Who did EYHANCE and Who did Mini Mono with Standard lens-Love to get feedback
Posted , 15 users are following.
My surgeon has never done any minus to make anyone slightly nearsighted with eyhance to give a little more intermediate vision and maybe into reading zone.Someone suggested I do -50 . He said he could do that He claims with that possibly worst case scenario is I could lose 2 lines of distance vision but more likely 1 line or less. I don't know if he would do more then that cause he hasn't done any yet. Just eyehance and no adjustments.
Who has done eyehance with leaving eye left slightly nearsighted. Did they do that on the first eye, second eye or on both eyes or how would that work.
What power did they do.
I see somone doing as much as 1.25. But not sure if that is first eye or second eye etc. And if they lose some distance and end up needing glasses for distance which defeats idea of being a distance lens.
I would like to see far without glasses but I would be giving up my natural close vision I have . I don't know if I can adjust to being reader dependent. Never wore readers.
I am on computer ALL DAY and from what surgeon said with eyhance I may get intermediate to see computer but have to pull it close to me and don't know if still would need readers to even see computer clear for working on it all day.
I am trying to see who has done mini mono if such thing with eyehance as there seems to be controversy doing that with the eyhance??
I am also considering mini mono with standard lens though would be giving up idea of seeing far without glasses and even then may need reading glasses.
I also have astigmatism 1.25 ?? where they may have to do laser to correct that in left dominant eye. And cataract not bothering my vision at all. The bad cataract is right eye( blurry eye and super light sensitive makes more blurry) and that needs to be done first. Astigmatism I believe can impact hitting the target numbers they are going for but seems many endless things seem to determine who get lucky and end up not needing glasses accept tiny print in eyhance and mini mono standard lens or any lens.
They told me with eyehance I would have to hold things way far away and would probably be able to read but not the tiny print. But of course no guarantee of anything.
Any one who did eyehance or mini mono with standard lens would love to hear back asap. thanks
1 like, 35 replies
bob38868 loveanimals
Edited
I have been reading the board for a while and have not set up an account until today. I was hoping for more information on the Eyhance lens before I had them implanted.
I had both eyes done at a surgery center on the North side of Indianapolis 3 months ago with Eyhance toric lens. The femto laser was used to insure good results with the toric alignment. All went well with the surgery.
A side effect of the surgery (likely) was I needed green laser treatment on one eye for a minor retina tear. That process was not pleasant however both eyes are good to go now and I am 20/15 both eyes at distance. The dominant eye was set for plano and the other eye was set for -.5 to give a little more close up vision. The results came out with the dominate eye at +.25 and the other at -.25 so I have outstanding distance vision. The lens are likely very close to monofocal in they seem to be very much like my original lens. The only difference I can tell is the vision is ever so slightly binocular by not quite having the full side vision sensation I used to have. It is not a problem at all as the other characteristics of the lens are super. The color fidelity is really good and I have very good night vision again. There are no halos or other night light problems at all. Stars look like pin points of light again.
As far as close vision goes I am quite functional without glasses as I can do all outside daytime things like yard work and driving (including reading the navigation screen on my Volt). I can also read my phone (although not with small fonts) without glasses also. I do wear .5 diopter German glass reading glasses in the house however as I find everything just feels more comfortable like that. I do wish the doctor would have moved me .5 diopter closer with the lens as I would be 90% glasses free. I test J3 with no correction.
I have a pair of 1.25 and a pair of 2.5 for detail work. I use the 1.25s for book reading and the 2.5s for working on electronic circuitry.
I love the lens. The Synergy lens should be very good as the use the same material as the ones I have (I believe). The downside of the Synergy would still be the rings and their side effects.
I do have a flickering problem that seems to be getting less over time. I have narrowed it down to a flutter in my eyes that is like a twitch when in bright lights like a store. I'm giving that more time.
rwbil loveanimals
Posted
Important to realize, everyone's results will vary, IOL only come in certain power steps and the surgeon does not always hit the mark.
