PanOptix experience
Posted , 89 users are following.
(apologies for starting a new thread, but my last one was more a question about PanOptix before I chose that route. Seems like it'd make more sense if someone was searching for info/testimonials that a new thread specific to my experience with the lenses. )
I'm 45, very active/athletic(competitive mountain bike racer, motocross rider, skier/snowboarder), and have been fortunate enough to have had 20/15 vision up until a few years ago. Not wanting to adapt to readers or other prescription glasses that accompany monofocals, I opted for PanOptix over Symfony partially due to the loose recommendation of my doctor, and mostly because once I was aware of their existence, the clinical studies I was able to find online seemed to show that PanOptix tested at least as good as Symfony in all manners, showed some level of reduced night artifact/glare/halos, and promised near-vision, in addition to midrange and distance vision.
I'm 4 days post-op of a PanOptix in my right eye, with the sole motivation of surgery to treat my rather severe cataracts. That eye was the worst of the pair, and now that I have what was considered my "good" eye as a baseline to compare the new lens to an old one, it's definitely a mixed bag.
Like basically anyone who's had IOL's implanted, the newfound vibrance in colors is phenomenal. There was a yellow wall that my old eye perceived as being gray the other day, if that's any indication of the difference. The day after surgery, my vision tested at 20/25 in the new lens, as opposed to 20/60 before surgery. I didn't have any eye issues that required glasses before surgery; it was simply the cataracts that was causing such poor vision. So, compared to my vision a couple of years ago, 20/25 is still technically a degredation for me.
Near vision is another positive with PanOptix, but it's admittedly a bit finicky with exact distance. Roughly 12-inches is the sweet spot where text is clearest. A few inches past or closer than that, and things begin to soften up. Text doesn't get too terribly blurry, and doesn't seem to progress into being completely illegible as distance away from the sweet spot increases, but there's an absolute sweet spot of near focus for sure. Midrange is somewhat disappointing for the claims and studies on PanOptix, as sitting at my desktop computer approximately 24-inches from the screen results in less-than-sharp focus. I have to get right up to within 12-inches of the screen to get the crispest focus, which is where the near vision focus is. Seems like these are almost bifocals and not trifocals.
Nighttime vision overall in the PanOptix eye is good. I don't notice a reduction in contrast like my doctor thought might be the case with the division of light to three points. It definitely didn't improve my night vision by any means, but it didn't seem to reduce it. My cataracts is very central in my original lens, so I actually see best at night when my pupil is dilated big enough to see around it.
Halos around all lights are very apparent, not only at night but during the day as well, and the halos even have that little spiderweb effect. One or two lights at a time, and it seems manageable. But, I just drove on the highway tonight and realized how much I was relying on my natural lens to see. With that eye closed, the PanOptix eye was creating such drastic halo that it seemed like it was keeping that eye from finding focus on anything. Truly blurred vision if there's more than a few lights, which was both scary and perplexing on what to do for my other eye as I can't imagine getting through the rest of my life without the ability to operate a car, walk through the city, etc. at night.
From the first day of surgery, I've also had a flicker in the PanOptix eye. The followup doctor(who I'd never met, and won't see again) said that's normal and should go away, but it hasn't really subsided in 4 days. I notice it gets much worse when there's light shining in from my peripheral.
Distance vision is worse with the PanOptix eye than my natural eye, which is disappointing. This discrepancy is amplified at night, especially if it involves reading street signs or things like neon lights.
I see my optometrist on Friday, and will share what he says about the debilitating night vision, flickering, and lack of midrange focus. Oh, I also noticed today that if the sun is directly in front of my vision and I have sunglasses on, that a reflection of the PanOptix IOL shows up in my sunglass lens. That wasn't expected, not sure if anyone else has had the same or similar experience with any other lens?
