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
valerio01538 007Bond
Edited
hello 007bond,
I developed core cataracts in both eyes at about the same time, a little worse in my dominant left eye, which ended up being operated on first. Interestingly, this type of cataract forms a type of lens in the center of the lens of the eye that, for those who already suffered from presbyopia, brings back the near vision that they had lost. At first it seems like a miracle, but as she progresses, her distance vision becomes double and blurry, in addition to the nocturnal dysphotopsias. In the opinion of all the ophthalmologists consulted, the surgery should be immediate, but I managed to get my optometrist (a friend) to spend some time with me and I even got prescriptions for glasses that allowed me to postpone the surgery for about 3 years, until night driving became dangerous and risky. The eye doctor I saw for the surgeries, after reviewing my scans, said I could choose any lens I wanted. By analyzing my profile he suggested the ZEISS AT LISA (trifocal). I spent a lot of time researching everything I could find about this IOL, and for some reason I didn't really like what I read. Later, I learned that, although my doctor had suggested ZEISS, the clinic where I would have the surgery did not work with the ZEISS brand (only Alcon and J&J), so I started a new search, but with little time until the surgery. I believe I made my decision based on very dated articles, coming to the conclusion that J&J's Symfony would be the better option. Approved by many surgeons, years on the market, less loss of contrast (MTF) compared to other lenses, lossless linear vision at all distances due to EDOF, close functional vision from 20" (for some patients). surgery scheduled and without much time to think, this was my choice. The end result was +0.5D sphere and 1.0D cylinder (spherical equivalent 0.0D). This eye tested 20/20 from a distance and I have very good vision at all distances, being able to read texts with normal font on my cell phone at 20", but to see photos and videos in HD is bad. I spent 4 months to decide what I would do in the second eye (non-dominant right), that's when I found this forum and made posts here. In the time I had the combination of the operated eye together with the non-operated eye, I never needed to wear glasses for anything else! My eye not yet operated on gave me functional vision from 6", due to the nucleus cataract that made it myopic. I confess that I got used to this range of vision (6" to infinity) and I realized that I would not like to lose it. For a while I was torn between Synergy (J&J) and PanOptix (Alcon). After a lot of uncertainty, I ended up choosing Synergy, driven by its +3.0D ADD which, based on its blur curve, could give me good lossless vision (also EDOF) from 13" to infinity, and also because some studies show that it has less loss of contrast (MTF) and, I will add that, I was so satisfied with the quality of vision of the Synfony, that I trusted to put another lens of the same manufacturer and of the same type (EDOF). The final result was sphere +0.5D and cylinder 0.0D. With this eye I can use my cell phone to read texts from 13", I can even read medication inserts, if I have a good light source and find the best focus at the shortest distance , but it is not an immediate read. To view HD photos and videos on your cell phone, it's better to zoom out to 16", but if you want to see the smallest details, I need +1.25D glasses. For everyday tasks I can go 100% without glasses, but for tasks accuracy and reading with small fonts I still need glasses. One problem I've noticed with this Synergy lens, also reported by others, is that the vision from a certain distance is not very clear! I can say that with certainty, because, I can compare it with the vision of my Symfony eye whose vision is very sharp and clear. I would love it if I could know what my vision would be like if I had chosen PanOptix...
Good luck with your choice, I know it's hard...
007Bond valerio01538
Posted
Great reply really appreciate the details.
Me too at first I thought my new diet I had just started was so healthy that I was getting my close up vision back. What an idiot I am it was a cataract forming like yours.
One issue in this area there really is no one Dr that offers all the brands they seem to stick to one only. So with my initial issues with the J&J Dr and finding a guy I really like who only does Alcon has kinda made me want to pick an Alcon product.
Like you I have done my PhD on this topic and the more you research the more you find both pros and cons for any of the lens no matter the type or manufacturer. So I was glad for find this forum with real people and not studies and internet propaganda.
I have read that there are sweet spots with all the trifocal type IOL’s but yes seems the one you have is 12 vs the Panoptix is 16.
My worries are that they get the 3 ranges spot on that I think it one of if not the most important mark to hit. I am also worried about the loss of contrast in dark places but another area you can find some people that don’t have any issues and other people that say they cannot even see at night. So it’s very hard to choose based on conflicting data points for contrast.
