I’ve booked refractive lens exchange and would love feedback re choice of lens

It's not recommended to do both eyes once, if you hate the lens you can't do anything about it. But if you only do one eye, you can still choose otherwise with the other. It usually takes several weeks before your eyesight settles and you get off the drops. One thing to understand about multifocals is that the way they work is show your eye 3 images at once, distance, intermediate and far. The ghosting and halos come from the out-of-focus versions of the thing you are looking at and they will always be there. Your brain will learn to filter them out... or not. Also, because multifocals split light, you will have worse contrast and color in your eyes, especially in the dark.

Monofocals have the best image quality and least dysphotopsias, there's also a new lens category called the EDOF lens, the clareon vivity is an example of such a lens. It gives a continuous vision from intermediate to far, but also has reduced contrast compared to monofocal because of the light splitting, but it has less issues with the image because it doesn't use diffractive rings like multifocals do.

A way to understand this is that the light going through the lens is a constant. Monofocal uses all the light to focus on your retina for the best possible image into a single point, but it has the least range and glasses are required. All other types of lenses redistribute this light to different distances in various degrees.

So in other words you don't have cataracts? Simply put, don't do it. As a physician you are certainly aware that no IOL can match the accommodation of your natural lens. Not to mention that you might still need corrective lenses after your surgery. Please reconsider.

i will pay good money to get presbyopic natural lenses than iols.

As far as doing it, I would recommend against taking out your natural lens until you have to for another reason, most likely cataracts. Another option to an exchange would be Lasik mini-monovision. However that will leave you with one eye for close and one for distance without glasses. That can be corrected with progressive glasses of course. And if you consider it, you want to ask up front if they can correct your hyperopia with Lasik. After doing two Lasik consults I have been told both times that it is difficult and not recommended to try to make the eye more steep with a laser. Making it less steep, correcting myopia, is apparently easy, but the reverse is not. I asked one of the clinics what they do when someone comes in with hyperopia and wants to be glasses free. The answer was that we do a lens exchange!

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On the PanOptix vs Synergy IOL I have no personal experience. I do have a friend that has the PanOptix in both eyes, and she is not pleased with the outcome for close vision, especially in dimmer light. She uses +1.75 readers for reading even in outdoor light. My running seat of the pants summary of comments here on the two lenses is that the PanOptix provides better distance vision and the Synergy provides better close vision. So I guess one could get one of each and hope that you get the benefits of each and not the disadvantages of each. My friend will not drive at night with the PanOpix due to the halos, and the Synergy could be worse. But it depends on how bothered you are by that, and whether or not you want to drive at night.

Since you are a dermatologist (M.D.) I should think you would be on friendly terms with some cataract surgeons, much more so than the members of the general public. Doctors tend to know other doctors. What do they tell you? But if you don't have cataracts, I would definitely not remove your natural lens. No surgery is minor, you know. Things can and do go wrong.