PanOptix and Other Trifocals: Reality Check about Halos and Starbursts

avoid these types of lenses in highly detail-oriented / meticulous type personalities (programmers, engineers, etc.)

As an engineer who spent a chunk of her career as a programmer, I can tell you that this is hokum. The bigger problem is that engineers want to know the specifications and performance data for the lenses, and the doctors/manufacturers don't want to share the information. We want to analyse our options and make an informed decision. Even the data in defocus curves is pretty bad--there is no standard for testing. Granted there is a layer of frustration with how much of a crap shoot this is--look at how often targets are missed, for example--and with the variability of biological systems vs manufactured devices. That said, if my eyes had been healthy enough for multifocals I would have strongly considered them. HOWEVER, if the only information I had was that that was supplied by the doctor--who used the "don't worry your pretty little head about the details" approach, I would have been absolutely livid with the typical result for those lenses. Not because I'm an engineer, but because the doctors treat you like an idiot and fail to give full disclosure on the possible side affects of a particular lens or surgical approach.

lucy24197

although some surgeons don't take that time to approach all our questions some do. Reason I think people should get a few consults. There may be aspects that a lay person may not understand and one must do a bit of reading and research to get a better grasp. I am sure in your field there may be things that only someone with similar training would understand. I had additional questions after my consult when I went home to read up more on IOLs and the procedure itself and O went back for a 2nd consult and that delayed my surgery (I was ok with that). Lots of people have zero interest - my brother in law had clear lens exchange and does not believe it is same as cataract surgery!

It is important to find the right surgeon for you - not that end result is better either way. Some surgeons who work for NHS or under medicare here in Canada and have many patients vs private often do jot have time to go into in-depth discussions with every patient. The onus deems to be on patient and if one wants a lot of discussion seek out a few consults to find a surgeon that will offer that.

I had multiple consults, at about $500 US each. I went into them after studying up and bringing a type-written list of questions.I had one surgeon practically run out of the room rather than answer any questions at all. As far as it taking someone with similar training to understand my work, at a detailed level, that is true. But I also had a responsibility to understand what I was doing well enough to explain it to a layperson should they ask questions. For example, I could have explained the power spectral density of random vibration to you as the Fourier transform of the autocorrelation function, or told you to picture yourself riding in the back of a pickup truck on a washed out dirt road. I was unable to get the surgeons to meet with me for follow up questions. They refused to let me see things like biometry results or displays showing my astigmatism. The only way I got a few questions answered was by refusing to sign the consent form that included the statement that said my questions had been answered. That triggered a call from the surgeon and I was given 10 minutes for questions. Some of the questions related directly to the fact that I'm a higher risk patient, and some of the questions that weren't addressed might have prevented some of the complications I'm having now. I was only permitted to speak to the "surgical coordinator" whose main functions seem to be to keeping a calendar and blocking patients from speaking with the doctor. If you asked anything technical they'd reply "That's a doctor question", tell you they'd ask the doctor and get back to you . They didn'tIt sounds like things are different with the health care system in Canada, but in my area of the US it's an absolute meat market.

Sorry to get political, but as a Libertarian I cannot help it. I doubt Canada or any Gov’t Big Bureaucracy system will be better. And in the US if on Medicare or Medicaid you are on a Big Gov’t Bureaucracy system. Remember the news how the VA was treating their patients. And if on private insurance it is just another Big Bureaucracy. Having 3rd party or 4th party paying for the service will never lead to high quality service. As the doctor is now responsible to the 3rd party and not the patient’s best interest. And the 3rd party goal is usually to get cost down as much as possible, thus turning the healthcare system into a meat processing plant. Why do you think it is nearly impossible to get a doctor’s phone number or email in order to contact them? It is because there is no billing code to cover that service.

