They say there’s nothing like hearing it from ‘the horse’s mouth’. So recently, when an ophthalmologist, an optometrist, and an engineer had their own eyes implanted with AcrySof IQ Vivity Extended Vision IOLs, we asked them to tell mivision readers what they thought.
Presbyopia correcting intraocular lenses (IOLs) – whether trifocals or extended depth of vision (EDOF) lenses – traditionally induce the risk of an increased incidence of dysphotopsia such as glare and halo, compared to monofocal IOLs.1
The AcrySof IQ Vivity Extended Vision IOL is described as a first-of-its-kind presbyopia-correcting lens that provides an extended range of vision with a visual disturbance profile that’s comparable to a monofocal IOL.2-4
Patients can expect good distance, intermediate, and functional near vision – for tasks such as reading on their phone…
Patients can expect good distance, intermediate, and functional near vision – for tasks such as reading on their phone – but are still likely to require glasses for fine near work or prolonged reading.3,4
This monofocal visual disturbance profile2-4 means patients who previously may not have been suitable for a presbyopiacorrecting IOL can now experience the convenience of an extended range of vision.
Here’s what the ophthalmologist, optometrist, and engineer had to say about the impact the procedure has made on their lives, and how it has changed the way they talk about IOLs with their patients.
DR ANGELA JENNINGS, OPHTHALMOLOGIST
Q. Tell us about your vision and cataracts prior to surgery?
I was shocked, I wasn’t expecting to develop cataract at this age, but once I realised that that was the problem, it was really clear that it was impacting on my ability to work.
I was cleaning the operating microscope yet constantly feeling as if it was blurred, but it wasn’t the microscope – it was my eye. So I made the decision to go ahead with surgery very quickly and in fact had an operation a week later with my colleague Dr Chandra Bala at PersonalEyes.
It was a little odd to be the patient!
Q. What visual outcomes were you looking for when choosing an IOL?
I spend a lot of time in a dark room with bright lights, so was absolutely adamant that I wanted to avoid the possibility of the light side effects that can be associated with diffractive lenses. What I was most interested in was clarity of vision, which moved the discussion on to EDOF lenses – they were much more appealing to me, having looked at the data.
Q. After your surgery, did your vision match up to your expectations?
My satisfaction is excellent with the Vivity lens. It has exceeded my expectations in every area. What I’ve got is excellent distance vision, I have no difficulties with intermediate vision whatsoever. My vision feels very continuous as you go from distant to near. It just feels like a natural visual range. I have no difficulty with close work, for things like reading my phone. My reading vision is far above what I thought I’d have.
We spend an awful lot of time looking at printed material, referrals, writing patient notes, and looking at printouts from various scans, and that is so much easier than it was previously. Now I can read those labels even in dim lighting with no difficulty whatsoever. I don’t need glasses for it at all.
Q. What do you like your patients to know about this lens?
I tell them that it really gives you something that’s in between the monofocal and multifocal options, that light side effects shouldn’t be a problem for them, that their distance vision should be good, I expect their intermediate vision to be excellent, and that it’s going to give them a significant boost to their reading vision – but I do expect that they’ll need reading glasses for fine print.
Q. How has your new vision affected your day-to-day life?
I think the nice thing is to be on the other side of it and to be so happy with the result. I think this lens came along at the right time for me.
JANINE HOBSON, OPTOMETRIST
Q. Tell us about your vision prior to surgery?
I had developed a posterior subcapsular cataract in my right eye. As I’m an active person and play a lot of sport, I noticed my depth perception was a little off at first as I’m right-eye dominant. As my vision started to deteriorate quite quickly, I decided to proceed with surgery. I’ve only had the right eye done as the vision in my left eye is good and I’m also plano in that eye.
Q. Were you interested in getting a presbyopia-correcting lens when you first decided on surgery?
I went in thinking I wanted a monofocal lens. The surgeon discussed all the options available and I was not overly interested in a diffractive lens due to the risk of glare and halos. However, when the surgeon talked to me about Vivity, and how it provides an extension of range, without the glare and halos associated with diffractive lenses, I decided to proceed with this option.
Q. How is your vision now you’ve had Vivity implanted?
It’s an amazing invention! I have to admit I was nervous about having a presbyopiacorrecting IOL but I’m very happy. The range feels continuous and I can read N6. I still use some glasses for near work during the week, but on weekends I don’t use them at all. The colour and contrast are great too.
