PanOptix and glistenings or "diamond eye"?
Posted , 11 users are following.
I've seen some very good discussions on the overall quality of vision and any impacts to contrast sensitivity with PanOptix (thanks especially to janus381 for her detailed descriptions of her experiences).
What I haven't seen is any mention here of incidences of glistenings with this lens. I've read elsewhere that the Acrysof platform in general, and in one source the PanOptix specifically, had a moderately-higher incidence of glistenings than other "glistening free" lenses like Tecnis platform and (I think) the FineVision.
Does anyone have any personal experience with these (either way), preferably with the PanOptix specifically? I'm also curious if a specific lens having glistenings is something that can be detected and caught prior to implantation, or if this determination is made strictly after implantation?
Same question about "diamond eye" - although I'm not completely sure what this is, and have only seen one surgeon making a related blanket statement about all Alcon lenses.
1 like, 21 replies
ivan89323
Posted
Answer to one of my own questions:
From what I've read online, (at least circa 2012) detection of these cannot happen when the IOL is in a dry state. Takes 1 to 6 months after implantation for these to start to form.
Guest ivan89323
Posted
I guess it is a good thing, that nobody seems to have any experience with that problem 😃
I would think that PanOptix have this issue figured out by now, otherwise it would make no sense, it is more than 10 years since the glistening was diagnosed as an issue.
The Panoptix trifocal is very popular and widely used, personally I would not have any concerns about glistening, even that I have got the Zeiss lenses myself.
ivan89323 Guest
Posted
Yeah, I doubt that it's widespread (at least at this point). I have seen reports from the last few years (post-2013) that the AcrySof platform and PanOptix still has higher incidences than the others, and that glaucoma medications may increase glistenings incidence independent of lens origin. Like everything with IOLs, it's not going to happen to most people, and even then those who have it aren't necessarily going to be bothered by it.
Still, the possibility is kind of disconcerting. Frankly, there are red flags on the issue out there: lots of independent papers and opinions out there claiming that when it's bad, it's bad. Meanwhile, lots of counterpoint sources appear saying that even high levels of glistenings are really no big deal (with every one that I've found written by authors with some sort of financial connections to Alcon) ... and then Alcon proclaiming in 2013 to have improved their processes to reduce glistenings by 10x (currently still not validated by third parties) ... which is nice, but a somewhat-incongruous move for a condition that Alcon was (mainly indirectly) claiming to be a non-issue.
Yep, that's the other side: I can't fathom that this is a giant issue given the PanOptix popularity. (It is also unfortunate that Zeiss still isn't coming here anytime soon, since this seems to primarily have impacted Alcon.)
PanOptix has otherwise indeed checked a lot of great boxes, compared to the other trifocals. I'm also very glad that @Sue.An2 and @janus381 have posted their detailed experiences with Symfony and PanOptix.
(BTW, janus381: apologies if I got your gender wrong above - I was on a monovision contact lens trial this weekend, and it was really messing with my head: "oKaY, tIMe To gEt Up aNd MAke a SaNDwIcH...")
janus381 ivan89323
Posted
I think "Diamond Eye" doesn't affect your vision, but is where others see what looks a like a diamond in your eye.
I looked up "glistening" after I read Deb03 post that she had glistening problems with her Acrysof mono-focal and does not recommend them.
What I found is:
Alcon changed their manufacturing process around 2012, to reduce glistenings.They were a common problem before 2012. Alcon claims their changes reduced glistenings by 87%.So glistening is still a possible issue for Acrysof lenses. For most people they are not bothersome. Some people do find it bothersome.
Glistening cannot be detected before implantation.
There are pros and cons with every lens.
E.g. search: "Review of ophthalmology annual survey 2019 iol preferences"
This is a US publication (so only lens available in the US are mentioned). For mono-focals, Alcon is the most popular choice, but one who prefers Alcon does say the con is:“I do not like the micro-glistenings that are less than in the past but still exist."
For PanOptix specifically, search for this: "Evaluation of the optical purity of a new hydrophobic intraocular lens (IOL)".
This compares glistening in the FineVision Tri-focal, PanOptix Tri-focal, and Symfony EDOF.FineVision and Symfony had very small levels of glistenings (Grade 0 on Miyata scale), while PanOptix had more glistening (Grade 1 -- on scale that goes 0, 1, 2, 3).
I'm just one person, but I haven't noticed glistenings in my PanOptix lens so far (just it's been over one month now).
PS. I'm male! Some people's names are obvious (e.g. WH is male, Sue.An is female, and ivan is male!).
ivan89323 janus381
Posted
Cool - thanks for the refs. I'll check them out. It's the "maybe, sometimes" kind of problems that make these decisions difficult.
