PanOptix and glistenings or "diamond eye"?

Don't be too concerned about some of the issues attributed to Alcon lenses in this old thread. First, I am convinced that this so called "cat eye" thing is an internet fabrication. I can find no credible substance to it. I have one Alcon AcrySof lens and my other eye is natural with a mild cataract. There is no way I can create this "cat eye" thing. Both eyes reflect the same to a point light source. Glistenings are real. I was concerned about them and did a lot of investigation. I am convinced they were the result of quality control issues which Alcon has now solved. But even when they existed in lenses the impact was nothing that the user sees. The optometrist can see them with a slit lamp, but the user vision is not impacted. My surgeon confirmed this conclusion. He said he has seen them but in all of his practice it has never impacted vision. If you are really concerned Alcon has come out with a new Clareon lens material which is said to be glistening free. Not sure how available it is though as it is very new.

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If you want to be worried about something then think about blue light filtering. Blue light filtering contrary to what one may think provides the most natural colour balance. It is designed to replicate the balance of a young adult. In comparison a clear lens will provide a bluer than natural colour balance. Then there is the resistance to PCO, which is common and clouds vision like a cataract. Alcon claims their lenses are more resistant to PCO, and some studies have found that Alcon lenses have a lower rate of YAG (a laser process to correct PCO). And Alcon claims there lense are more stable in the eye and move less. Some studies do back that up. This is more of an issue with toric lenses which are extremely sensitive to rotation after lens insertion.

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And going to a Multi Focal lens like the PanOptix has issues too. Keep in mind that the premium lenses mainly have a premium price, not premium optical performance. They give you closer focus but at a price of reduced optical quality. Spent a good amount of time finding out what these quality issues are before you jump in to going for this type of lens.

Ron, the diamond eye effect is not an internet fabrication. Many patients have it, you can youtube videos of patients demonstrating it. All high refractive index lenses have this effect. All Alcon lenses are high refractive. You may not notice it but many other people do. Many patients complain they were not warned of this side effect and find it upsetting. Some patients are not bothered by it. Shannon Wong posted a youtube video demonstrating the effect in one of his patients to educate others about this side effect in Alcon lenses.

The human lens refractive index is 1.41. Alcon is 1.55. Tecnis is around 1.43-47. The closer you stay to the human lens index the more natural it will look in your eye.

Sorry, but I can find no credible evidence that the diamond eye, cat eye, terminator eye effect even exists. It makes no technical sense, and trying as hard as I can, I cannot create the effect in my own eye which has an Alcon lens. Alcon has the largest share of the IOL market in North America, so nearly half the people in the general population that have had cataract surgery are using them. If it were a real issue it would be well known. There are many things to consider when selecting a IOL, but this "issue" is not one of them.

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A high refractive index material makes the lens thinner and easier to insert into the eye through a smaller hole, which is the main reason it is used. It does have some drawbacks though. First because the lens is thinner it may not sit in the same axial position as a natural lens. For this reason in some, it can be more susceptible to dysphotopsia. Silicone lenses have a lower refractive index, are thicker and are sometimes used to avoid this positional effect. But for other reasons they have pretty much fallen out of use. And because the higher index material bends the light more it can cause more chromatic aberration. But the impact is very slight on actual vision especially with the blue light filter. I have used eyeglasses with high index lenses and they are claimed to have the same effect But, I have never noticed it.

If your MD said wait, then that sounds like a good approach. The state of the art in lenses seems to be constantly changing, and you never know what advancement is just around the corner. In the meantime, you can research your options. There is a lot to learn and consider! One point to bear in mind: as cataracts mature, they can be more difficult to remove and it can cause more stress to your eye during surgery, so keep communication going with your doctor.

One thing you might want to read up on is monovision/minimonovision. The lenses in the 2 eyes are set at different focal points, so it expands your range of vision--one eye does the work when you're closer and the other for more distant views. That is the approach I'm using. I'm 2 weeks after surgery on the first eye, and I think/hope it's probably going to work out well. I suspect I will need glasses for reading and will be more comfortable using them for driving, but I will be able to drive without them (the optometrist has already given me the ok to drive glasses-free.) I'm hoping I won't need them at all to cook--fogged up glasses from a hot pot make me crazy. Think about your daily activities and where you visually spend most of your time. In my case, taking glasses on and off regularly (and trying to find the glasses that are never where your think they should be) would drive me absolutely nuts. But if I'm going to be wearing them for a reasonable period of time (driving or reading) and can keep my glasses that are only used for a particular activity in a particular place and can get by without glasses the rest of the time, I'll be happy. If I watch tv while eating, I'll be able to see the tv, my husband's face, and my food. That's my decision process; yours will be unique for you and your lifestyle. There's definitely been a grieving process--things are going to be different. I've never needed glasses to read, and I'm not wild about cheap readers. Things look much better through my husband's prescription readers, so I'll probably get some once both surgeries are done and my eyes have healed. There are also a lot of gains I haven't driven at night for years, and haven't been able to safely drive myself for months. My vision was getting so very bad I couldn't see any letters on the eye chart. There is so much to be grateful for, and the issues with wearing glasses to fix near or far vision are at least things that can be fixed.

The practice that is doing my eyes uses Alcon lenses as their default. My surgeon changed his mind and decided to use Tecnis--BUT I have unhealthy eyes. The doc mentioned glistenings and said there were some other reasons for the change. I think it is just that he is being very conservative in my case and trying to get the very best optics for my poor old eyes. He didn't want to do anything that could in any way make my vision worse, even if normal, healthy eyes wouldn't be affected. It says something that they usually use Alcon and the use of Tecnis deviates from their standard practice--if Alcon-brand lenses had a serious problems inherent in the lens material, they wouldn't be using them. From what I've read there are advantages to both Tecnis and Alcon. The main thing is selecting a lens that will provide you with the best visual quality for your lifestyle and minimizes any artifacts (glare, halos, etc) that would drive you crazy. I've got a little negative dysphotopsia--like a little dark crescent at the edge of my vision. It's a lot like seeing the frame of your glasses out of the corner of your eye. I hope it goes away, but if it doesn't, it's not a big issue. Read up on the different options, their pros and cons, and think about whether the known visual affects are something you can tolerate.