Intraocular lens exchange. Remove Vivity for Envy after YAG capsulotomy. Reverse optic capture.

Added: 2026-05-12

[00:00:00]You had lasacic surgery in early 2000s.

[00:00:04]Yep.

[00:00:04]>> And then you're how old are you right now?

[00:00:07]>> I am 58.

[00:00:09]>> Okay.

[00:00:10]>> And then about March 2025, you had sounds like elective lens replacement surgery with the vividity lens in both eyes. Correct. And then in May 2025, you had Yag capstomy to both eyes. Correct.

[00:00:25]>> Mhm.

[00:00:26]>> It's now, what are we now? We're May 4th, 2025 and your main issue is your left eye.

[00:00:35]Correct.

[00:00:35]>> Correct.

[00:00:36]>> So, can you share what bothers you about your vision through the vividity lens from your left eye?

[00:00:42]>> From my left eye, it immediately cut off like my peripheral vision. And there's always a constant sense of like squinting like there's glare coming in.

[00:00:56]I feel like when I move my eye, a shuttering or a fluttering of vision and light. When I try to focus up up close, it kind of in both eyes, it feels like I get that crescent, dark crescent shape in my peripheral vision just on the outside. And it's very uncomfortable. I feel very fatigued by the end of the day. I just want to close my eyes. But there's that constant sensation of something just abnormal going on in my left eye that I just feel very unreed.

[00:01:37]I'm always feeling my vision like it's it's almost like trying to tell yourself to like not be aware of your breathing.

[00:01:46]I always feel my my vision in that left eye.

[00:01:49]>> Do you wear glasses for any reason?

[00:01:51]>> I do um use readers up close. Okay. But nothing to help your far vision.

[00:01:56]>> Correct.

[00:01:56]>> How's your quality of vision? Right eye, left eye.

[00:02:00]>> The quality the left eye actually seems sharper than my right eye.

[00:02:07]>> Have the same lens um in the right eye, but I always feel discomfort and like like I'm always squinting in my left eye to kind of keep the glare out.

[00:02:19]>> Do you get glare from your left eye?

[00:02:21]>> My left eye. glare from your right eye as well.

[00:02:24]>> Not not >> what does that mean? So I understand what you mean by glare.

[00:02:28]>> It just feels like something is almost shining in my in my left eye. Like when I move it very hard to describe.

[00:02:39]>> Is it there all the time >> in dim light? It's it subsides.

[00:02:43]>> Okay. So if you could enumerate the top three things that bothered you about your left eye.

[00:02:48]>> Top three things. the the loss of peripheral, that sensation of shutter or flutter with glare every time I try to move and refocus my vision. I kind of feel like that's a combination of a bunch of things right there.

[00:03:05]>> Just the tiredness in it.

[00:03:07]>> What do you notice out to the side >> when I am like trying to look close up >> in both of the eyes? I get that crescentshaped um shadow when I'm trying to like right now.

[00:03:18]>> Okay. And does it go away when you hold your hand out to the side?

[00:03:24]>> Yeah, that reduces it.

[00:03:25]>> It reduces it. Okay, great. And then why didn't you had the surgery done in New York?

[00:03:30]>> Mhm.

[00:03:32]>> Why didn't they want to help you?

[00:03:34]>> They I was just told that you'll get used to it. I think that it's just nobody wants to try to tackle, you know, or or has proficiency in doing something further to try and help these side effects. So, nobody I couldn't get any help.

[00:03:56]>> Okay. So, our our plan is to remove the vividity lens. We're gonna have to do what we call a vitrectomy because you've had a capsule and we're going to use a multif focal lens called the Envy and we're going to place the Envy multif focal in a different location than your current lens implant.

[00:04:17]Hopefully the different location that we place the new implant will help reduce the peripheral vision >> and hopefully the quality of vision, the glare, the shimmering will go away. And you've had these symptoms ever since you've had the surgery and it just they just never went away. They never went away.

[00:04:33]>> Okay.

[00:04:33]>> Yeah.

[00:04:33]>> All right. And your anatomy is not perfect. I kind of shared with you during our initial appointment. There's like a 90% chance I think we can get this done. There's a 10% chance we'll have to go to plan B. And so we're going to do surgery in about another hour or two and then uh we'll we'll see how you feel tomorrow.

[00:04:55]>> Thank you.

[00:04:56]>> Thank you. Great.

[00:04:58]So let's pause. So here we are in the operating room. We can see the vividity extended depth of focus I the YAG capsulotomy opening in the posterior capsule and about a 5.25 mm slightly desentered anterior capsularis with 360° of overlap of the vividity lens optic. We reopened the primary incision created one year ago and placed Helon GV into the anterior chamber followed by elevation of the anterior capsule from the surface of the vividity lens with the Dawn and felt spatula followed by visco expansion of the capsular bag with additional helon GV. A Connor wand is then used to dial the vividity out of the capsular bag and into the anterior chamber where we are able to use MST forceps with teeth and I cutters to hold the vivid lens, cut it into two pieces and then remove each half of the safely. Anterior vitrectomy is performed.

[00:06:10]We then sweep the primary incision with our 27 gauge canula to determine if there is any vitrius prolapse.

[00:06:19]Helon GV is then used to fill the anterior chamber anterior to the iris plane. The NV multif focal lens is then inserted into the anterior chamber.

