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
Sue.An2 303z
Edited
Hi 303z - I hear your disappointment and frustration through your words. As others mentioned this surgery is usually for people 25 years older and you are able to compare the vision much more than someone whose vision slowly deteriorated with time before cataracts hit. At 53 I was only having to start wearing readers so i can understand how this must be for you.
It is interested how you describe the trifocal - I didn't didn't have that available 2 years ago so have 2 Symfony lenses. Right from day after surgery EDOF vision is seamless - I don't have a sweet spot. Perhaps that is one reason for this class of lens and maybe just my experience with them. I can relate to flickering (LE only as RE never had flickering). I assume you have square edge IOL lime Symfony is. They do a better job preventing/delaying PCO than round edge IOLs but have the flickering. Another situation one choose the tradeoff. The flickering takes a few months to disappear. Some say it's adaption but I read the the edge gets (for lack of better description) shrink wrapped)and so lessons the light catching edge of IOL.
I can relate to night vision. Although day time is good night vision takes some getting used to. I used to plan routes where there was overhead street lighting as the glare starbursts were hard to drive with. Even put the interior dome light on in car to keep pupils from dilating - helped a bit. Although it never completely disappears it gets better usually in 6 months time.
It is early days things likely will improve a lot and from others sharing and dome reading on trifocals there appears to be more of an adaptation time - brain has to adapt more to the new view with them.
One word of advice if your 2nd surgery is next week you may want to push that out a few weeks so that the first eye settles and you are over the drops. Your vision could change a bit too and some adjustments can be made to 2nd eye. You may want the time to consider the lens option too if not completely satisfied with this one. It is nice to have that time to see how this improves. It may be night and day in 6 weeks time.
all the best to you
derek40125 Sue.An2
Posted
303z,
I'm going to second what Sue An just wrote. If I had just one piece of advice to give someone getting any type of presbyopia-correcting lens (accommodating, EDOF, multifocal) it would be to delay the surgery on the 2nd eye until your first eye is stabilized and you are satisfied with your lens choice. This is counter to what most surgeons like to do because both eyes do work best together but there are people who never adjust to these types of lenses and the risk with potentially two lens exchanges is just too high to ignore.
What if you decide you can't live with the halos or some other artifact of your chosen IOL? If you get to that point with only one eye done, you could always go monofocal in the 2nd eye and maybe the blended vision will be good enough that it will reduce the impact of the halos and you could live with the multifocal + monofocal combination. You've just avoided (2) potentially risky surgeries.
Just my opinion, but think about it.
Deb03 Sue.An2
Posted
I third that advice. I really should have waited for my first eye and definitely should have waited for my second. It's very early and hopefully things will get better for you, but your choice of lens for the other eye should not be selected until you have had a period of time to see how you do with this eye. Hoping for the best for you!
claudiaRM derek40125
Posted
This is great advise. After my first eye done 4 weeks ago with multifocal Panoptix and lots of nervous days because my eye shift into myopia and blurry vision and I could not understand what was happening, my doctor and I ( especially me) decided not to touch the other eye until this was ok. It is not ok yet, today I have another visit to see what to do. I am having a lot of problems with this lens, problems well known apparently. The far vision must be adjusted, it is terrible. Some blurry vision also when reading, low contrast and horrible night vision with all the issues. I am considering a monofocal for distance at least in the other eye. My natural eye cannot see near or intermediate and far vision is good enough so at this moment I have a similar situation. Also my natural eye is toning down the dysphotopsias. I am wondering if this disequilibrium between the two eyes will have an impact . I think symmetry or close to it is always better .
derek40125 claudiaRM
Posted
Claudia:
Just give it some time for everything to settle (at least 2-4 week AFTER you stop taking medicated eye drops). If your vision is stable but they just missed the target, then this is usually easily adjust via Lasik or PRK. If you have other issues like halos or something like that you may find that they lessen a few months post surgery. At least you'll be in a better position to decide what to do with your second eye.
I'm now 3 years post-surgery and the cataract in eye #2 has not gotten noticeably worse. The doctor gave me 6 months, tops, but I'm still 20/15 with a contact in that eye and so glad I didn't do that eye at the same time as the first one (despite the doctor's persistence).
claudiaRM derek40125
Edited
I did the surgery 4 weeks ago and no improvement, I am exactly like day one. She noticed PCO right away and the myopic shift and suspected a forward shift of the lens. We waited to see some improvement that did not happen, she told me that yag for pco would help with the blur and clarity of vision but would not move the lens enough for correcting the far vision. Lasik also was an option but at the end she said that all this enhancements would not guarantee the crisp vision and it would risk to raise my eye pressure since I have short eyes with mild glaucoma. She implanted also an Istent successfully and this issue is solved. I saw her today and decided to explant this lens and gave me an option between Vivity ( she did an analysis of the eye and thinks It is a great option for me providing great distance and intermediate vision, I might be able to read some but for sure I will need reading glasses for detailed work at the end better quality of vision and life) or a monofocal for distance but it is a bummer ( her words) because I will loose some of the functions of the eye and I will depend on glasses for near and intermediate. I have to decide what I want. Vivity does not give any night vision problems or halos so it seems promising. I created a new post asking for suggestions if some of you know some more about this lens. I would like to hear also from people that have just a simple monofocal being active and in my age range..60.