You mentioned something interesting I was not really aware that linear vision could be or would be affected and to what degree. I must look up some info as I would want good linear vision it would be a mess if that’s off.
valerio01538 007Bond
Edited
"You mentioned something interesting I was not really aware that linear vision could be or would be affected and to what degree. I must look up some info as I would want good linear vision it would be a mess if that's off."
I remember reading something about vision loss in some points of intermediate vision in trifocal lenses and that made me choose EDOF...but it doesn't seem to affect all patients, some don't notice this loss...
RonAKA 007Bond
Posted
"My worries are that they get the 3 ranges spot on that I think it one of if not the most important mark to hit.
.
Keep in mind that the surgeon has only one distance that they can control. That is the peak visual acuity or LogMAR value. The other points where vision improves or deteriorates is locked into the MF design of the lens. So if for example if the surgeon expects that the PanOptix will not deliver the desired reading up close with distance vision set at 0.0 D they can under correct you to leave your distance vision somewhat myopic. This will cost you visual acuity at distance but increase visual acuity up closer. But, there is no way to fiddle with anything other than the overall power of the lens in 0.5 D steps at the IOL plane which are about 0.35 D steps at the eyeglass plane. The last thing you want with a PanOptix based on user experience I know about is for the surgeon to leave you in the "+" zone. That will cost you both distance vision and near vision. For that reason you want the measurements done with the best instruments, like the IOLMaster 700, and the best formulas used to do the power calculations. They are probably the Hill RBF V3.0, or Barrett II Universal if you have reasonably standard eyes. The RBF formula is based on artificial intelligence, while the Barrett is vergence based, and are considered to be the newest generation formulas with the best accuracy. I think it is best to have them both run and see if they come up with the same power. Ask to see the IOL Calculation sheet from the IOLMaster 700 to see what it says. I would also ask for the target refraction to be set at -0.25 D to minimize the possibility of a "+" outcome. If you want to be assured of good reading, and are willing to sacrifice some distance acuity, you might even want to go a bit more negative.
007Bond RonAKA
Posted
Thanks I need to look into this again thanks for this detailed info I feel a bit better to understand that they only need to hit a single mark.
Sue.An2 valerio01538
Edited
Thank you for sharing your journey. I have 2 Symfony IOLs - Synergy not available when I had surgery. I like the seamless vision and rarely wear glasses. Do have readers +1.25 for small print and if I do extended reading.
I do see concentric circles at night around light sources. Wondering if you have that with Synergy?
valerio01538 Sue.An2
Edited
Sorry for not replying sooner, but I still struggle with the order of posts on this forum!
Yea! For me, the Symfony eye's vision is sharp and clear, better than the Synergy's, and with readers +1.25 this eye practically equals the Synergy which, without readers, gives me vision from 13". And yes! As with Symfony, dysphotopsias are present with Synergy. As soon as it was implanted, I was scared because they were MUCH bigger (3x more), but after time, maybe due to eye healing or neuroadaptation, they are just different. What predominates for me in both Symfony and Synergy, are the "starbursts". They are different from one to the other. In Synergy they have more "radius" and are slightly larger, but binocularly it looks like there is a cancellation between them, getting smaller. In some light sources, especially in LED's, halos appear that merge with the "starbursts" forming "spider webs". Obviously, it would be better if they weren't there. , but luckily, I've gotten used to all these the dysphotopsias, and I drive at night without even remembering they are there. As I mentioned in a previous post, the dysphotopsias from my previous dense cataracts were much worse...
Sue.An2 valerio01538
Edited
Thanks for reply. This site could def use some improvements but i think this particular topic gets s lot more comments. On 2 others and people post way less.
Don't waste time regretting not getting a 2nd symfony. My first symfony couldn't be better - it is perfect. 2nd refraction missed a bit. But really think due to these coming in increments of .50 vs .25 diopters and healing process changing refraction (possibility) of .25. I also (thankfully that 2nd surgery eye) has a new condition brought on by cataract surgery (called epiretinal membrane) so vision from that eye definitely not optimal. Retina specialist wont due the risky operation till my total vision deteriorates. Right eye sees very well and takes over. I only notice I cannot read well or straight lines appear curvy when I close my good right eye.
all to say it may not have turned out any better with a 2nd Symfony. I am glad given this condition I chose EDOF because with one good eye prefer to see all ranges.
