PanOptix: My experience
Posted , 14 users are following.
PanOptix: A Cautionary Tale
I am 52 years old and have had extremely high myopia my entire life (-14 with astigmatism in both eyes). In childhood I wore and was relentlessly teased for thick glasses, and went through various kinds of contacts from my teenage years on. I achieved 20/20 correction with them until very recently, when it moved to 20/25 which is still good. I have had presbyopia for about 8 years but managed with reading glasses. I couldn’t stand monovision contacts when I tried them, but had a pair of progressive bifocals I wore in the evenings at home. I never wore glasses in public because I hated how thick they were and the lack of peripheral vision that comes with them, especially for someone like me with such a high prescription. I had noticed that it took a lot more light to see in the evenings, and I have always seen starbursts around lights at night due to my prescription, but otherwise I was humming along fine.
My old ophthalmologist, who was very conservative, retired between my last eye appointment and my most recent one in May 2021. The “new guy” seemed nice and came with impressive credentials. He took one look at my prescription and said, “This is practically a disability” and I said, “I know!” He also said that I had the beginnings of some small cataracts growing, which might account for me having more trouble reading at night.
He said, “Before you go and spend a bunch of money on new glasses and contacts, you could consider just correcting your vision with lens implants.” He said that the cataracts were small (I didn't even realize I had them) but could account for my troubles at night. Since I had early cataracts, he said I could probably get insurance to cover some of it.
This is the point I wish I could return to. Why I didn’t say I was happy with my contact lens correction and just say, “I’ll wait,” I will never know, but I will regret it until the day I die. I was dealing with a lot of strain in my personal life, which might account for a poor decision, but even then I don’t know what I was thinking. Over the next couple of months, I went without contacts for 2 weeks so they could get accurate measurements, and just went ahead with the whole process. He said he could get me out of glasses and I trusted him to make the best choice based on my profile. He did caution that the multifocal type of lens causes halos at night, but I was okay with that because I have always seen the starbursts, so it did not seem like that would be much different. He had given me a handful of brochures, but did not say specifically what I was getting, and apparently, I am too much of an idiot to ask. He patiently answered all of my questions, but I obviously did not know the right ones to ask.
I did not realize I had PanOptix until they handed me the card that said so after surgery. I feel so stupid because I see everyone here does such extensive research and knows so much about all the various options and understands a lot of the math behind prescriptions and different lens properties. After surgery, I saw somewhat better, but not great, and two weeks out he realized that I had the wrong power. He redid his calculations and exchanged the lens for the correct power about two months later. I did not have to pay for that lens or his service, just the surgery center costs.
All seemed okay after that; I still had one contact lens eye and the new eye was much clearer at all distances than I had ever had in my life, though not perfect. I noticed that the correction in my contact eye was sharper and crisper, and also that there was the faintest yellow tint to color compared to the implant, but the doctor said I wouldn’t see the full result until I had them in both eyes. We waited a bit and scheduled the second surgery, and when they had me sedated and were rolling me back to operate, they discovered no one had ordered my lens. I was sent home and rescheduled. This is another point I should have just taken that as an omen or sign and held on to my remaining eye as long as I could.
But of course, I didn’t. I had the second eye done and all went fine, except I kept complaining that things looked “fuzzy.” He assured me that as my brain adapted and my eyes healed, things would improve. At my final follow up visit, I measured 20/20 both far and near and no astigmatism, and he was excited. He considers it a great result. I told him that although I can see the letters on the chart, they aren’t clear. He said, “There’s a difference between 20/20 and a sharp 20/20.” As I continued describing that it was not as clear as my glasses or contacts had been, he said, “You’re never going to get as good of correction out of lens implants.”
