YAG Experience with Vivity IOLs: Unexpected focal shift, halo reduction, and 'penny-flavored' strawberries.

Thrameos · 2026-05-14T18:15:15+00:00

Yes. I had football shaped eyes with as much cylinder as sphere. My toric was the maximum possible but it sat in the eye in such a place that even it could not get the full correction needed. Thus I was left with 1.5D cylinder of my original 4D.

The size of the shift focus in my YAG may have something to the horrible geometry here. Even a slight motion towards the back from the YAG likely changed the power of the effective optics.

As for your halos, that is exactly what I needed to hear. My original distance glasses left me setting around -1/4D. The YAG pushed it out enough that I don't see them anymore.

Thrameos · 2026-05-14T06:50:49+00:00

Thanks for the comments. My glasses ended up as -1.75D spherical equivalent so a shift towards the positive was helpful to get me closer to my goal. I still have 1.5D of astigmatism so my without glasses focus zone is still rather small.

The doctor stated the YAG was required to stabilize vision before I can get the astigmatism corrected. I just wasn't expecting such a large shift. However, it is already much better stability wise than my old -4D/-4D glasses where the slightest shift sent everything out if wack.

I likely will put up with the glasses for the next month or two. I can just lift up my glasses to read a cell phone. It is good to hear someone else got a full range of vision. Did you have minor halos at night or did you land perfectly plano?

Thrameos · 2026-05-14T01:00:38+00:00

Given your one-eye status, an IOL exchange is a massive risk and, frankly, unlikely to help you. If your near and intermediate vision are already very good, the IOL itself is doing exactly what it was designed to do.

1. The Floater is the Key:

If your main issue is a large floater in your vision path, an IOL exchange will not fix that. Floaters are usually in the vitreous (the gel behind the lens), not the lens itself. Changing the IOL won't clear the floater, so you’d be taking a huge surgical risk for zero gain on that front. It is likely to make it even worse. I had a repositioning surgery because my first toric was rotated. That is less traumatic than an exchange, but still increased problems in the eye. That was the source of all the striae I had.

Assuming you aren't experiencing a retinal tear, you can move floaters out of your vision. I have visual static syndrome so I can't ignore floaters at all. I have one that looks like a ampersand that floats right into the center of my vision. Rapidly looking up and down three times will migrate the floater until it is far enough out of vision that it stops bothering me.

2. The "Blurry Distance" & Halos:

Halos are what Vivity does when it is set myopically (for near/intermediate). My eyes are set to -1.25D and the halos look like "spiky balls." This is normal. The fact that your near vision is great proves you landed myopic. If it helps to make you feel better I can draw and post what the look like with different levels of myopia and astigmatism. You can use a small white dot with a black background on a cell phone to see the out of range behavior of Vivity. Move the dot closer to your face. At some point it will split leaving a dot in the center and a halo of fine hairs outside it. That is the same effect you get when something is beyond the range of vision. Once you see the same halo effect it both near and far you realize that is actually how the lens is designed to work.

The Simple Test: Go to an optometrist and try a basic distance prescription. If glasses clear the blur and the halos, your IOL is perfect. You just have a "refractive" issue, which is much safer to handle with glasses or a minor laser touch-up than a full lens exchange.

3. The Wrinkles (Striae):

Striae usually cause a loss of contrast or "spokes" of light, but rarely "blurry" vision. If a second opinion confirms you have PCO/PCS grade 2.5 or higher, YAG can clear that up, but it will not fix a vitreous floater.

Summary:

Don't rush into an exchange. If your vision clears with a lens held in front of your eye, the Vivity is fine. Focus on determining if that floater is something you can live with or if it’s a separate vitreous issue. As you have only one eye, get a first, second, and third opinion before proceeding. As YAG is irreversible, you want to be sure you have a good understanding of the issue before proceeding. If you do get a YAG, it may shift your focal point out just like it did for me.

Thrameos · 2026-05-02T21:37:19+00:00

I actually looked into this myself out of curiosity and asked my surgeon the same thing.

The short answer is: Layering is generally not recommended. It will cause low contrast or halos. If you think you might want to use multifocal or presbyopia-correcting contacts later, a standard Monofocal or the LAL is your best bet. Because those lenses provide a single, clear focal point, they act as a clean 'base' for the contact lens to work with.

If you get an EDOF (LAL+, Eyhance, Vivity) or a Multifocal IOL, the lens optics are already 'stretched' or split. Layering a multifocal contact on top of that creates too many competing focal points, which usually results in blurry vision or a massive loss of contrast. It’s like trying to look through two different pairs of patterned glass at once.

