Why isn’t anyone talking about Technis Eyhance?

The loss of contrast sensitivity with Vivity was the big issue for me. Would you really want to give up a bright clear picture for occasionally, and in my case rarely if ever, having to wear glasses? Then what about in 20 years if you start to have macular issues? Put on some clear safety glasses which typically cut your vision down 5%, most are rated at 95%, and then think about putting a second pair over them and that is what your giving up and it cannot be fixed. With my mono vision the light is there and I can always put on some glasses.

It's a valid point. That's why it has a that warning on the label. But my understanding is that Vivity contrast loss is only noticeable in dim light. In normal light and bright light it would be almost impossible to detect a difference. So it's mainly just an issue for night driving.

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I wonder about monovision and contrast actually because when you think about it you're still splitting the incoming light in a way. It's just that you're splitting it between two eyes instead of within each eye. Just a thought. I have no idea if there's anything to that thought or not. And I've done zero research on it.

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But I agree. If the Vivity MTF50 bench test showed 0.35 peak contrast instead of 0.25 I would have had it implanted months ago... in a heartbeat. Instead I'm still researching and weighing my options. I've cooled on Eyhance because someone pointed out to me that if it only allows you to be glasses-free, let's say, 50% of the time... you may as well just be wearing glasses all the time anyway. So why not just get a free monofocal IOL from public health + progressives instead of spending thousands of a solution that doesn't really buy you all THAT much. Hmm. It was a good point. It's made me think.

Further to my last... if Vivity was offered in a clear version I would implant that in a heartbeat because I suspect that would noticeably increase night vision. I think it's bench test numbers would be much better without the blue light filter that Alcon touts so much.

I do not agree that mono vision splits the light. Mono vision is all about the brain taking the different images from each eye and making sense out of them. But it is true that seeing almost the same in each eye does have advantages; for those very few situations I can always wear glasses, maybe when repairing jewelry or something like that.

Seeing in low light is a big deal for me. I bike at night every day. I occasionally read a real book in bed as oppose to on the tablet. I rarely go to a dark restaurant but looking forward to being able to see the menu where I used to have to use my keychain light in order to see it.

EyHance also includes a UV filter and it does work. I can no longer use my black light to find pet stains. I am going to have to do some research and see if I can find a black light outside the blocked range. lol

re /Vivity was offered in a clear version/

Maybe if Vivity was offered on the Clareon platform it would be much better.

LOL that UV black light / pet stain scenario. That's one I bet no one thought of.

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Yes I also do a lot of hiking plus I'm a Ground Search and Rescue volunteer which means tramping through dense woods in the middle of the night. We have powerful flashlights of course but yah. I really wish Vivity has a little better CS. Sucks because it seems so great otherwise. Maybe even a "game changer" as everyone it saying. But the CS is making me reticent to go with it. And I think the only thing they'd need to do to improve it would be a material change (a plastic that doesn't filter blue light and that also corrects for chromatic aberration like the J&J material does).

I also would agree that monovision does not split the light, technically. What it can do in some situations is reduce the binocular effect of vision. I think of it like a loudspeaker thing. If you have a single loudspeaker with a 10 watt amplifier and then add a second speaker right beside it with a 10 watt amplifier set the same, the sound will be louder but not by very much. Theoretically it goes up by 3 dB. That is about the very minimum that a person can hear as a distance. I think it is like that degree. If you have perfect vision in both eyes and close one eye, the vision does drop, but not by very much.

I don't think the J&J material "corrects" for chromatic aberration. I think it just causes less because the refractive index is less.

Right. Good clarification. I just double checked the J&J language and what they say about Tecnis 1 is "Reduced chromatic aberration for excellent image contrast". I don't believe Alcon makes any claims about reducing chromatic aberration.

If you have a single loudspeaker with a 10 watt amplifier and then add a second speaker right beside it with a 10 watt amplifier set the same, the sound will be louder but not by very much. Theoretically it goes up by 3 dB

That makes sense

re/ If you have perfect vision in both eyes and close one eye, the vision does drop, but not by very much./

Agreed but with mono vision you can still wear glasses and put both eyes in sync and as long the lenses are not too wildly different, the binocularity doesn't really suffer. At least in my case I haven't been running into things and I can still catch a ball as good as ever. lol

Some thoughts on the outcomes with your operated eye:

The +0.5 D Spherical error is unfortunate. Normally surgeons target to leave you with an eyeglass prescription of -0.25, but never into the + side. This significantly hurts your intermediate and reading vision. If you look at the graph below you can see the defocus curves for a monofocal and also the similar to your lens, Vivity, lens. These charts are a bit hard to read but essentially 20/20 vision is at 0 on the vertical scale, while 0.2 is considered acceptable. At zero on the horizontal scale is long distance, and as you go to the right that is closer and closer. 1 is 40", 2 is 20" and 3 is 13". These curves are quite flat and the Eyhance is flatter. If you visualize these curves moving left or right you can see the impact of ending up with a +0.5 vs a -0.5. The impact on close vision is huge. That is why surgeons normally target to be -0.25 negative, and never positive. The short story is that it appears your surgeon missed on the power used of the lens.

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I cannot explain however why your distance vision is not corrected with eyeglasses. It normally takes up to 6 weeks for the eye to fully recovery from the surgery and swelling to go down so the eye shape is stable. Perhaps this is something that will improve.

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On the astigmatism my understanding is that a skilled surgeon should be able to get Cylinder under 0.5 and ideally under 0.25. Have you had any discussion whether your have normal uniform astigmatism or irregular astigmatism. It may be harder to correct irregular astigmatism.

Thanks for the insights and the info. Two different optometrists both came up with +0.50 sphere post surgery, although the autorefractor indicated +0.25, not great either. I'm feeling discouraged, especially since I paid a premium out of pocket for ORA and Lensx laser for more precise results. I hope the surgeon has some answers for me tomorrow.

