CataractCoach 1643: limitations with the Vivity IOL (extended depth of focus)
ฝัง
- เผยแพร่เมื่อ 4 พ.ย. 2022
- **I mis-spoke at the 1 min mark: small aperture is more depth of field and longer shutter time. The large aperture is less depth of field and shorter shutter time**
The only perfect lens is the one that you will find in a young, healthy 20 year old person. Nothing beats this young crystalline lens in term of visual quality and range of vision. Even the best man-made lens implants (including those still in development) only give a fraction of the accommodative amplitude. I was fortunate to be the first surgeon to implant the LensGen Juvene IOL back in 2015 as part of a trial outside the USA. That lens seems to offer about 3 diopters of total range which is still far less than the 10 diopters of range in a teenager. For most of the IOLs that we implant there is a trade-off in order to achieve a wider range of vision without needing glasses.
I first implanted the Alcon Vivity at the end of 2020 when it was on the AcrySof platform and now I have switched over to using the Alcon Vivity on the new Clareon platform. This new Clareon version has the same design and optics, however it is an upgraded material which may give better clarity and eliminate the issue of potential glistenings within the optic. The Vivity can give a wider range of vision compared to a monofocal (single-focus) IOL, but it does come at a moderate cost of contrast and quality of vision.
After 2 years worth of experience with this lens, we have learned a lot including which patients are the best candidates, how to choose appropriate refractive targets, the effect of pupil size on performance, and also how to deal with the higher rate of myopic surprise. This video is a great summary of all that we have learned about the Alcon Vivity.
I am 60 and the second Vivity EDOF IOL was implanted 2 weeks ago. I had Lasik 16 years ago. I am quite thrilled with the results! 20/20 vision! No longer need reading glasses for computer and books. Of course my vision is so much clearer without the cataract. I notice halos around the traffic lights at night, but only at that intermediate distance - looks normal otherwise.
I now have two vivity lenses placed 3 weeks apart last Oct/Nov 2022. My age 70 otherwise healthy eyes developed cataracts over the last few years and night driving was no longer safe for me.
The Vivity lens met my expectations in providing excellent focus from about 2 feet to infinity with minimal glare for night driving. For closer reading, I wear some off-the-shelf readers, as I have for many years. Thus, I understood the panoptic would focus better up close but also have more night glare. I chose vivity for the better night vision.
One really interesting thing is the impact of such a long continuous focus. With a natural lens, if you stand in front of a screened window, you might focus on what is outside, causing the screen mesh to blur out. Or you might focus on the screen mesh and have the outside scene fade out of focus. With Vivity, both remain in focus. You see the screen mesh superimposed over the outside scene. Its really pretty neat. I think the vivity lens technology would be an interesting enhancement for cameras.
The three week period after the first implant with one natural lens remaining was an interesting illustration how yellowed out my natural lens had become. I thought the blue electroluminescent dash in my car was failing as it became so dim. The new lens showed me that the car display was just fine.
Thus, I’m really pleased with how vivity is working out.
Hi Jeff, with the vivity when you drive can you see the dash gauges clearly without using readers?
Yes very clearly. When seated in my car, the distance from my eyes to the dash is about 2.5 feet. The dash and outside always appear to be in focus simultaneously. As you shift center viewpoint between dash and outside, there is no refocus time since there is no refocus step any more.
@@ProfessorFate what was your prescription before the operation?
Without correction I was showing about 20/100 left and 20/200 right. With glasses, they could only correct to about 20/50 in daylight.
At night, with pupils opening up there was lots of distortion. If I looked at the moon, I would see about a half dozen moons superimposed over each other. If I looked at a little pilot red light (like you find on many electronic devices) I would see a swarm of sparkle dots. Red car tail lights ahead of me were a mess and required intense concentration to manage driving distances.
I was told I would probably fail the next drivers license vision test, even with glasses.
Of course, it all deteriorated slowly. You tend not realize it until it gets really bad.
But, its all fixed now. Glad to be living in a time with such options available.
@@ProfessorFate Thanks for sharing.
I had lasik surgery 15 years ago and I lately have astigmatism. My eye doctor recommended Vivity+Toric lens (Toric for astigmatism) as he said Vivity lens would be more tolerated due to my previuos lasik surgery. I just had Clareon Vivity+Toric lens on my left eye weeks ago and I can now see 20/20 for driving, TV, computer. I can also read well except small tiny fonts and I'm very happy with the result. I'm going to have the same lens on my right eye in a few days.
Excellent evaluation. Thank you for this Very honest and true commentary
Great review of the Alcon IOL. Thanks for the refresher!
Amazing clarity of thought and depth of information.
Thank you.
Thank you for this very informative post. I haven't heard of any doctor's office visit (among people I know) who were given this much detail about cataract replacement lenses
Just wanted to thank you for these videos. Helping a friend make a decision about which lens.
