CataractCoach 1182: the J&J Vision Tecnis Eyhance IOL lens implant for cataract surgery
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- Опубліковано 21 сер 2024
- see here: cataractcoach....
for the full article and figures which will be live on August 1, 2021
I am thankful to the engineers who continually improve our surgical products through technical advances. These engineers are usually smarter than the doctors (definitely smarter than me) and they give their best effort to push the envelope of what is possible. I always welcome new technology and innovations for cataract surgery because they allow us to offer our patients more options to deliver the desired visual results. As ophthalmologists, we must also separate the marketing and the push from the sales representatives from the actual optics and the science. We never want to be in the position where patients believe that a magical outcome is possible and that we can mysteriously cheat physics. Let's be straight here: we cannot cheat physics and there is no free lunch when it comes to optics!
Today we are talking about the new (for USA) Johnson & Johnson (J&J) Tecnis Eyhance IOL for cataract surgery, models are Tecnis DIB00 for pre-loaded or ICB00 for the stand-alone IOL. This is a new monofocal IOL which is built on the previous Tecnis ZCB00 platform (ZCBOO is colloquial speak) and, in my opinion, is an incremental improvement to that lens. In this press release from J&J Vision, the Eyhance is clearly labeled as a monofocal IOL "designed to slightly extended depth of focus" -- the key word there is slightly. The Eyhance is not classified as a presbyopia-correcting extended depth of focus (EDOF) lens implant.
This article and video are entirely my personal opinion and figures are presented under the fair use educational review criteria. I do not have any disclosures or financial relationships to J&J (many years ago when the Tecnis platform was part of AMO: Advanced Medical Optics, I was a paid consultant to them). The Tecnis Eyhance comes with Directions For Use (DFU) which you can find at the manufacturer's website here.
www.jnjvisionp...
Should you click on the link and go through the DFU? Reading the DFU is not optional for surgeons, but rather it is required -- at least in my view. While the patient has done "Google homework" and the sales rep has given her/his pitch, the bottom line will be found in the DFU. Note that there was NO separate FDA study done for the Tecnis Eyhance DIB00 / ICB00. In an email to a J&J representative I learned that, "There was no FDA study for the Eyhance as it was a level A modification that did not require clinical data." Got it -- an incremental improvement and not a revolutionary change. Let's keep that in mind and temper our expectations.
This DFU reveals that the incremental change in the Tecnis monofocal (ZCB00 or ZCBOO) is a central 1 mm diameter zone of the aspheric anterior surface that creates a small continuous increase in central lens power. This is shown in the picture above which is from J&J and is presented here under the fair use for educational review (this is important in the USA when we use materials from others).
In the DFU for the Tecnis Eyhance DIB00 & ICB00 (colloquially called Tecnis Eyhance DIBOO and Tecnis Eyhance ICBOO) it clearly states that "clinically meaningful extension of depth of focus has not been demonstrated in clinical trials" (boldface/italics of the 'not' is by me, but the official text definitely says "not"). It goes on to state that "in general, extended the depth of focus negatively affects the quality of vision at far distances," which correlates well to our knowledge that you cannot cheat the physics of optics.
I think that the Tecnis Eyhance is a good incremental upgrade over the standard Tecnis ZCB00 (ZCBOO in colloquial terms) and that it is a really good monofocal IOL. It is NOT an extended depth of focus IOL like the J&J Tecnis Symfony (diffractive technology) or the Alcon AcrySof Vivity (beam-shaping technology), and patients should absolutely NOT expect to get an extended depth of field sufficient for reading vision (20 inches or closer) with this lens.
As you can see, there is no free lunch when it comes to the physics of optics. The total number of photons that enters the eye is going to be the same, but we can change how we distribute this light energy. In this MTF graph we can see that light energy is taken away from the red zone and then added to the green zone in order to increase the depth of focus by a slight amount. This is NOT an extended depth of focus lens and unless you have really, really long arms (1 meter), it will NOT give reasonable reading vision without glasses.
.... ran out of room here on UA-cam, so please go here to read it all and see the pictures / diagrams:
cataractcoach....
as a soon cataract surgery patient (1-3 months and previous RK) thank you Dr. Devgan for all your videos and insight.
Hello Dr. Devgan. I hope that 2 years later, you still monitor these posts.
Thank you for sharing your observations and those other professionals that help the concerned non-professionals make once in a lifetime decisions.