The best you can do is look at the defocus curve, but again that is the average results, so each person's results will be vary.
In general the Eyhance IOL give a little less than -.5D of EDOF and if you do an additional -.5 you will get a less than -1.0D of closer vision. That is less than the Symfony IOL, but without the side-effects of a defractive lens.
I would attach a Eyhance defocus curve, but lately when I attach it goes to moderation. So pull up the Eyhance defocus curve and move it out an additional -0.5D and you will get a rough idea of your Vision Accuity at different distances.
My rough ass guess is you will gain some intermediate vision but still need glass to do serious reading of a book or magazine.
RonAKA loveanimals
Posted
I do simulated mini-monovision with a distance monofocal IOL in one eye and currently with a contact in my nearer eye, under corrected by -1.25. I like it for pretty much everything, including driving in the city, day or night. However out of the city for longer distance driving I do get the best vision by wearing progressive glasses and no contact. My plan is to get my second eye, when it comes time, with a monofocal IOL set for -1.25 under correction. I will still get progressive eyeglasses for occasional use.
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Keep in mind that it is only cornea astigmatism that counts. Until your cornea is measured you will not know whether or not a toric IOL is needed. Usually not used unless astigmatism is 1+ D.
Night-Hawk loveanimals
Posted
This new Tecnis Eyhance in the toric version looks perfect for my left eye to go with my existing Tecnis toric monofocal (set for distance vision) in my right eye, when my left eye needs cataract surgery. My desire is to get decent intermediate vision (for computer monitor and smartphone) to go with the decent distance vision I have in my right eye now (about 20/25 uncorrected, 20/15 with eyeglasses correcting the <1d residual astigmatism)
My other options had been another tecnis toric monofocal but it would probably need to be at least -1d offset for intermediate vision since I can currently use a +1D correction to my right eye's IOL correction for decent computer intermediate vision. Or a Tecnis toric Symfony was my other alternative, but that would introduce other artifacts like the big spiderweb/circles around lights at night.
It sounds like the new Tecnis Eyhance Toric II IOL however could give me the good clean vision of a monfocal but about 0.5 more range toward intermediate, so perhaps I would only have to target 0.5 to 0.75d nearsighted in the right eye, reducing the mini-monovision difference between the eyes and giving better binocular distance vision that a plain monofocal.
derek99506 loveanimals
Edited
I had the Tecnis Eyhance done in both eyes. 7/7/21 my left eye was done with a -20 power lens for distance. The results were great 20/20 + and that was my weak eye. On 7/21 I has my right (dominant) eye done. My surgeon convinced me to dial back the correction to -21.5 to assist my near field vision.
Bear in mind I am still healing but my initial impressions are that my distance vision in my formerly dominant eye has suffered and that the improvement in near field vision is pretty minor thus far. So if things do not improve from here I would suggest NOT doing mini mono on one eye. I feel like I have lost more than I have gained, though I am hoping that changes.
All that said, overall, my vision has vastly improved and I would recommend the Tecnis lens.
RonAKA derek99506
Posted
Have you had your vision checked by an optometrist yet? That is the real measure of where you ended up after the surgery? The actual IOL power used is kind of meaningless as everyone will need a different power based on the error in the cornea. Even in the same person each eye is likely to be different when targeting plano in both.
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The normal target for plano distance vision is to be left with a residual eyeglass correction needed of about -0.25 D. You do not want to end up on the + side. For mini-monovision the usual target is to be left slightly myopic needing an eyeglass correction of about -1.25 to -1.5 D.
derek99506 RonAKA
Posted
Thanks for the reply Ron. I see the optometrist next week. My situation was complicated by the fact that, due to LASIK, the surfaces of my corneas are irregular.
My surgeon said this makes precise correction calculations more difficult. They use a formula to estimate but it is a little more of a risk for a less ideal result.
I also had Limbal Relaxing incisions done on both eyes to correct astigmatism.