That was fantastic explanation: you helped me make up my mind as to which lens to go with
Beautifully explained. Great ! Thank You Sir
Most of this IOL marketing is playing to the suckers and the doctors who participate are playing it all the way to the bank. It used to be considered unethical to treat patients the way they are currently being manipulated. Thanks for being honest Dr Devgan. You set the standard.
GREAT VIDEO! Thank you so much for explaining these details. ❤️ 😉
Thanks for your recommendations Sir...
Excellent explanation!!
Well said doctor, thank you for sharing!
WOW ‼️ I NEVER Heard It Put Like This ‼️MERCY 😮
Thank you for the video, having cataracts and just had the 1st appt. with surgeon and the decision feels very hard and subjective. This gave me a bit more of data to help decide.
Awesome video, thank you!
Dr. Devgan at 1:05 you got it opposite. Shallow depth of field is due to larger aperture (smaller f-stop number) while wide depth of field corresponds to a smaller aperture (higher f-stop). Secondly, shutter speed has no effect on DoF. It only affects exposure. 🙂
yes, you are correct. I mis-spoke. glad you pointed that out. And glad you understood what I meant.
He did say it the correct way around in the second scene, at his desk.
Nice lecture.....True advice...
Thank you. You helped me make my decision.
Thank you, great insight.
Thanks a lot sir
Very well said!
For example: I'm also an opthalmologist, and I have -3,00 miopic eyes. I only use glasses when driving or watching TV (and not when using computers, reading, shopping...) If I had to go cataract surgery I will be happy with a monofocal with a desired post-op refraction of -2.00 because my life mostly revolves around the near 1 meter around me and I am very accustomed to the blurryness in the far distance. Each person is a world.
Nice informative video
Great teachings! I agree with you in everything, but this video reinforced some impressions that I was already having with Vivity. Good IOL, but not for all.
I had the Vivity lens in August of 22. I only needed my left eye done, for some reason the cataract in my right eye still hasn't developed. The vision in my left eye is as good as it ever was, both close up and far away. There are no halos at night. It did take a while to adapt to the new lens. At first I couldn't see as well in a dimly lit room, or being in a room with led lighting. It took about 3 or 4 months to fully adjust, but now my vision is 20/15 in both eyes, both close and far away. No glasses needed. If I ever need the other eye done I will use the Vivity lens.
This is very encouraging. I only need a lense in one eye too and I’m considering vivity. My other eye is 20/15 already without correction. Did you have any balance / depth perceptions issues at all with only one eye done?
@@ruthemmett2704 I have no depth perception issues doing just one eye. It's been almost one year and everything is still perfect. I don't want to influence anyone with information that might not work for them, but my experience with the Vivity lens has been better than I ever expected. If I ever have to do the other eye, I will use the same lens.
@@OzFrog48Z that’s good! I appreciated your reply. One more question sorry. Do you see we’ll upclose in your non cataract eye?
@@ruthemmett2704 Yes. The vision in my non cataract eye is 20/15 close and far away. I've always had excellent vision in both eyes until a few years ago when the left eye developed a cataract. I don't know why it affected the vision in only one eye. The doctor says I had cataracts developing in both eyes, but the vision in my right eye is still perfect. I think there was a problem with the lens in my left eye but it doesn't matter. They replaced it. All is well now. If you get the Vivity, let me know how it works out. I'd like to know if others get the same result as I did.
@@OzFrog48Z that’s my exact same situation- except opposite ( right) eye has the cataract. My left has a tiny cataract but doesn’t affect my vision at all. Thanks for the info! I’ll let you know how vivity works for me.
Great video. How does the Eyehance compare to the standard monofocal now that it's been out awhile...any limitations or discussion on patient outcomes would be great....
Very good straighforward point! Early on, i've found out that most patients on auto-refractometer are between -0.50 to -0.75 even while calculating the IOL power for plano. This doesn't seem to affect significantly distance vision and most patients achieve Jaeger 2 binocular uncorrected near vision!
However I had patients getting -1.00D on AR and noticing diminished distance vision improving with -0.75D on subjective refraction. So some of it may be artifact from auto-ref readings! But it may be helpful to adjust the constant towards 119.12 to 119.15 .
Nice point on the pupil areal too, i've noticed patients with pseudoexfoliation and very small pupils getting jaeger 1.5! similar to trifocal lenses!
Finally this is a premium lens, and like all premium lens should be avoied in patients with corneal scars or increased HOA. The main advantage versus trifocal diffractive is that in my experience, there are no whatsoever complaints of night driving glare, haloes or other positive dysphotopsia! Meaning this lens is much more adequate for patients that work at night or require sharp color vision and an extended range of focus. All in all a great addition to the refractive surgeons iols portfolio when used properly
Best regards
Hi ivehad alcon mono for right eye ive got 20/25
Any suggestions for left
Im -8.50 ? Thinking either monovision at -1.5. Or and edof
Excellent
Very informative video.
