To Panoptix or not to Panoptix that is the question?
Posted , 11 users are following.
I am scheduled to have the Clareon Panoptix implanted next Tue.
I have been researching for a few months now and honestly it is very hard to decide on a lens since you want the first choice to be the right one.
My story starts first part of this year when I noticed that my vision is my left eye was to me improving. I had to switch to an older pair of readers and my as my new RX (2 months old) was just too much power. But soon I noticed this cloudiness when I walked at night and then some halos around lights. So I go the eye Dr and she says you have a cataract. She says it is fast moving and I should see their surgeon. So I do and what a complete disaster, that day I waited 2 hours past my appt, nothing worked well as in the equipment they had network issues half the machines needed to be rebooted what a mess took forever. Then I get to see the surgeon he is looking at the results of the testing, confirms I have a cataract, discussed the option but seems very unsure about the readings from the machines as they don’t match up with some of the manual readings for my astigmatism. So, he makes this comment when deciding what to do “well I guess I have to go with what she wrote here it should be right” What red light alert is this guy joking , no he is not. I decided no way am I using this place and said thanks see you later.
Then I start to think about it my reading vision has been slowing improving over the past 2 years. Then I read that this is a classic symptom of a cataract. So, IMO this place has missed the onset of my cataract for the past 2 years. Further I think hmm this visit for checkup was a different Dr and she picked up on the cataract right away. So yea other Dr I have been seeing has been missing it, so this place is a place to stay away from.
I find a new surgeon on the first visit unlike the other place he only wants to see me for a consult. I think maybe they are just making more visits to make more money, but he has a good rep as this time I did my research. Turns out he seems very knowledgeable does his evaluation confirms the cataract in the left eye and it should come out soon and that I have one starting in the right eye that in his opinion can be done when it gets worse or whenever I am ready and lets me know the options. Totally no pressure says he is here to answer my questions, but I need to make my own educated decision on what to do. He says eye surgery has risks no matter what even if everything goes well. This is your eyesight you need to think about it and make a decision you can live with. He says no rush think about it do some research we can talk on your next appt. So, I go back for the next appt we get all the testing done, it goes all well, everything works as it should, we get all the needed test, very professional, and makes me feel like they know what they are doing. See the doc he says to give him a min to look things over to see what lenses are optional for me based on all the testing. He then says based on the testing you can get any lens you want and goes over all the options. I ask lots of question he answers just like he should on all the lens and is spot on with what can happen with each one. I tell him I have had good vision all my life and only in the past 10 years needed readers. I really want the best vision possible all ranges and I prefer to not have to use glasses if possible. He says you can do the EDOF Vivity or the Panoptix and goes over each one. I says really don’t want to depend on readers for cell phone use or to read a label in a store but not sure if I like the trade off with the possible side effect of the Panoptix. He says I can answer all the questions you have but I cannot tell you what lens you should pick only you can make that decision. I tell him I am undecided I don’t know. He says listen we have all the types of lens in stock for your RX give me one to pencil in and you have up to the time I start the surgery to change our mind. I say ok give me the Panoptix he says ok just let me know if you change your mind or if I an answer any questions you think of as this is a decision you should be willing to live with for the rest of your life.
So I am scheduled for surgery next Tuesday.
Even after reading negative posts here, I am on the fence but still leaning towards the Panoptix especially since I have confirmed no matter what I pick it will be the new clarion a lens.
Here are some of my thoughts.
I currently have halos and starburst at night, and I can drive no issue, if I am not thinking about them, I forget they are there. But they are mainly in my left eye and right eye very little so brain is maybe tuning out.
I do work on small close-up tasks at times and I sweat a lot so glasses are a pain and sometimes can fall off when hands are full. So no glasses sounds really nice like it was 10 years ago.
Most of the workday I am on a computer where I do where readers but again if I get up to walk somewhere I must take them off to see distance, yup a pain.
If I have to pick just one concern it would be lack of contrast for night vision. I do notice the left eye has some lack of contrast with the cataract already and I manage. What I don’t want is to have total loss of contrast at night.
As for brain adaptions I think I will do well as right now I have effectively mono vision and really don’t need any glasses. Reason is left eye sees quite clear at 12 inches and right still sees ok at a distance so everything seems in focus for the most part, it is what I would call functional. But I can see both eyes especially the left getting worse as time goes by.
