Bad near & intermediate vision after Panoptix Multifocal
Posted , 15 users are following.
Hey all,
Looking for some insight. I had developed cataracts in 2018 at 34 yrs of age in my Dominant Eye. Recently had surgery on 6/18/20 with Alcon Panoptix put in. 3 days later i had pretty good distance 20/30 and holding at that 10 days after surgery.
However my near and intermediate is pretty poor. I cant read my phone and anything within 15 feet is blurry. Am I over worrying? Is this normal? Or if not has anyone had something similar as me and have near improve over time.
I have larger than normal pupils (not sure how many mm, but I read that large pupils dont do well with multifocal lenses. If thats the case, I feel ripped off for the $4k surgery and at this rate I would have just gotten monofocal at distance and have better near and intermediate than what i have now.
Please let me know if I'm just impatient. One of the staff told me that my vision could stay at where it is, and if necessary do Lasik for another $500 to "fine tune" my vision.
thanks everyone!
0 likes, 25 replies
RonAKA iamdecay
Edited
I have no personal experience, but have a friend that has the Panoptix in both eyes. She said the vision improved over a longer time than just a few days. She has had them for over a year now. So you may want to wait longer before making a decision on them. Overall she was satisfied with the distance and intermediate vision. But, she has been less than impressed with close vision for activities like sewing and especially in lower light levels. She routinely uses non prescription reading glasses for those activities. She does have the halo effect at night and does not feel comfortable driving at night because of it.
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I'm not a medical professional, and while there are some issues with larger pupils, I think they are mainly in dim light (pupil open) and with light coming from the side to cause vision artifacts.
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Not sure about a Lasik solution either. It could be used to correct any refractive error causing a loss in distance vision. It might help if they have over corrected your vision and made you far sighted. The normal practice is to slightly undercorrect to leave a -0.25 error. It could also be used to correct any residual astigmatism. A starting point would be to get your vision checked to see what your residual error is for refractive and astigmatism. But, I would wait for 6 weeks or so before doing that to make sure things are stable. Of course there is also the option of eyeglass correction of residual error.
Chris53317 RonAKA
Posted
It can be a bit of a "crap shoot" as there are so many factors involved, i.e., how good were the measurements taken before surgery, did the surgeon specifically under correct, how have your eyes responded to the surgery, etc. I had Panoptix in both eyes about 10 months ago. Reading and intermediate were good right away, but distance was maybe 85%. The first eye was initially 20/25 and the other 20/30, but they eventually settled to 20/20. Reading and intermediate remain good, distance has improved but could be better.
Only 10% or less of my activities are distance related, so all ok.
As Ron said, give it at least 6 weeks to settle down, maybe even 3 months. Your eye doctor may also recommend drops for dry eyes as this condition can affect the curvature of your eyes resulting in distorted vision.
Worst case, but not the end of the world, would be glasses or LASIC. Also need to determine if there is any residual astigmatism.
iamdecay RonAKA
Posted
Thanks Ron. I think for now I'm going to get some second opinions and see if they think my doctor did a proper job.
To be fair he was one of the highest reviewed in my area, and the other opinion I will be receiving is highly regarded as well (actually performed a procedure on Kobe Bryant)
I requested a medical record form so I will be able to look at that and try to understand more of what happened.
Sue.An2 iamdecay
Posted
Just a thought given your age you likely have very good vision in your non dominant eye. Could there be some issues with balancing your vision? As others said give it time as the healing process is 6 weeks and you'll see changes during that time.
iamdecay Sue.An2
Posted
My other eye is -0.75 and my eye before I had cataracts was the same. Now it is +1.0
I asked the doctor and told me my pupils are dilated to 8mm at night, and I have read that multifocal IOL's are not good for individuals with larger than 5mm pupils, I will ask about that during my next check in as well.
I am still one 1 drop twice a day, so maybe it will get better over time.
Sue.An2 iamdecay
Posted
Just a thought given your age you likely have very good vision in your non dominant eye. Could there be some issues with balancing your vision? As others said give it time as the healing process is 6 weeks and you'll see changes during that time.
janus381 iamdecay
Edited
Iamdecay:
I may have been one of the first on this forum to post my experience with PanOptix - very long thread with experience from surgery to several months after surgery. It's on page 2 now as last post was 3 months ago -- titled "Cataract Surgery Just Completed - Sharing My Experience - PanOptix Tri-focal"
I was opposite of Chris. I had really good distance vision (20/20) immediately 24 hours after surgery, but intermediate (which is computer screen distance) took about one week to clear up, and near (smart phone and reading distance) about one month. I knew it could take several weeks to adjust, but I was reassured by my doctor at my 24 hour post-surgery consultation that everything looked good and should improve, and having 20/20 distance right away was a good sign.I saw my doctor again at one month post-surgery.