I wanted to cry/die then and there. He had NEVER told me that, and I was too foolish to ask or look those things up ahead of time. I had been comforting myself that I might have a little residual error to account for the sub-par clarity, so I expected I might need some light correction to finish it off, but he said, "There is nothing to correct." At that point he delicately said perhaps my expectations had been too high, but I had not been given a full picture of what I was signing up for. I had tried to stay off the internet to avoid freaking myself out, but I have since done so much reading—so many things I wish I had known. I am the absolute worst candidate for PanOptix—I am a high myope used to good near vision (with correction—without it I could see exactly 2” from my nose, but in that 2 inches my eye worked like a jeweler’s loupe, which I actually used a lot in needlework and tasks like reading engraving inside a ring, spotting mites in my orchid pots or getting splinters out. I am perfectionistic, picky, anxious, and have bouts of depression. I notice tiny differences in everything. I’ve seen things where they caution against using these in high myopes because we are used to having really good near vision. A thousand red flags I discovered too late.
I had been complaining all along about shadows around letters and the fact that the outlines of everything have a semi-transparent outline beside them, so nothing looks completely in focus. He said my brain will adapt, but the more I pay attention to those things the harder it will be. I also see shimmery light in my peripheral vision, like my entire view is "jiggly", in different situations that is disorienting. I now understand that comes from the lens edge. I also now understand to my great sorrow what “loss of contrast sensitivity” means. And, worst of all, I realize that I have lost the opportunity to wait for better technology like the accommodating lenses in development and I could have waited. The way I see now feels unnatural, because it is. I can see almost exactly where the “dip” in intermediate vision is—I even measured it with a tape measure, and it is exactly what they say, but I did not know what that would LOOK like to me.
I fully realize that these were elective procedures that I agreed to (and paid handsomely for) so the ultimate responsibility lies with me. When I look over my patient notes in MyChart, the visit summaries say we discussed a lot of things I do not remember hearing, and I had a family member along with me for most visits. I was not told about the loss of accommodation and what that means. I was not told what contrast sensitivity is and how that would affect me. I was not told that my intermediate vision past about 28” would turn to crap and I would no longer be able to read labels on items in the fridge, at the store, or see my students’ papers when I stand beside their desks. I am devastated. I have beaten myself up over why I went along with this—I take months just to decide on a paint color, and yet I trusted the doctor and moved forward without all the information I needed. That is my fault, but I truly feel like I was poorly counseled, in spite of the doctor’s notes that said everything was discussed. I did not know to ask these technical questions. He made it sound like I would have clear vision with just some halos at night. I wish he had explained more, or told me about things on the horizon, anything. My sister had suggested from the onset that I get a second opinion, but I was under a lot of stress and had already had foot surgery and was dealing with that, so I felt overwhelmed—another reason I should have waited. I am a teacher, and I thought it was best to take care of things while I was off for the summer. I would give almost anything now to have listened to her. If I had even gone for my overdue contact lens fitting, that doctor could have told me more.
Now I have some PCO on one eye (and think I may be getting it on the other) and of course he wants to do a YAG capsulotomy. I have learned enough to know that if I want to explant these lenses and go with something else, the YAG would make it far more difficult and risky. He attributes some of my visual issues to that, but I think it is just the nature of the lenses, so I canceled that procedure. I have been told that neuroadaptation can take up to a year in some people, but I don’t believe that makes PanOptix a better lens for me. I hate my vision. I have had the (second attempt) left eye for 5 months and the right eye for 2 ½. I plan to give it at least a couple more months, but I do not see myself becoming more satisfied with the kind of correction I have, but I know that my options for exchange (and the results I hoped for) are limited.
I don’t know what to do. I am afraid of trading "the devil I know" for something I might like even less. The whole point of this was to treat the cataracts early and give me independence from glasses and contacts. Now I need readers for anything 3-8 feet away and my so-called “near” vision looks faded and fuzzy, with ghost images around letters. I see horrible halos at night, to the point I can’t distinguish a taillight from a stoplight. I even see them in the day if the light is bright enough. Recently I came upon a funeral for a firefighter and all the police cars and fire trucks were coming down the road in a procession with their lights flashing, and I couldn’t tell what it was in broad daylight—it just looked like a carnival of lights in a blob coming at me. If I look at my earrings in the mirror, I see a double edge around them. I can’t focus on anything shiny. I love to read, do needlework, and a lot of other close work, but I also garden and teach and would like to see the label on a shelf without getting within 16” of it or be able to lean over a student’s desk and see the paper there or see their computer screen. I can’t even see what is on my bulletin board above my desk.
