I have to make a decision for the 2nd eye soon

thanks for your comments. you bring up a lot of good points.

there is loss of light in dark with Symfony as well so it is possible that this loss may be higher with PanOptix.

i need +2.5 readers to get HD quality near with Symfony so a monfocal set at -1.5 correction would not give me enough near. Symfony set at -1 would also fall short hence the desire for a trifocal.

Symfony distance is good. but i still need 0.5 astigmatism glasses. intermediate is OK.

Is your right eye still good enough to do a contact lens test? That is probably the best way to determine how much power reduction is needed to allow reading. The article below determined that -1.5 was the optimum for monovision. However, it leaves a bit of a hole in the intermediate range of 1-2 meters. With your Symfony in the other eye that may not be a problem for you.

Optimal Amount of Anisometropia for Pseudophakic Monovision

Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD

One thing to consider is that even a PanOptix may not give you crisp reading real close, especially in low light. Even with it you may want to consider under correcting if you want good reading. I have a friend that has PanOptix in both eyes. Her #1 criticism is that her vision up close is poor especially in low light. She uses reading glasses all the time when she needs to see up close. Her second criticism is halos around lights at night.

right eye not good enough.

can you really under correct a trifocal or does it have a fixed near power? symfony undercorrection shifts the entire range to near. if trifocal is same way it would be great. definitely worth exploring.

will synergy give more crisp near. u just made me realize that crisp near is what i want desperately want.

I have not spent much time investigating the PanOptix. However, it makes sense that each lens is set for correction at distance and the other two distances at some ratio of that. If you undercorrect for distance it makes sense that you will also undercorrect for intermediate and near. Something to verify with the surgeon.

hi ron

i believe the ratio logic is valid only for edof lenses. bifocal and trifocal have fixed + power. that's why tecnis bifocals has choice of +3, +4 etc.

however i may be wrong.

From the bit of research I have done on the PanOptix I believe it has a near power add of +3.25 at the IOL plane, which I believe is about +2.5 at the spectacle plane. The intermediate is +2.17 IOL or +1.6 at the spectacle plane. It seems to me that like eyeglasses those are fixed adds. For example if you need a -5 distance correction, the +2.5 add gives you an actual correction of -2.5 for close up. If you were to cheat and use a -4.5 for distance (and not see so well at distance), I would think that lens with a +2.5 add would give you a -2.0 for close up, or a 0.5 diopter advantage for reading. Just my simplistic thinking though!

There seems to be a Tecnis lens that I have not seem much discussion about here, that is available that has this bias for close up built in. It looks like it is a bifocal lens that is optimized with a +4 add (IOL), (+3 spec). If it is a bifocal then it may leave more of an intermediate gap, but your already corrected up may make up for that. Here is a snip of one of the links that gives some information on it. This lens would appear to give a 0.5 diopter advantage for reading over the PanOptix.

I had understood your logic. But I am not sure that under correcting will work. For example if PanOptix has +3.25 fixed circular region on the IOL it will not matter whether you under corrected distance. The +3.25 would remain the same. The logic you mention would work only for EDOF symfony, lara, vivity etc. In the same way I feel the Tecnic +4 would not change if you under corrected that lens to give you more region. That may be the reason they have +2.75 and +3.5.

This is just how I make of it. It could very well be how you say it to be.

For me to see near in HD I need +2.5 on top of Symfony (+1.25) so I need +3.75 (=1.25+2.5). So I may need +0.5 over panoptix.

I would ask the surgeon what it would take to give you the near vision you want while compromising the distance vision for each lens option. I suspect the Tecnis +4 may give you what you want without any distance compromise. The Symfony would require the largest compromise, and the PanOptix less.

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Assuming you are near sighted, the more you undercorrect the distance, the less add you need to correct for reading.

RonAKA wrote: "My thoughts would be for a Symfony as it may be better in lower light levels. I believe the PanOptix separates the light into three different focal lengths and less light is available at each distance."

I don't check in as frequently here, but thought I'd chime on this point.

There was a very good discussion on this point in my very long thread (that's now on page 3 I think). When I was deciding whether to go for a premium lens, I was concerned about low of contrast sensitivity because of older negative articles on multi-focals; but in these articles "multi-focal" means "bi-focal", and many bifocals lose a good amount of the usable light.

