Cataract Surgery Just Completed - Sharing My Experience - PanOptix Tri-focal

BACKGROUND

I have been very conservative with eyes. No contacts ever, no laser surgery. Just used glasses, moving to progressive lens as I got older.

I golf once per week during the season, and was having trouble seeing the ball (I do hit it very far, LOL!). I attributed problems to the progressive lens with the ball moving out of the distance portion of the lens as it dropped, and also to my fit-over sunglasses (seeing through two layers of lens isn't going to be as clear). But I also had trouble seeing in bright sunlight due to glare, and eyes would routine tear-up uncontrollably due to glare and wind mid-round.

Night vision, I started thinking that a very large percentage of cars had high beams on, as ongoing headlights that were bright really bothered me. I realize now that I was also seeing starburst.

My 2016 eye exam with optometrist showed only mild cataracts. Next exam in December 2018 with different optometrist revealed cataracts in right eye were so bad that they would have had to take away my driver’s license if my left eye was as bad.Fortunately left eye had more mild cataracts.

Optometrist thought that I'd probably need to do both eyes as based on my eyesight, I might feel unbalanced with cataract surgery in one eye only.Later the ophthalmologist didn't think the Left eye was as mild as the optometrist thought. So I ended up doing both eyes.

CHOICE OF IOL

Monovision was not an option for me as the cataracts in my right eye were bad enough that I could no try out monovision with contacts to see if it would work for me.

While I didn’t mind wearing glasses, now that I had to have surgery, I wanted to take the opportunity to reduce my dependence on glasses, and possibly even be spectacle free. Would be nice to wake-up in the morning and be able to see reasonably well without finding my glasses first.

I also didn’t really fear artifacts at night, because I realized that the problems I had with ongoing car headlights were already pretty bad; halos or whatever couldn’t be worse.

To keep things simple, many eye clinics (I'm in Toronto) outline the choices in this way:

1.A basic mono-focal IOL that does not correct for astigmatism (no cost at all, surgery and IOL paid for the government (you will need glasses)

2.A mono-focal IOL that adjusts for astigmatism (a toric IOL), and you pay for the incremental cost.

3.Or a “multi-focal” IOL, here they really mean a premium IOL based on what’s best at the time and don't mean an older tri-focal. Two years ago, they would have used the Symfony EDOF in this category. So many are using "multi-focal" as a generic term.

Before meeting my surgeon, I did my research and had heard of all the possible negatives with the multi-focals (i.e. bi-focals). I was particularly concerned with lost of contrast due to lost of light when you split the light into two focus points. So I asked my surgeon about EDOF such as Symfony. She said they haven’t used that for two years, and the latest multi-focals have solved the physics and have been getting very good results, and don’t have problems with reduced contrast sensitivity.

She said they currently use either the Alcon PanOptix or the Finevision IOL depending on measurements. I would get the PanOptix. I didn’t “choose” the PanOptix, but I choose the premium lens option, and my clinic picks the best premium IOL based on what's available in my country right now.

I went home and did my research and was really impressed by all the things I read about the Panoptic (which I’ve shared in some other threads). It is the most recent tri-focal, having just come into the market in the fall of 2015, and is still only available in about 70 countries today. My many studies show that PanOptix performs better, with better vision and fewer artifacts than other IOLs and other tri-focal. Very high satisfaction from patients and surgeons.Subsequent discussions during and after surgery with clinic staff seem to show they really only use the PanOptix now.

In the follow-up checks after the cataract surgery, I had further discussions with my surgeon about IOL choice.She is conservative in her treatments, and used to discourage multi-focals due to artifacts and higher level of dissatisfaction. But now that the tri-focals are available in Canada, she loves the PanOptix. She mentioned the senior surgery at the clinic also loves the PanOptix and also uses it for refractive lens exchange (i.e. cataract surgery before you have cataracts) – which she doesn’t really like to do.

PanOptix IOL has both UV filter and Blue Light filter. Alcon and a couple of other manufacturers include a blue light filter to reduce the risk of macular disease, and reduces glare, with very little negative effects. I know some other manufactures are do not believe a blue filter helps.

The AT LARA EDOF only came to the market a couple of years ago, so we will have to see what studies show in terms of performance of the AT LARA vs the PanOptix as they are very different technologies (EDOF vs tri-focal). But Zeiss lens are not likely to be available in my country for many years.

LASER VS TRADITIONAL CATARACT SURGERY

I don’t think anyone should feel the need to pay extra for Laser Surgery, but I choose the Laser option.

I was surprised that my surgeon did not try to sell the Laser option at all.She told me that studies show that the outcomes are pretty much the same after one year.

So why did I choose Laser?

•While studies show the outcomes are pretty much the same, the thought of “more precise incisions, more precise placement of IOL, less energy to break-up the cataract” were appealing to me.