Are you (and the other professionals here) still sold on the benefits of the Eyhance. I am a 72 y/o +6.25 in both eyes with regular astigmatism, -1.75 in left dominant eye and -.5 non-dominant eye. I am averse to increased risk of dysphotopsias and with small epiretinal membrane seem not a good candidate for multifocal lenses.
I am scheduled for Eyhance toric/laser in dominant eye and Eyhance tweaked slight(?) minus in non-dominant eye. One comment here indicates that myopes benefit the most from these lenses.
Thanks in advance for keeping these posts current.
I've implanted more than 200 Eyhance lenses and haven't had a dissatisfied patient so far. We do both eyes at the same time and calculate slight myopia in both eyes (up to -0.50). Binocularly, they see 20/20, monocularly 20/25. But they can read J3, some even J2.
Have only done a handful Eyhance cases myself so far but having similar outcomes and very happy patients. Thanks for sharing your experiences . . . shooting for plano OU in my patients. Considering trying a mini-monovision with -0.5 in nondom eye
@@jonathanzelenak7498 you're welcome...
Thanks for sharing your real life experiences
@@dr.benaziransari8640 you're welcome.
thank you for your valuable input and experience. But certainly, by aiming both eyes at -0.50, you are sacrificing some degree of distance vision. What about doing surgery on a patient who was hyperopic to begin with, such as +3.00 and then would you aim for -0.50 instead of perfect distance vision (0.00)? I am happy to incorporate the Eyhance into my toolbox and I think it will serve many patients well. But patients should absolutely NOT expect to have both perfect distance vision and perfect near vision from this lens!
Thanks for great comments!!
I've seen several videos that talk about how great the Tecnis Eyhance is. But they don't say which focal points or visual zone was chosen. I'm guessing the patients selected distance as a visual zone. But what are the effects if the patient were to select a near noon (for reading) or intermediate zone (for computer use) or something in between? Does this lens offer the same benefit, or does the benefit change with the which visual zone is chosen? Thanks!
I just got the Eyhance Toric on Tuesday (Thursday now) and close vision is my priority for my work and I don't drive, so really don't need very far distance (I live in NYC so. I mostly walk). Well, I can already read my phone up close perfectly clear as well as my laptop AND walk around outside -and see better than I see with progressive lens glasses. But you can take data as a starting point, as I've been told over and over again to remember, each body is different. I was sitting in the recovery room and could read the digital clock in the nurse's station. I have to say I almost cried, I have been legally blind without correction since I was 10 years old, wore contacts for many years, too, but there is nothing like having your own eyes open and you can see the room around you, read book titles on the shelves and your phone, all crisp and clear and bright. I don't have a memory of seeing this well with my own eyes. For me, it is better than I ever imagined- I can't wait until next week to get the other eye done!
Please discuss the retinal detachment risk in patients with premium lens replacement surgery. Seems that a lot of surgeons ignore. This very. Real risk
Dear drDevgan,
I can not help saying that with all due respect to FDA etc.did anybody else on earth verify that the center addition power of eyehance does exist.I believe that eyehance is the new box for the Tecnis ECBOO.
Tecnis is an excellent,an super duper lens.i have implanted some 1000s.
Someone said that no one was dissatisfied with eyehance!! True !! Why should one be dissatisfied with a wonderful lens like tecnis 1.
Best value for money lens on Earth.
And now the real matter!!
Most single piece aspheric iols offer some pseudoaccommodation, as the ciliary body contracts it pushes the peripheral vitreous back,and the unsupported anterior vitreous juts forward by few microns, giving the 60cm vision.Not my discovery but the working principle of the erstwhile Crysta lens.
Amen.
Good point. I’ve done aberrometry on many eyehance. Sometimes you pick up the cone and often you don’t. My feeling is they induce coma if decentred
What about dysphotasia
Dr Devgan, If someone likes to paint, seeing color saturation (color intensity) accurately is very important.. Please talk about the best lens for this situation. I would also like to say your charts are extremely helpful. Thank you very much
I see Violet tint with my J and J lens. It's mainly in natural light after 4 PM. My surgeon never asked what I do for a living or my hobbies. Going to have this lens put in the left eye.
My suggestion is clear one, you always have options to correct or calibrate your color perception by glasses (e.g Blue block glasses)
Great input! Thanx for sharing Dr.Uday!
As always, a great source of information.
