Which IOL to chose? Which choice is better?
Posted , 5 users are following.
I use to wear glasses since age 10 to see far. But I got cataract on my right and mild cataract on my left.
I went to do my Cataract on my right and replace it with J&J Eyhance lens in Aug 2023.
My present reading for my eye both is as below after surgery
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Right: Sphere +0.00 Cylinder -0.50 Axis 160 Dist VA 6/6 -2 Add +2.25 Near VA N5
Left : Sphere -3.25 Cylinder -1.00 Axis 40 Dist VA 6/7.5+2 Add +2.25 Near VA N5
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Presently Monovision coping well unaided.
Doctor advise me if I ok with it, The second surgery can wait longer .He give me a 6 month appointment.
I need help as I have very poor immediate vision. I cannot see well in computer distance. Although I can see fine print using my own left eye . I need to wear a -1.25 glass to see better during work but i feel dizzy
if i move my head to much .
If I am not working . I am glasses free. I can read my handphone (Left eye ) watch TV (Right eye) .
I do not drive by the way.
Doctor suggest Rayone EMV for my left eye to see near if I wanted to exchange IOL
I read up Vivity lens and suggest it to him . He said it ok too if I want it.
I cut short doctor appointmenrt to 3 months and next appointment in Dec 2023. As I want better immediate vision and maintain my near vision.
So in conclusion which lens should I use to see near better RAYONE oR VIVITY? Or which lens can give me a mini-monovision so as aid me better to see far clearer too.
Any suggestion is welcome.
0 likes, 18 replies
RonAKA henry35359
Edited
Your right eye came out very good for distance. You are currently quite myopic in your left eye with a spherical equivalent (sphere plus 50% of cylinder) or -3.75 D. That is a lot and basically why you have limited intermediate vision, and why you may be having issues with that large a differential between the eyes. Standard full monovision is about -2.50 D in the near eye. And more popular is to target -1.50 D in the near eye, and is called mini-monovision. In most that is enough to good near vision for all but the more difficult reading tasks (smaller print in dimmer light). I currently have -1.60 D in my near eye and almost never uses glasses, except some readers for very difficult situations. I drive and never take readers with me when I leave home.
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Probably the best thing you could do now while you can still see well with your right eye is to use some contacts to correct that eye to a few different degrees of monovision. For example you could use a contact of about (consult with the lens fitter) -1.75 D sphere and -1.0 D cylinder to bring you down to -1.50 D sphere. Then you can experiment possibly with a little more to leave you at -1.75 D, basically to see what gives you enough reading vision, intermediate vision, and no issues with the differential between the lenses.
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With respect to lenses I would suggest staying with the Eyhance because your surgeon was very close to the mark with the first eye and should be accurate with the second eye too. When you go with monovision there is not really that much advantage in going with an EDOF lens like the Vivity, and the Rayner EMV does not add much either. I would focus on getting the right target in the second eye that suits your needs.
henry35359 RonAKA
Posted
I am thinking of mini mono of -1.00D if I use Vivity lens that give better range of view.
If use Vivity still need to Target -1.5D than might as well use Eyhance or any monofocal lens made no different as you suggest.
Thank you for your advise.
RonAKA henry35359
Edited
Targeting the Vivity to -1.0 D is going to give you about the same reading vision as a monofocal targeted to -1.50 D. You will not gain reading vision, but you may gain some more distance vision with the near eye. However, that distance is likely very well covered by your distance eye already. My distance eye lets me see down to 20" or so. My near eye lets me see out to 8 feet or so to watch TV, even though it is a monofocal (Clareon) set to -1.60 D. My point is that I don't think you will gain much if anything by going with a Vivity.
henry35359 RonAKA
Posted
I am hoping to gain binocular vision with Vivity set at -1.0D if it help the distance eye
Presently if I cover my right eye I got total blurry vision. Example if I sit behind the car and see outside the car window I must seat on my right side. if I sit on the left side everything is blur.
RonAKA henry35359
Edited
Yes, you will gain some distance vision and could expect something in the range of 20/40 perhaps with a Vivity at -1.0 D. When I had my second eye done, I asked the surgeon about using a Vivity set to -1.0 D for the same reasons as you. He recommended against it. He said he had another patient that was well informed about the lens options and requested the Vivity, and then was disappointed with the quality of the vision. He basically said that my expectations were similar and I also may be disappointed. There was an extra $2,200 for him if I went with the Vivity. With his advice I decided against it and got a Clareon monofocal that has turned out to be -1.60 D SE. Some here have reported very good results with the Vivity though.
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What you are seeing now bears no resemblance of monovision with your left eye at -3.75 D SE. That is very myopic, and way too much even for full monovision. That is why everything looks blurry with that eye only.
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You could evaluate your potential distance vision with a Vivity at -1.0 D by using some +1.0 D readers with your right eye, and the near vision with some +1.50 D readers. A dollar store may be a good place to pick up some inexpensive readers to do the testing.