I just feel sick, like I want to die. I am so depressed and angry with myself. I feel like I have ruined my own life. At the very least, my quality of vision and quality of life are worse. I have a knot in my ribs almost constantly from the anxiety and although I try to go to bed early, I wake up a lot and immediately start thinking about it again. I can’t believe I did this to myself and this is my life now for the rest of my life; why I didn’t say “If it ain’t broke, don’t fix it.” I try not to think about it and calm down to help with adaptation, but I can’t help it because the reality is there every time I open my eyes. I have started an antidepressant and therapy. At night I just want to go to bed early because my indoor and especially evening indoor vision is so poor. I am despondent and so upset with myself.
I understand that most people who can’t tolerate multifocal lenses end up in monofocals. At this point that sounds like a relief, but ironic because if the aim was to get me out of glasses forever, now I will likely be in them, and I know due to the lack of accommodation in the eye that contacts and glasses won’t work the same way so it’s unlikely that I can achieve decent vision across the board without taking glasses on and off constantly. I don’t know if there is a solution for someone with such a steep myopic prescription that would allow me to get through my day with the least hassle. I’ve thought about the EDOF lenses, but they sound like they come with their own set of compromises including loss of contrast. I wear makeup every day and do like that I can (sort of) do that okay, but worry about how I would manage tasks like makeup or plucking a stray eyebrow if I was in a monofocal and couldn’t see clearly until about 3 feet away. I don’t know if the weaker near vision would be AS weak as my natural vision was, which was practically blind—I couldn’t make out features on faces or even see the clock in the morning, let alone read the numbers on it. I wish there was a simulation of just how poor the near vision is with monofocals in a high myope. At this point I would be okay with reading glasses for sewing and reading because I now have to use them for more tasks than ever, but would like to be able to see well enough without them to do my face. And I would hope that some glasses would aid me in reading and sewing and close work like that better than what PanOptix passes off as “near.” I WAS SO MUCH BETTER OFF at all distances before. Even with reading glasses. My previous contact lens specialist says I might be able to wear a contact in one eye for intermediate, so I plan to talk to her, but I don’t know if that would work for me.
I am struggling with the letter shadows, the 3-D looking outlines around everything, halos, and the fact that other than distance, I can’t focus well on anything. I may be 20/20 on paper, but my reality is I don’t see well for many things I cherish. If this were a glasses or contact lens prescription, I would be back for a refund and new prescription.
I have requested an appointment with the doctor to discuss what my options are. I have also made an appointment with another doctor to get another opinion on what the best route would be—something I should have done from the very start and I would not be writing this. I may go for a third or fourth before I do anything. Maybe I will eventually adapt. I hate dealing with the scar tissue, but don't want to get it removed until I know if I will need to make an exchange. The thought of more surgery sounds terrible, but so does my current reality. If I had a time machine, I would go back and lock myself in a closet before I went forward with something like this. I was sold the idea that life would be better, but it is worse in every way. I have paid someone to take something precious from me earlier than was necessary and give me a handicap. Yes, I can see, but I could see before with the normal age-related concerns, and better. This was the worst decision of my entire life, and one I will regret forever.
I am sharing this to caution anyone who is considering these lenses. WAIT if you can. WAIT until your cataracts are advanced, and no matter how poor your natural vision is, just wear the contacts or glasses. Get multiple opinions. I realize what a stupid, life-altering decision this was, so I don’t need anyone to point that out to me—I am self-punishing enough and struggling with depression and anxiety, so if you feel led to comment, please be compassionate. Iknow a so-called 99 percent of people supposedly love this lens, but I am that one in a hundred who hates it.