We have Lucidis EDOF lens .
So main thing is avoid using this in night time drivers or perfectionist patients.
Sir,would you know how is the perdormance of these lens sjnce these are hydrophillic.we have opted this for my mother.
Hello Doctor. Great eye-opening video. I am considering between the Vivity and PanOptix and now I am more uncertain. I understand that the PanOptix has issues with halos at night, but how bad? And I understand that the Vivity has issues with near vision requiring readers, but how near? Would reading a phone be impossible without readers?
And with the issue of contrast sensitivity, is it worse in the Vivity or PanOptix? I was gravitating towards the Vivity for the better quality of vision but now I’m starting to see PanOptix as the better choice if it wasn’t for the halos.
Your insight would be greatly appreciated!
What do you think of the Vuity Eye Drops used to treat presbyopia? And can they be used for someone who went with the monofocal distance lens? Thank you.
I had Vivity lenses in both eyes for nearly a year. Poor image quality in anything but bright sunlight. Dusk and night vision was hopeless. Horrendous glare and starbursts from every single light point at night. Replaced both Vivity lenses with Rayner EMV and vision in all light conditions is fantastic. Zero glare or starbursts on any night light source except for the brightest car headlights, which still glare. Overall, I'd give the Vivty 4/10 for vision quality, the Rayner EMV 9/10.
I had a vivity lens (I have cataracts in both eyes) placed in my right eye 2 weeks ago. Have 2 more weeks of drops. Right now, my right eye is 20-20 and I can see great in that one eye. BUT I do have a couple of problems. #1 is I have a vertical blur that's maybe 1/8 of my total vision. When I look to the left quickly, it moves right to right. When I look to the right quickly, the vertical blur moves to the left.
And #2 lights at night are NOT halo but they have what looks like an arrow of light going right through the center of the light. I can see this light span during the day too. And it's one and only 1 light going out from the center. I've postponed my 2nd eye surgery till I can get these 2 issues resolved.
Any thoughts as to what's going on?
I'm currently 68. I've had Panoptix multifocal lenses for a couple of years. Admittedly, I ended up with ideal results, overall 20/20, and never needing reading glasses even for the tiniest of print. I didn't know what to expect with what is essentially looking through 4 layers of focus simeltaneously. I'd describe it as being virtually identical to natural vision as I look from one point to another near and far. Everything in my central vision is naturally in focus. The expense of the Panoptix lenses is worth every penny I paid for them. I'm glad I didn't cheap out. Ditching the reading glasses by themselves was worth the price of admission,.
I’m considering PanOptix but keep reading warnings about halos at night . What has been your experience as far as nighttime driving with the PanOptix lenses? Thanks.
@imtiazmunshischannel I do see some tight ring shaped halos around certain bright point lights at night, but I personally find it to be no big deal. It depends on the bightness of the light as well as the angle the light is coming from. I know that halos really bother some people. I have a friend that has high anxiety over GPS instruction voices. I find GPS computer voices to be no big deal. There are simulated halo images you can find online. The occasional halos are a tiny price to pay for NEVER needing reading glasses.
@imtiazmunshischannel By the way, I am an over-the-road truck driver and I frequently drive at night with no issues.
@@tomwiles Tom, thanks so much for your reply! Much appreciated!!
I will have cataract surgery on both eyes in 2 weeks. because the condition of each eye are way different. The eye surgeon recommended to use Vivity in one eye and the Light adjustable lens on the other eye so it can be adjusted as needed. Just curious how often is this done using two different type of lenses?
10:18 What do the ostensible light ray lines in the EDOFfigure represent? The rays that pass through the -1.5 point just stop at that point and don't reach the retina. Meanwhile, only the one horizontal ray reaches the retinal (labeled 0). So there appears to be neither a retinal image from the lens's -1.5 action, nor from the plano action.
You ended off arguing you would choose a monofocal, and that you don't mind wearing glasses when need be. Isn't that oversimplified? But wouldn't you needat least two pairs of glasses should your iol be set for distance? So when driving and walking you'd need int/far bifocals, and when reading another pair of near glasses?
Interesting video. Thanks. I got vivity in both eyes, right dominant eye first I have better than 20/20 far and excellent for intermediate on a computer as well. Near I needed readers. Left non dominant eye doc made a little myopic which improved even more intermediate and excellent near vision. Can read smallest text on test chart. Didn't affect distance too much either. I don't get any visual disturbances and don't notice any contrast issues at night either. (I assume I do have contrast issues but they don't bother me and I don't notice them). All in all my original goal was to only need readers and I wasn't prepared to take the risk of the panoptix and halos etc. So at the end of the day very pleased with the results. It would really suck to spend $10000 on cataract surgery and still need glasses after. I have not worn any glasses/readers since second eye healed.
Comes to india😁😁
Thanks for this. Your action is my plan precisely. So glad to hear it has worked well for you. Thanks.