Q. Now that you have a Vivity in your own eye, has it changed the way you discuss IOLs with your patients?
Prior to this experience, I would generally leave the IOL discussion to the surgeon and would generally discourage a presbyopiacorrecting IOL for my patients. Having experienced Vivity, I’m now more open to discussing the options with my patients and providing some input to the surgeon about what my patient may be interested in and suitable for. I will often recommend Vivity for the more active cataract patients, especially those who are hyperopic.
Q. How do you communicate this information with the surgeon in your referral letter?
I shy away from ‘prescribing’ a specific type of IOL as the surgeon will need to make their own assessment. However, I do provide information on the patient’s history of adaptation to their spectacles over time, their lifestyle needs and their sensitivity to glare. I will also share that I have outlined the different IOL options with the patient and that they may be well suited to, or interested in, a certain type of IOL so the surgeon can continue the discussion. It’s also important to manage any dry eye and any ocular surface issues prior to referral and advise the surgeon of this. Whatever lens is chosen by the patient and surgeon, it’s important that expectations are managed well and there is no over-promising.
Q. How do you manage patients when they come back following surgery?
It’s really important that patients are referred back for refraction and ongoing care. Ideally, the discharge letter advises what type of IOL the patient has received. Presbyopia-correcting lenses need specific refraction techniques and optometrists are the experts at this, but we need to know what lens our patients have received as it’s not always easy to tell under the slit lamp!
Q. Some optometrists may be hesitant to discuss presbyopia-correcting IOLs. What is your advice to them?
It’s imperative that we allow our patients to make an informed choice. I would be very disappointed if I hadn’t been told about Vivity and had only received a monofocal IOL. Optometrists need to understand that technology has improved and you just can’t compare to the IOLs of the past. Optometrists often have a long history with their patients, so have a responsibility to discuss the options and manage expectations, and communicate this to the surgeon.
JOHN*, CIVIL ENGINEER
Q. Tell us about yourself and your work.
I’m 64-years-old and I have two kids. Interestingly my son is an optometrist. I’m a civil engineer and I specialise in highway designs. Most of my time is spent in front of the computer.
Q. How was your vision prior to surgery?
The cataracts gave me a lot of trouble. In the morning, when I would walk to the station, the sun would be right in front of me – the light just scattered, which even made looking at the footpath difficult. I couldn’t see what was in front of me, and that was just when walking. It was the same when I’d drive, especially at night or in bright sunlight. It was really dangerous. After the surgery, it was so different. The halos were gone. This lens has helped me tremendously.
Q. Are there particular hobbies you get to enjoy more now you’ve had the surgery?
I love fixing cars. Before the surgery I had to use bright lights, but after the surgery I can see things in low light.
Q. What about your family, how have they reacted?
My son was really excited. He says my sight is better than a normal person’s eye sight. It’s made a great change in my life.
Dr Angela Jennings is an experienced cataract surgeon. She conducts a medical retina and general ophthalmology clinic at PersonalEyes Castle Hill, Parramatta, Dubbo, Mudgee and Sydney city locations. She is a member of The Australian and New Zealand Society of Retinal Specialists, has published articles in peer-reviewed scientific publications, and regularly presents lectures on macular degeneration and other topics to optometrists, general practitioners and the general public.
Janine Hobson is the owner and optometrist at Young Eyes. She has been practising for over 30 years, and has completed extra qualifications in therapeutics and behavioural / developmental optometry, including the use of colour for the treatment of learning related issues and rehabilitation.
John* is a 64-year-old civil engineer who specialises in highway designs. His son is an optometrist.
- Kohnen T, Suryakumar R, Extended Depth-of-Focus Technology in Intraocular Lenses. Journal of Cataract and Refractive Surgery. 2019 10447 1-28.
- Alcon AcrySof Vivity DFU
- Alcon Data on File, TDOC-0055575. 09 Apr 2019
- Alcon Data on File. TDOC-0055576. 23-Jul-2019
*Patient name changed for anonymity.
The opinions and views expressed are those of the individual and do not necessarily reflect those of Alcon. ©2021 Alcon Inc. Alcon Laboratories (Australia) Pty Ltd. AUS: 1800 224 153. Auckland, NZ. 0800 101 106. ANZVIV- 2100017