While you can expect improvement over weeks or months, I think your doctor should be giving you more advice than just telling you that you can get laser to "fine tune". Do they see any issues with the lens or placement of the lens? What do they think about your larger than normal pupils, and the impact that has? They should be giving you more advice and attention, even if it's just reassurance that things should improve. When is your next check-up with the doctor?
iamdecay janus381
Posted
Hey Janus, thanks for your response.
When you say your "near" got better after about a month, was it progressive, or was it kind of during the last few days of that month. My near vision has been the same. I can't even read a book no matter 6 inches or 12 inches from my eyes. I can't even tell what language it is. It doesn't look like words. On a sheet of paper, I can only read fonts that are around 12-14 and in bold. Anything less is illegible. BTW I am currently 19 days post op.
They keep saying the lens is well-centered and said that large pupils had issues with IOL's but the newer generation IOL's like the Panoptix and Symfony do not have those issues (I'm not too sure on this, as some of the articles I seem to remember are from the early to mid 2000's.
My next check up is 10 days from now. My IOP pressure spiked from 26 (pre-surgery) to 48 (post-surgery) so that was his concern. He seemed to say "Your vision might stay like this, or get better". When informing them that I was upset about the current state of my vision, they tried to tell me that it might get better, and if it doesn't they would like to perform Lasik.
However I have been reading that Lasik is not good for individuals with large pupils as the machines have a range of adjusting 6mm-6.5mm of the cornea (I found that my pupil at night is 8mm) which could easily result in even more halos, starbursts, double vision for someone with large pupils like myself.
I am getting a second opinion (possibly a third) before I go back to my doctor, to see if I can get another opinion. For me, I think the power of the lens might have been off since it was hard to get accurate readings through my cataracts (20/100 prior to surgery). I just feel upset that they said I would have good extended vision from near to far, and right now I barely am getting 1/3 of that for distance.
janus381 iamdecay
Posted
You asked if my near vision got better progressively, or kind of more all at the end.
It hard to tell. But near being poor initially was weird for me, as I've always been near-sighted. So it was wonderful that my distance vision was 20/20 24 hours after surgery. But like you, near vision was not good, and unlike before surgery, where I could just bring the thing I'm trying to see closer, that didn't help in the initial period.
I mentioned in my long post, that I did get cheap readers to help initially, but tried to avoid using them so that I gave my brain time to neuro adapt.
Thinking back, it would have been hard to notice any improvement in near vision in the first couple of weeks. Then it's hard to say if the improvement was progressive or all at the end of the first month.
I haven't had to look into laser vision correction, so no idea how it would work with a tri-focal. I have heard from many sources that PRK has a longer recovery time, but less risk of major complications that LASIK. Perhaps PRK is an option for you if LASIK isn't suitable. But let's hope your near vision improves. I was told that it could take weeks or even months to fully adjust.
janus381
Posted
Also, as Chris mentioned, it's pretty common for cataract surgery to cause dry eye in many people, and that can impact vision. My eye doctor also recommended some advanced eye drops, which I mentioned in my long post about my experience. Thealoz Duo is the one I'm using. Hi-Lo is also very good, but expensive.These are more specialized eye drops than your standard Systane, etc....
RonAKA iamdecay
Posted
I don't see how large pupils could cause reading issues in bright light. The pupils will be closed right down due to the bright light, just like someone that does not have large pupils. The large pupil issue should only come into the picture in dim light.
soks iamdecay
Posted
sorry u r dealing with this at 34. there is no under or over correction with bi or trifocal. the + power is what it is but the focal point will move for individuals.
i have read on here that many patients with trifocals report that near became better in a months time. so maybe that is what is happening. good luck.
large pupil is associated with poor near and dysphotopsia. however poor near should not be the case with a trifocal.
iamdecay soks
Posted
thanks. I guess my worry was i'm much younger than the average individual that had cataract surgery, and my healing time seems to be taking longer than others. i was just worried. i guess the best thing to do is wait at least a month. i was trying to also read as much as i could so in the case i needed a lens replacement it could be done before its too late. Again im no expert but from what i read in a support group, the longer you wait the less your options become - I guess that info got me a bit anxious
soks iamdecay
Posted
you can wait but dont have a YAG if you want to consider lens replacement. i got this at 41 and it really sucks. i can understand how difficult it must be for you. if you dont see lens edge at night then your pupils may not be as large as you think.
iamdecay soks
Posted
yea i definitely wont consider YAG unless everything else gets taken care of first.
and yes i can see the lens edge both during the day and night, although a bit harder during the day. and it appears only if i try to look for it by rolling my eye up.