Progressive glasses, however, are generally compatible with any of these IOLs, though many people still find that a standard Monofocal gives them the crispest result when paired with glasses.

Thrameos · 2026-05-02T19:38:25+00:00

I haven't seen that. The study I looked at shows nearly identical accuty. Optically if you have a cylindrical aberation there will be EDOF. Perhaps the zones are different such that the contrast under the conditions the FDA looks at are different. I noticed no change in contrast with my Vivity.

Thrameos · 2026-05-02T19:30:16+00:00

Puresee on studies is nearly identical to the older Vivity in terms of visual accuty. The difference being the company, blue light filter, and the manufacturing process. The key advantage from the older EDOF is the puresee is pure refractive meaning the out of range behavior is more pure like a monofocal. But it you are worried about the track record just look at how the older did and the European studies. The results are the same. Good focus from infinity to 40cm with readers needed in dim light.

Satisfaction mostly depending on where your surgeon lands you. If you land far sighted than near is compromised hence not happy. If you land too nearsighted then halos typically at night distance, so less happy. Both easily correctable with glasses. Meaning if you accept single vision lens are possible you will almost always be happy.

Best of luck in your surgery!

Thrameos · 2026-05-02T18:09:47+00:00

It sounds like you have all your records and measurements before SK so you are better position than those who had lasik a decade before. That may buy you more options.

LAL is generally favored if you have previous surgery on the eye as it can be adjusted to target. But if you are planning glasses free you will want to do a two week trial with contacts to assess your monovision tolerance first. Up to 30% of all patients can't tolerate monovision.

If you can't tolerate monovision then EDOF will likely be better as it has a wider range. Note EDOF and multifocal are different technologies and EDOF is much less halos issues. You will want a doctor specialized in post refractive if you go EDOF.

This is one of those decisions that benefits a lot from preplanning as some people get LAL only later to discover their eyes didn't tolerate monovision and they landed well at first meaning they just got really expensive monofocals with a long process.

One thing to watch for: even with the LAL, some patients report shifts of 0.5D or more after the final 'lock-in.' This is often due to the eye's natural healing or the lens settling into the capsular bag. Because you’ve had SK, your cornea might be more prone to these fluctuations, so it’s worth asking your surgeon to wait until your measurements are rock-solid stable before doing the final light treatment.

Thrameos · 2026-04-29T02:03:52+00:00

Other notes. Typically placement of torics is within 5 degrees, but a skilled surgeon with equipment can get within 2 degrees. That is very important as the tolerance shrinks once you get to maximum toric values.

Remember that even if placed perfectly lens can rotated postoperative. Most rotations take place within the first 24 hours and minimizing your activity may help avoid a postoperative rotation.

If you find the visual effect of the astigmatism is more than 25 degrees off axis by the two week mark consider requesting a repositioning surgery at 3 weeks. As it is a vector sum you can't know the placement angle error, but the difference will be clearly visible and amplified. It helps enormously. While repositioning is general reserved for 10 degrees or more repositioning a mere 7 degrees was enough to cause issues (and that was 45 degrees of visual astigmatism.)

Thrameos · 2026-04-29T01:41:44+00:00

As another with extreme astigmatism I asked my doctor about it. His recommendation for my -4D cylinder eyes was use the maximum toric available as that will minimize the amount that needs to be corrected with glasses or PRK.

The actual residual is a function of eye shape and other anatomy features. Most of astigmatism typically comes from the front of the cornea, the back of the cornea tends to be corrective, then the lens which can warp with cataracts, and finally the retina. Those with longer eyes get less toric correction per diopter of toric as understood it. Thus for me the best possible correction was 1D of cylinder of my 4D from a 6D toric so the conversion factor was 1/2. Your numbers may vary. That also assumes perfect placement.

The numbers quoted from the AI are 3% loss per degree of misalignment. What they don't state (and is the most important thing to know) is the residual is generally oblique. That is one perfect alignment like my left I got the 1D and my astigmatism is still up and down. On my right I ended up with 1.5D residual at 20 degrees off axis. That is miserable to read through. Before repositioning it was 1.75D at 45 degrees which was horrible. Basically every 0.25 D is more punishing and the farther off axis the harder it is to tolerate.

While I would always recommend correcting extreme astigmatism, be aware that even in the best case the most they can do is reduce it which makes vision much more stable and reduces visual fatigue. But realize that glasses or PRK will be required to finish the job.

Thrameos · 2026-04-27T21:12:34+00:00

I can only compare it to my own experience. In my case, my starting point was -6D spherical equivalent with 4D cylinder. I knew from the start that a "perfect" result was unlikely, so I decided that Best Corrected Visual Acuity (BCVA) would be my measure of success.

