Mixed lens Panopitix and Vivity?

Sounds your doctor is more knowledegable then many Opthamologist out there.

Anytime it comes to defractive IOLs the outcome varies per patients. Some will adapt and love it and others, a smaller percentage, will need the lens removed.

I 100% agree with your doctor about doing 1 eye and then seeing the results before making any decision on the other eye. For the life of me I don't know why anyone gets premium IOLs in both eyes done at the same time.

But most important is what are your goals. Are you willing to accept halos and dysphotopsias to get near vision. Any splitting of the light lens will result in less light and possible issues at night.

I would also recommend asking your doctor about the Tecnis Synergy, which is not FDA approved yet and about the Symphony Plus, which is FDA approved but not widely available yet.

You might get worse halos with the Symphony Plus, but supposedly 85%

of the light is used so less issues at night.

I already have a Tecnis MF in my left eye (the best option at the time), but if I was doing it Today, I would be leaning for the Tecnis Synergy in my left eye and seeing how that goes and depending on how it goes get a Tecnis Synergy, Tecnis Symfony Plus or IQ Vivity in the right eye.

IMHO it is about evaluating the results from one eye and then seeing if you need to mix and match to get the best outcome.

For example lets say you get the Trifocal in one eye and you love your vision during the day time, but cannot drive at night, then you could look at the IQ Vivity for the other eye.

I agree with @rwbil in that it is best to do one eye at a time and see what you get before making a final decision on the second eye. I like to think of it as a plan rather than a one time decision. I think your plan is basically a good one, to go with a presbyopia correcting lens in the first eye, and then decide on the second eye.

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My thoughts on the lens choices for the first eye would be:

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PanOptix - It should give you good distance, but probably not quite as good as a monofocal lens for pure distance. Intermediate on a computer should be good, and reading smaller print should be good, but may not be the case for everyone. I have a friend that has PanOptix in both eyes, but still needs +1.75 readers for small print, or fine work, especially in lower light. She also has significant halos at night when driving. That said, others have good results with them. PanOpix is a fairly recent arrival in the US and seems to be overtaking the Symfony in popularity.

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Symfony- This is an extended depth of focus lens, rather than a bifocal or trifocal. Visual acuity drops off the closer you get, and does not have any "sweet spots", like the trifocal or bifocal lenses. You may or may not get good reading ability with it, but should be good on a computer. Like the PanOptix it suffers from halos at night around the lights.

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Synergy - If you believe the presentations and specifications, this has the best visual acuity across the widest range of distance. Not available in the US yet, but should be soon. If you go back and look at some of the older threads here there is one thread that has a lot of posts from one user of the lens. Read them for yourself, but I would say they are not as good as the theory and presentations on the lens would suggest they should be. I suspect it has significant night time halos and flare as well. They tend to increase as the lens allows more close focus.

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Vivity - This lens is an EDOF as well and most likely would be marginal for reading. Some say they do, and some do not. It is said to be almost totally free of the night time flare and halos though. I think the weakness of this lens is that it modifies the asphericity of the lens to stretch the depth of focus. This means the visual acuity is somewhat compromised, especially in lower light. In brighter light they should be as good as a monofocal lens though, for all practical purposes.

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For the second eye, you could use the Vivity, but it may not be the best choice if you want that eye for shooting. It kind of depends on the shooting you do though. If target shooting with an adjustable objective scope, you are probably still going to get a sharp focus just by adjusting the scope. If you are skeet shooting then you probably want good binocular vision. Even at skeet distance a monofocal lens should be good for that.

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My thoughts would be that if you get the intermediate and reading you want with the first eye, you may want to consider an aspheric monofocal lens for the right eye. It will give you the best distance vision, and fairly close vision as well. I have one, and I can see my computer screen quite well at 40 cm, but that is a bit far to be from the screen. Still you do get very good vision at 50 cm plus. If you are handgun shooting, the gun sights should be in good focus. Night vision is also the best with a monofocal lens, and it could make up for poorer night vision from the multifocus lens in the other eye. The Alcon PanOptix, and AcrySof IQ Aspheric lenses are blue light filtering, and kind of like yellow shooting glasses, or ski goggles they are claimed to improve vision especially in lower light by filtering the chromatic aberration from the blue light. They are not noticeably yellow though like shooting glasses. In fact the colour is quite blue and bright compared to the colours you see with a cataract. They return the colours to what a person with a young non cataract eye would see with the natural lens.

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Hope that helps some,

Two additional thoughts:

1. Comment on Ron's Comment regarding Synergy.

I am not sure what the add power is for Synergy MF portion. One thing I saw that surprised me for this IOL is it showed close vision results at 33 cm, that reminds me of the Tecnis 4.0 and other high add MFs. And the problem with those MF is the high add created large halos, which is why they developed the low add MFs. I was not interested in the 4.0 add due to this as at the time I read the halo from car headlights can be so large they cover the car next to that car.

So this is a big question that I am not sure about. Maybe because the IOL has the EDOF going for it, the actual add power for the MF part is very low.

