Risk/Experience of Night glare/halo after Clareon Panoptix lens vs monofocals post cataract surgery
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Hi community.
New member - researching here on Cataract Surgery options for my condition. Any responses welcome.
Situation:
50yr old Crohns Disease patient (No ongoing meds presently) with Presbyopia (age related far-sightedness). Been using reading glasses for about 4-5 years. Went for a new glasses script, got referred to eye specialist for Cataracts (now) in both eyes - right side more advanced. Risk is in 6-12m at current rate of deterioration, eyesight may be below acceptable driving level.
Lifestyle
Drive for work (sales), freq travel (Car/Plane etc). Drive at night also.
High Computer Screen use. Day and Night.
Reader (Kindle + reg book),
Watch Movies/TV at night.
Game at night (console/PC) etc.
Photography (landscape/nature) both mobile and DSLR/Traditional Camera etc.
Today's consult advice:
Advised by eye specialist (surgeon) that best options for me is either;
- Clareon iol. Monofocal with cataract surgery - return optimal distance vision, retain glasses for reading. Minimal side-effect (Dysphotopsias).
- Clareon iol. Panoptix with cataract surgery - return optimal distance vision, chance at reducing or eliminating need for reading glasses. Increased side-effect risk (Dysphotopsias) - Positive Night Glare/Halo etc or Negative Night Darker spots etc.
Really just seeking any feedback on whether this seems a good summary/option recommendation (felt confident in the surgeon/specialist manner/knowledge in todays consult. Also Alcon seems fine vs other J&J option (no major better/worse than each other?).
Also - experience on halo/glare impact and lessening over time. With cataracts currently, have difficulty driving at night based on oncoming headlights seeming so bright due to cataracts. Hard to imagine this is worse again with multifocal iol?
Finally any word on risks of reduction in contrast sensitivty - for focal day to day and photography!
Many thanks 😃
Scott.
1 like, 32 replies
RonAKA Scott_au
Edited
I would add a third option to consider which would be Clareon monofocal lenses targeted to mini-monovision. This is when one eye, usually the dominant one, is targeted to distance, and then the non-dominant one is set for near vision after the distance eye has healed.
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Mini-monovision is something you can simulate now with contacts while you still have good enough vision to see what it is like. You correct your distance eye to plano, and under correct the near eye to leave you -1.50 myopic. This allows you to see a full range of vision without the side effect of a multi-focal lens like the PanOptix.
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The only more difficult vision requirement I see in your list is reading text in dimmer light. For that you may need reading glasses. I have a friend that reads a lot and has PanOptix in both eyes. She uses +1.75 D readers for reading books. She also does not drive at night due to what she describes as huge halos around oncoming headlights. I have mini-monovison with my near eye outcome of -1.60 D and for reading very small print in dimmer light I use some +1.25 D readers. I seem to be much less dependent on using glasses than my friend with the PanOptix is. I do drive at night in the city without glasses, but if I am going on a long trip with driving at night in the country I do wear my prescription progressive glasses. That is about the only time I ever use them. The rest of the time I just pick up some readers when needed, which is not often. I see my computer monitor, iPhone, and watch without them.
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Your photography requires some thought. You will want good distance vision to do TTL focusing, and near vision if you are composing the image on a screen on the back of the camera. PanOptix and mini-monovision should handle that. With monofocals both set to distance you will need reading glasses or better still progressives to see both TTL and the back of camera.
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If you are doing digital darkroom work, I would recommend getting lenses with blue light filtering. Some mistakenly think blue light filtering changes the colour balance away from normal. It is actually the reverse. IOLs without blue light filtering provide an unnaturally blue balance, while the blue light filtering in the Alcon lenses return your colour balance to that of a young adult.
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If you want to go down the mini-monovision road it is best to do the distance eye first, and then simulate the final mini-monovision with a contact in the non operated eye only. It also allows you to use different powers of reading glasses in the range of +1.50 D on your monofocal eye set to distance. The IOL eye will have no accommodation and this is a closer simulation of what you will get with an IOL set to -1.50 D. At age 50 even though you have some presbyopia you likely still have a lot of accommodation. This gives an overly optimistic view of what near vision you will get for a given amount of myopia. And, if you do the distance eye first you also keep your Option 1 distance in both eyes open as an alternative if you do not like mini-monovision.
