Choosing new lens with explantation of Panoptix.

I am in North Florida. I know why surgery or better the outcome is not desirable. Unfortunately I have short eyes and the Panoptix lens moved forward creating myopia. It is also opacified and that is the reason of blurry vision, lack of details. I don't know if this was predictable. My doctor is a glaucoma ( I have it mild) and cataract specialist. She has followed me for about 10 years so I think she knows me well. She performed the surgery. In this last days I was thinking that monofocal was the best and the safest for me despite its limitation but today she spent a couple of hours with doing an analysis of the eye and explained that in her opinion I would get more benefit with Vivity, Of course it has to be my decision. She described the lenses as acting like monofocals. Oh well, even Panoptix was described as excellent with only mild halos. Not really! What kind of side effects are you getting from your monofocals?

Hi Claudia,

As long as you feel comfortable with her then that's all that matters. I don't know enough about eyes to say if she should've could've predicted this.

With my monofocal, I am experiencing flickering on the edge, distorted vision in my outside peripheral when I move my head and a bit of shadows on the outside edge. I've only had the IOL in my eye for a little over 4 weeks but I plan to go back to my ophthalmologist next week as it hasnt gotten better. I still by behind what I said about my range of vision though. Check my thread here where some people explain how their monofocal range of vision is: https://patient.info/forums/discuss/if-you-have-a-monofocal-set-for-distance-what-is-your-vision-like-at-close-up-intermediate-etc--727412?page=0#3665979

Hi. May I ask what strength you have got in your monofocals?

//Evelina

"The one further comment I would make is that I was quite surprised with my monofocal lens on how close I can see with it"

Would agree with this. I'm starting to think that multi-focal IOL's are over hyped just to make money.

Ron, with your great results with your monofocal, why wouldnt you just go with that in your other eye?

Do you experience any negative side effects with your monofocal?

Thank you! Yes i saw your other response. I have a couple of days to decide. Sure Vivity seems promising but we know very well how they make their story looking like gold. I know that if I go with monofocal lens I will see well at distance, cristal clear but not near on intermediate but Kevin says he can and I heard many saying that after their monofocal implants they were able to read even newspapers. I don't mind wearing glasses and I know, because I used them for long time that progressive lenses are more comfortable and precise then readers. Said so, I have to decide: vivity = doct. opinion quality of vision and life and all of her patients are happy( my opinion yes it could be true but it might be risky) monofocal = straigh forward proven to work. Ah by the way I asked her if she had other patients like me with Panoptix failure and she said only 1, so I am number 2.

my 2 cents... how close one can see with monofocals depends on many factors, residual spherical aberration being a key one. Many people end up getting good intermediate and functional near with monofocals. Age is also a factor as corneal aberration increases with age with greater chance of ending up with positive residual aberration after the implant!and thus greater depth of focus.

claudia, i haven't had an IOL implanted yet but a well respected surgeon I consulted with, gave me two options: PanOptix if I'm okay with night time disturbance, and Vivity if I don't want to deal with such issues and had good opinion of Vivity. I'm not sure if you're getting the lens implanted in one eye or both. if just one eye, one of the questions to ask the surgeon will be about quality of vision in dim light. another question for some people is glistenings but since you already chose PanOptix, i assume its a not an issue for you. and the lastly I wonder if the surgeon only uses AcrySof lenses? if not, Eyhance may be another consideration. but above all, the most important thing is to match the lens to the eyes, have proper power calculations, and implant and center the lens properly.

i wish you all the best with whatever decision you make for the exchange.

I am going to have both eyes done,either with Vivity or monofocal with distance. Panoptix was my first choice and I did first eye only to find out I got all the side effects. When they say mild halos and starburts beware that it may be like that or much worse, plus it is very subjective. For my personality they are very bad but I know I am not overreacting. the street lights in the parking lot have very wide starburst with spikes of glowy light that connect one to the other. It is like a canopy of lights. Interesting but I don't want to see that. Driving was out of question. My doctor as an exchange offered Vivity or monofocal but said it was up to me. She also have very good opinion about this lens. I am considering if I want to be "safe" with monofocal ( can I go wrong with this?) or if I want a better broader vision, risking with Vivity not the halos but maybe loosing a bit of contrast sensitivity. I do have a controlled mild glaucoma and contrast sensitivity is important. . I just watched the video on youtube/zoom that you suggested. Very informative as I am just like case#2 they discussed. That patient could be me. Interesting that many of them in that discussion choose monofocal instead of multifocal or Vivity even though it was possible. They are expert and ruling out a multifocal, that makes me think twice about that.

