CataractCoach 1643: limitations with the Vivity IOL (extended depth of focus)

[@ewe2b]

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.

[@ProfessorFate]

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.

[@jayblue5310]

Hi Jeff, with the vivity when you drive can you see the dash gauges clearly without using readers?

[@ProfessorFate]

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.

[@Sipu79]

@@ProfessorFate what was your prescription before the operation?

[@ProfessorFate]

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.

[@bernie338]

@@ProfessorFate Thanks for sharing.

[@maryh6578]

Thank you for publishing this video. I am trying to decide which lens I need and the questions I asked the doctor were not even close to good questions. I wasn’t sure what to ask! Now I know. I am going with Monofocal

[@charlybrown9024]

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.

[@FarooqKhan-zp7bg]

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. 🙂

[@UdayDevgan]

yes, you are correct. I mis-spoke. glad you pointed that out. And glad you understood what I meant.

[@DennisSantos]

He did say it the correct way around in the second scene, at his desk.

[@moonlightsonata5576]

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.

[@HiepPham-e5k]

how much do you pay for 1 eye?

[@OzFrog48Z]

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.

[@ruthemmett2704]

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?

[@OzFrog48Z]

@@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.

[@ruthemmett2704]

@@OzFrog48Z that’s good! I appreciated your reply. One more question sorry. Do you see we’ll upclose in your non cataract eye?

[@OzFrog48Z]

@@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.

[@ruthemmett2704]

@@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.

[@DennisMathias]

This was so good and somebody finally said it. I get that we all want 20 year old eyes. But I don't want to give up ANYTHING that decreases that goal. Right now it seems that the solution is to go mono focus with concentration at infinity. Your eyes will stop down the aperture if you're in daylight and try to read something. But I'm going to drop a 2.0 diopter contact lense in the nondominant eye to do closeup. I didn't know that LIGHT (luminance) would be reduced with the extended. I want to be able to see a black cat in a coal bin. I don't need extended DOF. I need luminance some of which will be regained by getting rid of the opacity in the natural lens. That way I also get color correction which I would get with any replacement. I think a lot of these shows think that people just don't understand this, so thanks! You've probably saved my eyesight and saved me money!

[@goosygoose5462]

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

[@pinchcode9329]

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?

[@RebekahsZ]

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.

[@davidfwilliams1960]

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.

[@ramesh5g171]

Comes to india😁😁

[@micheleweiner-davis5198]

Thanks for this. Your action is my plan precisely. So glad to hear it has worked well for you. Thanks.

[@davidfwilliams1960]

@@micheleweiner-davis5198 yeah awesome result. Very happy. Hope yours goes as well

[@utube26able]

10k for bilateral vivity? Wow

[@utube26able]

Could have used Eyehance and mini monovision for free

[@willl5970]

Thanks So Much! This is exactly the perspective I needed to hear. You are the best, Doc!

[@stevenswann2835]

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.

[@krishnaramachandran7722]

I am very happy with Vivity. I still need glasses to read messages on my phone but that apart i don't have any problems with halo or night vision while driving. I have minimal glare. Multifocal lenses introduce halos and more glare because of the way they are built.

[@gopalphadke633]

Beautifully explained. Great ! Thank You Sir

[@fotosony]

I get the Panoptix today, tommorow I’ll have the surgery! I’m 46 and usually drive at night time, I hope those halos what thay say will not bother me much.

[@carolematar3760]

That was fantastic explanation: you helped me make up my mind as to which lens to go with

[@miketait1640]

Excellent video as usual from Dr Devgan. Really unexpected statistic that 90% of the experts would choose a monofocal over a Vivity. Why would anyone choose to opt for Vivity?

[@nandonando4421]

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.

[@scottwelker]

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.

[@mountdore]

Thanks for the info. I recently had vivity lenses installed and I'm really happy with the results. I've found that I can read computer and phone as before except when the phone switches to dark mode in the evening, it's harder to read (maybe it's a fatigue factor though - I haven't yet tried turning dark mode off). Reading glasses (old "cheapos" 1.5x) clear things up but add a bit of strain. I'm looking forward to seeing the optometrist for a post-op vision assessment to get her advice at the 6 week mark. Until then I'm a little concerned that the use of reading glasses might preclude the eyes from naturally adjusting on their own.

