Why isn’t anyone talking about Technis Eyhance?

It is four days after my Eyhance implant and I am here to report on the good results. On the day after surgery, my vision was blurry but I could tell that the distance focus was there, but also blurred by swelling resulting from the surgery. At the follow-up visit to the doctor, I could not do very well on the eye chart. By the second day after surgery I could tell how good the distance was and now it is even better. Interestingly, I am wearing my progressive glasses that I have worn for years and they give me great close vision and distance is excellent until a certain far distance at which it is much crisper when I take them off. Obviously, the prescription was not made for the new lens and I don't quite understand the optics of that, but I think my regular prescription is not very strong. I intend to get a new prescription after about one month. Most importantly, there are no weird visual artifacts; my vision seems perfectly crisp and normal which is a relief and a source of joy. I am very happy with the Eyhance. I have another doctor visit after 2 weeks and I expect to know actual logMar or other acuity info at that time. I want to share this experience for anyone else considering this lens.

Looking forward to the next update ScannerSchmoo. Can I ask what your specific configuration was? Did you get both eyes done? Are they both set for plano or did you do some degree of monovision?

Only one eye needed at this time but doc says other one is developing albeit at a slower rate. Maybe in one or two years I will need the other eye done. (I am relatively young and I think that is why only one eye is "ready" yet.)

Essentially going for distance with target of -0.25 instead of strictly plano (which i think would be 0?). I think this is to improve chances of best outcome (by not missing on the wrong side) but i think others on this forum might understand this strategy better than me.

I am planning to get a new prescription for progressive glasses so good distance was my main goal and I not planning on monovision configuration in the future. However, I will be watching out for developments in truly accomodative IOLs over the next couple of years because I think that would be ideal. As long as it is really one pure lens surface with no rings or zones such as Lumina Akkolens in this article:

https://www.ophthalmologytimes.com/view/investigational-iol-demonstrates-true-accommodation.

Yes after healing you can often end up being plus or minus 0.25D of the target. So by targetting -0.25D you can pretty much rest assured that you won't go over plano. If you miss plano it's best to miss on the myopic side so your closer functional vision can be as good as possible.

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Yay I'm not too keen on the idea of monovision either. MAYBE I'd agreed to a 0.75 offset is the sugeron assured me it would be worth it and would have very little downside. Dunno. But it still seems weird to me. Also wouldn't that mean you couldn't just buy cheap readers? Or you'd have to maybe buy 2 pair of cheap readers and mix / match the lenses?

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Haven't heard of the lens. The Juvene sounds very promising. One thing I wonder about though is why don't we hear about an upcoming accommodating lens from the big companies like Alcon and J&J? It always seems to be small startups. Too risky? Don't want to cannibalize their current offerings?

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Good luck with the surgery! I'll be very interested to see how it turns out even though it's just one eye for now. I'm probably going to do bilateral Eyhance both targetting plano or maybe mini-mono (no more than 0.75 offset)

You sound like you are in a similar situation to me although at 71, I don't match up with the "younger" part! I have one eye done with a monofocal lens and like it a lot. My other eye is too good for surgery so far. However, this situation is the ideal one to trial monovision using a contact in your non IOL eye. Many people with a bad cataract in both eyes do not have good enough vision to evaluate that option.

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Evaluating it is quite easy especially if you have access to a Costco. They will give you quite a few different contacts of different powers to try. My non IOL eye needs about -2.0 correction. I tried nothing in that eye as that is the way I wake up each morning. But, -2.0 differential was too much. I tried both a -0.5 lens (leaves me -1.50 under corrected) and a -0.75 (-1.25 under). They were both acceptable but I prefer the -1.25. If I actually go this way with my second eye IOL, I will ask for -1.25 to -1.5, as they can't guarantee to hit an exact number. You can however with contacts which is what makes them so easy to try to see if you like it.

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I got progressives to correct the residual error in my IOL eye (0.0 spherical, -0.75 cylinder), plus the full correction in my non IOL eye. It does give me the most crisp vision, but overall I much prefer the simulated monovision with a contact. I now am eyeglass free nearly all of the time. Not needed for computer work, reading unless the print is super small, watching TV, and driving day or night. While the vision is not quite as crisp I like it better. I have worn progressives eyeglasses for 25 years or so, but somehow this combination of almost zero correction in one eye, and full correction in the other makes me feel dizzy when wearing glasses. I think somehow having the correction right in the eye with the IOL compared to the other eye with the correction out front in my glasses may be giving my brain two different sized images. Don't know. I just know I don't like it so much. Some others here have also reported issues with IOL correction in one eye, and eyeglass correction in the other. While the contact in my non IOL eye was initially intended as a trial, it now is my preferred solution. I will continue with the contact solution until my second eye is operated on.

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Something to think about... For what it is worth, I found the Costco Kirkland branded contacts to be the best for me. They are rebranded Coopervision MyDay. Not available in toric though. For the torics I found J&J Acuvue Oasis 1-Day to be the best.

The contact lens is a very interesting solution, especially for trying monovision before surgery. That may be the only thing we can try before surgery in this whole arena. I've never worn contacts and don't think I'd like to deal with it, but it couldn't be too bad just for a try.

But, I am currently wearing my same glasses (progressives) that I used before surgery and they work great for near, intermediate, and (less perfectly) far. With a new prescription I think it will be great.

I am truly curious to learn how close to plano I landed. Since the lens comes in steps of 0.5, and noone is exactly at such a number, the doc has to select the closest target. I wish he discussed this with me before the surgery, though I probably would have agreed to the same thing he picked, which was -0.18 (if I remember correctly). This means it is somewhat likely that I landed on the "wrong" side of plano. But the next step would have targeted -0.68. Was this the best choice? I dont know. The actual result can be measured, right (based on charts and distances?)