2 likes, 42 replies
soks swm1970
Edited
sorry for what you are dealing with. can you exchange one lens for a monofocal. that should help with contrast somewhat. you got PCO because you are young so the body immediately tries to rebuild the lost lens. i am 46 with symfony and i understand what you mean by visual acuity - the ability to read and the visual quality - the sharpness. i feel doctors should have patients watch video on cell phone to assess quality. good luck! hope you find a solution soon.
swm1970 soks
Edited
Thank you for your reply and encouragement. I have wondered if just swapping one lens might help, although I tried monovision with contacts a few years ago and could not stand it. If I had seen something like Dr. Devgan's patient guide video that simulated what images look like and shows a graph of visual quality, I never would have considered this. I wish I had learned more beforehand, and I really feel my doctor did a poor job in patient selection and counselling. But honestly, I am not a doctor or a physicist; I am an English teacher. People count on me for my expertise in my field and I count on medical professionals to be ethical and responsible in theirs. We put a lot of trust in doctors to "do no harm" and do their best to help us, and most do. But I feel harmed, and being told my expectations were too high when I was not given all the information I needed feels like betrayal. Paying so much money to make my vision worse feels like exploitation. From a technical perspective, he achieved an ideal result for what these lenses can do. But from my experience, life is worse and I feel less free and independent. I would give almost anything to have my precious, super-nearsighted and astigmatic lenses back. Even if my cataracts forced the issue later, I would have had more years with natural lenses and might have had better options in the future and would be happy to have something restored instead of feeling I had something taken away.
soks swm1970
Edited
replacing one pan optix with monofocal will not be monovision. it will be mix and match. both lenses will provide distance. pan optix will provide intermediate and near.
i think what's done is done. look to how you can fix. avoid getting stuck. good luck.
swm1970 soks
Posted
Thank you again for your encouragement and suggestions. I will add this option to to my list of possibilities to ask about.
Sue.An2 swm1970
Edited
So very sorry and pained to read your experience. I am very much against clear lens exchange - and surgeons who encourage this (there is s lot of money in it for them). At 53 I had fast developing cataracts and had no choice but yo have this surgery - completely covered by medicare.
I know there is no going back for you but I would seek out a different surgeon - get several consults. You will need one very experienced in lens exchange - requires considerable more skill than cataract surgery. Personally I would not up for a premium lens if exchanging. They all have less contrast and night time halos/glare. Thinking if you exchange just one for a monofocal lens (best corrected distance) you should see clearer.
Go armed with questions. You may want to see an optometrist to get your exact prescription.
wishing you well.
swm1970 Sue.An2
Edited
Thank you, Sue.An2. I agree wholeheartedly. When I think that after my eye exam when the technicians could only get me to 20/25 after years of 20/20, and he did not even try to fine-tune the refraction like my old doctor would have, I feel sick and angry at myself and even more angry with him. My 20/25 was fine and far superior to the so-called 20/20 I have now. My intermediate cannot possibly be that clear. I think he just saw the high prescription and thought I was a good candidate, but to encourage me toward this without a long period of counselling and education and fully explaining the tradeoffs and risks was extremely poor medicine. If he had known me better, as my old doctor did (the old one had seen me since I was 16), or even given me a personality questionnaire, he would have learned I am an anxious perfectionist. Removing a reasonably healthy body part that is still functioning to replace it with something that has more risks and limitations is unconscionable.