[@jamesq3210]

Opthalmologists, by virtue of their profession, are inclined to prefer image quality and thus most choose mono-focal. But for rest of us mere mortals, less use of glasses really improve quality of life and may be worth the tradeoff in image quality. BUT the hardest part is that it is only after surgery that we can tell whether its worth the trade off 😅

[@Computerfly]

Just wanted to thank you for these videos. Helping a friend make a decision about which lens.

[@poojaanandjugran5357]

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.

[@Fireneedsair]

So did you get the surgery?

[@MichaelJohnson-wx8nw]

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

[@gussoid]

Hello Doctor, do you have any opinions about the puresee iols?, thanks for this great video.

[@AS-tt8ui]

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.

[@saumyatk]

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.

[@AS-tt8ui]

@@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.

[@qratedfilms]

@@AS-tt8ui I am assuming you are set for distance? Did your surgeon hit the distance target? Or are you slightly near?

[@AS-tt8ui]

@@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.

[@tomwiles]

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,.

[@imtiazmunshischannel]

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.

[@tomwiles]

@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.

[@tomwiles]

@imtiazmunshischannel By the way, I am an over-the-road truck driver and I frequently drive at night with no issues.

[@imtiazmunshischannel]

@@tomwiles Tom, thanks so much for your reply! Much appreciated!!

[@jasonludlowMD]

Well said doctor, thank you for sharing!

[@goslowgolongrr7654]

Thank you for the last few sentences sir.

[@JP-pf1nj]

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....

[@ilyasghauri1012]

Amazing clarity of thought and depth of information. Thank you.

[@FotomakerAcademy]

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.

[@temtationeyes]

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.

[@FotomakerAcademy]

@@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.

[@rhett7716]

Ive had mono in dominant eye. Can see quite good at arms lenght

[@antonioalfaro5749]

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?

[@dr.amitabhamukherjee3601]

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.

[@dr.pavanvjoshi7731]

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!😊

[@TimRoot-dotcom]

Great review of the Alcon IOL. Thanks for the refresher!

[@base4our]

Does this lens produce a shimmer that is visible to other people?

[@rhondatownes2013]

WOW ‼️ I NEVER Heard It Put Like This ‼️MERCY 😮

[@kevinc1218]

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!

[@lorihimes1786]

Excellent explanation!!

[@fjdkfdfjdf33]

How about a monofocal in one and a multi-focal in the other?

[@qratedfilms]

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?

[@miketait1640]

Yes very interesting statistic. If 90% of the experts choose a monofocal why would anyone choose anything different? My surgeon has recommended a Vivity for me and I really don't know what to do.

[@Graham_Wideman]

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.

[@SuperSZ]

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 ?

[@MrWatshisface]

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.

[@4ndrew4w44]

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.

[@bhavnaratwani4136]

​@@4ndrew4w44 hi,would you know the performance of Lucidis for distant vision and it been hydrophillic in nature

[@rhett7716]

@@MrWatshisface hi. Are u an eye doctor? U seem very knowledgeable

[@rhett7716]

@@MrWatshisface how about having mini monovision to correct near vision ?

[@paulsharpe4655]

There is a lot of mumbo-jumbo in this video. You can talk about the physics all day long, but how does that really translate to the actual patient experience ? I had 2 vivity lenses implanted 2 years ago at age 63. I developed cataracts as a result of getting bi-lateral vitrectomies. I chose the vivity lenses based on the comments at the time from Shannon Wongs u-tube channel. I got them in the understanding there would be some contrast loss, and halos at night to a small extent, but I would gain intermediate to quite near depth of focus. These tradeoffs seemed like the best combination for my personal preference. What I expected and what I now experience have given no surprises and have met expectations. I must say though that whether you see an improvement in your vision depends on what you are going from. In my case before the vivity, my night vision was bad. I could not see our black cat in the kitchen with the lights off or down low, but now I can. So to me, contrast greatly improved with the vivity. I can also read my cell phone no problem under most lighting, but I have to squint in a dark room. I have no problem whatsoever driving at night, and i can see the dashboard and distance clearly. I do see halos around traffic lights at night. Very small around red light, bigger around green or blue light, but it's minimal and you get used to it. It's the way things look now - and that's OK. You just get used to it - completely. Also I must say that I'm lucky enough to be reading 20/15 now after laser astigmatism correction during surgery. So am I happy with the outcome. Hell yes !!! There are always going to be tradeoffs, pick what's right for your case.

[@cathy3864]

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.

[@SThompson953]

How did you do with the Vivity?