@@micheleweiner-davis5198 yeah awesome result. Very happy. Hope yours goes as well
10k for bilateral vivity? Wow
Could have used Eyehance and mini monovision for free
Thank you so much for this information. I am 50 years old and have cataract in one eye only. My doctor wants to put in Vivity but I have my doubts since I feel I may not be a good candidate: I was highly myopic in my teens and as a youth and had lasik done on both eyes 20 years ago. I have heard that since the measurements on a lasik treated eye cannot be precise, it is better to go with a monofocal lens. In addition, since I may not be getting cataract surgery done in the other eye any time soon, I feel the Vivity lens could be a cause for imbalance with the other eye with the natural lens. What type of lens would you suggest for my eye? I have Posterior Subcapsular Cataract in one eye only.
Have u dad it done?
I got monofocal lens. Sharpest and highest contrast distance vision. Great night driving with no halos. (age 73) Great dim light vision. I use readers for reading but who cares. There are negatives will ALL multifocal lens. As you age you need all the light you can get to the retina.
Do you also need reading glasses for activities like cooking? I’m really trying to compare mono and edof for making a decision for my mother who has to get cataract surgery done.
@@saumyatk You may need readers for reading recipe if small print but not for actual cooking. I go to grocery store and never need readers for shopping except for really small print on a can. It's a gradual loss in sharpness from arts length. Never need readers for driving. Monofocals give you the brightest night and dim light vision. They are still the gold standard for distance sharpness and contrast. You can't get back your youth vision so why try.
@@AS-tt8ui I am assuming you are set for distance? Did your surgeon hit the distance target? Or are you slightly near?
@@qratedfilms 20/20 20/15 distance super contrast. I can see woodpecker holes in nearby trees. People forget there is loss of contrast with multifocal lenses.
I love my nighttime dysphotopsias..
It's like being in a disco! 🤣
I have Vivity in both eyes and have permanent night time fireworks everywhere I look!
Thanks for the honest and balanced review of the Vivity IOL and for talking about some of the other EDoF IOLs on the market.
One IOL you didn't elaborate on with the ray diagrams was the oculentis comfort.
I was wondering if you had any experience implanting this IOL and what your thoughts are on its performance?
Think oculentis went out of business !
@@shauns5680 I think it's been bought out by Teleon and the IOL are still being continued?
@@MrWatshisface oh thanks for the update - it sure why any surgeon would still want to use them though given the history of issues with oculentis IOLs!
@@shauns5680 please tell me more. What issues did the oculentis lenses have?
I, have minimal epiretinal pucker in my left eye and astigmatism I was informed that we can proceed I have selected the vivity lens would there be any problem using the vivity because of the pucker.
How about vivify in large pupils? would it affect near vision? thank you !
CataractCoach 1643 Would you recommend Vivity IOL for someone in their 40s who only has a cataract in one eye?
is it good for astigmatism eye ???
Sir is this vivity good for a patient who is laproscopic surgeon
Hi Dr. I am a 70+ year old man who had cataract surgery August 2022. The surgery itself was uneventful but my vision was actually worse than when I began the process and added halos around every type of light. It aslo turned my non-dry eyes to very dry eye. After several months the surgeon performed Lasik to improve the blurred vision and supposedly reduce the halo effect. After the Lasik my vision was at least as blurry as when it began but it feels worse. Additionally, I have both halo and rainbows. Its practically impossible to drive at night. I have been taking three different drops and have a new appointment in a couple of weeks. The Doctor said we could remove the Vivity and replace them with Monofocal lenses. What do you think? I admit, I am losing confidence in my surgeon.
Is it possible to install Vivity after Lazer correction? A have only cataract, otherwise my eyes is normal, but have small dry eyes effect?
Can i implant emv iol in the bag after pcr ,? Will that change the final result?
Dr. Devgan, does the Panoptix lenses provide more contrast sensitivity than Vivity? Less? Or about the same? Thank you
Less as panoptic is trifocals lens, light distribution will be less.
One eye J&J eyehance and other eye Hoya vivinex monofocus is good option ? Doctor , please..
Dr. Devgan, I am a sixty-one year old primary care physician based in Calcutta, India. Myopic for fifty years, healthy cornea and macula (so far), right eye cataract degrading acuity to 'last but one line', left eye cataract too early to impact on acuity, vitreous floaters in both eyes for last two years an annoyance I have learned to live with, don't mind wearing glasses AFTER cataract surgery, a voracious reader and movie buff (mostly at home these days), a perfectionist to a fault who greatly values -- and is finicky about -- the QUALITY of image (contrast, detail, depth, colour). Can read the smallest print WITHOUT glasses now with either or both eyes.
Seems like a monofocal implant is my best option. In that case what should be my 'target' IOL power -- aim for some distant-vision undercorrection i.e. slight myopia post surgery?
Will appreciate a response from you. Thanks and warm regards.