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Here is a link to another thread I started on mini-monovision. It is best to consider all views about it, and I encourage a trial to find out what it is like for you.
https://patient.info/forums/discuss/the-pros-and-cons-of-mini-monovision-798485
Scott_au RonAKA
Edited
Thanks so much for your detailed and considered reply! I will research this further and include it in my discussions with my specialist.
Lynda111 Scott_au
Edited
To help others who come here for advice, let the forum know what you and your specialist decided.
RonAKA Scott_au
Edited
The article at the link below is a good one to read about mini-monovision. The author is Dr. Barrett from Australia that is a world recognized cataract surgeon who is the developer of the Barrett IOL power calculation formulas. I agree with his approach to mini-monovision, except that I opted for a near eye target of -1.50 D instead of the -1.25 D he suggests. I started out thinking a -1.25 D target would be best based on contact lens tests and some published studies, but after I had the first eye done for distance and I did some testing with reading glasses using the Jaeger eye chart for near reading (using the IOL eye), I decided on the -1.50 target. With it, I could read the J1 letters in sunlight conditions. With -1.25 D I could not quite do it.
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https://crstodayeurope.com/articles/2009-oct/1009_12-php/
Scott_au
Edited
OK. Here's an update on my (unresolved) situation.
I was feeling pretty nervy about the multifocals (Clareon Panoptix) IOL option. Two biggest concerns = losing contrast and halo/glare effects. I drive a lot at night and also spend a LOT of time at dusk/dawn "golden hours" taking photos, especially of sunsets/sunrises. So I went back to my eye surgeon and asked about this and mini monovision.
When I got there - I had 20min with the surgeon's offsider (and Optomitrist min. - probably more by training). Told him my concerns, he believed based on the current state of my eyes (and their assessment) - that mini monovision didn't suit / wasn't optimal. He agreed that a Monofocal set for distance as optimal, and intermediate likely improvement with reading glasses may be my best option.
Then I went into see the eye surgeon. He read the offsider notes, quizzed me on the extra lifestyle factors he hadn't asked / I hadn't told in our first meeting. Understanding my concerns - he then proceeded to recommend a 4th option - Clarion Vivity EDOF IOL. <wtf sigh>
He basically was telling me its the best compromise option - almost excellent distance, much improved intermediate and some improvement at monitor level - reading glasses for fine print/close.
He said it only had 1 ring in it - so it was proven to have much lower rate of ppl bothered by halo/glare etc impacts. However I think it also suffers from some contrast reduction in vision.
Now I am a bit lost - and feel like I don't trust the surgeon fully. Is it time for a second professional opinion. I really am struggling (as a risk averse personality also) to land on a course of action.
Cheers.
RonAKA Scott_au
Posted
The issue with the Vivity is that it has just as much or likely more loss of contrast sensitivity than the PanOptix. And it can have issues too with halos etc. I seriously considered it but for the near eye only. I think the distance eye should be a monofocal to compensate some for the loss of contrast sensitivity. The other issue is that it does not provide much near vision and is only an increase of 0.5 D depth of focus over a monofocal. You need about 1.5 D for decent reading. For that reason a Vivity needs a target of -1.0 D to get the near vision that you would get with a -1.5 D target using a monofocal.
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One plan would be to get the distance eye done first with a monofocal, and then trial mini-monovision with contacts with different amounts of myopia for yourself to see if you like it or not. This would give you the following options for the second eye:
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These options were available to me after my first eye was done. I decided against the PanOptix based on the experience from others. After discussion, the surgeon did not recommend the Vivity. I think he decided I was too fussy about my vision. And since I like mini-monovision with a contact trial I went with it. I am currently at about -1.6 D spherical equivalent and am essentially eyeglasses free. No regrets other than the -1.6 D includes -0.75 D cylinder (astigmatism). I wish now I would have gotten a toric and reduced that as much as possible.
jo61855 RonAKA
Posted
"The issue with the Vivity is that it has just as much or likely more loss of contrast sensitivity than the PanOptix."
Which research studies support your statement that Vivity has as much or more (CS) loss than PanOptix?
How much CS loss does mini-monovision have compared to monofocals set to the same target? From what I've read it's more. Extending depth of vision increases CS.
