Cataracts/high myopia - wait for Vivity lens in my strength or do monovision now?

[kayak95]

I'm 56 and have always had high myopia with -9.5 in left dominant eye, and -9.0 in right non-dominant eye for many, many years.

Five years ago I had cataract in right eye and had it corrected with monofocal IOL - the surgeon advised a standard monofocal since I had previously had PRK on my right eye, which didn't go very well.  At my request, the surgeon under-corrected my right eye (non-dominant eye) a little so that I would have decent close and mid-range vision.  So for the last 5 years, I've basically had monovision with a contact lens in my left eye for distance and using my right eye (after cataract surgery) for close/intermediate.  

This has been pretty successful and I've gotten by just fine without any glasses. I've been able to drive as well as see my computer without glasses.  However, in the last several months, I found that my left (dominant) eye was getting blurrier due to a cataract which now requires a -11.0 contact and still doesn't correct it all the way thanks to the cataract.    

I had heard about the Vivity lens and liked the fact that it is supposed to give good distance vision and hopefully decent medium range vision without the glare/starburst that multifocals are notorious for.  I was hoping to get that in my left eye, but when they measured me in Aug. 2021, I was told that Vivity lens is not available in the strength that I need, but the surgeon said the rep said the new range of lenses would be available "next year".   The surgeon even texted the rep when I was in the exam room to see if he could be more specific, but he said that they just didn't know when they will be available  It could easily be April or May 2022 or even longer than that.  I called Alcon myself, but was told that they won't announce it until they have the lenses ready to be released, so it's completely up in the air when the stronger strength Vivity lenses will be available.

So now I have a dilemma..... I really wanted to get the Vivity in my left eye to get a broader range of vision, but that would mean waiting an indefinite period of time.  My cataract in my left eye is smack dab in the center field of vision, and it is getting worse over time.  I am getting increasingly concerned about driving at night but as of now, I feel I can still safely do so and at least I can use my right eye to see.  Not ideal, but I'm grateful to have one functional eye.

I don't know if I should hold out indefinitely into 2022 to wait for the Vivity lens to be available in the strength I need, or should I just go with the more conservative (toric) monofocal for my left eye and correct for distance, and plan to have monovision (which I'm pretty sure will work ok for me since I had effectively done that with a contact.) with my right eye used for closer vision which I already have thanks to my cataract surgery five years ago in my right eye.  

Since I will be living with the decision for the rest of my life, I want to be smart in what I choose.  I really don't want to wait potentially 6 - 12 months (or longer)  but fear that if I get the monofocal lens now, I will always regret not waiting for the Vivity lens in my strength to become available.

By the way, I am not interested in a multi-focal IOL - the potential side effects scare me too much. Also, I don't mind paying extra for the Vivity lens since this is an investment in vision.  I also don't want to get a lower strength Vivity lens in my left eye with follow up Lasik since my previous experience with PRK in right eye was very disappointing and left me with uneven thin cornea.

So I'd really like to know if it's worth it to wait for Vivity in higher strength lens?  I know many people have been disappointed in Vivity lens anyway, but I also tell myself that people who post on forums are generally those that had something go wrong, so data is somewhat skewed.  My gut is telling me to be conservative and get the toric monofocal for distance ,managing my expectations knowing that I will not have good close vision.  This is a hard choice!  I have a surgery date scheduled for Oct. 13, 2021 to get the toric monofocal, but I can still cancel if I decide to wait for Vivity.

Sorry to ramble... any feedback will be very much appreciated!

[John C Hagan III, MD, FACS, FAAO]

There is no IOL that is clearly 'best', if there was surgeons would all use it. Just like there is no 'best' automobile.  First of all a toric IOL is not a monofocal IOL technically since light is focused in different places in different directions.  The more 'technology' that is added on to an IOL  going from  monofocal to toric to extended focus/trifocal to multifocal/accommodating the great the cost and greater the chance of complications and dissatisfaction.   The plan to proceed with a toric IOL with the surgeon that did your first surgery satisfactorily is sound. You can discuss with the surgeon making the second eye a little more myopic than the first eye to try and give you some better reading vision.  We always tell people they may need glasses for some things.

[kayak95]

Thank you for your response and for explaining the terminology regarding toric lenses.  I did go back to the surgeon that operated on my right eye, but although he is still on staff at the hospital he is no longer doing surgery (possibly due to his advancing age?)  but instead he referred me to the surgeon that did his own cataract surgery.  I figured if my eye surgeon trusted this other doctor on his own eyes, that is good enough for me!

I guess my other question for you is your overall impression  with the Vivity lens.   I'm having trouble finding reviews from real patients who have this lens, maybe because it's still kind of new?   Plus, my impression is reviews seem to be skewed to the negative since people who are happy with their procedures don't always post about it online .  I know it's not the "end all be all" lens because as you pointed out, if there is a "best" lens then all surgeons would use it.  But I would like to know your opinion on the Vivity lens.  Are patients generally happy with the result, or do they think it's a waste of money?  Or worse, are there a lot of bad side effects/potential that make them worse off than if they had simply gone with a monofocal?   I'm sure there some that are thrilled with it and some that are deeply disappointed... so I'm just wondering what the majority of patients think about the results.

  I do not think I want to make my left eye more myopic because I would like to aim for the best distance lens I can get.  (My right is already undercorrected, so I believe the monovision with my 2 eyes together will serve me well based on how I have done the past 5 years with a contact lens in my left eye.)  So my thought is if I can get distance with Vivity lens in my left eye and some mid-range too, that would be "icing on the cake". I would just have to wait for the lens to become available in my power - sometime next year.   But if the Vivity has a bad track record then I would probably be better off going the somewhat conservative route and getting the toric lens in the near future.

Thank you so much, I greatly value your opinion and appreciate you taking the time to respond to us on this forum!

[John C Hagan III, MD, FACS, FAAO]

Our practice does not use the Vivity lens.  A high tech lens we have had great success with expecially in eyes with RK or PRK that created irregular astigmatism is the Light Adjusted Lens where adjustments are made after surgery then the IOL "set".