Now it may sound logical that a tri-focal that splits light into three focal points means less light available at each distance, but that's not really how it works. What happens is the brain is receiving three images at the same time: one will be well focused, and two will be not so well-focused - but the brain is very powerful and will filter out the noise to produce one image using light from all three. PanOptix technical information says it uses 88% of available light (which was the highest % of all tri-focals at the time), so there is some light loss, but most people with cataracts will be experiencing even worse due to the cataract. I do think EDOF would have better low-light intermediate vision, but not significantly better.No doubt most people with tri-focals need some extra light to read in low light conditions .

While we are not able to compare EDOF with trifocal in the same eye ourselves, there was one very active poster (who has since left the forum) who had EDOF in one eye and trifocal in the other eye. He liked the tri-focal more.

Also, in my readings, I found an articles (referenced in my very long thread) quoting European surgeons who really like tri-focals. One doctor said that he would recommend tri-focals over EDOF except for orchestra conductors who need to see clearly in dim light at a distance of 120 cm.

RonAKA, you also mention you friend in several of your posts. I believe she was very happy with PanOptix initially, and less so now. (I don't recall the full story). And she needs readers to read (especially dim light).Tri-focals aim to provide good vision at near, intermediate, and far, but that can't be guaranteed.However, if she was happy initially, and something has changed, I would hope she is getting it looked at, because it could be PCO or dry eye, because vision getting worse (rather than better) is usually due to one of these factors.

'Tri-focals aim to provide good vision at near, intermediate, and far, but that can't be guaranteed.' - that is a bit concerning.

Janus, I have not done extensive research on the EDOF or MF options, as I have basically dismissed them as options for myself. I don't think I have the personality and vision expectations that would make me a candidate for them.

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My comments are based on just a limited look at them to come to my own decision. I found this article of some help in understanding the differences between the options. Perhaps this is the same one you have referred to. It is from 2017 so is somewhat dated and does not include all options available today.

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Multifocal intraocular lenses: Types, outcomes, complications and how to solve them

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This table from the article has some data to compare the various lenses included in the article. I may be reading this wrong, but it looks to me that some options allocate less light to the near focus, with the AT Lisa bifocal and the FineVision allocating 35% to near. Most other bifocals allocate light 50-50. The PanOptix seems to allocate 44% to near.

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I think the overall light transmission is a different issue, and is mostly determined by the use of blue light filtering, or not. What is often forgotten is that the natural lens uses blue light filtering and has a light transmission similar to the lenses that use blue light filtering and is around the 88% level you quote. The clear lenses can achieve a higher light transmission than the blue light lenses and the natural lens. Whether or not that is a good thing, or not, can be debated. Some will argue that the blue light filtering improves contrast sensitivity.

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My friend was initially OK with the PanOptix as she was led to believe that vision up close and at night would improve. She has turned negative on them now that they have not improved. She uses readers all the time and in particular in less than bright sunlight. Her current view (at 18 months or so use) is that the extra $5,000 or so that she spent on them was not worth it. She has been happy with distance vision in daylight, but now says it is not what it used to be. She has not had it checked out, but I also would be suspicious of PCO.

None of us are qualified to get into the technical aspects, but so I'll keep it brief.

Yes tri-focals split light, into near/intermediate/distance. But my point is that it is NOT just the light that is allocated to each of these points that provide the light you use.You brain is getting three images (a very focussed image, and two less focussed images), but it will combine these three images, using light from ALL three images, into one focussed image though neuroadaptation.

There is some impact, but it is not nearly as dramatic as might be assumed from reading that what % of light is allocated to each distance.

Hope that makes sense.

i too would encourage your friend to have her vision checked out if she's noted a change in reading. I haven't had to wear readers much at all (almost never) with EDOF lenses. Yes the contrast i guessing is about 15% less (even monofocals will have less than a natural lens). Good lighting is needed to read. I experienced that too with cataracts.

There may be another issue at play with your friend.

vivity was fda approved in february but not yet available in US i believe. it sounds promising. i would set it for -0.75 correction.

what is glistening?

Glistenings are tiny pockets of moisture in the lens that develop over time. The lens material is part water and when the manufacturing quality control is not good, these pockets can show up.

You may want to google this phrase. It brings up a page with two articles. One is critical of glistenings, and the other says they are not really a problem. The articles are kind of dated as well. The manufacturer says they have resolved the issues of quality control. My surgeon says the same.

CRSToday How Serious a Problem Are Glistenings?