My surgeon did the first exchange on my left eye when the first lens had too much refractive miss, but that was after only a month or so. I think his technical skill is high, but I feel so let down by his lack of conservatism and for not educating me more thoroughly. I have an appointment to see him in April just to discuss what options there may be, because most other doctors will want me to talk to him first. I know he thinks the YAG will improve things for me, but I am afraid to move forward because it makes options more limited/risky if I can't adapt or come to terms and decide to exchange. Fortunately, I found one of the nationally recognized top rated surgeons in Charlotte and have an appointment with him for another opinion. Kerry Solomon is another top rated surgeon and researcher in SC and I could also take a day trip to see him. I called his office and they encouraged me to talk to my original doctor first. If I decide on an exchange, I think I will go to one of them or even another surgeon because I have lost so much faith in my current doctor over not helping me more with this decision or spotting at any point along the way that I might not be a good candidate psychologically.
My distance is actually the best with these lenses (but only in broad daylight), which makes sense now that I understand more about how they work--50% of the light goes to distance. It makes sense that near and intermediate would suffer because they the remaining light is split between them, and apparently some light is lost (12%, I think? I've read so much I wish I had known). I am not in a rush to exchange because I am afraid of trading one problem for another, and with my long eyes and retinal lattice degeneration, I am more at risk for retinal detachment and other problems. I have already been encouraged by the contact lens specialist to give it time, possibly another 6 months or more, to see if my brain adapts. I have a pair of multifocal non-prescription reading glasses that give some relief for my intermediate vision, but they are hit-and-miss for near now that my eyes no longer accommodate. I agree that it is probably a risk to try a different premium like an EDOF. I have toric PanOptix so I would likely still need a toric monofocal, but I am hesitant to switch and have no near vision in one eye. I am a crafter, needleworker, photographer, etc. and really need good near vision. From what I understand I might be able to wear contacts with monofocals, but they would have to be multifocal or monovision (which I did not tolerate before) and those have their own compromises on visual quality.I am still trying to learn what vision with monofocals is actually like and how contacts work with them, as I would prefer to put in contacts and go on with my day, but it sounds like the loss of accommodation makes corrective lenses a whole new ball game. It is ironic that in an attempt to be free of corrective lenses, I may need more complicated solutions than before.
As far as my exact prescription, they tell me I am 20/20 and there is nothing to correct. I am curious to see what another doctor says.
Sue.An2 swm1970
Edited
Should also add thank you for sharing your story. Many of us try to tell others not to do this procedure till it is necessary. Some cataracts progress very slowly and don't impact vision for years. Surgeons who say they see beginnings of cataracts should not be pushing you to do something about it till your vision is 20/40. Hopefully your story helps others.
swm1970 Sue.An2
Posted
I hope it does. I wish I had found this community before my surgery. I would urge anyone who can still see well NEVER to do this. It is a very drastic response to what was in reality a minor inconvenience of middle age. On some level I think I wondered about this, but my doctor made it sound like I would have better and permanently corrected vision and be more free as a result. The only thing he got right was the permanence. If my vision had become bad, there would be no choice, but I would give anything to have what I now know were very minor, typical for my age and eye type, and could have gone years without needing intervention. Don't tinker with anything that still works as is reasonable to be expected for your age, especially something as precious as your eyes.
rwbil swm1970
Posted
My only advice at this point is if you are in the US get a 2nd opinion of your options from a Top Ophthalmologist. I suggest you look at US News Report Top Ophthalmologist. Some of these doctors will communicate with you via email or phone and if one is even within a days drive I would go.
My only other comment is overall the PanOptics is a good IOL with many success, but even if everything is spot on, refractive error and astigmatism error, some people just don't do well with it.
swm1970 rwbil
Edited
Thank you, rwbil. I did find a list of top rated surgeons and one is in Charlotte (45 minutes away) and another is a half-day's drive to Charleston, SC. It makes me heartsick to think that either of them would probably have counselled me to wait. I already have an appointment with the Charlotte doctor to get advice.I am considering visiting the other as well, especially if I decide on an exchange.
I plan to give some more months to adjust as that is preferable to having someone cut into my eyes again, but am worried about the YAG. I can see the scar tissue in my right eye in low light; it seems like a filmy area on one side of my vision. My dilemma is that treating the scar tissue might help a little, but would hurt future options if I don't adjust.