And even if you are paying cash as you stated, you are still trapped into the system with others who are not. There are slowly becoming more doctors standing up and breaking away from this model. You can research primary direct care doctors, where the quality goes up and cost goes down as they no longer take insurance. I am talking about doctors that take the time to know their patients and you can actual Skype with. Heck, they even make house visit. Yes, you read that correct, house calls. The association of American Physicians and Surgeon (AAPS) is one of the organization that is leading the way on this issue. I don’t know if there are many

Ophthalmologists, more less cataract specialist, doing this yet.

Only other option is try and find a doctor that is willing to spend more than the allotted 10 minutes and give you his email so you can ask questions. But that is extremely hard to find and it is SAD!

In Canada there is a lot of strain on our free medicare system. Doctors, especially specialists, have long wait lists. Took 19 months to get in to see a retina specialist. I guess US system where they are higher paid has its drawbacks too.

All I can say is I am thankful things have advance in cataract surgery and it is definitely not the procedure my grandmother had. Diagnosed with cataracts both eyes at 53 was not something I expected. Although not perfect I am satisfied with result.

Yes bot place for political positions. i looked into that AASP some time ago - a lot of misinformation on vaccines, pandemic, etc.

Not sure I would want to see a doctor there.

No shortage of misinformation regarding Covid on all sides.

AASP is but one organization. The direct primary care doctors are individuals who goal is about providing direct primary care and not about a single approach to Covid.

If you don't like AAPS there is Direct Primary Care Coalition and many others and probably most don't even belong to an association.

One great resource to learn about direct primary care is go on you ..... tube and search for Josh Umbehr a DPC doctor. He talks about DPC and the amazing service and how he sells prescription drugs for next to nothing compared to the pharmacy.

Like I said it might be hard to find an Opthamolgist that is a DPC doctor.

Luckily I was able to find a doctor who I actual have his email tough I am careful not to abuse it.

And he tries to spend time to answer question, but he is in the insurance system, which means he has to see lots of patients a day.

One thing people don't realize is bureaucracy creates massive paperwork. For every doctor their is 4 stall support for billing and so forth. Their are codes for if you got hit by a duck .vs bit by a duck. This is the insanity bureaucracy brings.

I hope this does not go into moderation, there is nothing that breaks any rules.

And who determines what constitutes "misinformation" on any subject?

As patients who have to interface with the current so-called healthcare system to get cataract surgery/attempt to improve our vision, we can do best for ourselves by availing ourselves of all the current knowledge and wisdom we can gather, from all sources. Then making our own personal decision based on our belief system, values, personal history, and best judgment. I appreciate this information that rwbil has provided. I don't see this as political at all, but relevant to why we are all here on this forum.

At present, as I'm recovering from CME, I'm Extremely Unhappy with my eye surgeon, his office and staff, with how I've been treated there. Herded through their cataract surgery center like a cow, dropped like a hot potato at one week post-op, when vision was just starting to decline in operated eye. Had to get a 2nd opinion to get diagnosed with CME, now getting the total cold-shoulder from their office. My surgeon walked out of the room at my last appt (Oct26), without responding to my reported complaints... flashing shimmering lights in center of vision, having to use a magnifying glass to see up close because things are so small. I sacrificed the possibility of plano/clear distance vision, to have IOL set for near. He wouldn't say what my refraction ended up, keeps side-stepping the question, but going by which of my old glasses work the best, I think I'm probably a -3.00D in the operated eye. Last thing he said to me was "get some readers to see up close", which positively infuriated me.! I'm forced to try to get in with another ophthalmologist, pay out of pocket, and just wait it out for answers. I'm totally disgusted with our so-called "healthcare" system in US. It can be said that the actual clinics and doctors are just another arm of the insurance and pharmaceutical giants.

I do have insurance, and it's excellent once I meet the gigantic (high 4 figure) deductible. Before the deductible I pay everything. I'd met my deductible by the time surgery happened, so it was covered 100% except for the combination drops supplied by the surgeon, and I'm going to ask the insurance company if they'll cover those, too. My insurance is not-for-profit and that might make a difference, but it's the best insurance I've ever had.