•While outcomes are “pretty much the same”, is there even a very slight chance (say even a 0.5% chance of a better outcome with laser)?

•And perhaps the biggest reason for me is I’m a big chicken when it comes to eye surgery. I don’t like to watch videos of how cataract surgery is done – I really don’t need to see it. The idea of a laser making precise incisions, versus a surgeon (no matter how skilled or experienced) making manual incisions…. Well I’m going for Laser!

•The other advantage with Laser is that if your astigmatism is modest, then the astigmatism can be corrected as part of the Laser Cataract Operation with Limbal Relaxing Incisions. I didn’t know at the time of my decision if that would apply to me, but in the end, it turns out my Right eye had astigmatism corrected with the laser, while my Left eye was borderline so they went with a Toric lens in the Left eye.

In the follow-up appointment with the surgeon, I asked her some more about her views on this. She said she does not want to make patients feel that they need to pay extra for laser to get better outcomes, but there is no doubt the laser is more precise than she is in making incisions. And if it were her mother, and money was not a concern, she would choose laser.

So no one should feel that they need to pay extra for the laser option.Outcomes are pretty much the same. But I just felt more confident and relaxed with the precison of laser, and even that alone is something. I did have absolutely no pain during or after the surgery, but that's a post for another day!

Thanks for sharing your story - it will certainly be helpful to others who come here looking for support and options!

SURGERY EXPERIENCE

Only eye drops I was asked to do myself before surgery were drops to dilate the pupils done twice just before I left for surgery.

At the clinic, they give me a heck of a lot more eye drops in preparation. The assistant doing the drops only mentions the purpose for some of them. But I’m sure there were more drops to dilate the pupils, and this is probably when they first apply an antibiotic eye drop. There are numbing drops. And finally a “happy pill” that you place under your tongue to reduce anxiety (can’t recall the exact name of the pill – starts with an “A”, but it’s normally an anti-depressant). I didn’t feel any noticeable change from the happy pill.

Since I choose the laser cataract surgery option, the first step is with the laser to break-up the cataract and make the incisions to remove the natural lens. I also was told at this time that the laser would also correct the mild astigmatism in my right eye.

Laser Portion of Procedure

Some more numbing eye drops, then they put a rubber ring with some suction around your eye, and fill the ring completely with a mild saline solution; some of the saline solution drips down the side of your face. The ring keeps your eye open, and apparently, it’s necessary to have this fluid layer for the laser part of the operation. I typically have some problems keeping my eyes wide open for regular exams or eye drops, but the ring filled with the saline solution is actually quite comfortable.

Looking into the machine, I see some red ball like objects. The laser is doing something, and the doctor and assistant say nice words like “good” and “perfect”.Then I see green laser flashes. And I’m done with the laser portion – With the incisions to remove the natural lens, the laser to break up the cataracts, and the laser for limbal relaxing incisions to correct the mild astigmatism in my right eye. The laser part of the operation is easy peasy.

EXTRACTION AND IMPLANTATION

I then move the adjourning surgery room to complete the surgery. This part will is just like traditional cataract surgery. They do “draping” which is covering your face with fabric, that I assume attaches to your upper eyelid, so they can pull gently to keep it open. Surgeon cuts a tiny hole in the fabric so to expose the eye.I’m asked to look into the middle of three lights (that are attached to the microscope the surgeon uses). The lights seem to move around – I believe the microscope itself is not moving, but the lights appears to move as your lens shifts around during extraction). The surgeon removes the natural lens and inserts the IOL, you feel some pressure. The surgical staff is monitoring heart rate and blood pressure.There is no pain but it's not pleasant and there is mild discomfort during the extraction and implantation part of the procedure.

I mentioned my surgeon really does not try to upsell the laser option at all. That day she was doing about one third laser and two thirds traditional.

While the laser option seems very quick, I’m probably at the clinic a few minutes longer than for traditional, as the staff need to do a few things to prep me for the laser, then I change rooms, and the staff need to prep me for the removal and insertion.

But the surgery was smooth. No pain, no redness afterwards.Some very mild stinging when I do the eye drops afterwards. Next day my distance vision was measuring 20/20; intermediate and near vision will take from one week to 3 months to fully adjust. But distance being 20/20 is a good sign.

OTHER EYE THE FOLLOWING WEEK

When I had surgery on my left eye one week later, I knew what to expect. With my left eye, the degree of astigmatism was a little higher and due to the positioning of the astigmatism, the surgeon decided that the best results would be achieved by going with a toric lens instead of correcting the astigmism using the laser. With the toric lens, the second part of the procedure (insertion of the IOL) took longer as with toric lens, the surgeon needs to precise align the IOL on different dimensions.

Thanks for sharing.

Cheers

Christian