Sue.An2 claudiaRM
Posted
ClaudiaRM thinking about your situation I really think your surgeon coupled with your own dissatisfaction is driving you to do an explant too fast. Majority of surgeons say you ha e 6 months to explant a le s and some will do
it even later.
I really encourage you to seek 2nd and 3rd opinion from separate specialist. A regular cataract surgeon is not who you want doing an exchange. Even if your surgeon says they are confident it still would be to your benefit to have another specialist take a look. Not saying this is the case but another poster here about 3 yrs ago had a surgery that went wrong but the surgeon kept saying nothing was wrong. Another surgeon discovered one of the haptics wad outside the capsular bag causing lens to tilt. One wonders if her original surgeon saw it but didn't want to admit an error. Again not saying your surgeon made a mistake but it would be helpful to have another surgeon examine your eye to confirm whether it is too far forward. My understanding is that shifting back and forth stage before lens settles takes 6 weeks and once settled eyesight can be .25 diopter near or far from original position at most.
diane70001 claudiaRM
Posted
Claudia, I'm courious to know what you decided, and how your vision is today. I have a similar issue as I am now near sighted after getting panoptix in right eye 10 days ago. Night time vision with rings, starburst and halos are terrible.
Looking forward to hearing from you.
Diane
303z
Posted
Just got back from the optometrist, who discovered that I have an astigmatism. That's interesting news, as the surgeon's optometrist who did all of the pre-op measuring said that while I did have a slight astigmatism, it was in my lens, so replacing the lens would take care of that. Ooops.
A followup to my discovery of how horrible my night vision is in traffic, I began to notice that my far vision in general wasn't sharp during the day, too. So the hope is that with either lasik or corrective lenses, the blurry halos will at least calm down a little bit, and that I'll be able to find focus aside from the lights/halos.
My doc was cool enough to have some glasses made on the spot at the appointment this morning, and send me home with them - free of charge, no less. He agreed that I should hold off on surgery for at least a month on the second eye, and to give these glasses a week or two to see how they perform at night, and in general.
It seems like the surgeon's optometrist made a bit of a mistake, otherwise I probably would've had a toric lens implanted? My optometrist said my astigmatism wasn't bad, I think he said it was .75. He also said it can be corrected with lasik, and that should be covered by the surgeon, so if that's the case, and assuming the astigmatism is a big part(I'm assuming it won't solve all the side effects of the PanOptix lens by any means) of the issues I'm having, I'll definitely try that option. Maybe I can have lasik in place of my scheduled 2nd surgery.
Guest 303z
Posted
Sorry to hear that.
Astigmatism can change during cataract surgery, it might have got more than before.
But that said, 0.75 is not that much, and laser is a very common way of dealing with low astigmatism.
Toric lenses is for higher degree of astigmatism, I think it starts at 1.5, so a toric lens might not have been an option.
How close to target did the iol hit regarding refraction? I think this could be a bigger factor to the problems your are having.
303z Guest
Posted
Good to know that a toric may not have been an option for a relatively minor astigmatism. I asked my optometrist if it was possible the astigmatism was caused by the surgery, specifically if it was maybe due to swelling or similar, and he said it was unlikely.
I didn't ask how accurate the surgery was, nor was I told. I'll ask when I hear from the surgeon's optometrist. If it's off target, that could cause some of these issues, or at least amplify them?
Guest 303z
Posted
A small change in astigmatism is very common, I don´t understand the reply from your surgeon. I mean, maybe it was 0.5 before and now 0.75 that would not be uncommon at all.
I had 3.0 astigmatism both eyes, had toric lenses, and now have only 0.25 both eyes, a really good result.
0.25 - 0.5 astigmatism is normal in the population with healthy eyes, only very few have the theoretical 0.0.
Sounds a bit suspicious they don´t tell you about refraction, because this is really the most important part. Refraction will change a bit back and forth the first 6 weeks, until the iol settles.
But yes, if it has not hit the target well, your focal point for far distance could be well off, giving you bad far vision, especially if it has hit to the myopic side. And if this is the case, you would also feel a little bit weak close intermediate range, because the Panoptix have a little weak spot between far and intermediate, that you would normally not feel, but if this weak spot is being moved closer to you, you would feel it at pc screen distance.
But you would still have decent near vision.
Near vision with Panoptix is typically best from about 16 inches, so if your vision is best at 12 inches, I think many things speaks for the lens have hit a bit myopic.
Visual side effects tends to be worse, if the iol does not hit target well, several studies have shown this.
But if the lens have hit to the myopic side, it is better than the opposite, because myopic can be treated with the less intrusive SMILE laser, or off course a piggyback lens is always an option.
But really, it is still early days, your eye need to heal, and you need to get off the eye drops, before you really know what you have, I still think you will end up with a good result, some way or the other.
English is my second/third language, sorry for any wrong use of words 😃
W-H 303z
Posted
Uday Devgan just posted a video on You Tube-
"Limbal Relaxing Incisions to treat corneal astigmatism during cataract surgery"
Guest W-H
Posted
Yes - and when the surgeon suggest lasik to fix astigmatism, it makes me suspicious that the refraction is off as well....
Sue.An2 Guest
Posted
It's early days but I would be tempted to see my optometrist to have a refraction test done. At least have it done before considering any lasik procedure.