Hi sir, you can aim for -0.5 in the dominant eye and -0.75 in the non dominant eye 😊 that way you can have a good, glass independent near vision, with good quality distant vision 😊 of course you can aim for -0.25 and -0.5 also, if you're aiming for perfection for distance!😊
Dear Uday Sir - Please make a video on new alcon monofocal Clareon Vs old monofocal Acrysof IQ from Alcon - Does the new monofocal clareon give better vision in terms on no contrast loss ? Vivity has contast loss - so is clareon better than Vivity - eagerly waiting - have to get cataract surgery done asap - Thank you so much for all the information you have shared through your videos on so many topics - I am so grateful to you Sir.
So did you get the surgery?
Please let me know what you decided on your surgery and which lenses you settled with, as I am getting ready to move forward with my surgeries
After implanting more than 50,000 IOLs , totally agree , monofocal is the best IOL
Hi ive had monofocal in dominant right eye.
Thinking the same in left set for -1.5d monovision
So I was curious how you were able to replace 50,000 lenses? How long have you been doing this? How many days per year do you conduct surgery? How many surgeries do you conduct per day?
So, if you don't hate wearing glasses you better go for mono optical lenses?
Dr Devgan, I'm wondering if you would put a monodical (for distance) in the 2nd eye. I had the Vivity lens implanted last week. The other eye is coming up soon and I'm thinking I would like to save the $2500 and go with the monofocal lens. Does the brain usually adjust to that slight difference? (I'm aware I'll be giving up my close-up vision and will need readers). And I know you probably don't want to give advice to someone who isn't your patient and who's eyes you've never examined, but - in general - do you think there is a possibility this could work out just fine? (And I will indeed speak with my doc about it). TIA
Hi, I hope your surgery with your 2nd eye went on well. May I ask if you could proceed with the combination you asked above, Vivity in one eye and monofocal in the other? If so, I'd be grateful to know your experience and the type of monofocal lens you chose. Thank you!
Can u read with the vivity?
amazing content, i've had great eyes all my life, including excellent night vision, but now i'm suffering from cortison induced cataracts. Most of my day i use the computer to work and putting in a monofocal in is a huge concern for someone with otherwise excellent vision without pre-existing problems with vision at any distance. I also play disc golf which means having great distance is important. I'm not sure what to do.
@@IgorFrost every lens is a compromise
What is disc golf?
Is the loss of contrast at night only?
Your video has given me things to think about. I need cataract surgery (both eyes). I'm a serious hobbyist photographer & Photoshop image processor. I hoped there'd be an extended vision option (w/out flares/halos). But it seems as if I'd lose critical clarity/contrast/details I need for photography. I'll ask my surgeon what he thinks... after viewing this video I'm wondering about toric mono-focal in both eyes for distance (I wished it could be zones 1 - 3) then adjust for the rest with glasses; if that's my only option for needed sharpness/contrast for capturing/processing photos. Fingers crossed.
I also do photography/editing & need cataract surgery. My eyes used to be 1 far & 1 near naturally so didn’t need glasses. But both got worse last 10 years. I didn’t realize til I met 1st Dr that I’d lose close & intermediate vision with standard monofocal. So I backed off & started researching. I thought about mini-monovision but the Dr I met would do that only with light-adjustable lenses. I’m getting other opinions. I want high-quality vision with lowest risk of problems; this video makes me think monofocal for distance may be the best option idk.
@@temtationeyes The LAL's sound as if the near-term post surgery time would require more control over the impact of ambient light than I, personally, could manage.
Ive had mono in dominant eye. Can see quite good at arms lenght
I am myopic and have worn glasses since age 12 for distances (driving, watching TV, etc). My surgeon only offered me the choice in monofocal IOLs, the one that would make me farsighted! I figured I was stuck with that and was really dreading wearing glasses for closeup work. Fortunately, I found an ophthalmologist (and you reiterate the fact) on TH-cam that says a monofocal IOL exists that will allow me to keep my myopia, and will only requires glasses for distances (i.e. what I'm used to for nearly 60 years). I called his office and the surgical coordinator said she would make a note for my surgeon so he can speak to me. When I got to the surgical center, they had my order for monofocals that will preserve my myopia! ALWAYS ASK QUESTIONS!!! FYI, laser surgery was a breeze and so quick! Getting a crown on a tooth is a helluva lot more traumatic.
So are you happy with your results? When you wear glasses to correct for distance vision, is everything in the intermediate and near blurry? Meaning, do you have to remove your glasses to make use of your near vision with your new IOLs?
@@base4our Right eye is done; left eye is tomorrow! The monofocal IOL is Alcon Clareon UV. VERY happy with the results so far! I still need glasses for distances (just like the old days, which is fine). I'm typing this on my computer without glasses and it's clear, but things start getting slightly less defined around 10 feet. I walk around my house without glasses, and I have zero trouble getting around. The new lens is slightly stronger (better vision) than my old human lens, so much better that I had to switch to my old Rx progressive glasses because my regulars were now too strong for distances and I was getting nauseous. I will definitely need a weaker Rx for distances once the left eye is done. Since my current glasses are progressives, I don't have to remove my glasses for near vision (the bottom 1/3 of the progressives for reading etc. was always clear).