I have read many bad posts here and not so many positive ones. I found this site by searching for Panoptix reviews to see what was out there. I was looking for post by real people and not some sponsored study. I realize that people do have issues real issues but also that most people who have no issues don’t post anywhere.
Anyways thoughts opinions?
0 likes, 84 replies
jimluck 007Bond
Edited
It comes down to your philosophy or temperament about decisionmaking when the results of a decision are not predictable with certainty. Do you like to minimize your worst-case risk? Or maximize your probable outcome? From what I read, the multifocal PROBABLY will give you a better outcome than a monofocal. But the worst case is far worse with the multifocals.
My philosophy on a decision like this is to choose the option with the least-bad worst case. I haven't heard of any really bad outcomes with the Eyhance, or minimonovision or plain old monofocals set to equal targets, or the IC-8 that are attributable to the lens choice. I have with multifocals. So, I'm staying away from multifocals.
007Bond jimluck
Posted
Thanks for the reply.
That's the dilemma a monfocal has the best chance of a positive outcome as it should give you good distance 99.9% of the time. This option would give the safest risk is min. But you need glasses for everything else for sure low reward.
A EODF is a medium risk/reward option but kinda falls short on most fronts. You get the distance, good mid, and maybe if you are lucky some functional but not great up close. So this sounds safer than a multifocal still has some of the multifocal risk/reward but much lower. Where this sounds like a good option you really half solved the issue but agreed safer bet. For me I think if I still have to wear glasses then just save 3k each eye and get the mono.
Then we have the multifocal this offers the most reward with the most risk. You have the potential to be glass free but also the potential of more issues than you would like in of all things your eye.
What multifocal lens do you have?
RonAKA 007Bond
Posted
First I think you made a good decision to ditch the disorganized doctor. I got into this cataract thing a couple of years ago. Vivity was not available then, and the discussion was between monofocal or PanOptix MF. My surgeon frankly said he would not put the MF in his own eyes so he had a hard time recommending it to his patients. I ended up getting a monofocal AcrySof IQ lens as Clareon was also not available at that time. A year and a half or so goes by and I see the same surgeon again. His business model had changed. He now operates out of a clinic as well as a hospital, and his father who was also an ophthalmologist has passed away and give his office and practice to him. Now he splits his time between the hospital, his inherited office, and the clinic he uses to do the out of hospital surgeries at. As a result he has stepped backwards in technology with the equipment his father left him, and he also seems to have signed up with Alcon to push their lenses; Vivity, PanOptix, AcrySof, and now Clareon. When it came time to choose the lens for the second eye, he now was quite willing to recommend PanOptix. I said "no" as I had done enough research by this time to know that I was not willing to take the risk. His ability to view data and images on his computer was not up to the standard of when he practiced out of the hospital. And as a result of this I am now sure the wrong lens type and power was selected for my second eye. It should have been a toric monofocal with one step more power. Long story, but you are wise to go to a surgeon that has up to date equipment that takes measurements efficiently and can be shared on their computer system.
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Like your doctor, I can't make a decision for you. The PanOptix has a significant potential to have optical side effects like halos, flare and spiderwebs (combination of flare and halo). Some put up with that to get the glasses free convenience, and some regret it.
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In the end I decided to go for mini-monovison to get eyeglasses free vision but without the risk of optical side effects. If your vision is still pretty good, you really should try simulating it, as you might like it. Not everyone does. It is best done with contacts. Your dominant eye is fully corrected for best distance vision, while your non dominant eye is under corrected to leave you at -1.5 D. That is enough to give you decent reading vision. If the contact lens trial goes well, then you can do the same thing with IOLs. This will take some time of course, so you would have to defer your current surgery date. Remember getting an IOL is kind of for life, and it is worthwhile to make a good decision the first time. Exchanging lenses can be done, but there can be complications....
007Bond RonAKA
Posted
RonAKA thanks for the reply. I sort of have this mini-monvision now as the left eye with the cataract sees good from 12 to 20 inches and the right eye sees will past 6 feet not perfect but actable. So I mostly get by now without any glasses it’s been ok just the cataract is getting worse and hazing up during the day now so it has to go soon.
