Which IOL is best for IOP Clareon vs Tecnis?
Posted , 8 users are following.
Hi trying to decide which IOL will be better for lens replacement surgery for IOP. All IOLs have pros and cons. Just want people various opinions and experiences regarding the Tecnis ZCB00, Tecnis Eyhance, AcrySof IQ and the Alcon Clareon which just got approval here in Feb/21. The two I am thinking about the most are the Tecnis ZCB00 and Alcon Clareon. I prefer a lens that if I need further eye surgery or if I develop future eye problems would not be problematic hence aspheric monofocals. I presently wear glasses for reading but I am fine otherwise. I have been reading so much about each that it is all the info is starting to blur together. I thank every one for their input.
0 likes, 24 replies
rwbil ro49134
Posted
I got a defractive IOL so did not research those Monofocal IOLs, but a couple of thoughts.
Tencis Eyhance is a Premium Refractive IOL which is supposed to provide a little bit of EDOF with the same overall results of a standard monofocal. By that I mean similar contrast sensitivity, night vision, dysphotopsias and so forth. And from what I have read Opthmalogist have been reporting good results with it.
LAL - You did not mention what country you are from. But if you are OK with a monofocal and the light adjustable lens is available where you are I would add it to your list and give it consideration.
The more I read about the LAL the more impressed I am with it. One of the biggest complaints is the doctor missed the mark and with the LAL that can be adjusted post operatively. And I think it is a great option if you are thinking about monovision
ro49134 rwbil
Posted
Thank you for your reply. LAL nor the accomodating IOL are the best options for me. I will look into Tecnis Eyhance more but I think my doctor is leaning more towards Monofocal for me.
RonAKA ro49134
Edited
I have the AcrySof IQ Aspheric lens in one eye. It is set for distance and I get 20/20 vision with it. I can read a computer screen at a distance of about 18-20 inches, but it starts to get blurry at closer distances. It may be a year or two before I get the second eye done, and I am currently simulating a monovision solution by using a contact lens in that eye to leave me 1.25 D under corrected. Without glasses I can do most anything including reading all but the very finest of prints. No problem driving day or night around the city although I do plan to use progressive glasses when driving longer distances at night. I do not have any optical side effects like halos or flare. Overall I am quite happy with the lens and will probably use the same lens in the second eye and under corrected to give me monovison like I am now simulating. I considered the Vivity lens for the second eye but have pretty much settled that I will keep it simple and use the standard monofocal for the monovision.
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The most commonly used monofocals are the Tecnis and AcrySof. The AcrySof lens simulates the natural eye with a blue light filter, while the Tecnis is clear. There is a difference in the asphericity correction of the two lenses. The Tecnis uses the theoretically perfect -0.27 correction while the AcrySof uses -0.20 correction to leave the eye with a small amount of positive asphericity. They claim that provides better vision in the average eye... Who really knows though. I recall they based that on a study of people that had natural super vision -- better than 20/20, which found that these people with super vision has some positive asphericity, and not the theoretically perfect zero asphericity.
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I believe the Clareon is Alcon's latest design and is slightly different material than the AcrySof which has been around for 25 years or so. It is supposed to be more resistant to glistenings, which I believe have been resolved in the AcrySof material with better quality control. Clareon is very new and may be better but it has not stood the test of time yet. It could be better, but possibly with some risk of unforeseen issues.
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The choice I had at the time of my surgery was AcrySof or Tecnis. I'm sure either one would be fine, but I have no regrets in selecting the AcrySof lens. My eye pressure was slightly elevated right after the surgery but has returned to the higher end of the normal range when it was measured after 6 weeks.
ro49134 RonAKA
Posted
Thank you for replying. The AcrySof IQ was a top contender for me. The problem was the glistening which is still a problem for people who need to use eye drops that is why when I heard of the Clareon I was interested. I also heard of good things of Tecnis.
RonAKA ro49134
Posted
I am not sure what eye drops would have to do with glistenings. After my research I concluded glistenings were not really a current issue with the AcrySof lenses. My surgeon told me that he has seen them but they have never become a visual issue for the user.
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There are some studies which have found that PCO is more of an issue with Tecnis than AcrySof.
ro49134 RonAKA
Posted
Thank you for your reply.
I came across a research paper that indicated that the glistening problem is indeed better with the newer Alcon AcrySof IQ but glistening seems to occur at a higher level with people who use eye drops for glaucoma etc...
RonAKA ro49134
Posted
Had not heard of that one.
ro49134 RonAKA
Posted
Hi RonAKA
When you got the AcrySof IQ did you go for Plano or for a slight minus configuration I.E. -0.5D. Just curious. At one place I know of they routinely set it for -1 D while my doctor uses Plano. I wonder why they do this?
RonAKA ro49134
Posted
The discussion with my surgeon was that he normally targets to be -0.25 when the objective is for high acuity distance vision. With the measurements he had for my eye he said he expected the residual error to be about -0.35 with the lens he recommended. He said that he could go higher and theoretically closer to zero but also said that patients never thank him if he goes over into the positive side. I believe the reason for this is that when you go far sighted (+ve) then it negatively impacts your close vision much more than being slightly near sighted impacts your distance vision.
