PanOptix: My experience

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.

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