Monofocal or Clareon PanOptix
Posted , 6 users are following.
come down to these two. saw 2 surgeons both practices have stopped offering synergy.
tecnis monofocals set of -1 or -0.75 in both eyes and using glasses for both far and near. started wearing glasses only when it got to -1. good contrast, minimal night artifacts. most reading power required would be +2.5 hopefully and no glistening. natural loss of near would be a bit disheartening.
clareon panoptix. possibility of good vision at 3 distances or not. fainter vision due to loss of contrast. night effects possibility. currently see lens edge arc with symfony. glistening possibility or not.
0 likes, 15 replies
RonAKA soks
Edited
Your other option is pure mini-monovision with Tecnis or Clareon monofocals. -1.5 D in the non-dominant eye, and target of -0.25 in the dominant eye. They should be toric if needed to reduce cylinder to less than 0.75 D.
soks RonAKA
Posted
you keep recommending that and my rationale has always been if i am going to wear glasses for 0.5 to 1 astigmatism then why not add -0.75 of sphere to it. In the process when I am home I can be without glasses and get some more near due to binocular summation of two -1s. what are the holes in this plan?
RonAKA soks
Edited
The reality is that 0.5 D of astigmatism is almost nothing, and certainly not worth wearing glasses for. It is roughly equivalent to being -0.25 D which is a normal target for distance. Now if you are going to be -1.0 D of cylinder then it is worth getting a toric IOL. But keep in mind that even with a toric you are lucky to be under -0.5 D cylinder. My wife has a toric and still ended up at -0.5 D. She sees very well without glasses. She reluctantly got some progressives but I suspect they will not be worn that often.
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The issue with being -0.75 to -1.0 D sphere is that it leaves you in "no man's land". It is not enough for good reading and it is going to leave you with noticeably reduced distance vision without glasses.
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Indoors -1.5 D sphere based on my experience still allows some binocular vision out to 8 feet or so. Combined with full distance in the other eye, you should have excellent vision indoors.
soks RonAKA
Posted
how much near are you getting with your -1,5 eye?
one of the two surgeons is also not in favor of both -1. for monofocals he prefers LAL.
Night-Hawk RonAKA
Posted
Yes even with a toric IOL the residual astigmatism cylinder target is usually -0.50D, and ending up with -0.75D to -1.00D cylinder is often considered "acceptable" by doctors. Thats where my right eye ended up with a Tecnis toric monofocal at almost -1.00D cylinder, but before the IOL it was around 3.00D cylinder so it was a huge improvement anyway. With that -1.00D residual astigmatism and near plano sphere I get about 20/25 without glasses and with glasses to get rid of that remaining cylinder I can get around 20/15. My left eye still has the natural lens since cataract isn't bad enough to affect the vision at all yet in that eye, but it has about 2.0D cylinder astigmatism for 20/50 or worse unaided distance vision, so glasses are still needed for that. But around the house I can watch TV etc without glasses using my right eye's 20/25 vision for the most part. I use +1.00D Rx glasses for intermediate computer vision and +2.50D Rx glasses or my progressive pair for reading.
RonAKA soks
Posted
My near eye is somewhat compromised by a bit of a miss on the sphere and irregular astigmatism. It is -1.0 to -1.25 D on sphere depending on who measures it. And the irregular astigmatism is -0.75. The -0.5 D of astigmatism I have in my distance eye seems to give me no issues. The -0.75 D irregular astigmatism does cause issues. It gives me a drop shadow on letters, especially while letters on black. So I am not a clean example. I would estimate I am about -1.4D but there are issues. I would expect a nice clean -1.5 D sphere would be better than what I have. That said, I can read down to about 12". In bright sunlight I can see J1, and in normal indoor lighting I see J3 easily. The car dash is very clear, but my distance eye is very clear at that distance too.
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The big advantage of LAL is that you can fine tune it to get what you want for sphere. But, I wonder about long term durability and resistance to PCO. On that front I would be more comfortable with AcrySof or Clareon.
Guest RonAKA
Edited
Yes there's a thread on here about someone that ended up (unintentionally) in a kind of "no man's land" with good intermediate but poor far and near and they are not happy. I think it makes sense to do far or near (but very few people do near) but not… kinda near bit not really and kinda far but not really. Or monovision. Or multifocal. Or mini-mono with EDOFs like Vivity / Eyhance.
soks RonAKA
Posted
PCO is a foregone conclusion.
RonAKA soks
Posted
I am coming up to 2 years on the first eye, and no PCO so far....
Night-Hawk RonAKA
Posted
It took a little over 3 years for PCO to get bad enough in my right eye with the Tecnis toric monofocal to get the YAG procedure. I hear it happens sooner for younger folks and longer for older folks.
rwbil soks
Posted
If memory serves me correctly, don’t you have a Tecnis Symfony in one eye? Will you be explanting that?
My concern is that you had issues with the Symfony IOl, which makes me think you should choose a less risky IOL.
If it was me and I was going to choose a less risky IOL I would go with Eyhance or Vivity. The Symfony hopefully will give you good distance and if you shoot for -.5 D with Vivity you be getting -1.25 D, which should provide some close vision.
As someone that has a Synergy, curious why they stopped offering them. I think that IOL is best in a mix and match because it’s strong near add comes with large halos and starburst.
soks rwbil
Posted
making a decision on symfony. i have a lot of PCO so it will be sooner than later.
they say they have stopped synergy because patients have not been happy with its distance vision. one of the doctors is offering the tecnis multifocal instead.
RonAKA soks
Edited
For a monofocal you may also want to check out the Bausch+Lomb enVista. It is claimed to be more glistening free than the Clareon. And it uses zero SA correction which is claimed to be better for eyes that are less than perfect, and provides some closer near vision. Google this for more info:
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enVista Simplifeye Brochure pdf
soks RonAKA
Posted
thanks for sharing. i thought BnL never had a glistening problem (aka sofport). its quite something that they are comparing to Clareon.
any idea what happened to their trifocal.
RonAKA soks
Posted
I have not followed B+L much but in recent days I have been forced into it as my brother is getting close for cataract surgery. The B+L enVista and Toric version of it is being pushed for him, so I had to do some research on it. At first I was skeptical as they are not real popular choices, but they do seem to have some unique features. The enVista does not sound that much different than the Eyhance. Not sure about their trifocal.