My worries about the longevity of the Alcon lens material, as well as what might happen with my sight if my eye health changes (as PanOptix requires a very healthy eye to work properly), are some of my big questions I will take with me. No one discussed or even mentioned those risks prior to my procedures.
I am hoping with all my heart that my brain continues to adjust and I learn to live with the unexpected tradeoffs. I just feel sick about this decision.
nancy03915 swm1970
Edited
Wow. What a mess you are in. I really feel for you.
john20510 swm1970
Posted
would you advise people not to go with multifocal lens but stick to the simple monofocal lens and wear glasses for close up, is that alot safer
swm1970 john20510
Posted
For some reason my reply to you was deleted. To answer your question, the best choice is different for each person. The best thing to do is learn all you can about the various types of lenses, consider your own needs, desires, and trade offs you are willing to make, and get the advice of a doctor you trust, and probably a second or third opinion.
helenmarier swm1970
Edited
I hate and regret my Panoptix also. I trusted my ophthalmologist. I actually can see pretty well, but the smudgy edges and flickering are distressing and my eyes always feel tired ( after 4 months.) I have put in complaints to Alcon and the FDA.
I still have astigmatism, which the surgeon never explained. I resist allowing money grubbing docs to dig around again in my eye to correct this, nor does swapping these lenses out appeal. Too risky.
I have lost trust and feel cheated.
I recommend complaining to Alcon. They will research this with your doc's office also. The FDA needs feedback also ,as they approved these lenses.
swm1970 helenmarier
Posted
I apologize for just now replying; honestly, I had to take a break from thinking about my eyes night and day.
I am so sorry you have had a bad experience too. Some aspects of mine have gotten better, but many have not. I am still considering explantation, especially after an exam with a specialist at Duke Eye Center who has had to explant so many PanOptix that he no longer offers them. He says for my eyes, a monofocal is best and the only option he would feel comfortable offering me.
I agree that I should write to Alcon. I have gone for three opinions and all of the surgeons said the side effects I have experienced are well-known with any kind of multifocal lens, so my original surgeon was either poorly informed himself or just completely negligent in education me and managing my expectations.
I completely understand the feeling of lost trust and being used for someone else's gain. I know you hesitate to have anyone touch your eyes again, but it definitely gave me more information to see someone besides the original surgeon. I do not plan to return to him ever again. If there is a teaching hospital near you, or even within a few hours' drive, it might be worth it to get some guidance.
Best wishes to you that you will adjust or find the help you need. I am right there with you.
dunya swm1970
Posted
Thank you for your post!
Did you decide to replace Panoptix and if yes with what lens?
How do you feel now?
I just got my first PanOptix, with great far and mid distances, but very poor near. I don't feel like going for the second surgery now with this tricky situation that I can't read.
I hope your problems were resolved by now!
RonAKA dunya
Edited
You could consider a monofocal like the Clareon in your second eye that is targeted to -1.5 D. That should improve your close vision, but will leave you with the Clareon eye for distance and intermediate. I would advise discussing it with your optometrist as it would leave a possibly challenging to fit situation for eyeglasses.
soks RonAKA
Posted
ron, how is your distance vision with just the -1.5 eye?
RonAKA soks
Posted
I suspect it is somewhere around 20/40 to 20/50 uncorrected. Looking at the TV now from 10 feet or so, it is ok but not as sharp as my distance eye which is 20/20+. With both eyes the picture is just fine. Driving is just fine with both eyes, but I am not sure I would pass the minimum vision test for driving with my -1.40 D SE eye.
dunya RonAKA
Posted
Thank you very much for your commitment.
Yes my surgeon is suggesting doing what you said.
I think that would give me a good overall vision.
However , I am wondering does it make sense to keep the PanOptix for far and intermediate visio, when I wanted this lens for its best near vision feature. My far and mid vision are
good, but I do have anoying flickering sensation with the neon lights, and some halos around bright lights at night, not that bad but still present. This is known PanOptix side effect.