Going with a second monofocal and monovision is at the top of my list of considerations. Going with two monofocals for distance is going to require glasses for sure for reading. With monovision I can go 95% of the time with no glasses. I have been caught a couple of times in a store where I could not read something small, but other than that I only wear glasses when I take my contact out of my non operated eye. Monovision is not perfect vision, but it is very convenient vision. I would consider a Vivity in the second eye as an option that I will bounce off my surgeon when the time comes. I would only go with the Vivity if he thinks it will give me better overall vision than two monofocals and mini monovision. He is very negative on multifocals like the PanOptix, but I don't know where he stands on the Vivity. It is new, but I think by the time my turn comes up he should have tried it on others...

Yeah I was just thinking, since you've had such great results with your Acrysoft monofocal, why risk it and go with the Vivity which has very little patient reviews, possibility for negative side effects. Can't trust what these manufacturers say about their IOL's and how great they are.

I would consider the Vivity a much lower risk option than something like a PanOptix. I have a friend that got both eyes done with PanOptix. Her outcome was much better than yours but she does have issues, especially for reading and fine work in lower light. She uses +1.75 readers for that. Also she does not feel that driving at night is safe due to the halos. She is not considering an explant, and has decided to live with it.

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There are all kinds of combinations to consider but with your doctor recommending Vivity and feeling confident it is suitable for you, I would think about doing Vivity in the explant process, and then deciding after that what to do with the second eye based on the outcome of the first. I would even think about doing this eye, which I recall is the non-dominant eye, with a very small under correction to improve the chances of reading with it. It is normal practice to target being -0.25 for under correction because they never know exactly what they will get and they don't want you to end up on the + side. That gives both poor reading and poorer distance. But with the Vivity some are stretching that to be -0.5 to -0.75 D under, or a micro monovision. Then if this works out well for you although you might not get quite 20/20 for distance, then you could consider a full distance correction with the second eye. If you do not like the effects at night with the Vivity you could also go with a standard monovision for distance in the second eye.

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I agree with your thinking that progressives are better than readers. With readers you can't see anything when you look up and across the room. Also with prescription progressives any residual errors in spherical and cylinder for distance can be corrected. There will always be some. I have progressives for my current situation with one IOL eye, and it does give me the best vision at all distances, but I almost never wear them because it is much more convenient to have no glasses. This is especially true now when it is cold and you have to wear a mask. No glasses fogging up so you can't see at all!

I am with you. I know that Vivity is promising and from doctor point of view is not only quality of vision but also of life . Said so the quality vanishes right away if side effects are experienced. Also Panoptix is described as the magic wand but it comes with issues that might be bad as mine. My doctor was definitely pro Vivity but had nothing wrong with monofocal. I think some doctors are less conservative than others? I feel like I am already having an explant and I cannot risk further more and monofocal might sound "old and boring" but after this experience I cannot take risks in experimenting. When you go down to the small print, there you see that Vivity "might" give some night visual problems and also low contrast sensitivity compared to monofocal. That is exactly what you read for Panoptix. Mild disturbances that might go away. Probably for some, sure. I am concerned about explant surgery, she assured me that can be done safely after seeing the analysis of my eye, I had no YAG done, all is good and she has the equipment and knowledge. Surgery is going to be next Tuesday, we both agree that the sooner the better as the implant and everything else is still fresh/ not settled and that guarantee an easy explant. I hope so.

Wish you well ClaudiaRM

report back on how it went. Helps others making that decision.

So let me get this straight. Your going to put in a new iol that is made of the exact same material as the the one that opacified ( so badly it made everything blurry ) in only 4 weeks?

To be clear, multifocal visual disturbances never "go away". You can't change physics. A more accurate thing to say is that the brain habituates to them. The visual disturbances are still there and if you THINK about it you will see then exactly the same as you always have. It's just that if your DON'T think about it you don't notice it. You brain learns to "filter them out". But they're still there.

