Pan Optix Lens

There are lots of things to worry about in getting a PanOptix, but in my opinion glistenings and "cat eye" are not among them. The real issues are less than ideal vision at certain distances, as well as flare, halos, and spiderwebs around lights at night. If good night vision for driving is not a priority, then the PanOptix may be a good option.

@rwbil - I actually saw in one of Wong's videos where he shined the light into a patient's eye with the PanOptix and the way it reflected like a cat's and that did it for me - I decided I would not get that one. I also then read about the material and since I am younger decided it would not be for me.

Well, I have one AcrySof IQ, and now my wife has two of them. Have not seen this so called "cat eye" effect in myself or in my wife. However, if she starts to meow a lot and climb the drapes, I will start to get concerned!

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Right now I am trying to decide what type of lens I will go for with my second eye; Vivity or Clareon. Vivity is the same AcrySof material, and Clareon is the newer material. The only real reason I am considering the Clareon is that it appears to be the way to get into a private clinic for the procedure rather than the public hospital. The only substantial technical advantage I can see in the Clareon is that it has sharper edges on the corners of the lens. This has been shown to reduce the chances of PCO developing. PCO is a real concern with all of these lenses. The AcrySof material has been shown to be more resistant to PCO, but the Clareon seems to go one step further.

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The missing piece of the puzzle that I am waiting for is my surgeon's opinion on the probability of night vision issues like halos and flare with the Vivity. He is the same one that told me he had a hard time recommending the PanOptix to patients as he would not be willing to have them put in his own eyes. I see him on Friday and hope things will become "clearer" then!

Don't tell RonAKA about the cat effect as he is not a believer. And frankly I have no idea if true or not, but have read others that claim to be effected by it in a pretty serious life altering way.

So I just make you aware of some have complained about it and do your own research.

@RonAKA- I'd probably stay out of the public hospital...but that's just me reflecting on my horrific experience in the UK (people getting transfusions, going in their beds, etc. right next to me!) and I have no idea what Canada is like.

I guess the positive (and maybe a bit not so positive) is that we have so much information as opposed to previous consumers. It can both be enlightening and a burden.

All the best with your choice 😃

The way it works in Canada, or I should say Alberta as each province is different, is that a "premium" lens with an extra charge can be done in a private clinic, with the basic fully covered lens (AcrySof IQ or J&J Tecnis) are only done in a hospital. The one in our city has a very large clinic that occupies two floors in one wing. I was quite happy with the way the first operation went. They use IV for sedation, and that would be my preference over the Ativan under the tongue thing. The problem is that I suspect the wait time because of COVID and the general elective surgery backlog is probably months or a year or more. The private clinic wait time seems to be about 3 weeks. It is the same surgeon would be doing the procedure as would do it in the hospital. Long story, but if I decide on a monofocal I would be quite OK with an AcrySof lens and would prefer to have it done in the hospital. But, the Clareon lens is classed as a premium lens with an extra charge of $300, it becomes the ticket to get into the 3 week queue rather than a 1 year queue.

Sounds like the Clareon could be the winner. I guess it depends on how bad your cataract is in terms of how long you can stand to wait. $300 seems ideal compared to the $10K I just paid above insurance.

My concern is that it must be an extremely rare condition as Alcon seems to have more than half the market in North America. So, about half the people with cataract surgery are walking around with "cat eyes". About 4 million surgeries are done per year in the US alone, so that means 2 million more "cat eyes" get set loose each year US. If it really exists it is at worst a cosmetic issue, and there are much more critical things to consider when selecting a IOL. They would be things like resistance to PCO, resistance to movement in the eye, or rotation in the eye, blue light filtering for a natural colour, contrast sensitivity, dysphotopsia, and in the case of multifocal lenses the issues of halos, flare, spiderwebs and driving at night.

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I am about to make a decision on what lens to get, and this "cat eyes" thing is the furthest thing from my consideration. Currently I am most concerned about getting the correct power for my near eye to achieve successful monovision to be eyeglasses free. It is somewhat alarming when you look at the statistics for accuracy in selecting the correct power for an IOL. If the right formula is used it is up in the 95% success rate if you accept a tolerance of plus or minus 1.0 D. That is a huge error however when you want a target of -1.25 to -1.50 D. And, when you tighten the tolerance to plus or minus 0.5 D, then the % success drops to 70% at best. This is the part that is making me the most nervous about my upcoming surgery. If the expectation is to need glasses after surgery these errors are not a concern as they are easily corrected. But if you want to eyeglasses free, accuracy becomes critical.