[@krunalbhavsar5797]

Sir I am an ophthalmologist from India , sir want to ask about your opinion regarding eyhance iol from jhonson&jhonson and Rayner Emv lenses.

[@ebenlaubscher4153]

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

[@acidophulus]

@@ebenlaubscher4153 hi wote to you above. I have unusual target would love your feedback thanks also how many emv one have you done

[@rhett7716]

@@ebenlaubscher4153 hi would you prefer rayone over vivity ?

[@DennisSantos]

I love my nighttime dysphotopsias.. It's like being in a disco! 🤣

[@stevenswann2835]

I have Vivity in both eyes and have permanent night time fireworks everywhere I look!

[@cgreen6369]

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 KZbin 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.

[@base4our]

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?

[@cgreen6369]

@@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!

[@shivarahimipiano]

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.

[@rhett7716]

Have u dad it done?

[@utube26able]

Excellent evaluation. Thank you for this Very honest and true commentary

[@muriloborges9481]

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).

[@jgriffin282]

I’m curious. I’ve heard a lot of good things about the Light Adjusting Lens but very few of KZbin ophthalmologists list it as an option. Just wondering why.

[@user-pu6sg7ih8r]

Can you explain more what your last sentence means please?

[@muriloborges9481]

@@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

[@rhett7716]

@@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

[@muriloborges9481]

@@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

[@janezhu4124]

How about vivify in large pupils? would it affect near vision? thank you !

[@RobertMacCready]

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?

[@dat7hrfa]

You talk about pupil size's influence on refractive target. If so, doesn't the formula to calculate the power take this into account? I have a photopic pupil 3 mm (scotopic 5.8 mm), any concern with the calculated power? Planning to implant vivity in my dominant eye. Have panoptix in non- dominant, I am plano in that eye as planned. Hit the bull's eye 100 %.

[@無花果-w4o]

is it good for astigmatism eye ???

[@haidaralmamoory9179]

Thanks for your recommendations Sir...

[@ValeriiRaiu-s7c]

Dear Dr. Devgan, could you compare the LuxSmrt G&G and Rayner BVI with the other premium EDoF IOLs. Thanks in advance!

[@MrPetrvershinin]

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.

[@aniskaci9236]

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?

[@Mociatto]

Hi, I have similar question. Did you find the answer by any chance?

[@aniskaci9236]

@@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 .

[@Mociatto]

@@aniskaci9236 Thank you for the info!

[@aniskaci9236]

@@Mociatto sorry I mean slight myopia in non dominant eye 👍

[@Mociatto]

@@aniskaci9236 Thanks again!

[@mhdeutschland]

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

[@UdayDevgan]

yes, I agree. With avoid using the auto-refractor in these patients and instead do a subjective manifest refraction. Great point. Thank you

[@mhdeutschland]

@@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

[@Lotakambal]

One eye J&J eyehance and other eye Hoya vivinex monofocus is good option ? Doctor , please..

[@denipatov4187]

Is it possible to install Vivity after Lazer correction? A have only cataract, otherwise my eyes is normal, but have small dry eyes effect?

[@hansbeukers7725]

So, if you don't hate wearing glasses you better go for mono optical lenses?

[@jayblue5310]

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.

[@Sipu79]

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.

[@Sipu79]

@@IgorFrost every lens is a compromise

[@1taylorgibson]

What is disc golf?

[@kenningworth78]

Hello Dr. Devgan, what is your view on micro monovision, targeting around -1 for the non-dominant eye with a monofocal lens?

[@rhett7716]

@@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

[@rhett7716]

Have u had anything done?

[@NebulousCat]

Thank you, great insight.

[@caseycook4882]

CataractCoach 1643 Would you recommend Vivity IOL for someone in their 40s who only has a cataract in one eye?

[@RB-hj7qc]

Thank you. You helped me make my decision.

[@thaithaknot]

What happens { theoretically } if you remove the cataract lens and didn't replace it with another lens?

[@Don-bo7lp]

You become + 20 hyperopic Or whatever your natural lens was providing. Not exactly but that’s the idea (refractive index in water vs air).

[@generic_official]

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.

[@vmxd]

is it possible to have edof in one eye and mono focal in the other eye ?

[@rhett7716]

Id like to know too

[@rhett7716]

Ive been told yes. Edof in no dom eye

[@dr.kvravikumar]

Sir is this vivity good for a patient who is laproscopic surgeon

[@luckyacko7380]

Have you tried Eehnaced monofocal lenses? If so how does it compare to edof lenses?