Thanks Doc, for the comparison. Excellent video🙏
Hello Dr Uday Devgan. l need cataract surgery this year, is Eyhance the best monofocal IOL ? My main aim is good distance vision without glasses and intermediate without glasses, l dont mind glasses for reading, what is better the Vivity or Eyhance, ? Does vivity have lower contrast then Eyhance, ? is the lower contrast with vivity significant enough to make eyhance a better IOL
if you don't mind readers then go for any Monofocal (glistening free ones) e.g. Tecnis ZCB00 or Kowa Avansee
Dear Dr. Devgan. Thank you for your excellent videos, very valuable and instructive. I am a 73 years-old male that needs endothelial keratoplasty and cataract surgery and would like to know if the J&J Tecnis Eyehance can be implanted in someone with endothelial Keratoplasty done and if so, can one eye be adjusted for far and the other for near?. I think you already answered the second question to Eli Rosen but I did not quite get it (sorry)
Thank you for your reply. It will be greatly appreciated.
Dr. Devan, wonderful presentation as always. Thus far I am curious as to how many of the Tecnis Eyhance IOL's you have used at this point and what were the outcomes. What has been your patients' experiences? Pros and cons for their point of view? Technically are there any special challenges operatively? Thank you so much!
My right eye cataract operated and fitted with J &J Eyhance IOL. Can I opt for alcon Vivity IOL for my left eye. Pl. Help me doctor.
Dear Sir, is Alcon Clearon Monofocal can replace of Tecnis Eyhance?
I just received this lens 4 days ago … right eye . Left I will be after a week.
Perfect for far view - but I cannot see my computer / laptop/ can see my food blurry on my plate. 😢 I was expected readers only for book, handy etc.
Possible i will need progressive eyeglasses
Thanks for sharing your experience. I'm reading reviews for my dad's upcoming cataract surgery too. My interpretation was the same as you, to require readers for reading, but not for the vision being affected to see the food. I hope your vision is improved by now and you can see near much better.
@@Mociatto from arms length I need readers. I can see more clearly the food as well with glasses
I have multifocal glasses, it is comfortable for me.
@@12345678962499 Do you remember if both your Eyhance implants were set for distance? Do your multifocal glasses that you use now have different zones for close-up to intermediate, with clear on top for distance? Is it as effective as before IOL surgery when you had progressive eyeglasses?
Can you do a video that contrast this lens with the light adjustable lens and maybe separates different patient case studies? Ok
Has anyone put an eyhance in one eye and a vivity lens in the other. Would that work?
Is DIB00 with laser surgery worth an extra $4500 above what Medicare pays? My dr is not as forthcoming about explaining the pros and cons of the lenses. My doctor says no distance improvement with the ZCB00.
question: what is the "best" monofocal lens? by the way, you give great info. all your videos are super helpful in deciding. thank you.
Tecnis eyhance has any disadvantages-such as contrast reduction, light scatter,etc in any distance- in comparison to Tecnis 1 piece monofocal?
‘Department of Focus’ lol you’ve gotta hope that nothing else slipped through the cracks in design of the lens itself! 😅
Does the ZCBOO come in a toric version? Another site claims that the distance visual diifference btwn a monofocal and the Enhance would not be detected by a patient as it is minimal. What is your opinion on this?
I like this lens. My Opthamologist has lots of cataract replacement experience but not with this lens. I would be his first. Is this a bad idea?
Hi Sir, if possible please make a video comparison between Lucidis, Eyhance & Vivity because these EDOF Lenses are confusing like Lucidis advertise for all vision Near, Intermediate and far, if possible also include luxsmart iol, these days for cataract surgery younger people would like to choose IOL Lens which offer for Mobile, Tablet and computer use without glasses
I am so confused. I've had one eye (my right, dominant) eye done 6 weeks ago. My doctor used Eyhance DIB00, which he said was set for distance. The card I received after surgery says Diopter +22.50. He performed laser surgery to correct 1.50 astigmatism as well. I have beautiful, sharp vision for about 4-5 feet, including reading fine print without glasses. If anyone has any suggestions what I should choose for my non-dominant eye, I would gladly appreciate that. I'm currently wearing a distance contact lens to explore the possibility of Mono-vision, but as I understand it, to reap the most benefit of mono-vision, the dominant eye is usually set for distance. I also have concerns that I will experience loss of depth of field as I age which can contribute to falling. (68 yo) At this point, I'm thinking that having the left eye set for near and just wearing glasses might be the best decision.
