***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. We all want a wide depth of field with great image quality.
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. This is particularly noticeable at night.
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.
Uday, What is your opinion using the Vivity on a post-myopic LASIK patient? (Who happens to be a vascular surgeon)
depends on the individual patient. If older LASIK with higher K spherical aberration and really flat Ks, then image quality is already reduced by that. Implanting an EDOF could compromise the quality of vision even more. If the vascular surgeons likes to operate without glasses, then mild myopia with a monofocal IOL may be best. again, depends on the case.
Thanks so much for your input!
FOR A SURGEON AGE 60 YEARS.PLEASE ADVICE. THANKS.
I would consider also pupil diameter and HOA, especially spherical aberration into this special case. Maybe a monofocal plus with high spherical aberration compensation could be used in this post myopic corneal refractive cases
I’m not a surgeon, just a lay person who needs cataract surgery and is researching the different types of IOLs. This was very helpful; thank you.