RonAKA jo61855
Edited
That is a complicated question. Alcon in their Vivity P930014 Package Insert PDF provides a nice MTF simple comparison graph of the Vivity to a monofocal lens. At the optimum zero offset distance there is nearly a 50% reduction in contrast sensitivity (MTF) of the Vivity compared to the monofocal. However I cannot find a similar graph comparing the PanOptix to a monofocal. But, the PanOptix is splitting the light three ways so it makes sense light would be lost at the peak distance. It would seem surprising that it would be any better than the Vivity, but without comparable data I can only guess. And, since I have never seriously considered the PanOptix I have not put a lot of effort into it either. With a quick google I found comparisons to other multifocal lenses but not to a monofocal.
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The thing to consider with monovision is that when you target one eye to a nearer distance the visual acuity and MTF move together with the target offset. So, if you do it with monofocals the MTF peaks at distance, and the other eye peaks at your offset target distance, say -1.5 D. This gives you much more useable MTF across the distance range than say two monofocals both targeted for distance. And with the Vivity while it loses MTF at the peak, it does not drop off as fast at closer distances. But I would say that two monofocals in a mini-monovision configuration would maintain better MTF across the range than two Vivity lenses targeted for distance. It becomes more comparable when a monofocal is used for distance and a Vivity at -1.0 is used for near.
phil09 RonAKA
Posted
"This gives you much more useable MTF across the distance range than say two monofocals both targeted for distance."
And would it also be fair to say that MTF should be exactly the same (two distance-focused monofocal lenses vs. monovision using two offset monofocal lenses) when corrected for distance, e.g., with progressive lens eyeglasses?
jo61855 RonAKA
Posted
I am not sure about that. My surgeon cautioned me that Vivity would be a better choice as far as depth perception, and my experience with monovision contacts and later progressive glasses told me so. The risk of falling or not seeing the curb or an approaching vehicle is important. I have no trouble with halos or driving at night.
RonAKA phil09
Posted
I am not quite sure I follow that question. Contrast sensitivity peak follow along with the visual acuity peak. If you target for distance and near then the MTF becomes more uniform across the distance range. If you target both for near or both for distance then there is some small amount of binocular summation where both eyes peak, but not a lot.
RonAKA jo61855
Posted
Those with monovision tend to have the lowest fall rate. See this article:
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Review of Optometry Published August 25, 2021 Pseudophakic Monovision Patients Have Relatively Low Fall Risk
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My good vision band where both eyes contribute to binocular or 3D vision extends from about 20" to 5-6 feet. That said I can still thread a needle if I have to...
phil09 RonAKA
Posted
I'm thinking if you wear progressive lens glasses, then your visual acuity peaks everywhere, and so does your contrast sensitivity. So, either way, you can correct to good contrast sensitivity, so long as you are using good monofocal lenses.
jo61855 RonAKA
Posted
From the link:
"A total of 13,385 patients were included in the study, of which 1.8% had pseudophakic monovision, 21% had pseudophakic single vision and 77.2% had not undergone surgery. When the researchers looked at the documented falls after cataract diagnosis, they found that pseudophakic single-vision patients had the highest fall rate of 7.9%, followed by no-surgery patients (5.9%) and pseudophakic monovision patients (5.8%). The overall rate of falls post-cataract diagnosis was 6.4%."
Only 1.8% of the subjects had monovision.
RonAKA phil09
Posted
A progressive is a little different. You use your eyes to look through different parts of the lens which have a different power. If you look through the right part of the lens then vision and contrast sensitivity should be very good.
RonAKA jo61855
Edited
241 patients is a lot. All I can say is that this is consistent with my personal experience. I have no issues with curbs or stairs. The only time I have really had some issues with 3D vision or distance judgement is when I am trimming my shrubs with a hand held scissor type shears and working real close like 10" or so. It can be a touch harder to get the blades around the right branch. But the shrubs get trimmed, and I still have 10 fingers! The slight judgement loss is no big deal for something I might (should) do once a year...
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It is an unfortunate reality that many optometrists and even cataract surgeons are not all that familiar with monovision. It is even worse when they spread misinformation. Both my optometrist and ophthalmologist were very supportive in the use of monovision.
Guest phil09
Edited
Correct. But some people don't like progressive glasses as they cause some distortion on the sides and you have to be looking through the right part of the lens which can be a pain if you need near vision for something up high or far vision for something down low. But for most people and in most scenarios progressive glasses are a good solution and the most hassle free way (as opposed to carrying readers) to get the best contrast and acuity (with monofocal implants set for the same distance) at all distances, yes.