RonAKA henry35359
Edited
I looked at the CooperVision OptiExpert on line calculator for converting eyeglass prescriptions to contact lens prescriptions. It compensates for the fact that contacts sit on your cornea compared to lenses in eyeglass frames. It also compensates for the fact that contacts are not available in as fine steps as eyeglasses. This is what it recommends for the best correction to plano for your right eye:
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Sphere; -3.25 D, Cylinder; -0.75 D axis 40 deg
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So, if you want to simulate -1.50 D in this eye for mini-monovision you would reduce this to:
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Sphere; -1.75 D, Cylinder; -0.75 D axis 40 deg
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And if you want to also try -1.75 D then you would need:
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Sphere; -1.50 D, Cylinder; -0.75 D axis 40 deg
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Since the spherical equivalent of your right eye is -0.25 D, you can go to -1.75 D in your left eye without going over the recommended maximum differential between the eyes of 1.50 D.
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If you have not used contacts before I would suggest the CooperVision daily disposable MyDay Toric. Costco has the CooperVision lenses under their Kirkland brand, but I don't know if you will find the toric version. Another choice would be the J&J Acuvue Oasys 1 Day. These lenses are comfortable but easy to handle especially for new users.
Night-Hawk RonAKA
Posted
From what I've found on the Costco website, the only Kirkland contact lens is the non-toric daily that is the same as the CooperVision MyDay. Have to get the real CooperVision for the MyDay Toric daily one.
I see the MyDay Toric has a BC of 8.6 and the Acuvue Oasys 1 Day has a BC of 8.5 - I believe my eyes were measured to have a BC of 8.3 however. Would a BC of 8.5-8.6 still work OK in that case? The only daily toric soft contact lens I've found with the lowest BC value is the Bausch&Lomb Biotrue ONEday for Astigmatism which has a BC of 8.4
RonAKA Night-Hawk
Posted
My thoughts are that the BC or base curve is more important with hard contacts than with soft ones. I have never paid much attention to it. I checked my spreadsheet that I used to keep track of the contacts I had done a trial on or considered. I noticed that the toric versions seem to have a larger diameter and base curve for some reason. Perhaps it is related to the need for them to float and rotate into the correct angular position. I would just try and get a free sample and try them. My experience with soft contacts is that it is a trial and error thing more than a fitting to a specific BC, or diameter.
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I see that the Alcon Precision one is a 8.3 and the toric version is 8.5. I have not tried this lens as Costco had not gotten it yet. However, I tried the Alcon Total 1 and liked it almost as much as the Kirkland (MyDay). The Precision 1 is supposed to be quite similar but is made with a different manufacturing process to make it cheaper than the Total 1 which is quite expensive. So you could also try a Precision 1 although it is only .1 lower than the MyDay.
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I recall I tried the B+L BioTrue One Day, and did not like it. It is a hydrogel not a silicone hydrogel material. I found the hydrogel material like it and the Acuvue Moist were very difficult to handle.
Night-Hawk RonAKA
Posted
The J&J Acuvue Oasys 1 Day also has a BC of 8.5, but I figure 0.1 difference is insignificant. Yeah I have also heard BC may be less important with soft contacts, I'm used to the old RGP contacts that use to wear years ago. I've just been using eyeglasses for the past 10 years but am now interested in trying the newer daily toric soft contacts at least for my left eye which has 2.25D cylinder, my right eye that had cataract surgery a few years ago has a Tecnis toric monofocal and has about 1D cylinder residual so I get decent vision 20/25-30 out of it. I'm looking at a toric contact for my left eye set for intermediate (computer viewing) - I currently use a separate pair of eyeglasses with +1D from my distance Rx. Using that pair of glasses I get excellent 2-3 foot viewing distance to my PC monitor. I also tested with my left eye wearing those glasses and at 20ft to an eye chart I can get 20/25-30 distance vision with it so similar to my right eye uncorrected.
RonAKA henry35359
Edited
There is one more thing you can do to determine how much myopia is needed for the near eye with monovision. The contact lens simulation is good to do, as you can go for extended periods of time trying it. But, the one drawback is that the near eye still has a natural lens and will have some accommodation left to focus nearer. This tends to give a slightly optimistic near vision picture.
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Now that you have an IOL in your right eye, it will have no accommodation ability. It has a SE of -0.25 D, so if you get some +1.50 D dollar store readers and wear them, it will give you a good simulation of the reading vision you would get from an IOL set to -1.75 D. There is a web site called All about vision that has some printable Jaeger eye charts that you can use to evaluate your reading vision. This is just a test, and you will have to keep your left eye closed when evaluating the reading vision. The idea is to simulate what you would get for reading vision with an IOL in your left eye targeted to -1.75 D.
henry35359 RonAKA
Posted
I do not think I wanted to try contact lens as I never use it better.
I got mild hyperthyroid my hand shake sometime since late twenty.
But under control with medication till now.
Anyway thank you for your suggestion.
RonAKA henry35359
Edited
If you do not want to do a contact lens trial, then I would suggest doing the reading glasses test I suggested in the other post.
soks henry35359
Edited
if u got not so great near acuity with a plano eyhance chances are very high that you wont be happy with vivity at -1. this could be possible if you have large pupil.
you can put a contact of +1, +1.5, +1.75, +2 in your eyhance eye and see if you are happy with the near and the distorted distance. also correct your left eye for plano with -3.25 and cylinder correction contact and see how you like and tolerate mono and mini monovision.
this way you could find your sweet spot.
henry35359 soks
Posted
Great suggestion but I do not wear contact in my whole life so far.
soks henry35359
Posted
just wear for an hour to see how you like the vision.