20/21 at distance with a -0.25 D result in one eye and c. 20/25 with a -2.00 D result in the other eye. As that well may be more monovision than you can tolerate, and may be too ambitious a target given that your surgeon may exceed the target by up to 0.50 D and still think it a reasonably-close result, I think you need either a multi-focal, like the PanOptix, or a willingness to compromise on either distance or close vision.