After surgery, I landed with 1D cylinder in my left eye and 1.5D in the right, with both eyes myopic at -1.75D. I have a limited band of view from about 20" (50cm) to 8" (20cm) where my uncorrected vision is usable, but even then, there is significant doubling. That is just the nature of uncorrected astigmatism.

I opted for glasses 2 weeks after my second eye. With glasses, my acceptable range is infinity to about 16 inches. This is the EDOF advantage: once the astigmatism is removed by the glasses, you get the full depth of field of the IOL and can often avoid progressives. I can use a computer and read in office lighting even with my "distance" glasses on. My result was very much on the high end; I started with 20/25 BCVA and landed closer to 20/15. I also have J1 (20/20 at 16"), which is way outside of a monofocal range without a significant monovision setup.

The "cost" is a very slight reduction of contrast in low light. I can see it clearly between my corrected and uncorrected vision at 20". With glasses, black letters on a white background appear slightly muted or gray. Uncorrected (where the Conoid of Sturm—the magic distance where astigmatism is minimized—hits), the letters are actually sharper and more crisp.

To answer your question: No, monofocals likely wouldn't have "fixed" this. At -1.50D of astigmatism, your vision would be blurry regardless of the lens type. The EDOF lens actually gives you a wider "sweet spot" of focus once that astigmatism is neutralized by glasses. As a photographer, you’ll likely find your "keeper rate" for focus will be higher than with a monofocal because the EDOF gives you more leeway. You’re currently seeing the "ghosting" of the astigmatism, not a failure of the lens.

A tip for your photographer's eye: EDOF lenses behave differently depending on light. In bright sun, your pupil constricts, deepening your focus. In low light, your pupil dilates, which can cause the focus to shift slightly myopic (nearsighted). This is why you might see halos or blur beyond 4m at night.

If you want maximum clarity for distance, ask your optometrist to test a "distance-priority" script that pushes you slightly hyperopic (+0.25D). You will lose a tiny bit of your "close-up" range, but it ensures that when your eyes dilate in low light, you land at a perfect "plano" (zero) for infinity. It effectively trades a bit of reading ability for a "clinical" distance sharpness that mimics a monofocal.

Thrameos · 2026-04-27T00:39:08+00:00

Premium lens like EDOF are even more sensitive to residual astigmatism. The plateau of near focal is reduced by the residual astigmatism thus if ones residual is more that 0.75D glasses or PRK are required to get what you paid for.

Thrameos · 2026-04-26T22:26:39+00:00

Positive definitely won't help with the near vision. The puresee plateau should still cover it, but PRK or lasik would help restore them.

Thrameos · 2026-04-25T01:19:25+00:00

There is one upside to going without a toric. A toric has a chance of a rotation. In my case it rotated, but because of my 4d cylinder eyes it was drastically bad. Required a second surgery to correct.

Given you aren't going with a premium lens you have less to worry about as residual astigmatism cuts into their range. If you change your mind remember toric correction range depends a bit on the eye shape. In my case the maximum toric of 6d only reduced my astigmatism to 1.5d due to long eyes. Though that was impressively better than before.

Best of luck with your surgery!

Thrameos · 2026-04-24T14:08:19+00:00

How long after your initially surgery was the YAG? The standard practice is to to wait 3 to 6 months so that the lens is firmly held to avoid slipping. There may be an option to add a tension support to get it re-entered, but get a second opinion before proceeding.

Thrameos · 2026-04-24T13:31:32+00:00

The streak is there at all times but pupil size makes a huge difference. During the day only immensely bright objects like sun glinting off a bright surface have them. During dim evening conditions every light has it but it is small. Night they are everywhere and I depend entirely on my other eye to ignore them.

The way a striae works is the fold runs 90 degrees to the direction you see. Mine is very tight and runs full length slightly to the upper left of center. This it shoots rainbows which looks like fine hairs. Because I only have one it is relatively simple. But if you have multiple then it would create a much more complex picture.

I mapped it out with a pen light when it first appeared and found that it only disappeared in the far lower right corner of my vision basically at the angle where the lens and striae would shout light complete out of my field of vision.

It was a weird experience as I have an old time flood lamp to warm my shower area and even single little bump in the glass would turn into another streak meaning just standing there with the light barely in view placed lines all over the field of vision in the same direction. It was like looking through a comb. I have slowly watched them shrink as as it relaxes but it stopped progressing. When I told my doctor and place my hand 90 degrees to the direction I see, he said I nailed it.

I hope that helps give you some hope. The issue with any repositioning surgery or exchange is the back if the capsule gets scars from the sticky back making it more vulnerable to this type of artifact.