My near vision in the right eye is still improving but not dramatically ie. I can read the computer screen (sometimes) but not clearly.
In order to deem the mini mono a success my near vision will need to improve quite a bit more. Readers are fine with me, I just want to be free of glasses the rest of the time.
lucy24197 loveanimals
Edited
There's an interesting discussion of the Eyhance posted within the last day or so. Be sure to read the comments. There's a cost issue for doctors. J&J is charging more for the Eyhance than for a standard monofocal, and the insurance companies are only reimbursing at the standard monofocal rate.
Guest lucy24197
Posted
I read somewhere that Eyhance only cost 5% more than the Tecnis 1. Hmm.
lucy24197 Guest
Posted
The site I referenced above had a comment that the toric Eyhance was about 33% higher priced than the toric Tecnis. Don't know about standard lens. But--the doctor who did the review did like the Eyhance. There just might be some doctors who resist it due to the extra $$ coming out of their pockets depending on your country's health system.
RonAKA lucy24197
Edited
I can't imagine any health care system where the premium price for a lens comes out of the surgeon's pocket. What I see is the opposite in Canada. Some clinics push the "premium" lenses so they can put more money in their pocket. Some will not even implant standard lenses. When the lens is covered by health care they are paying for the lenses and they negotiate with the likes of Alcon and J&J for price. But, when you go outside of the health care system, at least in Canada, they still pay the basic price, but any premium beyond that is paid by the customer. The extra cost is determined only by the surgeon and the deal they have with the lens supplier.
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And not to diss the surgeons, the other thing that needs to be considered is that these so called "premium" lenses are no where near as trouble free as a standard monofocal lens - from the surgeon's perspective. There is much more extra "chair time" for the surgeon dealing with pre surgery consultation, perhaps extra measurements, and also unfortunately dealing with the post surgery complaints about poorer than expected vision, and in the worst case the need to remove and replace them.
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What needs to be kept in mind in all of this is that the term "premium" does not refer to the vision quality. It refers to the extra price that EDOF and MF lenses cost.
lucy24197 RonAKA
Posted
"I can't imagine any health care system where the premium price for a lens comes out of the surgeon's pocket."
My understanding of the situation--the problem for the doctors is that the Eyhance is being called as a standard monofocal, not a premium lens. The insurance companies will only pay a set amount for standard monofocals, and J&J is charging more than is reimbursed by the insurance company (or at least more than is charged for Tecnis or other monofocals.) In many/most cases they can't balance bill the patients, so using Eyhance instead of Tecnis or some other standard monofocal can hurt their bottom line.
RonAKA lucy24197
Posted
I can't imagine any surgeon that is too shy to ask for the difference from the patient. At least that is the way it works here. Healthcare pays up to a standard amount, and you (or your insurance company) pay the rest.
lucy24197 RonAKA
Posted
Not the way it works here in the USA. Insurance companies have contracts with doctors/facilities within their network. There is a contracted amount for reasonable and customary charges. So if you use a network doctor and you've met your deductibles and co-pays, the insurance company (in theory) will pay the rest up to the contracted amount for covered charges. Things get convoluted in a hurry, because what happens next varies by state, and even within a state. For example, in Washington State, regulations on insurance purchased through the state-run insurance exchange protect the patient from balance billing, where the doctor asks for the balance above what is paid by insurance. If the bill from an in-network doctor exceeds the contracted amount, the doctor cannot legally ask the patient to make up the difference. It's not a matter of the surgeon being shy--they are legally obligated to accept contracted rates. Doctors can take the insurance company to arbitration if they disagree with payments, but the patient is not part of it. (This just took effect in 2020.) If you're seeing an out of network doctor, you may be on your own with no protection--the doctor can charge what he wants. Or if you're buying your insurance outside the state run exchange or getting it through an employer, you may or may not be protected from balance billing, depending on the insurance. It's a real mess, and can add up to huge amounts of money. I had a 6 day stay in the hospital last fall. The bills were over $60K. The insurance company's contracted amount was about $25K, and the doctors and hospital had to accept it.