I am good to drive now at night too. Guess you get used yo spider webs. Circles huge but get smaller as I get nearer to light source. Outer rings very faint - inner rings more vibrant.
valerio01538 007Bond
Edited
I agree 100% with all of RonAKA's posts and suggestions! I should have asked for the results of my exams with all the measurements and calculations, before the surgeries. I was afraid of not being able to understand the information present there, and of being useless, still creating a feeling of distrust between me and the surgeon. If it were possible to go back in time, maybe I wouldn't go for surgery again without first "checking the calculations". I say this because I believed that there was a refractive error in the Synergy eye since the distance vision was not as good as that of the Symfony eye, and even though my doctor claimed to have reached 0.0D in both eyes on every visit follow-up, I decided to do tests at another clinic and also with an optometrist, who measured a refraction of +0.5D in each eye. I don't feel that it affected my vision too much, as I didn't notice much difference with corrected or uncorrected vision. Even so, after the surgeries, I requested all my exams and calculations, and I learned to use the formulas (Hill RBF and Barrett Universal II and others) and I redone the calculations, reaching the conclusion that my surgeon could have corrected the refractions of the my eyes, if I had followed EXACTLY the results obtained in the calculations. I even sent him an email with my calculations, asking him to check them and try to explain his choices for the powers of the lenses. He simply replied that my calculations were correct, however, I failed to consider his "SF" (surgeon's factor). According to him, his implant technique tends to position the lens with a slight tendency towards myopia, which he corrects with his own SF. In short, the final word always ends up being that of the doctor. It is easy now, knowing the real results, to claim that he could have chosen the EXACT potencies, if he had chosen exactly the results of the formulas, without using "his SF". I keep asking myself if it could have really interfered with the surgeon's choices, since he is the ophthalmologist...
007Bond valerio01538
Edited
Thank you so much for your reply.
I think this is one of the things that I am learning from many posts the choice of surgeon may be the largest determining success factor. I think this surgeon factor as your guy says has to do with many different doctors having their own opinions they differ from standard formulas or recommendations slightly. It brings home the point that years of experience can certainly make a difference but where inexperience and going with the exact measurements sometimes can be have a better outcome.
Somebody once told me they are all practicing physicians, they're all still practicing on you and me, maybe someday they will get it right and stop practicing on us.
jimluck valerio01538
Edited
Hindsight is always 20-20.
If the surgeon had asked you before the surgery, "Should I include my SF in the calculations or not?" would you have said "not?"
Sue.An2 valerio01538
Edited
just a comment valeri001 . The Synergy likely like Symfiny come in increments of .50 vs glasses that have increments of .25
As well sue to settling of the lenses in healing process it can be plus or minus .25 So there are variables not controllable. It is the reason most surgeons don't aim for plano but rather -.25 No point over correcting to give distance at the expense of near.
valerio01538 jimluck
Posted
This is the point! Each IOL has its default SF provided by the manufacturer, however, as the name implies, this "Surgeon Factor" is a real variable, existing in the formulas exactly so that the surgeon can modify this default value, improve his results based on your personal experience. Since the specialist is the ophthalmologist, should we believe that his calculations considering his own SF would result in a better result than if he used the default value?! What didn't happen in my case! But yes! I would probably accept your calculations as the most correct. But I can't help but wonder if this justification given by the surgeon wasn't just a way of explaining not having achieved 0.0D...
Regardless, at follow-up appointments I tested 20/20 on both eyes, a little less on Synergy, something like 20/20-2.
RonAKA jimluck
Posted
Some formulas allow for a surgeon factor. Others do not, but the surgeon can always change the A constant. In principal I agree that each surgeon should compensate for what their experience is with each lens. The problem is whether or not they have enough trials to ensure what they get is statistically significant. Edward Deming with his funnel demo illustrated the dangers of making adjustments based on limited data.
007Bond
Posted
Ok so I Panoptixed!
I had the Panoptix clarion implanted yesterday about 1pm so about 21 hours post op at this time of writing.
Procedure was much better than I had thought it would be. I was overall quite nervous about people touching my eye but it was ok.
Dr was really good IMO during the procedure he told me everything is going well it is taking me some time because I am anal. I have to get this in the perfect position right on the mark or you won’t have the clear vision we are going for. He was very clear no looking down, bending, keep your head as upright as you can for the next week most imp today and tomorrow. Go home lay down with your head up on a pillow close your eye for the rest of today. He stressed this is a specialized lens if it moves even a degree in any direction it will not end well. Do not take a chance I spent a lot of time getting it in your eye perfectly. He said keeping the eye shut today ensures the incision will close fast and lessen the chance of any infection.
