Risk/Experience of Night glare/halo after Clareon Panoptix lens vs monofocals post cataract surgery
Posted , 8 users are following.
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
jo61855 Scott_au
Edited
In your situation, I would avoid multifocals and edofs in favor of monofocals set for distance. If you have had successful past experience with mono-vision you may try a lens offset (1.0 D) to gain more intermediate/near vision, but there are risks with that as well.
maura04015 jo61855
Posted
What do you consider the risks of monovision? For those of us with successful past experience with it the only risk I see (other than those involved in any cataract surgery) is that the surgeon misses the target by a considerable amount. Off the top of my head I can think of 3 posters here who have had that experience:
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Bookwoman - .5 miss, happy with outcome anyway
RebDovid - .5 miss, happy with outcome anyway
Judith### - can't remember size of miss on 1st eye, now being forced to decide on what to do with 2d eye and understandably not happy
The so-called refractive surprise, which I think should be more accurately called refractive screw-up, ruins people's outcome even when they wanted just distance. There have been posts from people who ended up seriously farsighted.
RonAKA maura04015
Edited
The last I heard from @judith93585 is that she ended up at -1.50 D on a spherical equivalent basis and essentially right on target as I understand it. Certainly ideal for mini-monovision.
jo61855 maura04015
Posted
Monovision affects depth perception, it's like looking at your vehicle's rear and side view mirrors to judge distance. With a mismatch, there can be eye strain and headaches.
RonAKA jo61855
Posted
In the range of distance where vision is good in both eyes, depth perception is not impaired. In further distances there is not much depth perception even with the eyes matched. At closer distances it can be impaired some, but the effect is minimized if the differential between the eyes is kept under 1.5 D.
maura04015 jo61855
Posted
Since we're talking about people who have had successful experience with monovision, I really can't see how worries about depth perception and eye strain would be a concern. People who've never tried it probably should be discouraged from jumping in, and my understanding is some surgeons won't do it for people who haven't at least done a trial run. There definitely are people who can't adjust to it. One of my neighbors starts raving about how terrible it is if she so much as hears the word. Fortunately for her she just tried it with contacts, not Lasik or surgery. With contacts it was wonderful for me from Day 1. That was back in the 70s, and my eye doctor even warned me, "A lot of people don't like it."
Considering the percentage of target misses often cited, people who sign up for plano on both eyes probably end up with micro or mini monovision a lot of the time.
RonAKA maura04015
Posted
Up until fairly recently the norm was to do full monovision with -2.5 to -3.0 D in the near eye. That amount of differential is hard for many people to adapt to. That is probably what many people and professionals base their opinion on. I suspect for that reason some like LAL RxSight advocate "blended vision". It is the same as mini-monovision but sounds gentler and most important different.
maura04015 RonAKA
Edited
I do think blended vision is a better name for it. Monovision always makes me think of someone with a patch over one eye.
phil09 maura04015
Edited
"...blended vision is a better name for it."
Maybe, if the purpose is to market it as a product. But 'blended vision' is not really descriptive - what exactly is it supposed to mean? How about:
No? Ok, I'll keep working on it.
jo61855 maura04015
Posted
Agree, but the risk of falling and injury increases with age. My primary care office has a question about falling on their appointment data form.
RonAKA phil09
Edited
I would vote for iVision, but probably that would require a payment of a $billion or so to Tim Cook...
RonAKA Scott_au
Edited
To answer your original question about risks of PanOptix I found this when searching for something else. It is a comparison of what % of users rated as severe with the PanOptix compared to what monofocal users rated as severe.
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Full article can be found at this link:
https://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S087C.pdf
Scott_au
Posted
OK Update. Had to get through Xmas and a holiday break. So what's new.
I ditched the previous eye surgeon/specialist. Just not happy with how I was being treated or listened to. Lost confidence in them.
During the break - my right eye (non-dominant) has worsened sharply. Def need the surgery sooner rather than later. Starting to impact work.
Got a referral to a new specialist, who came highly recommended. Told him my user case. Not aiming to get rid of glasses. Comfortable with glasses for reading / computer work. Must have A+ night driving. DIstance Clarity, contrast & colour for landscape photo work and astro photography. Need to see the white board/screen presso's in the office meeting rooms.
New specialist has Crohn's disease like me. AMAZING "bedside manner" and quickly said lets do the right eye first, and said he recccomends FOR ME and my user case; J&J Eyehance. Best Distance, Improved Medium and .... on closer (no guarantees but may improve, still need reading glasses) and good for night driving etc.
Then said we will see how that goes and work out if same for left eye down the track (still around 20:20 in that eye but also early stage cataracts). Mentioned than monovision offset is an option (but would then aim for MED in non-dominant eye, distance in dominant) - but thinks that clips the best distance view a bit as compromise and a bit more patient variability in how they handle the offset. Believes at 50 and happy to keep reading glasses, the J&J Eyehance is the best fit for me.
Any thoughts? Not wanting to second guess him - my confidence in him, his abilities and record are chalk and cheese to the previous bloke.
Cheers!
Scott.
Scott_au
Edited
Had the RH Eye done yesterday!
Day 1 postop and have my reading glasses on and writing this.
I had in a Tecnics Eyhance DIB00 Diopter +20.0D
Taking the daily drops. Wearing my old reading glasses working on a PC is fine.
Interestingly, closing my right (operated eye) - the white screen background on the PC is an off white - like a white that has gone a light yellow tinge like an old photo.
Opening my RH eye and closing the left has the screen a true (bright) white with higher contrast for the black text. The LH eye is still clearer on screen with reading glasses whilst the RH operated eye day 1 is a bit blurry still. Without reading glasses on, both eyes are even blurrier.
Both eyes open sees the new RH eye whiter/higher contrast coming out about 75% vs only RH eye open. Very interesting. Another 1.75 days until I have my follow-up appointment with the specialist/surgeon to get the all clear to drive again and see how the eye is going.
Reminder, surgery was ~27hrs ago.
Hoping the clarity and distance reading (how many number plates I can read ahead) from intermediate to distance improves more over coming days/weeks....
RonAKA Scott_au
Edited
Some thoughts:
It is best to get an exam at 24 hours post surgery in case some adjustment of the lens is required. The incision will not be healed, and they can go back in to adjust, if necessary, but unlikely.
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Don't consider getting the second eye done until the first eye is fully healed which takes 5-6 weeks. At that point get an eyeglass refraction to determine where the first eye really landed. Knowing that should let your surgeon refine IOL power calculations for the second eye.
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Use the time between eyes to experiment with reading glasses on your IOL eye. The object would be to determine how much myopia in your second eye would be ideal. If you IOL eye is for example -0.25 D and you put on some +1.50 dollar store readers, that simulated -1.50 D of myopia. If you use the Jaeger test chart which can be found at the All About Vision website you can find out how much you need to read comfortably. If you find +1.0 D readers work best then a target of -1.25 for the second eye should give similar. You can also look off into the distance to see how much impact the myopia has on distance vision. The reason for doing this with your IOL eyes is that it will now have no accommodation and using a reader with it, gives a more realistic view of what vision will be like with the second eye.
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The second thing you can do if you can still see reasonably well in the unoperated eye is to get a contact lens for it that leaves you with say -1.0 D to -1.50 D of myopia. This will give you an idea what monovision is like. The near vision simulation will be more acurate, but the contact lens trial is more representative of the overall feel of it. It will give you a somewhat optimistic view of your reading ability as you likely still have some accommodation in that unoperated eye. And, you also get the choice of course to do distance again with the second eye if you do not like the monovision experience.
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Hope that helps some,