Thanks.

An autorefractor will NOT get an accurate result with a lens like Vivity or Eyhance. Refraction NEEDS to be done manually with the "push plus" technique otherwise the refraction will end up being an over-correction.

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When the optometrists did your refraction did they start blurry and then keep adding lenses on the phoropter until you could just barely start seeing clearly. Or did the start with your vision fairly sharp and then start adding lenses until it got blurry? The former is the "push plus" technique. Did they know you have an IOL in your eye with a (slightly) extended depth of focus?

Like was said earlier, two weeks is not long enough to form a conclusion. One of my eyes took six weeks to settle in. And I complained to my brother the optometrist several times while I was waiting. lol

David, I didn't know about the "push plus", and don't remember how they did it. Thanks for the info, it's good to know that I need to mention next time that I have an IOL for better results.

two weeks is not long enough to form a conclusion

Yes actually this is the most important point. Refraction (regardless of the technique used) is only reliable after 6 weeks. I forgot about that. When it is done though make sure they know to "push plus"

Rabbit, thanks for sharing your experience, now I have a little hope. My doc is a very poor communicator, he never told me anything about various IOL options, what to expect, what his strategy was with respect to targeting a certain SPH power, what my astigmatism situation will be. I'll be asking very direct questions tomorrow, based on what I'm learning from responses I'm getting here.

Thanks.

Rabbit, when your eye took six weeks to settle, what does "settle" mean? What fluctuation did you have in SPH and CYL? Was there a perceptable improvement after six weeks?

Thx,

Allen

For my distance eye it seemed forever that I could only see the tv clearly. I was especially dismayed that I couldn't see the computer clearly with this eye.

What were the final results after six weeks with respect to TV, computer screen, driving, etc?

Read an earlier post where I described my results after six weeks.In page 7 of 8 here.

Bear in mind when I talk about "push plus" that is ONLY about determining your glasses prescription which, as rabbit points out, doesn't usually happen until 6 weeks after surgery once they know the eye isn't going to potentially change anymore. I don't know what your Ophathalmologist did to determine the +.5. But yes it could change (hopefully for the better but hard to say). Good luck in your followup appointment.

The IOL is much thinner than natural lens so it shifts back and forth and takes about 6 weeks to settle and adhere. That shifting back and forth can account for .50 diopter either why which is why surgeons don't target plano.

Sue, if shifting can go either way, targeting anything other than plano sounds risky, doesn't it, since the shift can magnify/compound either - or +. What am I missing?

Just my opinion - but a question for surgeon. I think being .50 too farsighted is not useful to a person. better be under the plano target than over. My own targets for -0.25

I'll begin by saying I'm definitely not an expert on this subject. I have done some research in advance of my own upcoming cataract surgery. I cannot venture a guess as to why your distance vision doesn't correct to 20/20, other than your eye still has a long way to go with the healing process.

As far as your Rx is concerned, most ophthalmologists write Rx and refractions in plus cylinder. Most optometrists write in minus cylinder. They cannot be compared to each other. Think of Celsius vs Fahrenheit. The temperature outside is the same, but the numbers are completely different depending on which measurement you use. Your Rx written in plus cyl would be: SPH -0.5, CYL +1.00. Is your right eye dominant? Surgeons seem to always want to set the dominant eye for distance. If your surgeon tried to target a - 0.5 sph, which is pretty standard, then he pretty much nailed it. Even with the slightly better depth of focus the Eyhance offers, you would probably need to be sph -1.25 or -1.50 to have "good" uncorrected intermediate vision.

I feel it is much too soon to make a judgment on the success or failure of the astigmatism correction. The phaco incision (for the removal of the natural lens and insertion of the iol), itself, can improve or worsen the astigmatism up to 0.5D, depending on where the incision is placed, and whether you have WTR or ATR astigmatism. These days, most phaco incisions are placed on the side of the cornea, closest to the temple. With that placement, the incision will usually improve 'against the rule' astigmatism, and worsen 'with the rule' astigmatism. You didn't include an axis when posting your Rx, so I don't know which you astigmatism you have.

Again, it is probably much too soon to predict the eventual outcome of the LRI, as I suspect the healing of the incisions will change things considerably. BEST OF LUCK TO YOU.

Rh, thanks for sharing your insights and injecting a bit of optimism and hope. Can you refer me to any online resources where I could learn more about plus cylinder and minus cylinder and about optometry and optics? What you said was a revelation to me, perhaps I was comparing apples to oranges. But my surgeon did say that LRI didn't produce the astigmatism correction, and he suggested last Wed (2 weeks post-op) for me to consider laser RK enhancement, or more LRI, or an IOL exchange for a toric one.

I'm getting a second opinion on Monday, and another one in June from surgeons who do lots of cataract surgeries.

Another observation - my unoperated eye sees better in good lighting, but amazingly in poor light and in near-darkness the eye with the Eyhance IOL sees much better: brighter and better contrast and sharper.

Thank you for the info.

Allen

I have gleaned a lot of useful information from MedHelp.org. The eye care community on that site is moderated by an ophthalmologist with a great many years of experience.

As far as optometry and optics is concerned, there is so much information available online that my brain is quickly overwhelmed. So, I try to hone in on just the specific question I have at the moment. You can Google a plus cyl to minus cyl conversion tool. It's extremely confusing when your surgeon is talking in plus cyl and your optometrist is talking minus cyl.

I think a second and third opinion is a great idea, and the sooner the better, I'm told, if you're considering iol exchange. That would be a tough decision for me, but then again, I really don't mind wearing glasses.

Have you been diagnosed with a mild cataract in your unoperated eye? That could account for the difference in low light vision.