3 likes, 162 replies
soks 303z
Posted
thanks for sharing. very articulate description. doctor office is going to ask you if you are an engineer. my cataract is also central and like you my vision gets great at night in the unoperated eye. my natural eye is balancing the halos from my symfony eye and i too am in dilemma on what action to take on the other eye. i had flicker the day after but i havent noticed it thereafter. there is a possibility that you feel the distance vision is worse due to some surgery induced astigmatism. optometrist should be able to confirm / deny that. treating astigmatism may also move your sweet spot a little farther that 12 inches. i can see symfony rings, pco as well as my cataract in the other eye in the glasses reflection as well as by barely opening the eyes and looking through the eye lashes like derek says. good luck.
Deb03 303z
Edited
I had the lens flickering. It was very aggravating. Peripheral light is what has the biggest impact on it. Four months later, It has not gone away totally, but has lessened significantly. Do your best to ignore it so you can neuroadapt faster. Did you have your dominant or nondominant eye done first? Does your other eye need surgery also?
303z Deb03
Posted
I had my non-dominant eye done first as it had much worse cataracts than my dominant eye. I'm scheduled to have the other eye done on the 8th.
It's kind of funny as before surgery I found myself closing the non-dominant eye to see better in brightly lit environments, and now I'm closing my dominant eye(that was considered my "good" eye) as the IOL sees so much better in those conditions. Then last night in traffic, I was back to closing the IOL eye in order to see.
LaVonne2020 Deb03
Posted
That is depressing to hear that after 4 months you still have problems. How are your eyes now? I have terrible spider rings. Do you have those still? I received the PanOptix lens, did you and are you happy?
Sue.An2 LaVonne2020
Posted
Hi LaVonne - based on my experience the glare does improve but my concentric circles still visible after 3 years. If you were advised about the spider webs that is unfortunate and surgeons should discuss those. Best when patient is fully aware of what side affects there are with the lens. I have an EDOF lens but did know the possibility of the concentric circles from people on this forum. My surgeon described those as halos and did say that night vision would be affected.
I will say that once glare subsided the concentric circles were light and not as bothersome.
Hope you can adjust. If intolerable do not get a yag (if you develop pco) so that you can consider an exchange for s different lens.
tsp1 Sue.An2
Edited
Do you mind telling me how long it took for the glare issues to finally subside? I still have it very bad and can't really drive during the day. I had surgery 4 months ago and am hesitant to do the other eye at this point. I had the PanOptix lens put in. The rings around lights at night are bad. Probably see around 4-5 around a headlight/street light but my main issue is everything is blurry during the day with the glare. I even experimented with a blind open and closed inside my house and it affects my vision then also. When doing a glare test at the Doctor's office, I could not read 2 lines with glare. It definitely hinders my vision. I just need to make a decision whether to have it removed and go with a regular lens. Also I already am told I need to have laser because of a tear or something in the back. Maybe that is YAG that you mentioned. ???
Sue.An2 tsp1
Posted
Oh your situation sounds worse than mine. I had very good vision during the day with Symfony lenses. The concentric circles I could start to see at dusk. The glare hid those for about 6 weeks. I found it easier to drive then with inside dome light on and a voided routes where no overhead street lights. At 4 months if all has healed correctly you should not be having issues during the day.
It may be the power calculation is off or if you have a toric lens it may have rotated. If it were me I would not have another PanOptix implanted in the other eye. Your surgeon should be able to tell you why your vision is off. The premium lenses seem to require greater accuracy with refraction calculation to see well - far less forgiving than monofocals. You could make a visit to your optometrist to see if vision can be corrected with glasses. Get an exact prescription. If vision can be corrected with glasses it would seem there was a miscalculation in the lens power.
You might want yo get a monofocal in the other eye and if that goes much better consider an exchange on the other. Something is definitely not right.