I don’t know if these places get a kick back from what I see they are making more $ on the premium lens for sure. I did ask this Dr if he need an IOL what would he pick he said he too is on the fence and could see himself getting the Panoptix or the Vivity as both have their own set of pros and cons. He said he just did his moms cataract and she got the Panoptix. I said you would not get a mono vision he said no not when there is a better option but again, he said he is not me and I have to do what is best for me.
So sound like your Dr is working with outdated equip like this first guy I seen wow seems a lot of Dr are making guesses with eyes when extreme precision is needed to hit this spot on. Very scary and maybe the cause of some unhappy cases.
RonAKA 007Bond
Posted
I guess that gives you some idea what mini-monovision is about. But, to really see how it works I think you would have to try the contacts. If you have a current eyeglass prescription, places like Costco are quite liberal with giving out free contacts on a trial. The one I go to has a good stock of most brands and powers in 5 contact sample sizes.
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My surgeon kind of regressed with respect to equipment. He now has an IOLMaster 500 in his office, but has access to an IOLMaster 700 in the hospital. However, he has connectivity problems and seems unable to view all data from his office. When I went for the final consult to select the lens on my second eye, he had to defer the decision and we made the choice by two follow up phone calls from the hospital where he could see the data. He actually hit the target he was trying to get to, but in retrospect it was the wrong target. I blame it on a lack of a fulsome discussion of the available options.
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It sounds like the surgeons you have seen are Alcon advocates. Alcon makes the AcrySof IQ, Vivity, and PanOptix. Some of these are now available in the newer Clareon material. The other popular supplier is J&J. They offer the Tecnis 1, Eyhance, Symfony, and Synergy. Without going down the rabbit hole too far, the Tecnis is a monofocal like the AcrySof IQ (or Clareon). The Eyhance called a monofocal plus as it has a small amount of EDOF, but not enough to be technically called an EDOF. It is similar to the Vivity, but does not provide as good closer vision as the Vivity. It also probably has fewer side effect issues. The Symfony is a combination EDOF and MF lens, and Alcon does not have a similar current lens. Their latest MF is the Synergy. It is comparable to the PanOptix and likely has the same potential optical side effects. What I have gathered here is that the weak point of the PanOptix, besides the side effects, is that in some it does not provide enough reading vision. I have a friend that has the PanOptix in both eyes, and needs to use +1.75 readers for many things. The Synergy is said to provide more reliable reading vision, but at a cost of weaker distance vision. I believe some have used the Synergy lens in one eye for the superior close vision, and Symfony in the other eye for the better distance vision. However, you still risk the optical side effects with both of these lenses. Here is an update from one participant here, @Jennifer_Guess, that did the Synergy/Symfony combination.
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https://patient.info/forums/discuss/symfony-synergy-six-month-update-788537
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The problem is that you likely would have to switch surgeons from an Alcon loyal one to a J&J advocate. They seem to go into one camp or the other. That will take a bit of time. But, as far as I know it is not more difficult to remove a lens with an advanced cataract compared to a less advanced one. The big issue is in getting accurate measurements when the cataract becomes dense. However, with a good instrument like the IOLMaster 700 they have the capability to measure accurately with much more dense cataracts than they could before.
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Hope that helps some,
007Bond RonAKA
Posted
Thanks this is helpful
Yes I have noticed the Dr’s are only offering one brand or the other depending on what camp they are in. My original Dr was J&J and I was thinking of the Eyhance since it seemed ok actually was mid cost between STD and MF. But since his office fumbled so bad I looks for a better Dr all together. Found a guy that works at Wills eye hospital and seems to be top of the line. He happens to be in the Alcon camp so I thought let me pick among them since I now feel the skill of the Dr and his equipt is a big factor in the success of the outcome.
One thing that is a bit different is at this time I only need my left eye done and that is my non dominate eye. The cataract in the right eye is just beginning and he says it could easy be ok vision into next year or even more. So he says eye surgery is risky business even as common place as it is so there is no need to rush you get it done when you are ready. I asked why do most get it done back to back and he says most people’s eye are progressed about the same. He says he does have many other patients that only need one eye but love the results so much they cannot wait to have the second eye done. But he says truthfully there is no rush you do what you feel the most comfortable with. So I do like the no pressure let’s wait and see take your time attitude.