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On astigmatism he said he measured my eye with two different methods and with one I had 0 astigmatism, and with the other he got 0.40. And, that amount is not enough to use a toric lens. Doctors tend not to use a toric unless 0.75 to 1.0 or more is needed. I believe that is because the minimum toric power is 1.50. If your need is 0.75 or less the minimum power toric lens makes it worse instead of better.
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6 weeks after my surgery I got my eyeglass prescription and it came out as 0.0 for spherical and -0.75 for cylinder. I was expecting -0.40 or less for astigmatism but it appears the incision for the lens exchange impacted it somewhat negatively. But since I have 20/20+ with no eyeglass correction I am not bothered about the residual astigmatism. And for the close distance I can start to read a computer screen with normal font at about 18". That also is fine with me. However if both eyes were done this way, it would not be comfortable to use a computer without reading glasses or progressives. That is why I will go with monovision for my second eye. I would like to do as much as possible without any glasses.
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I have no idea why the one place you mention would target -1.0 D, unless they are wanting to give some ability to ready and sacrifice distance 20/20 vision to do it. For my close eye with monovision I will ask to target -1.25, but I know that will result in far from crisp vision at distance. With both eyes done that way glasses would be a necessity for driving and distance. I will only do one eye of course.
ad12345 ro49134
Edited
My simple advice - go with Clareon. Acrysof IQ has issues with glistenings in the long run. I have Tecnis and am expiriencing Positive Dysphotopsia. Of course, you may end up without any issues with that lens, but I'm just talking about my expirience. If you're really scared of dysphotopsia, find someone who offers Bausch and Lomb Li61O Sofport IOL.
ro49134 ad12345
Posted
Hi ad12345
Thank you for your reply. I am sorry to hear of your problems with the Tecnis IOL. Did you get the Tecnis ZCB00 and do you have large pupils? How long ago was your surgery and do you think the Positive Dysphotopsia will get better for you? I will look more into the Clareon also but it has just been approved here in Feb. so I was hoping to hear from someone who has personal experience with Clareon.
ad12345 ro49134
Edited
ro49134 ad12345
Posted
Very wise words. I agree is is very individual what result you got. I guess I should say that I wanted some input regarding the Clareon as it just got approved in February here. I know people who have gotten Tecnis and others AcrySof and the majority are pleased with their choice. Mind you most left the decision to their doctor. I haven't met anybody who has gotten the Clareon here so I wanted some input on it. I suspect since it is the same platform as AcrySof it will be similar. The research I have read seems to indicate same visual acuity.
rwbil ro49134
Edited
I will give you one other thought and you can research the topic. First I am a procrastinator. If you just got diagnosed with cataracts and you can still correct your vision such that it is acceptable to you, you might think of postponing cataract surgery and start to research what new advances are on the way or maybe even get in a clinical trial. Some people get cataract surgery right after they find they have a cataract and in most cases just get whatever IOL their doctor recommends, without doing any research themselves. In fact many don’t even know what IOL their doctor implanted. It looks like you are doing some upfront research which is Good. It was years after I was first told I had a cataract until I had surgery.
The reason I mention this is there are some exciting new IOL in development like Juvene, but more important IMHO is the modular bases that are in development. These bases go in first and fill the capsule bag. They also then allow for relatively easy exchange of IOLs in the future, but the former reason is just as important if not more important. A lot of problems occur due to the capsule bag retracting / shrinking after an IOL is inserted such as tilt, PCO, floaters and so forth.
So again if the cataract is not at the critical stage yet, take your time and research some of the new IOL and other medical devices / techniques being developed to keep the capsule bag intact. I wish I could wait longer for my other eye.
Also I strongly agree with Ad12345 advice, anecdotal evidence is not that meaningful in itself. Try and look for clinical trial results. Maybe their has been a study comparing the different IOLs you are interested in. Also look for a doctor that has experience in implanting all the lens you are interested in; I tell you this from personal experience.
When I had my cataract surgery I knew I wanted a defrative IOLs and in my area every Ophthamologist implanted the Restor IOL. It was actually a surprise to me how they all just used that manufacture product. But all my reaseach showed the Tecnis was better (that was back then, I don't know about now) from glistening to dim light performance.
In addition to my research I finally got a clinical trial doctor on the phone and what was so impressive about him, was he had implanted all the different IOL including on his family members and then told me his experience with each one. Try and find that doctor over one that is affliated / tied to a single manufacturer.
ro49134 rwbil
Posted
Thank you for your reply.
Unfortunately I will need to do my surgery soon. I have read so many research papers that all the facts are starting to blur together and appear confusing at times for me. As I replied to Ad12345 I just wanted some input on the Clareon as it just got approved here and not much is known about it. Unfortunately trying to find a doctor here that is not affiliated or tied to a single manufacturer is difficult from what I can see.
RonAKA ro49134
Posted
Have you done a search at the FDA approval site? Sometimes they publish very detailed study results on newly approved lenses. I have not looked for it or seen it for the Clareon. There is some good information on the Vivity so I would expect there may be similar on the Clareon.