[00:06:30]Additional anterior vitrectomy is used to clear vitrius visco elastic and any debris from the visual axis posterior to the Iol optic. Microforcepips are used to hold the optic and maneuver the right haptic posterior to the anterior capsule. And then the same sequence is used to maneuver the left haptic posterior to the anterior capsule. The lens optic is elevated anterior to the anterior capsule with a connor wand. In order to optimize the amount of anterior capsule to support the optic, the optic is rotated about two clock hours clockwise. Then the connor wand is again used to elevate the optic anterior to the anterior capsular rim. VSSs flushed through 27 gauge canulas allows us to gently and safely remove the helon GV from the anterior chamber of the eye.

[00:07:27]At the conclusion of surgery, the Envy lens is verified to be stable and centered and the surgery concludes successfully.

[00:07:37]Now let's talk to our patient one day after surgery. How is it?

[00:07:41]>> The eye, my left eye is feeling better.

[00:07:44]I don't have that sensation of discomfort every time I kind of look to the left or have that shimmering. My peripheral feels like it's improved. Um, not even 24 hours out and I I still have good up close and distant vision and it feels the vision feels more comfortable.

[00:08:10]I have typical, you know, post-operative feeling of of dryness, which is to be expected. But aside from from that, it feels like everything goal-wise is feeling good. I feel like this is so far a positive outcome. I feel more comfortable moving my eyes around and I'm pleased. I actually feel my my right eye now is the weak eye.

[00:08:36]>> Good. So, you have a vividity in your right eye. Now you have an envy in your left eye. You had shimmering when you would look around. You had the shadow out to the edge >> and those are less gone still.

[00:08:47]>> So I don't feel that that shimmering every time I move my eyes to the left. I feel like now my peripheral is improved whereas I feel like anybody could sneak up on me on my left side and you know I wouldn't know. So that feels more comfortable. The other thing now on my left eye when I would look up close, um, I don't see on that left side, I don't see that that crescent. I could see it on my right eye, which hasn't had the the new lens. I could still see up close that crescent shape on the periphery.

[00:09:23]>> It's gone when you look far away on your right eye, but it's it comes in when you >> on my left eye. I don't I don't see it anymore.

[00:09:30]>> I still see it on my right eye. Then when you're, let's say we give you something to look at, which eye sees better up close?

[00:09:38]>> Hands down, my left eye.

[00:09:40]>> Yeah, because you have a multif focal lens on your left eye. You have a a vividity. It's an extended depth of focus that doesn't uh give as good a near vision.

[00:09:49]>> Yeah, >> that's great. And so do you feel like were you using reading glasses before?

[00:09:54]>> Yeah. Yeah.

[00:09:55]>> So [snorts] do you think you could um >> see well enough now to not need reading glasses? Do you have your phone with you? Well, let's see. Let me let you borrow my phone. So, we'll have you look at let's say the weather. How easy is it to to read that now? You can hold it wherever you want.

[00:10:10]>> I I can I can read that >> comfortably.

[00:10:14]>> Yeah. Yeah.

[00:10:15]>> Would you need reading glasses to see that before surgery? Before yesterday's surgery.

[00:10:21]>> It's more comfortable right now.

[00:10:23]>> Yeah.

[00:10:23]>> Yesterday I would be straining more to see this. Okay. But this feels more comfortable made able to read that.

[00:10:31]>> Let me see. This is the size. All right. So, you're 2020 in perfect focus. All good. Any questions?

[00:10:42]>> In the future, would I be able to do the same thing on the right eye?

[00:10:45]>> You could.

[00:10:47]>> You We could do your other eye, but >> I think there's like a See how it goes.

[00:10:52]A lot of times people when they have when they're bothered with both eyes and then we do some type of exchange on one eye, they'll be good enough where they'll end up leaving their other eye alone. Um so it's not a requirement to do anything of course. Um if this combination works well then you might just leave it alone. This is what's called in the business mixing and matching different lens types. So, you have a a right lens that gives theoretically less nighttime halo, although I would like to know if that's what you perceive, and your left eye that gives a little more halo, but better range of vision. Any other questions or thoughts?

[00:11:33]>> No.

[00:11:34]>> And then tell me again, where do you live?

[00:11:37]>> New York.

[00:11:37]>> We're in New York.

[00:11:38]>> On Long Island.

[00:11:39]>> Oh, Long Island.

[00:11:40]>> Yeah.

[00:11:40]>> And you you you're a veterinarian.

[00:11:43]>> Yeah.

[00:11:44]>> What kind of animals do you take care of?

[00:11:46]>> Dogs and cats predominantly. Yeah.

[00:11:48]>> Okay. Yeah.

[00:11:49]>> Okay. Good. Good times. All right. Um, we're here for you if you need us. You can call or email me if you need me. Um, if you want to come back, you're always welcome to come back. If you're doing fine, you can just be seen by your opthalmologist or optometrist. Okay.

[00:12:04]>> Back home.

[00:12:05]>> Um, I'm glad it worked out. Beautiful.

[00:12:07]>> Thank you, Mary.

[00:12:08]>> Yeah. Thanks for coming all this way.

[00:12:09]Appreciate it.

[00:12:10]>> Yes. Okay.