You will know what you got for final error when you get your eyes tested for an eyeglass prescription. I was advised to wait 6 weeks to allow the eye to fully heal before getting a new prescription to buy glasses. If the eye was being targeted for distance, I would suggest -0.18 is better than -0.68. However if you are planning to wear glasses the eyeglasses will correct for it in any case. If your objective is to be eyeglass free then it is more important.

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My surgeon was targeting about -0.3 D if I recall correctly. He actually got 0.0 D, so I am pleased with that. I did not have enough astigmatism for a toric and he expected between -0.0 and -0.4 for cylinder. I actually got -0.75. So a little worse than expected for astigmatism. I still see better than 20/20 with the eye though...

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On contacts I have worn them off and on for 45 years or so. They have improved a lot. I got discouraged with them when I got some new ones a few years ago for snorkeling. They were so difficult to put in my eye, I almost never wore them. They were 1-Day Acuvue Moist, which are hydrogel material. They are extremely flexible to the point that you can't get them off your finger and into your eye. I hated them. This time I did some more research and got ones that I gave the names of in the earlier post. They are silicone hydrogel and much easier to handle. They are a bit more expensive, but if you only use them in one eye you get a 50% discount right off the top!

It might be typical for this lens to end up (land) further back than anticipated. My doctor expected -0.13 (next "closer" would have been -0.5 more, which would have been better IMO as it turned out, more below on this opinion). My result is slightly on the "wrong" side of 0. The doctor said that he has been seeing this tendency with Eyehance and does not understand why since all the "constants" are the same (landing further than he is used to with regular Tecnis). I was like the 5th patient with this lens and at my 2 week checkup he had done about 15. He is going to target a more negative number going forward and for my other eye (in the future) an extra -0.5.

I am going for another follow up next Tuesday, and that will be a 5 1/2 weeks, and I'll get final refraction info and I'll then get new prescription glasses. I don't think my vision has changed much since the 2 week visit. I can see clearly only starting at about 1 meter. In retrospect, although I plan to wear glasses anyway, I would have been better off targeting 0.5 closer because if you think about it, the times when you aren't wearing glasses (while shaving for example) is when close up vision is more useful. That said, it is very nice to have perfect (and I do mean perfect, crystal clear) vision in this eye without glasses for distance. It is quite astounding actually; I sometimes just close the other eye and look at a distant object (across the room, or while driving for example) and I am amazed at the absolute clarity.

Interesting update. It goes to show that there is no substitute for experience in using these lenses. There is all the theory, and marketing claims, but as they say the proof is in the eating of the pudding. Do you think you have 20/20 even though it sounds like he went positive? If so, then it is not that bad, especially if you go under with the second eye.

So would 0.5 have been "second minus" as they say? I know surgeons tend to target what they call "first minus" right?

I'd be interested to know exactly how much over correction you ended up with considering that clear vision on starts at 1 meter. Eyhance doesn't have a lot of extra focus range over a regular monofocal but it should give you good vision down to 66cm anyway. Hmm.

I do think I have 20/20 vision but I'll know for sure next Tuesday when I go for my next follow up and get the final refraction.

Going positive was not the intention, but the target was so close (less than 0.25 from 0) so that it landed on the positive side. That is why I think it would be wise to go target further negative, and that is what we will do on my other eye in the future. I'll post another update with update after Tuesday.

I'll find out exactly how much over I ended up with next Tuesday when I have my next follow up appointment. It might have changed slightly in the past 3 weeks since my last follow up. But, I don't think it has changed greatly.

I think that Eyhance theoretically gives good vision down to 66cm if it truly lands at 0. But that is impossible in reality for two reasons. Even if the measurements of your eye are perfect (they aren't) and the calculations of what diopter lens you need based on those measurements are impeccable (maybe they are?) the lens do not come in an infinitely adjustable diopter. So you have to choose the closest available one (in 1/2 diopter steps).

So, since I landed, lets say 1/10 diopter on the positive side, I guess that accounts for the missing 30cm. (Maybe someone on this forum can confirm that; I do not understand the relationship between diopters and minimum distance).

I have never seen those terms before, but it makes sense if the first minus is the choice of lens that would theoretically land closest to 0 but at least a little bit negative and the second minus would be the next higher (1/2 diopter more) power lens, such as 18.0 instead of 17.5. In my case, the second minus would have targeted about -0.58 but actually would have landed at around -0.4 which would have been a better outcome I think. (Although I do not know what distance would be like at -0.4). Right now, if distance was all that mattered, I would not need prescription glasses in that eye at all, my distance vision in that eye is amazingly good. And I suppose that if I landed at -0.4 and found that distance was blurry without any corrective glasses, I might not be happy about that.

The defocus curves show the impact of being under or over for correction really well. In the curves I have been playing with in trying to decide what to do with my second eye, I put the various option I am considering on the same graph. The dark blue is a monofocal set for plano. It gives better than a LogMAR of 0 (20/20 I believe), but it reduces if you end up on either side of that. The dashed dark blue is 0.25 D under (slightly myopic). Vision is still 20/20 but the reading vision is extended closer. In fact being 0.5 D under still gives you 20/20 and even closer reading. 0.25 over does the opposite. It keeps making reading worse the further you go over. I believe all of this is why surgeons target to be 0.25 under or a little more.

If you divide 100 cm (or 39") by the Defocus D position you can get the distance in cm or inches respectively. The Defocus curve is needed to estimate the impact on vision at the various defocus positions.