Wish you well.
janet80554 LaVonne2020
Posted
I am awaiting my surgery. my options include panoptic iol
I'm not sure it is worth it. am i going to have problems. I live alone and have no one to drive me anywhere.
john56935 303z
Edited
You need to give it some time to adjust as symptoms generally improve over time. However, a word of warning, while many post on here that their symptoms went away, for some people like myself I still see the concentric rings just as much 3 years later as I did right after surgery, and the glare actually got worse after the YAG procedure. I may be an unfortunate outlier but that is what makes it so difficult to decide how long to wait to see if symptoms improve or swap it out for a different IOL. I didn't want to take the risk of doing an exchange because I have good vision with the symfony other than the nighttime issues. Had I known right after surgery that my symptoms would not improve much even if I waited, I might have opted for an exchange, but maybe I would have just ended up swapping out one set of issues for another. Not saying this to freak you out but wanted you to be able to make the most fully informed decisions possible. That said, I can still drive at night and have just learned to live with it and appreciate the good daytime results, plus maybe for me and others they will miraculously disappear after 5 or 10 years--who knows! PS--I also see the rings reflected like you asked about which I don't particularly like but again just learned to live with them.
Sue.An2 john56935
Edited
John I think you are right about exchange of IOL could bring on a different set of compromises. No perfect lens. If only we could pick what we like about each and put them all together in one lens.
LaVonne2020 john56935
Edited
Oh my gosh! This is so depressing! I feel sick reading this! My night vision is horrible! I hate the rings! I see spiders everywhere! I got surgery on the first eye on Friday, I am supposed to get the next eye on Monday.
ruth00928 LaVonne2020
Edited
LaVonna, I'm 3 months out with my first PanOptix and feel the rings are less distracting, but definitely still there. That being said, I'm not thrilled with mine due to what I consider poor mid and reading range. could be the surgeon didn't get the alignment right (was rotated once already). I'm seeing another surgeon at the end of this month before I decide what to do with the other eye.
Keep us up to date with your progress and let us know if you have the other eye done, and how it is for you.
LaVonne2020 ruth00928
Posted
As for the day vision I am 20/20 and read very clearly. I do hope the placement gets worked out for you and your vision improves. I am glad to know the rings are better and not distracting. I guess I could live with it as long as I can see at night. Was in between surgeries the hardest? My non surgery eye seems to be blurring things. I am just concerned with having two eyes see all those rings! I know if that were the case I might not be able to drive at night.
I still have the flicker. it is 1 week tomorrow for first surgery.
ruth00928 LaVonne2020
Edited
I understand your fear of having both eyes seeing the rings..something that has concerned me also. Have you discussed your concerns with your doctor? I was so disappointed with my original outcome, that I canceled my second eye surgery. They went back in and rotated the IOL, and it's better, but I'm still not overly happy..which is why I haven't had the second eye done and am seeking another opinion.
I honestly still don't know what I'm going to decide. I've adjusted to the differences between my two eyes at this point..using the IOL eye for distance and my natural eye for reading. Occasionally, the poor distance vision of my uncorrected eye bugs me (blurry) but I've gotten used to it.
You are only 1 week out from your surgery, and it can take several weeks to adapt.
Guest LaVonne2020
Posted
LaVonne2020 - when you are having so much doubt, you should postpone your second surgery.
Everyone with trifocal and edofs have side effects.
Lenses are different, but concentric rings, halos and sometimes starburst are very common.
The biggest fault in your case, is that you have clearly not been informed of what you should expect with these lenses. And then when it comes as a shock it is a hard pills to swallow.
I have edof one eye and trifocal one eye.
I had the edof first, it makes concentric rings around bright lights sources at night, especially led lights. And it makes starburst as well, or it did.
Right after surgery these side effects were quite visible, but my vision was far better than it was with cataracts, so for me it was an improvement in any case.
I had 5 weeks between surgery, and in these 5 weeks not much changed.
Then I had the trifocal in the second eye, and I had really good vision right away, but still these side effects were quite visible, and cars coming towards me did bother me, I drove anyway.
After about 2 month, it started to change noticeable. Now I am 6 month in, and starburst are almost gone, they are only a slight mist now.
Concentric rings are still there, they are bigger the further away the light source is.
The concentric rings is due to the lens design, I don´t think they will ever go away, but I do think they are less dense now.
In my case I have good night vision in general, and no problem at all driving at night.
Today I honestly don´t think much about the concentric rings when I am driving in the dark, they are there, but I don´t think about it.
Some people can tolerate these side effects and get used to them, some can not, it has a lot to do with personality.