Is it maybe worth replacing PanOptix and
starting over with Vivity? My surgeon was in favour of Vivity since I first contacted him. It was me who requested PanOptix ( unfortunately).
I am sorry for typos, I can change the text for some reason.
I am also wondering is it maybe possible that my issues with poor near sight will resolve after some time?
I know many people are ok with PanOptix but
many have some side effects despite great vision.
I just wonder how is this approved with so many side effects and numerous ways for things to go wrong. I have 3 side effects for example.
Thank you!
RonAKA dunya
Edited
We have a friend that has PanOptix (both eyes) and she hoped that the issues she was having such as the optical side effect as well as less than ideal closer vision would go away with time. She must be up to nearly 3 years now and I don't believe they have, but she has not gotten to the point of considering an explant. She uses +1.75 readers for reading even in fairly bright light. I think she would describe it as OK, but not what she expected, and not good value for money spent.
I started with a monofocal set for distance in my first eye and got a good result with 20/20+ vision. I wanted mini-monovision and considered a Vivity for my second closer eye. My surgeon talked me out of it. I think it could work though, but would have to be targeted to about -1.0 D to give good closer vision. I selected a second monofocal and it was targeted for about -1.5 D when combined with my astigmatism. That is about what I got. I have very good eyeglass free vision, but do occasionally reach for some +1.25 D readers for very small print especially in dimmer light. My only regret is that I did not go for a toric. It may not have been ideal, which I why I passed on it, but I think in hindsight it would have given me better reading vision.
.
I think in your case I would consider a monofocal with a -1.5 D target, and then postpone any decision on the PanOptix eye. If still not happy with the PanOptix, you could exchange it for another monofocal set for distance.
soks dunya
Edited
you are only 6 days out. wait for a month. many times the pan optix near will come in by the end of a month post op.
the glow and loss of contrast will not go away. only monofocal will give you great vision quality. vivity will have contrast loss so finer details will be lost and if you do go with it set it at -1 like ron says so you can decent near with it.
dunya RonAKA
Posted
Thank you very much.
My surgeon mentioned there is 4 months time to decide to exchange the implanted lens.
After that it becomes more tricky.
I know the other eye can be tuned for reading with a monofocal lens , but what leaves me in doubt is this:
if I now choose the other eye to tune for the near visin and in future I can't stand this PanOptix lens
that will put constraints in the selection of the replacement for PanOptix.
RonAKA dunya
Edited
If you go with a monofocal like the Clareon set for near (-1.5 D target) in your second eye, this should not limit future options. If this makes your overall vision with the PanOptix suitable then you are done. If the PanOptix remains suboptimal then you could do an exchange with another Clareon monofocal set for distance (-0.25 D).
soks RonAKA
Posted
wish there was a way to experience this. loss of near but higher quality vision.
rebecca62090 RonAKA
Posted
Hi Ron,
I am having all the same problems as swm1970. Can you tell me about your experience with the Clareon lens? Do they have a reputation for not having the shimmering side effect? I am seeing a new surgeon next week and I want to discuss any options I might have.
RonAKA rebecca62090
Posted
I am afraid I am at a loss in understanding what the "shimmering" side effect looks like. I have an Alcon AcrySof IQ monofocal in my right eye which was done first. My vision is very good with minimal side effects, although at night there is a bit of flare coming from point source lights like street lights off in the distance. At about 10 months post surgery I had a PVD (posterior vitreous detachment) in this eye which gives my a large fuzzy floater that I see in certain light conditions but it really does not affect my vision. However coincidental to this I started seeing flashes of light like a shooting star in the very right periphery of my right eye. Both my optometrist and ophthalmologist have tried to attribute it to the PVD progressing. I don't believe them. I believe it is a reflection of the edge of the lens, and somehow the the PVD event has possibly move the location of the lens in my eye. I only see it when there is a light well off to my left side and it is dark. Street lights on a dark night trigger it the most reliably, but I see it at night when the house is dark and there is a light on somewhere else that I catch with my eye. I could class it as a minor distraction, but does not really impair my vision at all. Despite what the professionals say, I believe this is a case of positive dysphotopsia or reflection of light off the edge of the lens. I'm 73 and probably have a smaller pupil, but the issue can be worse for those that are younger and have a larger pupil.
