Why might my opthamologist refuse to use the Vivity Toric IOL because I had Lasik?

I think the basic reasons that surgeons do not want to do MF or EDOF with prior Lasik are:

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1. Lasik makes it harder to measure the eye accurately and get the correct IOL power. If they miss the power it can compromise vision which may compound the inherent optical issues common with these lenses.
2. These lenses are susceptible to halo and flare on their own. The scar tissue left by the prior Lasik can compound the halo and flare problem.

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If the power is selected correctly there is no gap in vision with a monovision solution. The ideal power for the non dominant near focus eye leaves you at -1.5 D myopic. And it is best to correct any astigmatism with a toric monofocal lens at the same time.

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It sounds like your surgeon prefers Alcon lenses. What I would ask for is a monofocal (toric if you are going to be left with 0.75 or more cylinder) with the power to achieve -0.25 in the dominant eye, and -1.5 D in the non dominant eye. Clareon is the newest monofocal that Alcon has and I would get that one if possible. If you need a toric and it is not available in Clareon than I would go for the AcrySof IQ instead. Be sure to ask the surgeon if your astigmatism is irregular or not. A toric lens may not correct irregular astigmatism properly. And, prior Lasik increases the risk it may be irregular. The good news is that if you can get the correct sphere with the monofocal lenses, any residual astigmatism, even if it is irregular can be corrected with Lasik post surgery. Before going into cataract surgery you should have a full plan with your surgeon of what you can do with post surgery Lasik.

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I mention this need for a Lasik plan as I got myself into a bit of a jam with the second eye of my monovision. I wanted -1.5 D, but I have irregular astigmatism that I could not get a straight answer out of the surgeon on whether could be corrected or not with a toric IOL. We finally decided to not use the toric and he talked me down to a -1.25 D target because he said the astigmatism would give me some reading. So now I have ended up with a little less myopia than ideal and on top of that some shadow images on letter due to the astigmatism. I can read well, but not as good as I could if I was -1.50 with no astigmatism. If I had it to do all over again, I would have stuck with my target of -1.50 and dealt with the astigmatism after the fact. I have found out that correcting astigmatism is relatively easy, but making the eye more myopic is difficult. One Lasik clinic has turned me down. I am now waiting for a consult at a second clinic to see if they believe it can be done accurately. I am looking for a -0.25 to -0.5 D increase in myopia. That seems to be less than the normal margin of error when going in the myopic direction.

In a way I'd think IOLs like Vivity and Eyhance could be BETTER in post-Lasik eyes because they have a wider "landing zone" or "sweet spot" than a monofocal, so they are more forgiving of refractive error (Lasik makes hitting the target less predictable).

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That said I've also heard that Lasik can reduce contrast sensitivity so maybe your surgeon is worried about that given that Vivity is know to alreasy be starting from a somewhat low baseline in terms of contrast?

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Maybe J&J Eyhance mini-monovision would be a solution both you could both agree on? The Eyhance monofocal is supposed to have almost identical image quality and contrast to a regular monofocal but with a slightly extended range. That could help with both hitting the targets (bigger "sweet spot" is good for post-Lasik eyes) and with the focus overlap you're hoping to achieve (wouldn't need quite as big an offset as with regular monofocals)