I have Tinnitus and I think it's the same kind of thing. For the first 2 years it drove me insane. I seriously thought I was going to lose my mind. But for the past 20 years it's been like I don't even have it. It's still there though. I'm hearing it right this moment as I type this because I'm talking about it. It hasn't gone anywhere. In fact it's probably worse than it was 22 years ago on first onset. But as soon as I post this and go back to what I was doing before... it will be "gone" again.

No I am not going to use the same lens, absolutely not. This one I have there are too many things wrong, might be the lens, might be me or my eye. My eye actually is part of the problem as I have short eyes ( meaning there is more risk of refractive errors or the lens accommodate itself forward)sorry I don't have fancy medical words to explain this. I am going for a monofocal for distance to avoid as much as possible side effects.

I know, so if I start from a very high point of disadvantages how many chances I have to adapt well enough that I can then drive or being comfortable? Plus lets not forget the refractive error. I cannot see well at distance, my vision gets blurry past 4 feet. That means I will need glasses or more lasik and YAG. It could be acceptable but no guarantees of results and we have not done the other eye yet. Tinnitus is terrible I have it in one ear that comes and go. Not fun but yes we get use to it. We have no choice so I think in the case of my eye/vision I do have a choice why I would want to live with this eye?

If you have 100% decided on a monofocal, you might ask your Opthmalogist about the Light Adjustable Lens (LAL). Note all Opthmalogist have the special equipment. The LAL might be a great fit for you because it is possible your power was off on your last IOL. And with the LAL you get to change refractivity after surgery and from what I have read maybe more than once.

I have had several Opthamolgist tell me they think the LAL is the best invention ever.

I would not suspect the lens material as being the cause of the PCO. The PanOptix, the AcrySof Vivity, and the monofocal AcrySof IQ all use the same material. This material in studies has been found to have the lowest YAG rate. But there are no guarantees against PCO. It is still can happen. 4 months out with the AcrySof lens I have nothing resembling PCO, so my finger are crossed.

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I think what your surgeon is talking about with the term short eye is hyperopia or far sightedness. I recall you said you were far sighted. Before cataracts what was your eyeglass prescription? The higher the spherical + diopter in your prescription the more far sighted you are. Hyperopia can be caused by shorter distance from back to front than myopia (near sighted) which has a longer distance from front to back. See photo below.

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I found an article which talks about IOL issues related to a short eye or hyperopia. It is pretty technical and I don't follow it all. However what I was able to understand from it is that it is much harder to accurately measure a short eye to determine the power of the lens needed to get plano distance vision. From what you describe your surgeon missed on this required power by quite a bit and left you myopic. The article talks about methods and instruments to get the most accurate measurement for a short eye.

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Another issue is the compressed space to insert the lens. This complicates the lens removal and insertion. In the article they recommend a AcrySof lens because it has the highest refractive index and as a result the thinnest lens. That is what you got with the PanOptix too.

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The last conclusion I came to was that dealing with a short eye requires a very experienced and skilled surgeon that knows how to deal with the issues. It is obviously much more complex than a standard cataract surgery.

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In any case here is the name of the article that you could google to find it. You have to read it carefully as they keep switching back and forth between short eyes and long eye issues!

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eyeworld october 2015 considerations in long and short eyes ellen stodola

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Hope that helps some

I had progressive lenses but I don't know my prescription. As I aged I became far sighted, as today I cannot read anything, very blurry even if I squint. At this very moment I am not using glasses because of 1 eye with Panoptix. The near vision...very near is good but still a bit blurry so I am keeping my computer very close. I did read too of how more difficult is to calculate the power of lenses with short eyes. My doctor/surgeon is part of a clinic that treat only glaucoma and cataract I am assuming they know what they are doing. They are well known and people come from many places to see her and another doctor but yes mistakes can happen. They have all the instruments and two clinics with different purposes. Lasers and such . I talked to her today saying that I was not willing to try a new lens like Vivity even if she is so fond of it. She told me that just today had a patient explanting a monofocal to match the other eye that already had a Vivity since he loved it. Note that she wears glasses lol. I probably don't have the personality for such lenses and I have no more bullets for this eye and I want to play safe so it is decided for monofocal at distance most likely for both eyes. Glasses here they come. Seeing well is my goal, I've been wearing them for long time I know what it means, the good and the bad. I do well with contacts so that is an option too.

