Cataract Surgery Just Completed - Sharing My Experience - PanOptix Tri-focal
Posted , 30 users are following.
I was a lurker for awhile before I registered and started posting.Just had my cataract surgery done (Right eye one week ago, and Left eye yesterday).
Thought I'd share my experience. To avoid wall of text, I’ll break it up into separate posts (which won’t all come today). Areas I'll cover include:
- Background
- Choice of IOL
- Laser vs Traditional Surgery
- Surgery Experience
- Post Surgery Experience
- Follow-up with occasion longer term updates
10 likes, 103 replies
RonAKA janus381
Edited
Thanks for your very detailed reporting of your PanOptix experience. I found it very informative, and I can see how you ended up going down this road. I did consider the PanOptix as a friend had them put in both eyes nearly a year ago. She was initially impressed, but as time went by she was less impressed. She's afraid to drive at night, and has problems reading and sewing in anything but very bright light. The latest update I got from her is that while distance vision during the day was excellent in the beginning she is now having trouble reading distant road signs even during the day. She reports they are not sharp. Do you think that would be PCO?
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Early in your post I see there was some discussion about light transmission of various lens choices. Perhaps you have seen it but I have found a report that compares some of the multifocal lenses. On the PanOptix they report percentage light transmission (balance) for near/intermediate/far as 44/22/22. That adds up to 88%, so they must be considering the reduced transmission due to blue light filtering and just normal lens loss of light. The B&L Fine Vision on the other hand is reported at 35/17/48. That adds up exactly to 100%, and it appears to be a blue light filtering lens also. So, this does not seem like a true apples to apples comparison. It does seem to indicate that the Fine Vision lens puts more emphasis on distance and less on intermediate. I also see that there is some difference in pupil dependence, but not sure what that means. In any case here is the comparison table, and name of the report.
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Multifocal intraocular lenses: Types, outcomes, complications and how to solve them
janus381 RonAKA
Posted
RonAKA,
I'm not doing as much investigation now, as I'm well past surgery, but my quick thoughts are that the chart you referenced can't be comparing apples to apples.
I'm am quite certain that the light distribution quoted in that chart are all before considering if there is any "loss of light" due to splitting of the light into different focal points (all of them add up to 100%).While the very last quoted figure for PanOptix (unpublished) seems to be showing the distribution of the usable light only (so it adds up to 88%).
When I was doing my research (and I quoted the figures in one of the earlier posts in this thread), the PanOptix had the highest light transmission among all tri-focals and multi-focals at 88% -- higher than Fine Vision at 86%. Search for article "Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different lens designs".
While tri-focals are significantly better than older bi-focals (such as the Alcon Restor -show shows 50% + 50% = 100% in the chart you found -- can't be apples to apples) in terms of usage of available light, there will still be some loss of usable light. With 88% transmission, I really don't notice any contrast issues, except for reading in dim light (such as menus in a restaurant) where I will use my smartphone to add some light.
On PCO, yes indeed, if your friend thinks vision is worse now than immediately after surgery, then PCO could be the reason. Lots of people of posted that if you live long enough, you will get PCO for sure.Her doctor should look into this.The other factor (which my doctor has diagnosed using OCT scans) is dry eye can be worse after cataract surgery, and this can result in sub optimal vision.
RonAKA janus381
Edited
Thanks for your comments and link to the paper. My friend is scheduled for an eye checkup in a couple of months. Hopefully they will determine what the issue may be. Sounds like needing YAG for PCO is not unusual. I doubt that her issue would be the dry eye thing. Her doctor had her taking all kinds of very expensive eye drops both before and after the surgery. In comparison my doctor is recommending very minimal eye drop use. It seems doctors have varying opinions on the use of eye drops.
Sue.An2 RonAKA
Posted
the eye drops one takes before and after surgery aren't for dry eye. They are to keep infection away -I had prednisolone and antibiotic drops. Cataract surgery can induce dry eye and one can take artificial tears for it.
janus381 Sue.An2
Edited
I think I posted in another thread what eye drops my ophthalmologist suggested for my dry eye:
She gave me a sample bottle of HyLo, whose main active ingredient is Sodium Hyaluronate, but said HyLo is very expensive.
She suggested looking for drops with trehalose instead, so I'm using Thealoz Duo, whose main ingredient is thehalose, followed by a smaller concentration of Sodium Hyaluronate.
These drops are not as common as Systane or other brands that you find at most stores.
I also found that HydraSense (known more for nasal rinses) makes an eye drop with Sodium Hyaluronate at a significant lower cost than HyLo (but the concentration of may be lower). I will ask about HydraSense when I see her next.
RonAKA janus381
Edited
Thanks for the information. My wife is into the dry eye drops. I will have to check to see if those other drops are available here.
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As for my friend, I recall that she was taking drops for dry eye as well as the antibiotic ones as I believe some have the view you cannot get accurate pre-op topography measurements if you have the dry eye issue. My doctor does not seem to be concerned at all about the dry eye thing, at least at this point.