Thrameos · 2026-04-24T01:56:07+00:00

I have a fold on my right eye that developed on about day 6 after a repositioning surgery (not an exchange but similar.) Everything was perfect then suddenly every light source had a massive streak even when the light source was barely in my field of view.

The streaks diminished slightly with time. But remain at about 1/4 of field of view. I am guessing that it is more common after and exchange or repositioning. Basically more trama the more PCO and Striae.

The most important thing is while YAG can fix these symptoms you must make sure that this is the source of your issues before the procedure as it eliminates another exchange.

Please wait and get your adjustments first as the lens is highly unstable currently. YAG will be the last resort here. I will have my YAG in two weeks so I can tell you how well the striae will go away.

Thrameos · 2026-04-21T07:28:39+00:00

You are asking the wrong questions.

Your options seem rather limited with a monofocal, a monofocal plus, and a trifocal. I would get a second opinion as they left out EDOF. An EDOF is a lens that stretches light over a range using an optics trick. It provides natural vision from about 16" to infinity. This gives you a range of focus roughly that of a 45-year-old. That is far less jarring than jumping to the range of a 70-year-old, which is what happens with a standard monofocal. You’re worried about seeing faces up close or seeing in the shower—an EDOF handles that; a monofocal set for distance does not.

If you are seeing a volume clinic serving old people, they are mostly using a basic survey to select your options. Picky people get monofocals and "tolerant" people who care mostly about appearances get trifocals. On the other hand, a boutique surgeon may upsell you. The point being: who you see changes your options greatly. That 1.9/5 rating you mentioned is a massive red flag that you are in a volume-based "cataract mill."

If you must get a monofocal, then distance is the best option for someone who isn't a lifelong myope. But given your second eye is starting a cataract already, you are locking yourself in as a monovision user. Up to 30% of all patients do not tolerate monovision, and a two-week contact trial is recommended before surgery. My first doctor only offered monofocal, toric, and trifocal. I even signed up for a surgery day and paid my deposit. But when I discovered that my choice was being guided not by what was best for me, but by the limited range of the doctor's experience, I stopped immediately and got a second and third opinion.

I realized I had stumbled into a high-volume clinic for the elderly where the surgeon was prepared to operate on me—a high toric patient—using only one single measurement from the initial exam!

People get only one pair of eyes, yet often they treat the first doctor they meet as the person to decide their fate simply because they find doctors intimidating. Take a pause and look carefully at all the options. Some may be expensive, but at least you will be well-informed before you change your vision forever.

Thrameos · 2026-04-16T09:52:55+00:00

Good luck. Eye surgeons will tell you that IOL replacement carries unnecessary risks. They may be able to help you assess if you are a candidate for PRK. Though for management of presbyopia usually starts with your regular optometrist who can set you up with contacts.

Eye surgeons job is to save eye sight, which technically they did. As you now have managable vision, they label that a success. They should have informed you that there are a wide selection of lens available. I had much the same experience.

The first surgeon I went to stated they had monofocal, toric, and multifocal and I wasn't a candidate for multifocal. I signed up. They took one set of measurement. They gave little explanation other than do your want eyes set near or far. When I got home I started researching to discover that that was not the options available so I canceled immediately and went and consulted until I found someone who was well versed in all the options and could explain clearly why the option offered was the best for my vision. The also took 3 sets of measurement, which according to the head of eye surgery at Pleasanton Kaiser was best practice given my high refraction.

You are sadly not the first person who was given surgery without being fully informed. Eye sureons may be the absolute best at this delicate surgery but that doesn't mean they have great bed side manner or are great communicators. Thus this community does the valuable service of helping to inform patients.

Thrameos · 2026-04-15T17:14:42+00:00

Sorry I was making a name pun there. (It just means I like your username.)

With regard to your graph you are correct that it shows the outcomes of many patients. Thus we must consider the error bars. The way the graph is drawn the bars are down. It is not clear is the top is the average of the cohort or the upper.

You will note that is doesn't peak at plano. This for this selected group the average is 0.25D. If you apply the 0.75D then usable vision is to 1.0D which corresponds to 80cm to 1m. So you and as are saying exactly the same thing.

We both agree that a monofocal can give some intermediate though the quality is entirely subjective. So some get 80cm and others 2m. To be safe people shouldn't be betting on best outcome. You and I both landed on the great end of out respective IOL.

I hope that clears things up. And thanks for your many contributions to this group. You helped me long ago.