A monofocal set for distance is probably the lowest risk option. Being far sighted you already know what it is like to need glasses to read. It should be no change from that. I would count on getting progressives for reading. They are better than simple reading glasses. And, they can correct any residual distance error as well.

i suffer from tinnitus too and it drove me nuts - still does at times. wish there was a cure but you are right if I don't think about it brain tunes it out but that takes time

Regarding having the "personality for such lenses"… just to be clear the Vivity in nothing like a multifocal. It is a refractive lens so there are no weird dysphtopsias. It has been shown in two different clinical trials to have the same rate of visual side effects as a monofocal. So there is no neuroadaptation with Vivity. No weird effects to get used to. It's a very natural type of vision apparently. The only real downside as far as I can tell is the reduced contrast sensitivity in dim light. That said, a monofocal will give you the absolute best quality vision and is a very safe way to go. The safest way to go. You just may not get the greatest close range vision but you never know. Some lucky people (maybe 10%) get monos and can read fine without glasses!

I got into hearing aids two years ago, and followed a hearing aid forum for quite some time. Some tips, if you are thinking about it. One is that some hearing aids have tinnitus programs. Most however are not satisfied with how it works. It really just is an additional noise to try and mask the tinnitus. And, what most find is that simply having hearing aids significantly reduces the tinnitus effect. They amplify background noise that is there, but if you have high frequency hearing loss, you are not hearing it. I am in the same position that when I am in a quiet place and don't have my hearing aids in, and think about it, I have tinnitus. With aids in, not really a problem.

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And if shopping or thinking about it, Costco is the best place to start. They have much better prices, and have a Kirkland "brand" that can be a very good buy. The warranty and return policy is excellent of course.

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It is nice now with hearing aids to not have glasses. Too many things banging around behind the ear at the same time can be an issue...

First, there is absolutely nothing wrong with going with a monofocal. They are the dominate IOL used for cataract surgery in the US and the World. And the safest most true and tested IOLs out there.

I started to read up on high hyperopia or short axial lengths or as you call them, “Short Eye” and personally I would want some question answered by the Ophthalmologist as I am still unclear on exactly what happened.

If you have high hyperopia, obtaining accurate refractive power is more difficult, but here is what I would want answers to for at least you are aware for the other eye.

1)You stated the Lens Moved forward and proper placement is important - I read on High Hyperopia eyes there can be issues, but if a monofocal had been used, why would it be any different. Was the Ophthalmologist planning to use a monofocal of different material or characteristics that would have made a difference? Or would the monofocal been more forgiving of movement. Bottom line – I would want an answer on how a monfocal would have produced a different results than the PanOptics in regards to IOL movement.

2)Power Level - Again I am confused if the IOL movement is causing the problem or the power was just off. If it was off, I would think it would equally be off if you had a Monofocal implanted. I would want an answer to this.

3)Dysphotopsias – From what I have read the more myopic you go the more dysphotopsias you get, which is one of the reason I always suggest micro-monovision only. I just think you cannot truly tell evaluate dysphotopsias with all the other problems you mentioned as they might be the main cause for the dysphotopsias.

My hopes and prays are with you. But before you do anything with the other eye, I would want to get clear answers to exactly why there was an issue with the PanOptics and how a monofocal would have made any difference.

I am far sighted and my near vision started to deteriorate at 40ish now being 60 I cannot read anything or even see the food in my plate well. Low level of astigmatism. Of course I need glasses! The lens is centered . PCO and forward position. I read that can happen quite easily and sometimes with YAG you get two birds with one stone, as the laser hit the tissue it creates some space and the lens might settle a bit back improving the vision. ( I read this in another article) I found a very interesting article I don't think I can post links so here is the title: "The effects of different shapes of capsulorrhexis on postoperative refractive outcomes and the effective position of the intraocular lens in cataract surgery" it is recent, 2019.from BMC ophthalmology. My doctor confermed a myopic shif so this could have been the problem but I could have had a low power lens as well. This I don't know. but I know for sure that to improve the near vision you have to give away some of distance. It happens with contact lenses too. It is a compromise some people don't mind because maybe they don't need a lot of correction. ( my guess here) Also she confirmed that myopia aggravate dysphotopsias I told her I was not willing to stand the bad side effects without getting the benefits from this lens and I was not thrilled to have lasik. She asked me to draw my starbursts and halos, to give an estimate of dimension ( mine are big enough to cover more than half of the highway and at that point she said it shouldn't be that difficult , offered an explant and the two lenses options. I am so glad I denied Vivity as I just recently saw a post of a young guy with both implanted and having lots of problems similar to mine. I know she is going to clear CPO during surgery in this eye to prevent blurry vision and such. This is just my experience but I know a lot of people is happy with both Panoptix or Vivity. But wearing glasses is not the end of world!We are not all equal. That is what I blame the most in doctors. They should know better who is the best candidate.