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My friend that has PanOptix and is not fully satisfied with them probably had a miss to the + side in her power selection. That kind of error results in poor reading ability, and her need to use readers despite the fact that she has multi focal lenses that should allow reading.

What is cat's eye?

Trying to keep it as clinical as possible there is an article, Intraocular Lens Refractive Index and Its Impact on External Surface Reflections.

Results: External reflections from the anterior surface of the studied implants increased as the RI of the IOL material increased. The IOL models composed of high RI material (RI = 1.56 ± 0.02) were found to have a more than threefold higher external surface reflections compared to those with low RI (RI = 1.45 ± 0.02). Ultraviolet or blue light-filtering functions showed no significant correlation with the external reflectance.

Conclusions: IOLs with a high RI are associated with external surface reflections that are more than threefold higher than those with lower RI. The "cat's eye" phenomenon seen in pseudophakic eyes by an outside observer strongly depends on the RI, but is independent of the filter incorporated in the IOL

PanOptics Index of Refraction is 1.55 one of the highest on the market.

Also if you watch Dr. Shannon Wong vidoe, Panoptix v Synergy – Which is the BEST lens for presbyopia-correcting premium cataract/lens surgery?

At 29:40 he states the Synergy IOL looks better in the eye and cosmetically it looks completely normal and that the PanOptics lens material causes a cosmetic reflection that may be seen some of the time at certain lighting angles.

As someone that has 2 cats, I am sure the term Cat-eye is an over exaggeration of the effect.

Thank you!

I also have two cats! Yes, agree, the term is not accurate LOL

What did you decide? My doctor is suggesting PanOptix in the non-dominant eye and 2 weeks later Vivity in the dominant eye to minimize halos and glare.

I have not decided on my second eye which will be for closer vision. I have a monofocal AcrySof IQ set for distance in my first eye. The second eye will be a Clareon monofocal set for mild myopia, or a Vivity with milder myopia. I get to see the surgeon next week and I will likely make the decision based on what he says about the probability of halos and flare if I go the Vivity route. I am not willing to risk the PanOptix.

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If you are willing to risk going with a PanOptix in your non dominant eye, I would do a monofocal Clareon or AcrySof IQ in the other eye. The Vivity is not going to add much if you already have the PanOptix for closer vision. A monofocal set for distance is going to give you the maximum contrast sensitivity, to make up some for the loss in the PanOptix.

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What I am not sure about is if you have the PanOptix will your brain ignore the flare and halos if the other eye does not have them. Don't know.

thats a great idea. pan optix gives you close. vivity cancels out halos and other artifacts from pan optix.

@1Ellen,

I had my surgery 4 weeks ago now and ended up getting a Clareon lens targeted to -1.25 D. At the 3 week follow up the autorefractor reading was that the target of -1.25 was achieved. I don't have any measure of astigmatism yet, and will get that from my optometrist in another couple of weeks.

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In the final consult with my surgeon he was all over the map for advice. Despite telling me a couple of years ago that he would not consider putting the PanOptix in his own eyes, he suggested that it was an option for me. He seems to be transitioning his business from a public hospital clinic to a private clinic. He now hands out a package of glossy Alcon materials on the various Alcon lens options. I suspect he has transitioned from what is best for the patient to what is best for his new business...

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In the end I considered an AcrySof IQ Toric, a Clareon monofocal, and a Vivity Toric, as well as a Vivity non toric. I dismissed the PanOptix suggestion, and he was not positive on the Vivity, so I went for the Clareon monofocal. It think the price of this decision is that I may have to get Lasik to correct the residual astigmatism in the Clareon eye. It is currently OK, but I think could be better. I can read J3 in normal indoor light and J1 in outdoor full sunlight. I think the Vivity Toric may have been the best option on the table but I could not get a positive endorsement from the surgeon on the Vivity lens, so it fell by the wayside.

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Hope that helps some.

did he say why he was not positive on vivity, l read its a good IOL

I asked him directly what his experience was with Vivity and would he recommend it. He had categorized me as having high demand for the best vision, and responded that he had one patient that had similar demands and that patient was not happy with the lens. So, did not recommend it for me. I got the distinct feeling that he just did not want to deal with another unhappy patient. The unfortunate part with this surgeon is that he is always in a rush for time, and will not allocate enough time for discussing the issues with the lenses. I think if we had more time for discussion we would have resolved it. In the end we did not even come to agreement in that consult as to which lens I would get. There were two follow up phone calls from him before we settled it. They were rushed too. On the first one he said he had a patient with dilation drops in their eyes and he cut the call off. Fortunately he called back again and a final decision was made. The bottom line is that he never really too the time to explain what the issues were with the Vivity.