Panoptix Multifocal Toric IOL Experience (Refractive Lens Exchange)... Long but worth it

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I am a 34 year old male who recently underwent Refractive Lens Exchange surgery with the Panoptix Trifocal Toric IOL. I am a healthy adult with no pre-existing health issues. My glasses prescription before the surgery was +7.00 x -3.00 x 175 (left eye) and +7.25 x -3.25 x 010 (right eye). I wore contacts + glasses from 13 to about 25, but after 25 I have seen many optometrists and have not been able to nail down a contact prescription. This mostly has to do with the fact that I can only wear hydrosoft toric lenses which are 100% custom and take 3 weeks for every revision. The reason for my decision to have this procedure done is simple, for golf. I cannot see the ball through my swing with glasses and the vision change from the lens to underneath it uncorrected is incredibly uncomfortable, and for most people would be impossible. Over the past couple years I have seen a few very highly regarded ophthalmologists in Chicago to inquire about Lasik/PRK, and all of them said I am not a candidate. They all mentioned RLE, however one said he would not perform this until I was at least 40. I did not understand this at the time, but now that I am 10 days after surgery I fully do. During the hundreds of hours I spent researching everything about this procedure I didn't find many experiences well detailed by patients, or why one Dr. wouldn't perform this over the others. The cost for this procedure all inclusive is just over $5500 per eye which I paid out of pocket for. Don't get me started on the self inflicted diseases such as obesity and drug addiction that insurance will gladly cover for life, but refuses to help out a blind person. I hope this helps anyone else who is in the same position.

On surgery day I arrived at the surgery center at 9am on a Thursday. The surgery was performed on my right eye which I should note is not my dominant eye. This was like any other normal out patient surgery, they put me in a gown, dilated my eyes, put some needles and tubes in my arms then waited about 30 mins for the drops to work. When I was wheeled into the surgery room I was greeted by the dr/nurse and was given fentanyl and some other kind of muscle relaxer combo cocktail. After about 1 minute I have no recollection other than coming to and seeing some dots and bright colors and the Dr. saying that everything went well. I had a patch over my eye and was sent home about 45mins after the surgery. From there I slept most of the afternoon.

Friday, the next day I had a morning follow up. When the patch came off, I could see, but everything was very very blurry. The distance vision was by far the best, however the intermediate and near was virtually non existent. The Dr. said everything looked pretty normal and to continue with the self care (drops / taking it easy.) After the follow up I relaxed until Monday, then I returned to work to almost all normal activities. Below are my experiences and opinions so far with this lens. I would also like to note, that I am 10 days post surgery writing this article. I will need a laser touch up 3 months from now which is very common with a prescription such as mine so don't get super worked up if you're vision is not as good as it was after glasses right away. I would also like to note that I was incredibly well prepared with what to expect at every step of this process.

This is a great lens, however there are side effects that you need to be aware of, especially if you are considering this at a young age where you have 20/15 corrected vision in both eyes with glasses. After surgery I was very afraid that I lost my near and intermediate vision forever, however both of these came back just as strong as the far vision. I think part of this is due to the heavy dilation and also allowing my eye to relax after the incisions. This did come back though. Being able to focus at all distances 100% seamlessly is huge, and you wont understand that until you lose those ranges. At the time the first Dr. denied this process this lens was not on the market, and honestly if someone would've put me in a monovision lens I would be very f*****g unhappy right now. Out of all the side effects I've read about I only notice 2 so far. The first being that the lens feels loose in my eye. The lens is actually not loose, but rather the light diffracting through the different sight rings within the lens. This was very annoying the first few days but even after just 10 days, this is barely noticeable and expect this to almost fully disappear over time. The second is halos which seem to be the most common among all patients. Personally this is the worst side effect for me. It is so bad that unless they get better over time, I will not be going through with the left eye because it affects my night driving so negatively. As I stated before I have some residual blurriness which is also intensifying the halos. Other than these side effects I feel great, maybe a little dryness or scratchy feeling from time to time as the eye heals, but that's it.

Overall, if you asked me would I do it again knowing what I know now..... I absolutely would. I would recommend what my Dr. recommended to me. If you can see fine and you're doing this because you cant have lasik, do your non dominant eye first. For me this was easy because my left eye easily does 80% of the sight work. This will allow you to use a contact lens as a control in your dominant eye to determine if and when you want to do the other eye. You need to commit though however, once you do one you need to do both or get a contact lens for the other or you will have a significant imbalance in vision .

Feel free to ask any questions you may have. I wrote this off the cuff so there probably a lot more detail that can be added. I can't promise I'll be able to answer them, but if I can help one person better understand the beginning, middle, and end of this process I'll have succeeded.

0 likes, 9 replies

9 Replies

  • Posted

    An interesting story and experience. I had explored RLE about 20 years ago when trifocals were not a consideration. I was not advised at that time about the importance of them. Monofocals would have been a disaster.

    I was never able to wear contact lenses because my eyes did not tear enough, but I never felt the need to use eye drops to keep them lubricated.

    Your experience sounds like a case of dry eye. Since my PanOptix IOL a year ago I have been using Systane Complete. It has helped reduce blurriness that may also contribute to halos. Suggest you try it, and maybe this will allow you to proceed with the next eye.

    • Posted

      Chris53317

      Thanks for the response and rec. for the drops I will definitely look into these. Did the halos decrease overtime for you? Also what was your refractive prescription prior to the procedure?

    • Posted

      I think the halos decreased a bit. They were observed from car lights but I have not been out at night for the last 4 months. No issues during the day.

      My eyes were quite bad, but I cannot recall the prescription (maybe mid teens). The IOLs were 11.0D for the left eye and 13.0D for the right eye. The interesting part is my left required a stronger prescription prior to the surgery.

  • Edited

    I am glad you ate pleased with the outcome. Not many on the cataract forum who have no choice except this procedure are fans of clear lens exchange. As you've noted there are compromises to make and more risks for younger patients: retina detachment being one. The younger you are the more your pupil dialates beyond the IOLs which ate all 6 mm causing more visual disturbances. This is a good reason why many surgeons won't operate on someone without cataracts. As lenses get better (but currently they all have drawbacks) more look into this to avoid losing near vision. Some surgeons wont mention the cons as this is a costly procedure and profitable for them.

    Glad you are pleased with your outcome. I am curious about all the prep - sedation including fentanyl. I had no sedation at all. Just numbing drops poured into the eye. I experienced no pain at all. Took less than 10 min.

    • Edited

      Sue.An2

      My prep was simple. Like I said they dilated my eyes, let me sit for about 30-40 mins then wheeled me into the operating room where they said it took exactly 30 mins from when I arrived to when I left. The Dr. said it depends on the person for the sedation. Some just get drops, some get the twilight treatment.I was pretty tired and a little wobbly after but nothing more than a couple cold ones would do to ya. I also experienced almost no pain. There was a little the next day but nothing more than some scratchy feeling.

  • Posted

    seems like your near vision has always been poor at +7? are you j1+ after the surgery for near vision and at what distance. glad you are happy.

    • Posted

      My vision at any distance was poor. I couldn't see anything without glasses or contacts. If I had to guess I would say no less than +1 and no more than +2 with a slight astigmatism because everything is equally blurry at all distances. I have an optometrist apt. next tues and can give a better follow up then.

    • Posted

      how was your optometrist follow up?

  • Posted

    Hello McNilly09,

    I'm scheduled for RLE in a couple weeks. Now that some time has passed since your procedure, how have your Panoptix Trifocal lenses been? have the halos improved? Any new issues come up?

    Thanks,

    Jeff

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