Excellent detailed information indeed, what will be your advice regarding implanting eyhance Iol in an active Young eye surgeon ,does it hamper operating ,or you will give him ZCBOO
Good video sir
Hola Doctor Se predetermined operaron con laser, de fragmento retenido del lente,os
Dr Devan I got an Enhance lens surgery 5 days ago. The day after my far fission was 10/10 but today after the surgery I still do not see my dashboard…. Will the close vision improve with time ?thanks
Dr. Devgan how do the patients choose the IOL brand with you. Do you offer an specific brand between for example (Alcon Acrysof IQ, J&J Tecnis, B&L EnVista, PhysIOL MicroPure etc...) or do you offer only a brand? Thanks and great video!
We offer everything. We have the full spectrum of all products that are FDA approved for the USA and the surgeon chooses the option that is best for the patient. We take into account the patients' desires, biometry, anatomy, and more.
I need your expertise. Kaiser in Colorado did my cataracts 8 months ago . 2 weeks post op I started seeing fingerprints on my lenses. At 3 weeks they told me I needed yag done. I told Kaiser that I wanted the single vision lenses , one being a toric, I was not able to see computer distance and only long distance. Which the surgeon told me I would be able to, and only need readers for my phone and watch. I wanted an exchange for multi vision because as a nurse I spend 10 to 12 hrs on the computer and draw up injections. Which I could even with my cataracts. They just kept passing me around to different Dr.s in their practice insteas of replacing my lenses. My eyes are healthy outside of having those cataracts. Can you help me?
Check out the Light Adjustable Lens
Sir I have eyes that look VERY GOOD, but have astigmatism. I’d like to try mono vision with the Eyhance toric iols. Any advice or thoughts?
Hi sir, whats your opinion about RayOne EMV IOL ?
to a difference between zcb00 and rayner aspherica rac600c. advantages and disadvantages between them?
hello sir.i am from pakistan.i had cataract surgery 3 months ago with monofocal lens.i am very depressed with the results.i want exchange this lens by you.
Dear Dr. Devgan.
Thank you for your excellent lessons... about using the Eyhance Iol.... what is your opinion about doing "mini- monivision" with these Iols (e.g. dominant eye about plano, second eye about -1.25)?
That could be very effective and perhaps using even less anisometropia. Perhaps plano and -0.75
Which is better technology for lasik between contoura vision and I design refractive studio hdv 2.0 (Johnson & Johnson)?
should i go for eheance toric II with -1D cyl power. can i avoid toric lens and go for normal one
Can we use EYHANCE in primary open angle glucoma? In view of contrast
I have been recommended ICB00 lens implants to correct my sight. Please can you tell me if there is any chance that my sight will deteriorate after the implants have been done? Will I still be affected by age degeneration? Would there be any fuzzy/non focussed areas or should the sight be perfect?
Many thanks
Thank u sir
Amazing video
Doctor prescribed alcon iq for my father for cataract operation but they are saying that vision will be little yellowish and contrast and bright ness will be less in night. Please suggest.
Is Tecnis Or tecnis 1 or Eyehance white or yellow lens?
Tecnis Eyehance lens are white
Any answer
What about glistening
Is IOL is considered as Implant?
Professor Devgan, thank you for the amazing and useful information! Great site!
Question - with the J&J Eyhance, would I be able to read an analog Speedometer in a normal car, or will the police have a field day(s) ticketing me because i cant read what speed Im going at?
J&J Eyhance I tihnk you can read clearly up to 67cm? What's the feedback with your patients for the Eyhance?
Im a little confused since i know you need reading glasses to read the laptop screen and to use the keyboard with both Eyhance and likely Vivity (do you likely need glasses to use a laptop with the vivity?)
like I say in the video, you are not going to figure this out with google homework. come see me as a patient and I will measure your eyes and then give you an expected outcome that is specific to you and your eyes.
@@UdayDevgan ok thank you!
We need LensGen asap. How's that coming along?
coming along very well but it takes time!
Lance ka price kitna h sir
pl.give price details.
Dear Dr.Devgan great learning with your videos...would like to know your opinion / say for a patient 43 years ( dense psc cataract and diabetic for 6 years with a normal macular oct)who has technis 1 in one eye and the second eye planned for cataract surgery...what's a better choice technis 1 or technis eyehance monofocal
You are the surgeon and you need to make this decision. I have not examined this patient, spoke to him/her, reviewed the biometry, etc. Put on your surgeon's hat and you do what is best for your patient!
Alcon arcysoft glistening?
How much rupees for technis 1 surgery
Kindly let me know the source where we can get J&J technis lens, how much is its cost in US dollars. Does it come with toric combination. Thanks
@@mohammadalishah4375eBay is best place
Uuyuooe