I have heard from others that hearing aids greatly reduce tinnitus. A couple of years ago I had a sinus issue and had sensation of wars always being full. Doctors prescribed nasal sprays but still felt that sensation of ears full - particularly the left one and the doctors could see fluid. I developed tinnitus at that time - drove me nuts. Took 18 months to see ENT specialist and he sent me to an audiologist for hearing test and there was hearing loss but not enough for them to prescribe hearing aids. For now it will be something I just have to live with. Most of the time I learn to tune it put. First several months it was awful. I dis go on the tinnitus forums here (as the cataract one was very supportive and helpful) but that forum very depressing. A lot with suicidal thoughts - no helpful suggestions or answers. Many doctors dismiss it. With insurance coverage I have i would be covered for hearing aids if they were prescribed. Maybe next visit. For now i use a white noise app or set TV timer so that there is other noise on. Getting older not much fun and I seem to be 20 years ahead with cataracts and tinnitus. Both my parents are still living and experience neither of those issues.

Thanks for sharing about hearing aids. Hoping they eventually help

me.

I have seen the latest hearing aids. So much tinier than they used to be. Controlled by an app on your phone so at least. Unlike cataracts and IOLs one can try out various brands.

Hearing aids are a very technically complex subject, and the manufacturers go out of their way to make it difficult to evaluate what you are actually buying. They all have their own self invented feature naming library. There are far fewer actual manufacturers of them than what it appears to be, as they are creative with making multiple brands out of one basic model. At the end of the day what they say they will do tends to be somewhat inflated. The current trend is closer and closer integration to a smart phone. It all sounds good in theory, and I have those features but I mainly just run the aids in the Automatic mode which at least in theory determines what you are doing, with help from the smart phone and self adjusts.

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A couple of tips. First is that most people wait far too long to get aids, and then have trouble adjusting to them. I messed up my left ear when I was younger and enjoyed shooting large caliber rifles (without hearing protection of course). It mainly affected my left ear. When I finally decided to go with aids I thought I just needed one for my left ear. It turned out that my left ear was so bad that a hearing aid did not help all that much. My "good ear" however responded quite well to a hearing aid, and that is the ear I get the most benefit from. The second tip would be that you really only know how well they work by trying them. Costco gives you an in store demo pair, but to take a pair home you have to buy them, with a 90 day return policy. The cost differences between Costco and small specialty shops are huge. Costco prices are 1/2 to 1/3 the cost. The premium level Kirkland Signature 9.0 aids they are currently selling, I believe, are $2000 a pair. They are premium level Phonak aids, and you can easily pay $6000 for them in a specialty shop. It varies from province to province, but in Alberta we get about $800 from Alberta Health Car. Providing you are a member, you can get a free hearing test, and they should give you a fair opinion as to whether or not you could benefit from them. They do not operate on a commission basis like most small shops. Costco does not sell aids that have a tinnitus program. I suspect they know it does not work effectively or at all and don't want to deal with unsatisfied customers.

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Hope that helps some,

Yes thanks for the tips and advice. It has been 18 months since I saw the specialist and had my hearing test at the hospital. Hopefully they will give the recommendation for hearing aids so that I can get Sunlife to cover the expense. Love Costco for many things and will definitely check out their hearing aids. If it helps with tinnitus so much the better.

Appreciate your comments.

Claudia,

Tried to PM you, but apparently that feature is now disabled. Wanted to see how you are doing with the monofocal.

Also now that the Synergy is finally approved I thought I would start gathering information on it from Opthmalogist. In addition to the doctor I went to I thought I would check around. Your doctor was highly rated; doing clinical trials and publishing papers and the like. Have you been happy with her.