FYI, my friend just got Vivity and she has to use reading glasses! I would have died if I spent all that money and got that result!
Very interesting as usual Dr Devgan thank you 👍, what do you think about this choice for emmetropic patient : monofocal lens in the dominant eye and an EDOF in the non dominant eye?
Hi, I have similar question. Did you find the answer by any chance?
@@Mociatto yes, it's a good option, you can also use EDOF iol in both eyes with mini monovision aiming slight myopia in the dominant eye .
@@aniskaci9236 Thank you for the info!
@@Mociatto sorry I mean slight myopia in non dominant eye 👍
@@aniskaci9236 Thanks again!
Does this lens produce a shimmer that is visible to other people?
Hello Dr. Devgan, what is your view on micro monovision, targeting around -1 for the non-dominant eye with a monofocal lens?
@@IgorFrost hi igor so u can read newspaper at 45cm? Were u myopic before? Im lookinv at vivity in my left eye i have alcon mono in my right set at plano.
And u have got good low light contrast?
The low light contrast thru my alcon mono is dissapointing
Have u had anything done?
So i should get the Panoptix then?
Just starting to use them . Tx for advice . Your opinion on Rayner EMV iol ? . I have used them for more than two years already and get really goid results
@@IgorFrost .I find the Rayner EMV with slightly myopic target _0,25 in non dominant eye gives very good results in all distances .Patients are really happy about their quality of vision .There is a couple of weeks of neuroadaptation ,but all patients adapt quickly and then both far and near is excellent .Near is not as good as a multifocal ,but the side effect profile is minimal .As an eye surgeon i would have this lens in my own eye and i have placed them in my own family already
@@ebenlaubscher4153 Can a -1,50 EMV & either -.75 or .50 in second eye give good range. Now doctor will only do the bad eye and waith till next ready.-since other eye -3,25 with slight asigmatism he said has to balance eyes There will be 2 between eyes which seems a lot. If EMV hits target and gives enough near so wouldn't be readers dependent can use second eye for distance when time comes. Wont know how much I would toleaate now since never had mooocontact lens. Ever do such targets and what can I expect to see without glasses. Also so the eyes work togehter or problem with 1 between eyes Thanks
@@acidophulus have u had anything done yet?
Great infomation. So, wich target do you recommend for the first eye?
plano. then if you get a myopic surprise you can adjust for the 2nd eye. it is explained in the video -- watch it again
@@UdayDevgan excellent! Thanks for the tip! The most of my patients with vivity are -0.50 or -0.75
@@dego2899 does that mean they read up close well?
What happens { theoretically } if you remove the cataract lens and didn't replace it with another lens?
You become + 20 hyperopic Or whatever your natural lens was providing. Not exactly but that’s the idea (refractive index in water vs air).
Agree…You said it all, and as an ophthalmologist I would never trade image quality for spectacle independence, and like the graet majoritry of our felliws, I would choose a monofocal IOL in my eyes.And now that some, not all but many, of Eyhance with 20/20 and J1 this is a complete nonsense to put a multifocal, unless the patient requires spectacle independence and knows the side effects this trade will cause.We all know that cataract patients with loss of contrast are happy with multifocal, but that one with good vision and early cataracts, they are the ones that will cause problem and complain or that RLE(wich I do not do).
I’m curious. I’ve heard a lot of good things about the Light Adjusting Lens but very few of TH-cam ophthalmologists list it as an option. Just wondering why.
Can you explain more what your last sentence means please?
@@user-pu6sg7ih8r RLE refractive lens exchange I do not do it, because there is no cataract…and patients with incipient cataract are the worst to put a multifocal IOL as they will notice loss of contrast
@@muriloborges9481 hi i have noticed loss of contrast with alcon mono over my natural lens with cateract. I have to get my left non dominant eye done its -8.5d wih astig and considering monovision -1.5d or the vivity but surgeon thinks i wont get close up focus with vivity
@@rhett7716 this is not expected to have loss of contrast with a monofocal IOL if you have cataract…it can be posterior capsule opacification…as I said I prefer Eyhance over Vivity
So you would have the monofocal IOL for yourself. I had the PanOptix IOLs implanted in October 2022 in both eyes. The visual side effects at night were horrendous. I could not drive at night which resulted in a poor quality of life.
Yesterday I had the LT eye IOL exchanged to the Vivity, and the RT is scheduled on 3/20. Now, after watching this video, it appears that I made another mistake with exchanging to the Vivity. So now, I still may not be able to drive at night.
How did you do with the Vivity?