He did confirm all the stock they have is all the new Clareon material and 100% my lens will be the new Clareon.
I did find some articles that the new Clareon material lowers any possible side effects but who knows if this is true or hype.
So since there is no rush for the second eye I have plenty of time to see how things settle in and think about what lens I will choose for the right eye.
My biggest fear is really that all 3 targets are hit. I explained my expectations that are in alignment with any MF. I want to see close things cell phone, hobbies, detailed small work close up 12-16 inches, I want to see my computer that I work on all day long clear, I expect anything past 6 feet to be clear TV, street signs, things like that. I do understand that a MF that splits the light has some disadvantages you are dividing light photons. You cannot cheat physics so there will be tradeoffs for sure. I understand that one of the main will be when light is low as this is where the division of light matters the most. The Dr did say that in the cataract eye no matter what lens I pick that eye will get more light then it currently is. So he says from that perspective no matter the choice there will be an improvement. I do know at night when I close one or the other eye the left eye has much less contrast, appears dimmer, however I am able to work with it safely.
Sure we also have the other issues some exp spider webs, halos, glare. He said I will have some if not all and they may or may not bother me no one can predict. I may or may not get use to them everyone is different. Right now I have glare and halos with my left I quite noticeable if I think about it. But when driving I generally forget all about it and just drive. Granted I do have the right eye that has this to a much lesser extent and most likely the brain is tuning out the left to a point. All these little factors make the decision more complicated not less.
At this point I am banking on him hitting all 3 target ranges and hoping I can deal with any of these possible issues related to my choice of lens. I have accepted the fact that no matter my choice nothing is going to replace my natural lens and anything I pick is substandard compared to what I was born with.
greg59 007Bond
Posted
One of my surgeon's recommended using preservative-free eyedrops and nightime eye ointments several days/weeks before getting biometry. Most people have some dry-eye, especially after driving a car a substantial distance. Dry eyes are hard to measure and are frequently causes of inconsistent biometry. If you are getting ORA or similar biometry readings after your cataract lens is removed and before the IOL implant, make sure you clear up any dry eye before the surgery so that you get the best readings possible and your surgeon picks the best power of lens for you.
007Bond greg59
Posted
Interesting the first place asked me to do this I thought it was a good idea so I also did it for the second visit too. However I only did it for the week before the measuring. I wondered why or what it would do.
Sue.An2 007Bond
Edited
0007Bond
This is not an easy decision or even one where you can be 100% comfortable. Your surgeon sounds like mine. He would not make decision for me even when I him to give me his thoughts. Given pros snd cons to each IOL I guess it comes down to your priorities and risk tolerance. I made a list of work activities sports hobbies with times spent at these. I was also 52. My surgeon said people of normal cataract age have something to gain whereas I had to make a compromise on what to lose. I had fast growing cataracts too likely due to steriod creams for eczema used years. Both surgeries were done in 2017 so the 2 lenses you are considering weren't on the table for me.
i heard some offices do a personality test for cataract patients. Type A / perfectionists generally don't like the compromises of premium lenses. Vision not as sharp, lower contrast sensitivity to monofocals. But you can be glasses free - however not guaranteed. in healing process you could be + or - .25 diopters either way while lens settles. You could also still have astigmatism. If the readings at all off power calculation could be off and IOLs come in increments of .50 vs glasses that come in increments of .25.
Jokingly I read somewhere the surgeon's worse nightmare of a patient is an engineer whose hobby is photography and has a Jewish brother in law that's a lawyer and he wants to be able to see a gnat on the back wall!
All to say it is a hard choice. But there is much advancement and has a high rate of success. Fortunate to have IOLs. Our grandparents had their natural lenses removed and handed a pair of coke bottle glasses.
I wish you all the best.
Oh perhaps I will throw another alternative into the mix. Some get a monofocal targeted for best corrected distance in their dominant eye and a premium lens in their non dominant eye. The monofocal will mitigate the halos and glare of premium lens as your brain will chose the better view. Since your other eye sees well and doesn't need surgery you will already be simulating that scenario
some surgeons do not like to mix and match but it can work well. Something to consider and maybe discuss with your surgeon.
