Panoptix or Vivity and will 1 eye done only work

I'm just at the beginning of the learning curve, but asked about getting one eye with a panoptix lens, thinking it might reduce the possible side effects while giving me improved closer vision.

The surgeons office told me these types of lenses were designed to work in tandem.

Hopefully someone more knowledgeable will respond

I assume you are thinking of doing the 20/40 eye first? If this is your dominant eye, then it would be a good choice to do that eye with a monofocal with a power set for distance so you get 20/20 vision. There is no harm in waiting for the second eye especially when you are seeing 20/20 with no eyeglass correction? Is that true that you are getting the 20/20 and 20/40 without eyeglass correction?

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If so, you can decide after the first eye is done, what you should do with the second eye. The choices would be a multifocal like the PanOptix, EDOF like the Vivity, or just another monofocal that leaves you somewhat near sighted (-1.25 D or so) so you can read with that eye. That is called monovision and can be done with the monofocal but also with the Vivity or PanOptix. Most common to do it with a monofocal though. Also, least costly.

First you vision is a heck a lot better than mine was when I finally had cataract surgery in 1 eye and your vision is a heck a lot better than my current vision now that I need surgery in the other eye, so IMHO you have plenty of time to do research as there is no easy answer to your question.

"Panoptics and Vivity there seems to be a lot of unhappy patients stating

Panoptics-now they get halos, glare rings

Vivity-worse vision for close reading"

Yea that basically is how it works and why you have to do the research. Defractive IOLs will come with dysphotopsias. As others have stated, there is only so much you can do with a non moving piece of plastic. In fact you can get halos with a monofocal IOL. It all depends on the individual and your eye condition(s) and your surgeon ability to properly place the lens and hit the mark. Eye conditions is a paper in itself.

I have the Tecnis MF and I get dysphotopsias, but think it is worth the tradeoff for close vision.

I will give you my standard reply about IOL options below:

There is no perfect lens selection for everyone. You need to take your time and think about what activities are most important to you. Only you can decide what tradeoffs you are willing to accept. If your 100% sure you want to reduce the risk of halos, starburst and other dysphotopsias, below is my list of refractive IOL option in order of risk:

Non Premium Monofocals:

These are the most common Iols implanted. They will have the best contrast and the least issues of any lens (unless you consider close vision an issue). They have been around and tested for a long time. A Monofocal lens should provide great distance. In general close vision is reading your cell phone or a book, maybe 33cm-40cm. Intermediate is about 2 feet or so. A perfect example might be the dashboard on your car.

One comment on distance vision. Some people I think are confused by that term. If you look at the defocus curve on a monofocal you should get pretty good vision down to about 2' -3' or so (again it depends on many factors). As you get in closer; vision quality drops off rapidly. This is important, everyone Visual Acuity will vary as there are so many factors, such as short eyes, astigmatism, previous Lasik surgery, and on and on.

I also suggest just getting 1 eye done at a time and evaluating the results before getting the other eye done. Mix and Match is always a possibility to obtain the best vision possible.

Premium Monofocals:

LAL – If considering a monofocal I would recommend giving this IOL serious consideration. I have had Top Ophthalmologist highly recommend this lens. Having said that it has been around for a while now, but not as long as the standard monofocal so there is the test of time issue.

What makes this lens great is no matter what equipment Ophthalmologist use they don’t always hit the refractive mark and in a few cases can be way off by more than 1D. And let’s say you decide to do monovision. You want to hit those marks.

But it even gets cooler than that. From what I understand you can adjust the LAL more than once. So you decide on monovision, but not 100% sure how much monovison. So set 1 eye to plano and then try various settings with the 2nd eye to see which one works best for you. I would only consider micro-monovision like -0.75D, but if I had the option to adjust it you could try a different setting and see if you end up with a lack of stereopsis or other problems.

Crystalens Lens – You hardly hear about this lens anymore. This is the only FDA approved accommodating IOL. Many people did not get accommodation or much accommodation, so you were paying premium price for a monofocal lens that did not give the range of vision expected.

But from what I have read Crystalens at distance provides the same level of contrast as a standard monofocal and you are likely to get some accommodation. This lens could be a great mix and max with a PanOptic Trifocal IOL.

IQ Vivity and Tecnis Enhance - The newest hottest IOLs on the block. A refractive IOL that provides some EDOF. I think IQ Vivity is around .5D and Eyhance a little less. So not a lot but combined with micro-monovision you should get decent intermediate and some close up vision.

Now here is the part that is trick. I have read that Vivity gets EDOF by manipulating SA. So that means contrast sensitivity will not be as good as a standard monofocal. Could the average person notice the difference, I don’t know. But I suggest you get an Ophthalmologist who is an expert with these lenses so you can discuss that exact issue. And of course there is the test of time issue.

I tried mono-vision with contacts and I know it is not the same, but I hated it. I need good distance vision. That is why I say if doing mono-vison go with micro-monovision (<-0.75D). If you do that with Vivity you will be getting -1.25D of mono-vision, preferable in the non-dominate eye.

Enyhance is a little less clear to me as from what I read there is no CS lost, but you don't gain much EDOF. I am not even sure it is much better than some monofocals. But IMHO you have to be giving up something to get even that little bit of EDOF. So this one needs further research.

Vision accuity is more complex than it sounds. There are just so many environment factors and so many ranges to go with those conditions. Will you be able to see well indoor at a concert or basketball game vs seeing up close in dim light vs moderate light vs bright light.

One final thought and it is not for everyone. I am a procrasinator. If I was use I would wait as long as practical, dont want to be driving in unsafe conditions. You just never know what new IOL or invention is around the corner. In near future there is the Symfony Plus and the Synergy (for US) and longer term maybe an actual accomodating IOL like Juvene. Also some have mentioned the LAL being used in EDOF mode. But IMHO there is not yet enough information and real world results on that option.

Thanks for all the replies and info

I did the dominant eye test and no doubt it is the right eye the bad one that is 20/40

I never wore glasses or contacts just cheaters for small print like perscriptions, etc so the 20/20 left eye and 20/40 right is without lenses

I went for a drive in the dark and when I close left eye no doubt reading signs is quite blurry

When I keep both eyes open no problem at all and when I close right eye and look out of my 20/20 left eye no problem. No doubt my cataract in right eye will need work fairly soon but my left eye that has cataract also probably at least a year to go

Any other advice based on this