Government isn't all bad. One good thing my state government does is have some laws that are supposed to protect the patients (and can also protect doctors.) There are some requirements that should be simple for the doctor to do, like explain to the patient the proposed treatment, tell them the anticipated results, tell them about recognized alternative treatments (including doing nothing), and tell them about risks, complications, and benefits in the proposed treatments and alternative treatments. This information can be provided via a consent form--assuming they let you read it. When I went in to sign the forms for the second surgery, it was a good thing that I'd read the consent form before the first eye was done. The coordinator who was collecting signatures said she would NOT let me read it because it was too long (2 pages) and she didn't have time. What makes this particularly offensive is that once they have your signature on the consent form, the doctor is in the clear with the state and the patient has no recourse if things go pearshaped. I'm seriously considering reporting them for forcing patients to sign under duress. If the doctor doesn't have time to go over all the required information, they could make a simple handout. It's not that difficult to provide people with basic information about the surgery. What really chaps my backside is that in their records they claim to have discussions that never occurred "explained in detail the risks" etc. They're lying and covering themselves legally--a real disservice to the patient.

Before seeking out another specialist perhaps your own optometrist can do a refraction test. I find my own very helpful. A lot can be gained/learned from the actual prescription. My surgeon had me read the eye charts after surgery at 24 hours / 2 weeks and 6 weeks. But wasn't given a prescription at those times.

True enough. Just had enough of family members sending me stuff from this particular organization which was a little out there and had an anti science viewpoint.

I agree that getting an eye test at about 6 weeks and an eye glasses prescription tells you a lot about the outcome of cataract surgery. You then know the residual error in your spherical and cylinder parameters. That explains a lot about what you can see and can't see, and why.

Those with the highest expectations (perfectionists) are most likely to be disappointed.

Bingo. And that's exactly why I ruled them out. I'm a ridiculous perfectionist. I KNOW the halos, no matter how subtle, would drive me crazy. Personally. I zero in on that kind of thing and can't let it go. That's just my personality. So they're not for me. But a lot of people get them and love them.

The trade-off is clear, but the idea of "perfectionists are most likely to be disappointed" with trifocals is probably (I think) something invented and promoted by ophthalmologists who are trying to categorize patients easily without consulting psychologists.

For example, I believe that I'm a perfectionist. My choice was either monofocals and use readers or glasses for distance... or EDOF and probably still need readers... or trifocals and get halos and starbursts at night, but get a full range of vision. Plus halos and starbursts still happen with monofocals and EDOF.

None of these choices are perfect for perfectionists. They all are starkly imperfect. But what is the most perfect choice for me? Or for your friend? That's why I started this thread... to help perfectionists understand IN ADVANCE that halos and starbursts WILL happen. Using this information, perfectionists can measure the benefits of greater depth of field more appropriately against the possible problems in other areas.

Indeed, I imagine that some NON-perfectionists happy-go-lucky souls may be more likely to wave away the bother of trifocals and get the cheaper IOL monofocals and wear glasses... because who really cares about extra depth of field except a perfectionist?

All I can say is that I am a perfectionist and I know 100% without a doubt (based on other experiences) the halos would drive me bonkers. But yes of course it's just a general rule of thumb and everyone is different.

I currently have a monofocal IOL in one eye, and use a contact in my other eye which still has a natural lens. If anything there is less flare with the IOL eye, and no real halos with either eye.

All I can say is that I am a perfectionist and I know 100% without a doubt (based on other experiences) the halos would drive me bonkers.

That's all you need to say. My original post in this thread is intended to be unequivocal that (in my opinion) halos and starbursts WILL happen with trifocals. As far as I can tell from personal experience and research, it always happens for everyone with trifocals when lights shine directly at the eye. So anyone who would be "bonkers" from halos should not be tempted by the promise of near-perfect depth of field. I'm hoping to save patients from significant disappointment, bonkers or otherwise.

author11 from what I have gained in speaking with others with monofocals (I gave Symfony) is that it is also a matter of a clearer, sharper vision not just starbursts and halos. As I cannot visually compare I take their word for it.

Another factor is cost - there is a significant difference in cost and the more one spends the higher the expectation.