So, back to Eyhance. If a doctor is in-network for an insurance company, depending on local insurance regulations, a patient covered by that insurance cannot be charged more than some contracted amount, including insurance payments, co-pays, and deductibles for covered treatment. If we're talking "payment for monfocal IOLs" and the Eyhance is exceeding the allowed payment by a significant amount, doctors may be disinclined to use them. But--if there's a upgrade that's not covered by insurance--like using a toric lens, the doctor can charge more for the not-covered-by-insurance "upgrade" and make up the difference.That's my understanding of it, anyway. The laws are constantly changing.
RonAKA lucy24197
Posted
Sounds complex, and even unfair if the patient cannot pay the extra amount out of their own pocket to get the lens they want.
derek99506 RonAKA
Posted
Eyhance cost me $80 per eye above what Medicare would have paid for the standard mono lens. But that's not all:
$1500 per eye for the femto laser
$850 per eye surgeon's fee
$650 per eye surgery center fee
$320 per eye amount not covered by Medicare
$80 per eye for Eyhance
So even with insurance it cost me $6800. Had I gone with Vivity it would have cost an additional $6500.
RonAKA derek99506
Posted
Wow! That is costly.
My Alcon AcrySof IQ Aspheric monofocal lens cost me $70 CDN. That was for the Vigamox and Durezol name branded eye drops, an eye shield, dark glasses, and a cute little plastic case to carry it in! Everything else was covered by our Alberta Health Care. That said a friend got Alcon PanOptix in both eyes and I think her out of pocket was in the order of $4,500. That would be the amount not covered by Health Care.
derek99506 RonAKA
Posted
Wow $70 total out of pocket? That's great. By shopping it around I might have saved a little bit but I didn't want to trust my eyes to the lowest bidder! My surgeon's reputation is top notch so I was willing to pay. I wanted the laser too and Medicare will not cover that and I do not have any additional insurance.
lucy24197 derek99506
Posted
Yikes! That's a lot! I have my "pre-op" meeting tomorrow and they're supposed to tell me what the costs/options will be. So far the charges have been:
Exam/consult with Dr #1: Charged: $654.33 Insurance allowed: $298.98
Consult with Dr # 2 (Same practice) Charged: $434.28 Allowed: $195.85 (He had access to test results from Dr #1, so that's part of the cost difference. Plus I was an "established patient" instead of a new one after seeing Dr #1.)
Both docs recommended aspheric monofocal IOLs. I'm planning to get them targeted for mini-monovision. Aspheric lenses may be considered an upgrade/non-covered expense, so insurance might not cover the whole cost.
Dr. #1 recommended laser & toric lenses. Doesn't like to do monovision,
Dr. #2 said no need for laser and no need for astigmatism correction as my astigmatism is minimal. Said doing a 1.25D offset for monovision shouldn't be a problem.
It will be interesting tomorrow to see how the prices compare to what others have seen.
RonAKA lucy24197
Edited
Not convinced there is a compelling case for using laser. I did not have it, and I am quite OK with my outcome. Toric is a different matter. If your cornea astigmatism is more than 1 D of correction it can be a good idea. Less than 1 D it is questionable because the minimum power for correction is 1.5 D. The critical question is what your cornea astigmatism is measured to be. I would ask both doctors to see if they have the same amount. If not then you will have to decide which one to believe. My gut feeling is that Doctor #2 may be giving you the straight goods, and Doctor #1 is looking at pushing up the tab.
lucy24197 RonAKA
Posted
I have the same opinions about the motivation of the 2 doctors with regard to the astigmatism.
