Her younger sister had had cataract surgery at our clinic (monofocal), and she first visited us on referral from a nearby university hospital. Both eyes had reduced vision from cataracts with cortical opacity reaching the pupillary area, and after discussion she wished to have surgery. She had always seen well at distance without glasses and drove often, so we planned to use monofocal lenses set for distance; but when we told her about early use of TECNIS Eyhance, she said she would like to use it if it had none of the halos and glare of multifocal lenses and widened the focal range even a little. So for the dominant right eye first, we set the power with the primary goal of firmly securing distance vision so she could drive without glasses.
On day 4 after surgery the right eye had 1.2p distance / 0.8 near, near vision better than the +0.5 D add specification would suggest. However, in the right eye's uncorrected vision test just before surgery on the fellow left eye, near vision had fallen as per specifications, to 1.0 distance / 0.4 near; after discussion, since she was already satisfied with distance vision, we changed, though just before surgery, to a power setting shifted about 0.5 D toward near.
Preoperative retroillumination photo Postoperative retroillumination photo
As a result, the left eye's uncorrected vision improved to 0.9 distance / 0.8 near, and uncorrected binocular vision was good, 1.2 at both distance and near; she said small print at hand was difficult but she could read the newspaper perfectly well without glasses, and night driving was no problem at all, with no halos or glare, and she was very satisfied. As the difference in clarity between the pre- and postoperative fundus photos below shows, after surgery not only the patient herself but also we ophthalmologists find it easier to detect and treat fundus disease early.
Preoperative fundus photo Postoperative fundus photo
TECNIS Eyhance has a +0.5 D add but is a monofocal lens that uses aberrations, so its candidacy is very broad; it may suit combined glaucoma surgery, which is prone to refractive error, and, in the absence of unsuitable corneal spherical aberration, people who have had LASIK. Of course, it has no diffraction grating, so there are almost no halos or glare (equivalent to a monofocal lens), and unless the patient told us, we might not be able to tell it from a monofocal. It therefore seems suited to people who want to prioritize quality of vision equivalent to a monofocal. However, its add is far smaller than LENTIS Comfort's +1.5 D, so on specifications too, LENTIS Comfort is far more reliable for near vision.
Incidentally, a +0.5 D add means that when set for 2 m at distance, one can see from 2 m to 1 m (1/0.5 to 1/1.0 m), but when set for 40 cm at near, from 40 cm to 33 cm (1/2.5 to 1/3.0 m). In other words, it gives an extension of depth of focus of 1 m when set for distance but 10 cm when set for near, so, depending on lifestyle, setting it for distance may give the greater benefit in range of clear vision.
*For details of TECNIS Eyhance, see the following (Japanese)
https://morohoshi-ganka.com/news/868
TECNIS Eyhance, like LENTIS Comfort, is covered by insurance (treated as a monofocal lens), so people who have already decided on monofocal surgery may want to consider it as another option. TECNIS Eyhance is scheduled for general release at the end of October, so if you are interested, please feel free to consult us.
2021.10.17