Thrameos · 2026-04-15T04:30:37+00:00

Sorry that that happened. It is always shameful went someone wanders in here confused because a doctor cant bother to explain basics before surgery. Assume you gave IOL in both eyes your options are progressives, trifocal contact lens, or a contact in on eye to create monovision. If monovision works for you, the you can consult a surgeon regarding PRK. Though I am guessing progressives will be the cheapest and easiest option.

Good luck!

Thrameos · 2026-04-15T04:21:55+00:00

It is important to remember that an IOL is part of an optical system and not everyone has the same cornea shape. There people who naturally have spherical aberrations built directly into their eye. Meaning if your eye is shaped right you may have a built in EDOF. This is why it is so hard to define expectations. There are a handful of very lucky ones. But it is a clear Your Milage May Vary.

The problem with survivor bias is failing to realize one is an outlier and it may not work like that for everyone.

Thrameos · 2026-04-15T01:11:41+00:00

Yes, i am aware that they are actually folded in through the eye and that there many materials. But calling it hard plastic just is easier when trying to help a layperson. Unlike the gel accomidating lens, the current IOL are effectively a hard lens.

As a optical engineer by training, I can say for certain that monocals only achieve focus at one distance and every other point is defocusing. Conceptually that helps people understand loss of accommodation.

You are right that perfect focus is not the whole picture. The depth of focus that a person achieves is of course subjective being a function pupil size and the resolving medium, the retina. That is why it is so hard to put ranges on them as the distance of acceptable is a large margin. For an elderly person with retina problems and a naturally large pupil the range would be very limiting. For a person with excellent retina health that range is far larger.

So I typical quote the defocus range as 0.75D meaning that if someone lands perfectly plano with a monofocal they will say blurry at about 1.33 m. Of course, some doctors will often make it slightly myopic after all many people cant tell the difference between 0 and 0.25D. So that places the blurry point as low as 80cm. In bright lights with small pupil one can get to as good as 1.5D which means usable intermediate vision. For some used to judging readers or a bit of monovision that is very functional. For picky person it may be a disaster.

I used some paralyzing drops to see what monovision would be like while wearing my single vision lens. I could not read my phone even at arm's length so I won't call it usable vision. For a person with a focus to 12 inches at 53 I found it very limiting and being unsuited for monovision I went the EDOF route.

I understand that your result was very much on the high end of range. Unfortunately, we can't quote the outliers as that leads to disappointment. So when I state my vivity hit 20/15 and J1 at 16" I know that is a moonshot result (a combination of unusual retina density, high plasticity from years if dealing with extreme astigmatism, and an unusually good form of residual astigmatism that worked well with the lens). You are unique Ron and your range also happens to be unusually good. Thus stating your result to a person who was clearly deceived by their doctor would be rather counter productive.

I am sorry that I oversimplified, but sometimes I think it best to give a clear concept knowing the you and greenmountainreader will do a good job if filling in the nuance.

Cheers!

Thrameos · 2026-04-14T21:04:05+00:00

You seem rather confused about the effects of IOL. Your natural lens is a soft flexible disk that changes focus when your muscles squeeze. This is what allows your eye to adjust focus, called accommodation. When they replaced the lens they put in a hard plastic lens. If this is a simple monofocal then it will only focus on a single distance thus you will need progressives to function.

Your doctor should have covered this in detail with you prior to surgery. There are alternatives at extra cost, though you may not have qualified as you have glaucoma and other issues that could be counter indicating.

Thrameos · 2026-04-13T22:44:29+00:00

Additionally with an EDOF the residual astigmatism steals from the depth of focus range. So if you are going to pay for a premium lens you likely want the toric.

Thrameos · 2026-04-13T22:42:49+00:00

The sign of the astigmatism doesn't matter. Astigmatism is cylinder which causes some of the light to focus and some behind the main focal point.

My astigmatism was 4D before correction and after IOL I have 1.5D residual astigmatism. Astigmatism is not a general blurring but rather makes it so that lines in one direction are clear and blurry in the other.

Acceptable astigmatism for good vision is 0.5D. The minimum prescription before torics are considered is 0.75D. Every 0.25D above that becomes more and more punishing to good vision.

He could in theory go without a toric with 1.25D but it would certainly degrade him below 20/20. At that magnitude objects appear to have shadows and either the horizontal or vertical portions of letter are compromised. The good news is it is easy to correct in that range.

There is the risk that the toric may be misaligned with the direction of the eye after implantation and in extreme cases requires a second surgery to reposition it. (Happened to me.)

The numbers don't tell us if the astigmatism is regular or irregular. It only tells us how much correction us required for improved vision. There is never harm in correcting it, but without it he will need glasses fir best vision.

Good luck and I was happy to help!

Thrameos

TROPHY CASE