Sue.An2 janus381
Posted
haven't heard of those types of drips. I had been using the preservative free Systane . I don't need them as much as i did. Always good to learn of other brands that are good to use.
ayeaye RonAKA
Posted
mine also no drops days before surgery...only minutes before the surgery itself
RonAKA ayeaye
Posted
The pre-op and post-op drops seem to be a controversial subject. Some do pre-op and others do not. Some do an antibiotic injection into the eye as part of the lens implant procedure and others do not. The length of time for drops after the implant seems to vary a lot too.
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At the bottom there is an interesting (but difficult to read) article on the issue. Various doctors give their opinions on what is right and what is wrong. One example from a doctor that is against pre-op drops:
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"Dr. Arshinoff’s infection-control protocol doesn’t involve any preoperative drops before the patient walks into the OR. “I think it is a really bad idea to give patients topical antibiotics for a few days preop. If you do that, microbiologically, the drug kills off all the sensitive bacteria, but it leaves the nutrients on the conjunctiva for resistant bacteria to grow,” he says. “You encourage resistant strains because you’re selecting for them by killing off the bacteria that are sensitive to the drug. When patients come to the operating room, they’re not there for long preoperatively, so then I give them topical Vigamox (Alcon, Novartis) three times over 15 minutes: It kills off all the sensitive bacteria that are there, but there isn’t enough time to grow resistant strains to colonize the ocular surface.”
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That seems to make some sense to me. The preferred antibiotic seems to be moxifloxacin. I don't have much idea what my doctor is going to do although he recommends using the Vigamox branded moxifloxacin to minimize the number of days/times drops are used after the operation.
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In any case, here is the name of the article:
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After Surgery: Shots, Drops Or Both? Kristine Brennan Review of Ophthalmology
Sue.An2 RonAKA
Posted
Most are given pre-op drops. Perhaps when given at time of surgery that is OK as well. i am no expert. However several who have had this done on NHS were given zero anti-inflammatory drips and developed Cystoid macular edema (CME) as a result and it took weeks for them to heal having been given drops after this complication.
My personal preference would be the drops either pre or during as a prevention.
janus381
Posted
8 MONTHS AFTER SURGERY - CHECKUP AFTER YAG ON LEFT EYE
A quick update.Summary of prior posts - distance vision was great 24 hours after surgery.One month post-surgery check-up found left eye vision blurry (I had not noticed this using both eyes) - PCO suspected and confirmed.YAG done not quite 4 months after surgery on left eye to clear up PCO.
Next follow-up after YAG showed left eye had improved, but still a little fuzzy. OCT scan to confirm no issues with retina. OPD scan diagnoses dry eye. Ophthalmologist suggested eye drops:
Had next check-up today.
My vision is very good with both eyes. It just with the single eye test that I still notice left eye is not as clear. Ophthalmologist will see me again in another 3 months to see if continuing use of eye drops improves left eye even more and to make sure there is nothing else going on.
I'm very pleased with the care I'm receiving from my ophthalmologist.
Chris53317 janus381
Posted
Good to hear your Janus. Your experience is similar to mine, but I had YAG on both eyes. Was 20/20 one month after YAG but distance vision was not as sharp as I would like. My Opthamologist recommended Systane Complete which I think has helped, but it is difficult to tell with these gradual changes. Currently, faces seem slightly out of focus at a distance of 30' or more. Next checkup is in a month, and I will find out it it is my astigmatism of 0.25/0.75, the power of the IOLs, dry eyes, or something else. Otherwise all is good.
hil_jac janus381
Posted
Hello all. My surgery was on Monday (9). I had the Pan Optix implant. I am having the side effect of the crescent or shadow in my peripheral vision. My first check up went well, and the doc said this was normal and should go away with time. I can deal with that, but today, it seems worse and a little out of focus. I felt my vision was getting better day to day, but today seemed like a set back. I'm thinking of making an appointment tomorrow, but just wondering if anyone else has had this experience.
RonAKA hil_jac
Posted
You may want to google dysphotopsia. It sounds a bit like negative dysphotopsia.
janus381 hil_jac
Posted
When is your next check-up? You are still in the very early days after surgery so your eyes are still healing. I didn't have good intermediate vision until one week post-surgery, and near vision took longer -- about one month before i could read newspapers on the subway. And I opted for laser cataract surgery which provides faster recovery (even though my surgeon did not upsell laser).
If you notice a really significant worsening, then call your doctor up. if it's just slightly worsening, it does take time for your eye to heal and i wouldn't be too worried.I think if you read stories from others who have posted, you will see fluctuating vision in the early days is pretty common.
I assume you have been given a course of eye-drops to use post-surgery?
hil_jac janus381
Posted
My second follow up is with the surgeon this coming Tuesday. I was originally scheduled to see my regular eye doc for the follow ups, but with this side effect, I will drive the extra miles to see the surgeon. I feel I can wait until then. Wearing sunglasses helps, and I also learned wearing my old prescription glasses helps. Although the prescription is very week, I don’t want to use my glasses too much bc I think I will adapt faster without the use of these things. I also chose the laser surgery, and I have been diligent with the eye drops 4 times a day. I am also using Systane drops when needed.
hil_jac RonAKA
Posted
My sister had this happen with her surgery This is probably what is going on with me as well Very annoying, and it makes me feel slightly ill as well. I am praying it subsides soon