007Bond Sue.An2
Edited
Oh yea my father had his done in the 70's it took him months to heal and he had the coke bottle glasses.
Thanks for your thoughts I think you are right with your last paragraph where I put the latest Panoptix in the left non dominant eye and see how things go. If all good maybe get the same in the right eye next year or if not so good go for the EDOF for the mix.
I was just driving, night, raining like crazy. Left eye sees crazy halos, glare, star, but right eye still ok with both open vision is still good to drive safely and see everything needed so the brain does do a good job of filtering out the unwanted images.
I think in a few years they will have improved the EDOF to the point of the MF and that may become the new state of the are IOL with the best bang and the least chance of issues.
Jennifer_Guess Sue.An2
Edited
"Our grandparents had their natural lenses removed and handed a pair of coke bottle glasses."
Is this true? Am I understanding correctly? Are you saying that before these lenses, people had their natural lenses removed and then they wore thick glasses (so no lens to implant but very thick glasses so they could still see?). Very interesting. I wondered what happened before these lenses were available and thought people just went blind 😦
Sue.An2 Jennifer_Guess
Posted
it is an interesting read. Healing time much longer too. Google history of cataract surgery
here is a portion "
In the first half of the twentieth century, cataract surgery meant the complete removal of the crystalline lens in the eye. Removing the lens left the patient aphakic (without the natural lens of the eye), and dependent upon very thick glasses, or hard contact lenses to be able to achieve some visual acuity. The procedure was done in a hospital, and large incisions, followed by stitches, were necessary for the surgery."
Jennifer_Guess Sue.An2
Edited
Hi @Sue.An2 😃 So nice to 'see' you here.
Oh dear! That is interesting! My goodness, we have so much to be thankful for.
Sue.An2 Jennifer_Guess
Edited
yes we do. and yet we still naturally want more. Hard to settle for less vision
Jennifer_Guess Sue.An2
Posted
That's true. Wanting more can foster positive outcomes - such as innovations that are these lenses. I am so grateful.
Sue.An2 007Bond
Posted
Hoping things work out. Lots of options - finding a surgeon willing to discuss and explore is sometimes the harder thing to find. I have 2 EDOF lenses and night driving a challenge with the huge concentric circles around certain light sources. Perhaps an EFOF or Panoptix with a monofocal would better mitigate the circles
007Bond Sue.An2
Posted
I was not aware that the EDOF had the same level of issues. I thought it was not as bad or at least much less but seems that is not the case.
007Bond Sue.An2
Edited
@sue.an2 question how long have you had your EDOF? Reason I ask is I was just reading an article that says with these lenses some report it gets worse months 3-6 but then improves months 6-12 and is hardly noticed after 12 months by many. No idea if this is true at least for me only time will tell and since I still have my natural right eye any adaptation may be delayed or not even happen.
Sue.An2 007Bond
Posted
i had my surgeries in July 2017 and Aug 2017 both with Symfony lenses
first couple of weeks there was strong glare around lights so did not see the concentric circles. As eyes healed the glare was less and i could see the big concentric circles. They reach wider than a car or in case of traffic lights to the ground and gradually get smaller and disappear as i get closer to the light. The outer rings ate very faint. Still there if I look for them. Inside ones are more vibrant. Only see they at night or dusk otherwise they are not there.
007Bond Sue.An2
Posted
Thanks for the reply. Yes agreed the distance looks like total blur and as they get closer it gets more clear and when close is normal. Issue I have is with lots of lights the distance is just a total blur and really useless as it looks at least for driving. I had hoped that the Vivity would not have the same issues and I could pair it with my Panoptix, Today is the last day of drops and I actually started to cut back the dose Monday and I can see some improvement. I do like my vision during the day the range is from near to far is actually decent without glasses. However night that's another story.
Sue.An2 007Bond
Posted
oh that's a shame about things being a blur at night. Despite the circles i see things are clear not blurry for me. if distance is clear during day cannot be a refraction issue. Perhaps if early weeks/months there is flare and glare that is making things harder to see clearly. I did not a difference in that after a few months. Hopefully will be same for you