It takes about 6 weeks for your eye to heal, and brain adaptation can take up to a year, even more for some.
There are two videos you really should take the time to watch.
They are made by a guy that have had two trifocal iols as a clear lens exchange, and the two videos are from 1 year and 2 years after surgery.
Search youtube for these two:
Testimonial Trifocal IOL lens inplant from day 1 to 11 months after operation
Trifocal IOL lens inplant testimonial from month 12 until month 24 (part 10)
assia99778 ruth00928
Edited
Ruth, how did you decide for your second eye? Did your intermediate and near vision improved during the last 10 months? Any further reduction regarding halos, concentric rings?
I'm asking because I'm suffering a lot from my trifocal ZEISS Lisa IOL implanted three months ago. Like you I had a rerotation but the lens is still 10 degree off. I've got induced astigmatism with left eye, residual astigmatism in my dominant right eye due to the rotation. I need glasses for far and for intermediate sight. I can manage best intermediate (laptop, desk) with putting a 1.0 reading glass in front of my far glasses in a piggyback.
In addition I have severe halos, glare, concentric rings and spiderwebs. Since surgery my life is out of order. It's a nightmare. I tried to get varifocals but it seems to be impossible because of those trifocal lenses. If only I could see clearly again in all directions with contacts or glasses. How did you solve the intermediate and near issue?
ruth00928 assia99778
Posted
I never did my other eye. I wear a contact in that eye for distance, and use reading glasses when i have the contact in. As for the PanOptics eye, it has stablized somewhat, but my intermediate & close up vision aren't as good as I had hoped.
My current opthamologist believes I was over-corrected for astigmatism. I still get the halos around lights, but they aren't as big or bright as they were in the beginning..not sure if that would be true if both eyes had been done. I've been told glasses cannot correct the PanOptics eye. So when the time comes that I HAVE to do the other eye, I will just do a distance lense.
assia99778 ruth00928
Edited
Thank you Ruth! Wise decision. I think I'm going to prepare myself for lens exchange to get monofocals corrected for far vision. Seems to be the only chance to receive proper vision again with contacts or glasses. I was misled by the doctors promising me good vision in all distances with the trifocals and downplaying side effects like halos. Unfortunately I found this forum after surgery because it's not provided in Europe if you use the search engine. There is no comparable information available in my country. Therefore thanks to all contributing to this forum.
If someone is able to explain why trifocals cannot be corrected by progressive glasses or multifocal contact lenses please let us know. I'm curious for that knowledge.
ruth00928 assia99778
Posted
assia, I wish you luck. I questioned whether or not I should consider an exchange & was told if I can live with what I have, leave it. Evidently that's not a common practice here and there would be a chance of having a worse outcome .
Curious3123 assia99778
Posted
"If someone is able to explain why trifocals cannot be corrected by progressive glasses or multifocal contact lenses please let us know. I'm curious for that knowledge."
I am also curious to know the answer to this issue.
RonAKA Curious3123
Posted
@Curious3123, I suspect it varies from person to person. A progressive eyeglass basically corrects the distance and then provides a transition to a near vision + add. There is really no control over the intermediate distance. It may be ok or it may not. I have a friend that has the PanOptix and she is not that pleased with the close vision, especially in lower light. She uses some basic +1.75 power readers and that seems to work for her. The problem with basic readers is that when you look up to the distance you can't see anything. Progressive glasses or special readers that are clear on the top should help to solve that problem.
rwbil Curious3123
Edited
It depends on what you are trying to correct. Is your concept that the MF contacts would boost the close and distance vision at the same time. I am not sure if MF contact lenses on Top of a Trifocal IOl will work. Be interesting if anyone has tried to see what happened.
But what you can correct is if your distance vision is great and your near vision is blurry you can get readers for that.
Also you could do Lasik for example to become more myopic, so this would allow you to pick up more near at the loss of some distance.
This problem is why if you are thinking of monofocal; LAL is the way to go IMHO.
There is a tradeoff to whatever you do which is why there is no perfect IOL, at least yet.
The doctor can try different lens after cataract surgery so one can see the effects. So you might end up with night time glasses or readers for close or etc.