So IMHO if the Synergy interest you, you have to be patient. Not only to be FDA approved but given time to see what Ophthalmologist experience with the lens. I would wait until there are more real results showing exactly how the halos compare to the Trifocal and the Symfony Plus.

2. I am a procrastinator and read about other developments in the pipeline besides the Actual IOL that seem interesting. Of course how the trials go and if they are ever FDA approved is another story.

One of those new development I read about was a separate base component for the IOL to go into. A big problem with IOL implants is if you don't like the IOL or later your prescription changers or a newer better IOL comes along it is pretty major to exchange the IOL and especially if you had YAG done. From what I read this new base would make changing the IOL relatively simple compared to current method.

I wanted to add.

I have the Tecnis MF +2.75 in my left eye, so for my other eye I am looking at either the Tecnis Symfony or Synergy.

One weakness of the MF is the light splitting and seeing in dim light conditions. So I want a lens that does the least light splitting for my other eye.

I plan to wait until more doctors implant those lens and see what type of results they get. I have yet to find a defocus curve for the Symfony Plus, but I read it is supposed to give an extra .5D boost to intermediate and near vision.

If you search for, "VIDEO: Extended depth of focus IOL shows good visual results" on the healio site you can see one doctors assessment of the ZHR00V (Symfony Plus) IOL.

My thinking is to also get mini monovision (−0.50D). From the chart below that should also give me another line or so on the close up chart.

So in theory that should provide "Pretty Good" vision at all distance with only a small amount of light splitting and thus hopefully better night vision. There will still be dysphotopias.

I know this is an old thread, but I thought I would resurrect it, as I am also 51 and in the process of having a Vivity lens in my right eye and Panoptix in my left.

Last Friday I got the Vivity lens and WOW! I woke up Saturday morning with perfect 20/20 (distance) vision in my right eye. I am now four days in and I am amazed at how good I can see. I've always had a high correction (-8.5 contacts), but generally could see 20/20 (close/far) with contacts. In the last three months my right eye had fogged up to about 20/80 due to the cataract, so the new lens seems that much better. I thought I had "20/20" in my left eye with contacts, but I can see far better with my new lens, not just sharpness, but the colors are richer and brighter, where my natural left eye with contact is dull and slightly yellow. I never realized that before.

For me, I had good vision at about 18 inches that make using my phone and a computer very crisp and clear. It gets blurry below 18 inches. My eye test shows 20/30 at 18 inches with the new lens which is the same or better than my left eye.

I am scheduled to do my left eye (weaker eye) in one month with a Panoptix. I decided to go that route, so I would have even better close-up vision for reading in bed, but I know there will be a long adjustment period and more halos at night. Hopefully the Panoptix goes as well as the Vivity lens. I read a lot of scary posts on this forum before my surgery, so I just want to report to others that so far I am amazed at my results. I attribute a lot of that to reading and researching the lenses ahead of time, so my expectations were better aligned to what the different lenses can and can't do.

If anyone has completed a Vivity/Panoptix combination I would love to hear how the adjustment period was for you. Thanks!

Theres some good videos on youtube on the different lens. Theres no perfect lens they all have pluses and minus . lm 48 having cataract surgery in a few months my Ophthalmologist recommends vivity , he said it should give me good distance and intermediate without glasses , my only concern is it has lower contrast then monofocals, so l plan to have one eye vivty first and if l dont like the contrast l will get a monofocal the second eye. With panoptix you probably wont need glasses for close up reading but with vivity you might. The disadvatage of panoptix is you will get halos at night if driving and l think the brain takes longer to adjust to the panoptix then the vivity. You should probably get two opinions from two specialists beofore you go ahead

Hi, I would like very much your advice because I'm with a quite big trouble to decide between Panoptix or Vivity IOL.

I have got a pseudoforamen only in my left eye (it isn't yet a macular hole and I pray it never break ). The eye with that problem is the one that has the smaller cataracts and as I have no symptoms of the macular problem, so I can read books and work on my computer without glasses perfectly with my left one.

I was told that the cataracts surgery in that eye, might cause the macular membrane breakage, so I think it would be better for me to go under surgery only for the other eye, the one with the biggest cataracts.

I would love to go for the Panoptix, because near vision is very important to me and I don't mind the night halos, but I don't know if it's possible to adjust having it only in one eye and leaving the other eye natural and untouched as much as possible (perhaps if I'm lucky for years) ? Does anyone stood (or knows somebody) with only one MultiFocal lens for a long period of time?

Is Vivity easier for doing that?

I'm afraid if the worst (the breakage) happens in the other eye, a monofocal could be the only choice for it, perhaps of I'm lucky, an EDOF, but I think doctors won't agree to put me a Panoptix, neither to play with micro monovision in an eye with a macular hole, even after undergoing a vitrectomy surgery. Having that in mind I would rather have a good near vision in the healthy eye, but the idea of difficulties in adaptation with only one Panoptix frightens me.

Looking forward to your reply.