PanOptix: Did you adjust to them or explant? Were you happy with results if exchanging?

PanOptix: Did you adjust or explant? How happy were you with the change if exchanging?

I am 52 years old and received PanOptix toric in both eyes, LE on 9/9/2021 and RE on 11/30/2021.

I did have the beginnings of nuclear and cortical cataracts, although they were not bothering me that much, and my doctor encouraged me toward going ahead and “taking care of those” while also addressing my extreme myopia and astigmatism. Much regret about this, but here I am and deciding how to move forward. He did not tell me what lens I was getting, and I was too uninformed to ask; I just knew I wanted to be as free of corrective lenses as possible; otherwise, there wasn’t much point since my cataracts were not yet severe. My doctor told me that the lenses I would receive had the side effect of halos—which I accepted because my extreme myopia has always given me starbursts. He did not mention any other trade-offs from the lenses I would receive. The LE took two tries—the first lens implanted in July 2021 was too much of a refractive miss, so my doctor explanted it uneventfully and replaced it with the correct power on 9/9, so the LE has already undergone a lens exchange once, early in the post-op period. Now that my RE (dominant eye) is done, I measure 20/20 both near and distance and show no signs of astigmatism. My doctor is happy and considers it a great result.

My original manifest refraction, is below. I am not savvy on exactly what everything means in practical/scientific terms; I just knew I couldn't see 2" past my nose without my contacts, although my correction with them was very good except for needing readers up close. At my last exam in May 2021 the correction had dropped off slightly to 20/25 and I had presbyopia in addition to mild cataracts. I was noticing needing more light to see in the evenings. Other than some expected lattice degeneration which was examined pre-operatively, my eyes are otherwise healthy.

SphereCylinderAxisDist VAAdd

Right-13.25+2.2511020/20-1+1.75

Left-14.00-2.7508020/20+1.75

How I wish I had left well enough alone.

My overall quality of vision and quality of life are worse, in spite of the technically "perfect" result, and I am wondering if I should risk exchanging one or both of these lenses to restore a better quality of vision and reduce the number of visual side effects. I know on paper everything looks great, but I am frustrated and upset every day. I am experiencing these side effects in my vision:

The bad:

Shadows/blobs/offset gray images around text, especially light text on dark backgrounds. Additionally, all text looks faded and pale.

Glimmers and shimmers in peripheral vision, especially in low light or when seated by a window. Very disorienting.

Poor intermediate vision that drops off after about 28” and makes it difficult to impossible to make out

labels on store shelves, in my refrigerator, on bulletin boards, or when looking over my students’ desks to see their papers or computer screens. Everything from about 28” to 8 or 10 feet is less sharp and detailed and slightly unfocused, then it gets better again in the distance.

Halos around bright points of light even in the daytime (example: looking at my silver stud earrings in the mirror, they have halos or double edges). I had expected night halos, but not daytime too. Focusing on a shiny surface or object--forget it.

A double edge, ghost edge, faint transparent projection of the outlines of every object I Iook at up close. Everything looks slightly out of focus and nothing has sharp, clear edges.

Especially when I am indoors, objects look slightly out of focus due to the double outlines; it is hard to describe, but things almost have an electric glow around them, or look like a printed image that ought to be viewed with 3-D glasses in order to merge the outlines.

A projection of road signs so that I see the sign and then a faint copy of the sign on one side, especially on bright days

Dryer eyes (which I know can also affect vision). I use preservative free eyedrops probably 10-12 times a day.

Worse fuzzy vision in low light.

The good: I can see acceptably well/clearly outside in bright daylight. I can see to put on makeup and work at my computer (14-16” away from my face). Nothing is as sharp and clear as before with my contacts, however.

I do understand neuroadaptation takes some time, up to a year for some people, but I am not sure I am ready to accept strange glowing shadow outlines around everything and "soft focus" for the rest of my life. I do have decent near vision and can see to read and use my computer (although with the ghost letters) and can see well enough to put on makeup, so I hate to lose that, but the overall quality of my vision is much less sharp than I was used to with contacts, and between that and all the strange visual effects, I am just not having a good time. I am in a bit of a dilemma because I want to see if time helps, but I have some PCO that my doctor wants to YAG and know treating might help a little, but would make exchange more dangerous, and that the sooner you exchange, generally the better.

I am a detail person and tend to notice everything; I do photography, needlework, calligraphy, artwork, antique restoration, crafts, and a lot of reading. I also do a lot of things like cooking and gardening that require clear vision a few feet farther out. My current vision, both its lack of sharpness and the weird visual effects that may or may not resolve, is very distressing. A pair of trifocal readers helps somewhat with the intermediate, like when I am in a store, but does not entirely resolve the double outlines and weird reflections. At many points in the day things just look "off" and I struggle to focus.

Has anyone here exchanged one or both PanOptix lenses for a monofocal? If so, how long did you wait? I am interested to hear if the exchange resolved your problems, improved your vision quality, and made you happier. Did the additional procedure make your eyes even dryer? Were there any complications? How close is your near vision after the exchange? I am an extreme myope and have long eyeballs; does that affect the range of clear vision with monofocals? What lens did you receive instead? Were they able to exchange for another in-the-bag lens, or did they have to use a sulcus or other type of fixed lens and aren’t those more risky/worse outcomes? And finally, is there anyone with monofocal lenses who is able to wear contact lenses for near and intermediate without having to take them out to drive or do outdoor/distance activities? I understand I could get progressive glasses, but really would prefer contacts and am not sure if they can be inserted in the morning and worn throughout the day without affecting some other distance I need. Or do you regret exchanging your multifocal lens?

If you kept your PanOptix, did the disturbances eventually resolve? After how long? The two that bother me most are the ghost outlines and lack of sharp edges. I have read that they are always there but you learn to tune them out, the way you tune out tinnitus (which I also have). I do not think I can live with "visual tinnitus" if that is the case.

I am afraid of trading one set of problems for possibly worse ones and exposing myself to the added risks of explanation, but am very distressed about dealing with these visual disturbances forever. At the same time, I wonder if I should leave well enough alone and just learn to accept it.

Any real-life experiences are most welcome as I weigh my options and consult with professionals in my area.

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