And of course when talking about EDOF or MF lens there are visual issues on top of the normal visual acuity. And different people get different results. And I would go as far as to say different people react different to the same results. You could have 2 people seeing the same dyphotopsias and one love it for the trade off and another person hate it.
I tell anyone getting defractive lens to expect dysphotopsias that is the trade off for close vision. And if that is going to bother you don't even think of getting a defractive lens. I hate doctors who do not completely explain the risk to their patients.
Personally I am not so vain I can't wear reader now and then. But I want to be able to go to a restaurant and read the menu if I forgot my glasses. I wanted to be able to go into a store and be able to read the label if I forgot my readers. And for that price I get Halos, glare, starburst and the works and I am fine with that for the tradeoff.
claudiaRM LaVonne2020
Posted
I had mine done with panoptix as well. I did left non dominant eye and after 4 weeks and my vision is like yours, horrible. I don't see at distance ( it was pretty good before) trye I can read near, mid distance is okish but all together is blurry. Night vision is scary! I cannot drive and I see all the glare, halos, starbursts of this world. They are big! My doctor postponed the second eye surgery until this is resolved but I am considering explantation. Do I really want to see the world like this for the rest of my life? I am not sure about adaptation when I start from such a low point.
claudiaRM rwbil
Posted
I totally agree with you, but it depends how high is the price to pay to get to the point you want to be. I had first eye done with Panoptix, I was prepared to use in and there some readers, I was prepared to see some mild halos ( they described them this way) I was already having some night vision issues when driving so I thought it wouldn't be that bad....it depends! I was not prepared to my eye become myopic, now I cannot see distance and I was not prepared to have severe dysphotopsias. I cannot drive. It is only 4 weeks I had my first eye done, my doctor decided to postpone second surgery until this one is some how fixed...how I don't know. She game me to try few contact lenses to see if correcting myopia I will be more comfortable (duh) and the night vision/starbursts will tone down. Yes my far vision improves but not the dysphotopsias. The tradeoff for me is not fair. Before I could not see near and intermediate but progressive glasses where just fine. Now I don't see a thing in the distance but I can read a phone ( best vision) or on pc ( okish/blurry) PLUS night vision issues. Is it really worth it? No in my opinion, I will need glasse all the time anyway and all of the above issues. I am hoping for a swap and if not possible I am asking: how do people get used to this? I wish I had just monofocal for distance and glasses for the rest. Crisp vision and simplicity. Am I wrong?
rwbil claudiaRM
Posted
It sounds like your issues are not typical results. Everyone is different and everyone seems to get different results. Just so many factors. Some people do not or hardly drive at night so again each person has to be evaluated.
For me distance is King. I need good Distance. Everything else is icing on the cake. But there was one person that posted that did mostly things like knitting and they wanted intermediate and close more than distance.
I have dysphotopsias and think everyone that gets a defractive IOL gets them. But some people's are worse than others and I hear it gets worse if you are myopic.
I don't drive that much at night and they are not that bad than I cannot drive. For me the trade off was worth it.
But I swear you could take 2 people with the same dysphopsias and get 2 complete different opinions. Everyone is different.
I just get so p****d when Opthamologist under play the dysphopsias. They need to be upfront and honest and show Realistic situation including the extremes some people experience. I am talking 3 Sigmas out.
They should not be just showing the mild case and if the patient is not willing to accept at least 1 Sigma out they should not even consider a defractive lens. Instead they now the option for the IQ Vivity and micro (< .75D) monovision. I know Ron will talk about -1.25 monovision. But not for me!!!!
claudiaRM rwbil
Posted
Exactly! I always been far sighted so I am used to it, if I don't see well at distance all in once I panic ...I did...and I am used to glasses or even multifocal contact lenses so even if I showed some interest in a multifocal this doctor should have at least explain further more. Well it is my fault too, I should have investigate more not just reading around more. Doctor mentioned vivity but I was like...no more multivision of any kind. Is it pretty bad to have both monofocal with distance and progressive glasses? She was like ...I can do better for you? Question is: Am I over reacting??