I really wish I had had access to this last year :)
is it possible to have edof in one eye and mono focal in the other eye ?
Id like to know too
Ive been told yes. Edof in no dom eye
How about having a mix. Mono for reading in one eye, and another lens that's good for far?
Do you recommend such ?
from my practice I find you should be very carefull when you check the first eye after the Op. because the Auto Reraction with EDOF is not accurate because of the wide land Zone. Thats why u get a lot of myopic "Pseudo" results. in This case just chech the vision without correction... if he reaches 80-90% then ist for sure almost emmetropic
yes, I agree. With avoid using the auto-refractor in these patients and instead do a subjective manifest refraction. Great point. Thank you
@@UdayDevgan thanks a lot Doc for the reaktion. I noticed also some Patients develops Neuroadaption and they come very happy with the sight after a few weaks... (even if they where not happy or nearsighted at the first weeks). this should be taken in consederation also... and maybe included in the Information before the Operation. My Experience more with Symphony....Cheers from Germany
Thank you for sharing it. As you mentioned monofocal IOL for best image quality, how about eyhance IOL compared with monofcal IOL in terms of image quality ?
I am implanting Eyhance lens to many of my cataract patients. They all have excellent vision postoperatively and read J3, J2. No halos or glare are reported.
The compromise in visual quality is barely noticeable c.f. other monofocals. On the flipside, the benefit in intermediate vision is also pretty minimal in most patients.
Treat it as a monofocal.
@@bojankozomara9559 hi is that j2 j3. Set at plano? I have had alcon mono in my right dom eye at plano. Do u think i could u eyhance in my left eye to achieve good resding or set at -.5 or use a vivity?
@@rhett7716 not plano, binocular micro monovision of up to -0.50 (usually -0.30).
I still don't fully get the point about EDOF IOLs. I mean, yes, very good intermediate distance but it decreases contrast. However, a trifocal IOL has a good intermediate, but also a good near distance (which EDOF may not). Both trifocal and edof decreases contrast, but if that's gonna happen anyways with any non-monofocal IOL, why would someone choose a far+intermediate distance vision by EDOF, while they can choose far+intermediate plus NEAR vision by trifocal ?
With a trifocal the patient already loses 10-20% of the light to destructive interference from the diffraction to begin with.
The remaining 80-90% of the light is split between distance, int. and near
So the patient might only get 40% of incoming light focussed at distance, 25% int., 20% near.
The patient will also have to contend with glare and haloes from the diffractive optics AND there are also small 'dead zones' in between dist., int., near (depending on IOL design) where the image will be even more out of focus.
Patient's won't really have to wear glasses and their vision "ok" for the most part at all distances.
On the other hand, most EDoF lenses (depending on design and mechanism of action) will not lose any photons to destructive interference. So about 70% of the light will be focussed around distance, with a smooth transition to the intermediate range. This results in less glare/haloes, no 'dead zones' and much better contrast sensitivity than most multifocals but at the expense of near vision. EDoFs give higher quality, 'smoother' vision in a sense than multifocals but with some on-going reliance on glasses for near.
It's really up to each patient what they want but the more 'glasses-free' they are, the less the actual image quality.
Maybe you can try mixing one edof lens with lucidis edof that come with 3 diopter depth, then you will have better contrast as compare to trifocals IOL’s.
@@4ndrew4w44 hi,would you know the performance of Lucidis for distant vision and it been hydrophillic in nature
@@MrWatshisface hi. Are u an eye doctor? U seem very knowledgeable
@@MrWatshisface how about having mini monovision to correct near vision ?
Just for a reality check. I had an alcon monofocal iol placed in one eye. day distance is good. Intermediate and of course reading are bad. what they won't tell you is that occasionally, even a monofocal can cause serious dysphotopsias. My night vision in that eye is plenty compromised, with long streaks and many bothersome moving lines. I can't see the road when approaching vehicles with LED lights. the problem I believe is that the lens is hydrophobic acrylic which causes internal reflections (also subject to glistenings). Other types of lenses have other issues and may require explantation in worst cases. Probably the best monofocal is the Starr collamer lens, as it most closely resembles the natural lens. bottom line: don't assume a monofocal will be dysphotopia or other problem free. BTW, I have vacillated on the 2nd eye, but may go with the eyehance since it should work the best with the monofocal already in place.
Hi why not the vivity with better focal length?
Can you tell me something about the Starr Collamer lens?
Sir I am an ophthalmologist from India , sir want to ask about your opinion regarding eyhance iol from jhonson&jhonson and Rayner Emv lenses.
I can give you my opinion from using Eyehance and Rayner EMV .I stopped using Eyehance as I found it not much better than a monofocal .EMV gives way better results in overall quality far and near and no disphotopsia
@@ebenlaubscher4153 hi wote to you above. I have unusual target would love your feedback thanks also how many emv one have you done
@@ebenlaubscher4153 hi would you prefer rayone over vivity ?