RonAKA lucy24197
Posted
I would question both doctors carefully about the amount of astigmatism in your cornea. As I mentioned I would not consider a toric unless it is over 1.0 D. The other issue is whether or not it is regular or irregular astigmatism. In other words is it a nice symmetrical hour glass shape. They should be able to show you the astigmatism on a computer screen. If it is not symmetrical then it is difficult to impossible to correct it with a toric lens, and it is better left alone. Some astigmatism is not all that bad, and can help your vision at closer distances. I was left with -0.75 astigmatism and I still have 20/20+ at distance. My spherical is 0.0 D so that helps. The rule of thumb is that astigmatism counts for half that of spherical. Or, 1.0 D astigmatism impacts vision as much as 0.5 D of spherical. And it would add 0.5 D to your reading vision.
derek99506 lucy24197
Posted
In my case, both my corneal surfaces were irregular due to previous LASIK surgery and I had mild astigmatism in the left eye and more severe in the right so laser was needed. I also had astigmatism correction (limbic relaxation) incisions done for both eyes. No toric lens needed.
Guest RonAKA
Edited
I've actually read articles saying that diamond blades and the regular method for opening the capsule are better. They both leave a cleaner edge under the microscope. A laser leaves a rough edge. The main benefit of the laser is accuracy which is essential for a bag-affixed lens like the Occulentis but in most cases I think it's a waste of money.
derek99506 Guest
Edited
Maybe. For my pathology the surgeon thought it was advisable. More precise and not as subject to the surgeon having a slip up. Fortunately, I'm not in a position where I had to say "No Doc, do it by hand because I need to save some money". I'll do that with a lot of things but not my eyes.
lucy24197 Guest
Posted
I've seen the same article. I've also seen some surveys where doctors who use lasers say lasers are better, and doctors who don't use them say manual surgery is better (imagine that.) I'm getting manual for monofocals--the doctor I'm seeing recommended it (sounds like he only uses laser if doing astigmatism correction with monofocals.)
lucy24197 RonAKA
Posted
Trying to get an answer out of the people at my doctor's office is like pulling hen's teeth. I had a meeting with their surgical coordinator a couple days ago. She did one test (I believe it was optical biometry, based on the printout I could see across the table--she wouldn't let me look at it, but from a distance it looked exactly like some printouts I've seen online.) She was supposed to answer questions. When I asked her about the astigmatism, she pulled values of 0.25 R and 0.37 L off the printouts--didn't provide an axis. When I asked whether it was corneal or total astigmatism, I got a vacuous stare and the reply "That's a DOCTOR question." (Several questions got that response.) Then she wanted me to sign a form that said all my questions had been answered. Based on my most recent glasses prescriptions and what I've read about biometry results, those are probably corneal measurements. But I'm one of those bad patients and didn't sign their form yet, waiting for questions to be answered by the doctor.
She did provide some prices after talking to my insurance company. My particular insurance pays 100% of covered costs after meeting my deductible, and I've done so for the year so my out of pocket costs for manual surgery with monfocals is predicted to be $50/eye, because I'm spending $50 to get the pre-mixed eyedrops at the surgical center rather than getting separate prescriptions at the pharmacy that would be paid for by insurance. She did mention that they file with the insurance company for $3000/eye for monofocals. That might not include anesthesia, facility fees, etc. They have packages for other pricing that isn't covered by insurance: their "astigmatism management" is an additional $1750/eye, which I suspect includes a toric lens, laser surgery, and "if you're a good candidate" they include laser refractive surgery within a year if needed. Don't know if ORA is included. Their "Distance Vision Plus" reads like it's for EDOF lenses--an additional $3250/eye, and "Multifocal vision" is also $3250/eye.
RonAKA lucy24197
Edited
I suspect you are correct. Those are most likely corneal astigmatism numbers. The angle does not matter much, as they are both under 0.5 D and are not nearly enough to correct with a toric lens. You should conform with the DOCTOR though!
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With respect to the type of astigmatism they should have computer images of the topography of the cornea that look similar to the ones below. The left one is regular astigmatism and is relatively easy to correct with a toric lens. The one on the right is irregular and much more difficult to correct.
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But, if your astigmatism is under 0.5 D I would not worry about it.