Yeah, sorry again - I caught that once the contacts came out, and unfortunately we apparently cannot edit posts. Man, it would take me a while to be functionally effective with those contacts.
W-H janus381
Posted
Janus, I thought you were female too until my wife corrected me. Hell I was even calling you Jane 😃
W-H janus381
Posted
Any info on Zeiss IOLs with regards to "glistening"?
Their ZEISS CT LUCIA monofocal- "Ultra-high purity acrylic and proprietary cryo-lathing process to minimize glistening"
I am also thinking that all these drops must have some impact on the IOL material?
janus381 W-H
Posted
Zeiss marketing materials uses pretty strong wording "Glistening Free"!
Found one study of 54 patients that found no glistenings after one year for CT Lucia. search for this:
**Long-term clinical results and scanning electron microscopic analysis of the aspheric, hydrophobic, acrylic intraocular lens CT LUCIA 611P
Deb03 janus381
Posted
I have Alcon Acrysof IQ monofocals. Janus, I do not have glistenings. I'm sorry if I gave that impression. After selecting my surgeon, I discovered he only uses Alcon lenses. I researched them and had concerns with the high refractive index and glistenings. Like you Ivan, I found research on both sides regarding glistenings. Even though my preference would have been to not use the Alcon lens, I went ahead with the lenses and my surgeon. Part of my rational was that it's the number one monofocal (in the US). So here I am 3 months out and I have positive dysphotopsia and PCO. It's possible a YAG procedure for the PCO would resolve the positive dysphotopsia, but if not I would be faced with a risky post YAG lens exchange. For me, driving at night is very important (part of why I went with the monofocal), so I have elected to have my lenses exchanged to silicone. If I had to do it all over again, I would have picked the Tecnis monofocal as it has a lower refractive index and glistenings concern me. Who knows, I could very well still be in the exact situation though.
Regarding diamond eye, my family has commented on it so I'm sure other people see it. I have also read that it's inherent in all Alcon lenses.
W-H janus381
Posted
Well Hoya Vivinex page says "Glistening-free hydrophobic acrylic IOL material " too!
Yes I saw that Zeiss CT Lucia study too.
soks Deb03
Posted
hi deb
when is your exchange? how confident is safran that the dysphotopsia will go away with softport? did you use alphagan or other miotic? your dyphotopsia started after 6 weeks correct?
did u get monfocal for both eyes and were they both set for distance? how much near could you see with them?
Deb03 soks
Posted
Currently have both monofocals set for distance. Ended with:
non-dominant RE: Between 0 and .25 no astigmatism (have measured both so I am probably somewhere in between)
Dominant LE: .5 .5 127
I do not have good near vision. It was slightly better at first, but as my eye settled I ended up more farsighted. I was 20/100/Jaegar 10 one week post op and am now 20/200/Jaegar 16.
I did not ask Safran how confident he was that it would go away. I used lumify (2 drops) one time and it did not make a difference. It started approximately 6 weeks post-op in RE and fairly quickly in LE although I can't recall exactly when.
Right eye exchange is this Thursday. Targeting -.4/-.5. I am also having a vitrectomy so I'm not sure how long it will take to see clearly. I'm guessing there may be more inflammation, etc but don't really know.
I believe you have Symfony so I'd be more leery about exchanging it. I'd want to have pretty high confidence that it would make a difference. I suggest you also ask Safran if there is a way to do the YAG to make it less risky if you need an exchange. Seems someone posted about that on this forum before.
W-H Deb03
Posted
I think my surgeon said YAG is no big deal and he does lens exchange onYAGed capsule! Unless I heard wrong.
Why do you say that? As far as lens exchange is concerned monofocal or multifocal would not make a difference.
Deb03 W-H
Posted
Sorry, poor wording choice on my part. Yes, the surgery is the same. It's just that Soks would be losing the extended range from the Symfony when going to a monofocal. Assuming my surgery is successful, I'm not really losing anything since I'm going from one monofocal to another monofocal. In Sok's case, I'd want to feel more confident that the exchange would correct the problem before undergoing the surgery. Hopefully I made sense this time!
W-H Deb03
Posted
Deb, yes you made full sense 😃
Soks might even gain better monofocal quality vision although the PCO is already there so...
I wonder if plate haptic helps with dysphotopsia.
Tough game this cataract!
soks Deb03
Posted
thats is what two surgeons told me: that you will lose whatever near you have. alphagan helps eliminate it completely.