.
As for my second eye I got another monofocal but this time a Clareon, mainly because I paid extra for it and that would get me into a private clinic to get it done sooner. My vision in this eye is very similar. I do see a bit of flare around point sources of light at night, but it is quite similar to the AcrySof lens. There is some research comparing the AcrySof lens to the Clareon which suggests that the Clareon may be more susceptible to positive dysphotopsia as it has sharper edges, which are claimed to reduce the risk of PCO. I got this lens the day before Putin invaded Ukraine and so far with fingers crossed I have not had a PVD event, and I have no positive dysphotopsia events. But, I am only coming to the 10 month mark.
.
This all said I could only guess what a "shimmering" effect might look like. I wonder if it is a bit different form of positive dysphotopsia with unstable reflections off the edge of the lens. What I see is a very quick and repeatable arc shaped flash like a shooting star.
.
Hope that helps some
Bookwoman RonAKA
Edited
What I see is a very quick and repeatable arc shaped flash like a shooting star.
Ron, I have the exact same thing in my left eye (Acrysof IQ). I agree with you that it's positive dysphotopsia. I only notice it when I walk into a certain dark room in my house when there's a light on off to the side. It's an interesting phenomenon, and fortunately doesn't interfere with our vision.
soks Bookwoman
Posted
what direction do you see the arc? i see it and the arc will stay constant. mine is in upward nasal direction. 11 to 2 o clock.
Bookwoman soks
Posted
Mine is about 10 - 12, but it vanishes as soon as I move out of that particular lighting situation.
RonAKA soks
Posted
I would say the flash for me is a curved shape from 1:00 to 5:00 in position. It is so quick that it is hard to tell if it goes up or down. I suspect depending on how I tilt my head, it can go in both directions.
007Bond helenmarier
Posted
@helenmarier when you say you still have astigmatism that the surgeon never mentioned is it that he or she did not tell you and also did not offer the option or it was corrected but they missed the taget?
007Bond Bookwoman
Posted
I was getting this a lot in the beginning it has mostly stopped except when in certain lighting conditions/angles. Now I have more negative dystopia that comes and goes.!
dunya RonAKA
Edited
While my PanOptix eye is recovering after surgery and hopefully getting some near vision, I purchased a pair of
glasses with -3D for my (-4.75 eye) not operated eye.
This gives me such a nice vision with my myopic eye.
his gives me such a nice vision with my myopic eye.
i am wondering is this " diopter" transferable to monofocal iols?
You mentioned I should aim at -1. 5D with monofocals.
Do you know what is the font size that can be read with -1.5D?
Thank you!
RonAKA dunya
Edited
In my opinion I think -1.75 D in the near eye is a bit much. Remember that in monovison you need to cover a good part of the intermediate range with the near eye. You may want to try a -3.25 D contact in the non operated eye to see what that looks like. But, with the PanOptix in the other eye, the intermediate may be well covered, and you will improve near vision with -1.75 D.
.
I am at about -1.40 D but that is a spherical equivalent which adds in my -0.75 D astigmatism. It is not ideal, but I can probably see down to about 6-8 point text if the light is good.
soks dunya
Posted
so you are saying thay with -3 glasses on a -4.75 eye give u nice far and near vision?
dunya soks
Posted
Unfortunately, this can't be otherwise we would have prescription like that .
I wanted to say that -3D gives me a nice near/mid vision. The distance vision is poor, but PanOptix eye does the long distances.