[@UdayDevgan]

cataractcoach.com/?s=eyhance

[@jsmariani4180]

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.

[@rhett7716]

Hi why not the vivity with better focal length?

[@Fireneedsair]

Can you tell me something about the Starr Collamer lens?

[@dr.abdulhaleemaltabshi9275]

Can i implant emv iol in the bag after pcr ,? Will that change the final result?

[@WysteriaGuitar]

So i should get the Panoptix then?

[@SueAnnaJoe]

Dr. Devgan, does the Panoptix lenses provide more contrast sensitivity than Vivity? Less? Or about the same? Thank you

[@4ndrew4w44]

Less as panoptic is trifocals lens, light distribution will be less.

[@usamaal-hassani8505]

After implanting more than 50,000 IOLs , totally agree , monofocal is the best IOL

[@rhett7716]

Hi ive had monofocal in dominant right eye. Thinking the same in left set for -1.5d monovision

[@mikewilliams7019]

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?

[@dat7hrfa]

"Best" is relative. Whst is best to you is not best to others.

[@tejpalpatel8975]

Nice lecture.....True advice...

[@ebenlaubscher4153]

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

[@ebenlaubscher4153]

@@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

[@acidophulus]

@@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

[@rhett7716]

@@acidophulus have u had anything done yet?

[@Dr_Naeem_Awan]

Excellent Very informative video. We have Lucidis EDOF lens . So main thing is avoid using this in night time drivers or perfectionist patients.

[@bhavnaratwani4136]

Sir,would you know how is the perdormance of these lens sjnce these are hydrophillic.we have opted this for my mother.

[@Bepike]

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

[@Mociatto]

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!

[@rhett7716]

Can u read with the vivity?

[@MrWatshisface]

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?

[@shauns5680]

Think oculentis went out of business !

[@MrWatshisface]

@@shauns5680 I think it's been bought out by Teleon and the IOL are still being continued?

[@shauns5680]

@@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!

[@MrWatshisface]

@@shauns5680 please tell me more. What issues did the oculentis lenses have?

[@VikasSharma-mu4im]

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 ?

[@drbojankozomara]

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.

[@MrWatshisface]

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.

[@rhett7716]

@@drbojankozomara 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?

[@drbojankozomara]

@@rhett7716 not plano, binocular micro monovision of up to -0.50 (usually -0.30).

[@shamurphy6255]

Is the loss of contrast at night only?

[@nickkatsoulakis6103]

Very well said!

[@aurovindsahoo]

Why therw is not natural lens like iol in market

[@dego2899]

Great infomation. So, wich target do you recommend for the first eye?

[@UdayDevgan]

plano. then if you get a myopic surprise you can adjust for the 2nd eye. it is explained in the video -- watch it again

[@dego2899]

@@UdayDevgan excellent! Thanks for the tip! The most of my patients with vivity are -0.50 or -0.75

[@rhett7716]

@@dego2899 does that mean they read up close well?

[@andresalgadomarques]

Awesome video, thank you!

[@katycat2]

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?

[@alial-nasrawi8812]

Thanks a lot sir

[@alexoftalmo]

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.

[@raymondberard8559]

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?

[@nataliyagrant671]

Hi Raymond. I think I’m in the same situation. What have you decided to do ?

[@dhamieyecarehospital]

Would such a outcome of myopia be variable across different cross section of populations

[@karankhanna2873]

Nice informative video

[@suziehartwright]

GREAT VIDEO! Thank you so much for explaining these details. ❤️ 😉

[@Camelrider-om1ei]

None of this fits with my experience. I have two Asqelio EDOF IOL's which are in the same family as the Vivity. One eye is set to plano and the other at +.5 dpt My distance and intermediate vision is 20/20 and my near vision is 20/30. I am able to look at my smart phone, watch, etc. without any issues if the light is adequate, although I sometimes use minimal readers for long reading periods. I have absolutely no problems with Dysphotopsias, loss of contrast or night vision. I cannot claim that this experience is universal but I can't imagine a much better result. I cannot imagine being satisfied having to use reading glasses for almost everything other than far vision. I am also skeptical, but cannot know, of course, of the claim that the overwhelming majority of eye doctors would choose monofocals.

[@fp6889]

I really wish I had had access to this last year :)