Hello SIr,
I got my right eye cataract surgery done with J&J Tecnis Eyhancehence. Getting good contrast and intermediate vision ( laptop /even reading)
What is your take on putting the same IOL in the left eye?
Whats low light contrsst like. Can u read yr phone ok?
I know doctors that outright refuse to do vivity, that button causes too many patients to be unhappy. These specialty lenses are not worth the trouble folks… and vivity is the worst! 80 percent happy 20 percent very unhappy. Standard lens 95 % happy….
Pard me, I was just subjected to a Vivity IOL implant ......at the moment experiencing multiple problems.
However, in reading your comment about the % of satisfied vs non satisfied, could you please provide the source of your percentages???
Based on my three months of experience with the Vivity IOL is more like torture and sufferable......
Thanks for your assistance.
@@aldogelpi4166 sorry no source just anecdotal - what I’ve seen and why some docs prefer not to use it anymore. You can have another surgery to exchange but this is not without risk. Return to your doc and ask about your options and get a second opinion from an experienced ophthalmologist. Sorry to hear your experience.
Why therw is not natural lens like iol in market
at the 6:10 mark of this video, you show an image - but I don't understand what you're trying to show me. At first I thought the image was comparing between two products. Are you saying that the distance focus image (top image) should be more like the intermediate distance focus?
I wish I had seen this video prior to cataract surgery. I had the Vivity lens implanted bilaterally not knowing the my left pupil was in the range of 2.5-2.6mm. I had post cataract PRK in my left eye with no improvement and now I have to wear a contact in my left eye just to have some visual comfort due to the imbalance created. I am contemplating having the lens replaced with a mono focal lens. Your thoughts?
Hi Raymond. I think I’m in the same situation. What have you decided to do ?
Just FYI your camera example is somewhat backwards. You are correct that large aperture equals more light coming in, but a large (as in physical size, not the F-number) equals a small DOF, while a small aperture lets in less light but has a large DOF.
Later in the video you did say something about increasing the DOF by making the aperture smaller, so I believe the 1st- backwards -example may have just been in error.
Yes. Thank you. I misspoke. Read the description.
@@UdayDevgan yep good info. I almost never read the descriptions on video so that's my mistake.
I had a ICL surgery about 7 years ago that has now lead to cataracts. So I need to have the ICL removed and cataract surgery at the same time. My eye pressures have been slightly high (low 20s), but my corneas did measure on the thicker end and the ophth believes it may also be due to the ICL. I'm about 40, very active in sports, sailing, motorsports, photography, camping, welding/fabrication, art etc. I also read a lot and need close up vision for work, but can wear glasses there if needed. Before ICL my prescription was at -10 to -10.25 in each eye. My surgeon is recommending monovision but may be willing to do a EDOF or multifocus if I really want. My concern is monovision may limit some of my activities because of poorer stereo vision/depth perception. The surgeon is really against panoptix because of glare but seems open to vivity, synergy, symphony. I have mostly come up with my list of lenses that would compliment my lifestyle needs but I'm trying to read as much as I can and look at it from every angle and would love any feedback. Thnx.
Would such a outcome of myopia be variable across different cross section of populations
You got it backwards. Wide depth of field is small aperture.
Yes. You’re right. I misspoke. See the video description for the correction.
Intraocular lenses become dislodged due to scarring of the lens capsule, trauma, lens ligament atrophy, and laser treatment for secondary cataracts.Secondary cataracts (opacity of the posterior capsule of the lens) sooner or later develop in almost all patients who have undergone lens removal.
Vivity UV, on eye blurry near and far. Blinder eye feeling both eyes. Instead of a nice halo have a horizontal lighthouse effect on bad eye. Not happy.
🤡mono
You get one chance to be perfect: when you are born. God is the Master Physicist and Engineer. The rest of us fall short-every time.
Doctors get paid more money to put in specialty lenses…. Let me repeat that … doctors get paid more (are incentivized to recommend) specialty lenses. Academic ophthalmology centers are less incentivized. Think about that next time a ophthalmologist recommends anything but the standard lens. Toric lenses are great too… vivity is a hell no!!!
I have standard lens and on Medicare see great . Have it set near vision and only need glasses for distance , . Saved $$$$ and my cost 0. First thing i told them was i am going for standard and can't afford anything else. The upsell is real. My cost 0 , lady sitting next to me in waiting room 5500 to 7000 same surgery and she also on medicare
Very interesting to hear that you and most opthamologists would choose monofocal. I am a very young patient needing to make the IOL decision. I also thought I would want a monofocal set for near as a myope, but my surgeon said that they think I am making a mistake by not choosing range over clarity since I have never experienced loss of accommodation and have no idea what I would be getting myself into with the monofocals. They also suggested LALs because apparently they have the benefit of clear vision (like a monofocal) and also range (like Vivity). Do you have any thoughts on the LAL technology?