I wanted to document my experience for everyone.
Right after the procedure of course everything is blurry just put on the sunglasses and wife drove me home. Tested vision a few times very blurry at all distances, unusable.
Within a few hours vision became extremely cloudy to the point I could not really see anything. Instructions say this is normal can happen just chill. So, eye closed drops on time dozed off a few times was just feeling the drugs they gave me.
About 8pm I noticed the cloudy was starting to clear away, it was all gone by 10pm now things were just blurry at any distance.
By the time I did the bedtime drops eye was still as expected blurry but no cloudiness. Vision was getting less blurry but still not usable at any given distance.
Since it was dark, I did some contrast testing yes with a blurry eye. I could not see a difference between the left and right eyes (right eye is natural lens with very tiny cataract not in need of replacement at this time). Got up a few times to go to the bathroom no issues in the dark both eyes could see the same and as expected the left was a big improvement over the cataract where contrast was a problem.
Woke up today 7am left eye some improvement in clarity somewhat usable vision especially in combo with my right eye. Put the drops in made it feel better and going about my day.
8:30 am check up with the Dr he says incisions are all healed up everything looks good, but eye pressure is a bit high. Gave me some drops said use for the next 3 days at night then stop. He says they use something during the procedure that they flush out but sometimes it raises the eye pressure so drops should do it see you in 2 weeks call if any issues. He says computer and TV ok today and again stresses all the things he said about not bending or doing anything that can move the lens until it settles in. He says the blurriness is normal this close to post op and will clear up over the next few days.
As of right now I am not wearing any glasses my right eye is farsighted and cannot see anything closer than arm’s length. I am working on my computer now and left eye is yes blurry but clearly picking up the slack enough for me to have usable vision to wright this. Distance is good since right eye is picking up that slack. Overall for not even 24 hours post op things are ok IMO.
Things I have noticed.
-if I really look at certain angles, I can see the rings of the Panoptix in the reflection of the safety glasses more so in the clear eye patch I wear at night.
-I have noticed some flashing of lights more yesterday some this today. I almost think it is just light catching the liquid in my eye as they are a bit more watery then normal right now.
-looking outside my window before bed last night streetlights looked normal, stars looked normal, everything I could see looked normal. I did not see any starburst, rings or any visual disturbance that would cause a concern. In my home I tried looking at as many light sources as I could find alarm keypad, led’s, under counter lights, I have to say it all looks pretty good to me. If I had to pick something the halogen under counter lights had some stars when reflecting off the marble countertop but in all fairness I kind of notice that with my right eye too.
-I have the as expected foreign body sensations.
-A bit sensitive to light things are bright I have turned down my laptop monitor brigness.
-For sure the color temp of the Panoptix eye is different. It is brighter as in a higher color temp when compared to the natural lens of the right eye. My right eye is more yellow like warm white where the left is bluer like cool white. I cannot perceive this in any way with both eye open and I kinda like the crispness of the brighter color temp.
-at this time I cannot notice any change in focus at any distance everything from up close to infinity is equal. Granted still not clear as expected this close post op.
I will try to get the terms and numbers right as I remember. My astigmatism measures 1.75 he used a 1.5 correction and lens corrects me 2.5 for vision slightly negative. Since currently I would say my vision is equally blurry at all distances, I believe that the blurriness I am currently experiencing is just the normal post op that anyone would experience post op with any lens.
Overall, it is way way too early to make any judgment or call any outcome. At this time, I am just moving on with my day and hoping things gradually improve as they are expected to do.
At this time if the left eye with the Panoptix can become clear vision in all ranges I think I can function with my right eye for the foreseeable future in a sort of monovision setup until that cataract becomes more of an issue.
I am mentally focused on the outcome I want, that is clear vision in my left eye at all ranges with minimum if any visual disturbances. Will the Panoptix be as good as my natural lens, no way never gona happen. My goal is set to see as good as possible with an IOL lens that is not my natural lens. I do not ever expect it will or can replace a natural lens and I realize that there are tradeoffs have to live with.
Again I still believe the Dr is a big factor in the success of the implant as well as level setting your expectations.
I will keep this post updated.
Thanks everyone for your comments.