Vivity and PanOptix - My real life experience

If you are here researching cataract/IOL options then congratulations — you are way ahead of most people. I also found my way here, just a few months ago, as I had an increasingly bad cataract and a diagnosis, but very little “chair time” with doctors to fully understand options. After a few hours in this forum I was more worried than educated, as it seemed like 90% of people here had issues. I’ve come to realize that most of the people that end up posting here are the ones with issues and those with no issues, generally go on to live their lives and don’t hang out in forums like this. I told myself I’d come back and post my experience for others, regardless of outcome. I'm grateful for others that have shared. Here is my story…

My background:

I am a 51yo male. I’ve had a very high (myopic) prescription, since I was 10yo, but my prescription has been stable (-8D,-8.5D) for the last thirty years and I’ve been 20/20 in contacts, so I've had no real complaints. I had some near vision loss, due to age, but not much given my high myopia. Then 3-4 months ago I started noticing I was going through more right contacts (disposing more frequently) and noticing my vision was inconsistently blurring in my right (dominate) eye. The onset of my cataract was fast, with it getting progressively worse over a few months.

Doctors and Options:

After my regular optometrist diagnosed the cataract, I got a referral and met with one of the best doctors I could find in Southern California in a large and highly regarded group. After a few hours of testing, I got “chair time” with the doc and he recommended the LAL lenses. These appealed to me, since they could be adjusted after they were inserted, but the 4-6 weeks of wearing funny looking glasses and staying out of the sun did not appeal to me. So, I got a second opinion. I found another doc through referral that had done 20,000 IOL surgeries. His recommendation, after more “lifestyle Q&A” was a combination of the Vivity (in my dominant/cataract right eye) and PanOptix in my left eye. He suggested surgery a week apart.

I thought I had done my research, before going to the docs, but I really had no appreciation for the technical difference in lenses. I’ve spent a lifetime with photography, so I quickly figured out that there is no “perfect IOL lens” that will provide low light, high contrast vision with a focal point from 6” to infinity, except for that natural human lens -- for humans lucky enough to have no vision issues. In general, IOL lenses come in distance or close up, but not both. Getting two distance lenses is great for driving, golf, and other activities, but still requires readers for reading, phone, computer, etc. Going the monovision route, you get a close-up lens in one eye and a distance lens in the other, which then provides full range vision for reading up close and seeing distance. The big downside of monovision is halos and noise around lights at night, since one eye is fuzzy at distance and one eye is clear — the effect is always there, but it is more magnified at night, especially while driving. Eventually the brain tunes out the halos and noise (or so I am told).

Why I selected the Vivity / PanOptix combination:

The “correct it after it is in” technology of the Light Adjustable Lenses (LAL) really appealed to me, but I discovered that the Alcon lenses (Vivity/PanOptix) were just better/different lenses for their focal length. My doctor also neutralized the advantage of the LAL lenses, by saying any need for correction after surgery could be done with a short lazik session. The Vivity lens was regarded as very good from 18” to infinity, providing far more mid vision (phone, computer) than others. But… the Vivity was useless under 18” without over-correcting the prescription. The PanOptix lens acts more like a trifocal lens, providing short-mid-and-long distance viewing, but still suffers from some of the light halos at night, due to its outer “close up rings”. I debated going with two Vivity lenses and reading glasses, but I really LOVED the idea of never needing glasses or contacts. I also considered two Vivity lenses with one over corrected for more near vision, but ultimately I decided to go with the PanOptix, knowing I would get the very close-up (6”) reading — like reading my phone or kindle in bed. I did not explore a lot of other lenses or options. My doctor was able to connect me to another patient that had recently done a Vivity/Panoptix combo and that put a lot of my concerns to rest.

Also, I am fortunate that money was not a factor for me. The “premium lenses” can be very expensive and are, unfortunately, not covered by my “premium health care insurance” (UnitedHealthPPO). So, my out of pocket cost (all in cost with surgery) was about $12,000 for both lenses/surgeries. I could have found the same lenses for less, but I came to the conclusion that the doctor was as important, if not more important, than the lenses.

The first procedure - My right eye:

The actual surgery went very well for me. I did my right eye first with the Vivity, since it had the cataract and was starting to be a problem. It had always been my dominant eye, but in the last month my brain had promoted my left eye as dominant. I spent a few hours in the waiting room and pre-op, but once they gave me the fun juice, I have no memory of the surgery. I was memory black, until I woke up in the car, although I was clearly conscious, talking, putting on my shoes, and telling everyone in the waiting room on the way out that I was now a pirate (rrrr…). I took off the eye shield the next morning (a Saturday) and WOW - Holy moly!, I could see perfect. My right eye was now perfect 20/20 without any glasses or contacts. But it was better than 2020, as all the colors were brighter and whiter. I’d toggle between and left, which I thought was “perfect” and my right, and the difference was stark. I had set up a bunch of tests at home before surgery to test my sight near, far, with pen lights in the dark, etc. After the first morning my right eye was already at 2020 and it got even better within a week. With that lens I could see 2020 to 18” but then it immediately dropped off if I got any closer. At 10” with the Vivity I was blind, unlike my “old right eye”. Initially, I was not willing to do the one week back-to-back surgeries my doc recommended (especially after reading this forum), so I scheduled my left eye for one month out. That worked fine for me, as I wore a contact in my left eye, although with my contact out at night, reading was very hard (I had to hack some old glasses with only one lens). In hindsight, I would have been fine scheduling one week apart, but having the month to recover also worked OK.

The second procedure - My left eye:

My second surgery for my left eye (PanOptix) was just last week. Again, it went very well and similar to the first. Only about 15-20 minutes in surgery, but about three hours, including over an hour in the waiting room. I recall more from that surgery, including light flashes during the surgery, but for the most part I was out with no substantial recall, until I got in the car to go home. I removed the eye shield when I got home. My “new” eye was working well, but the first surgery day is a bad measure due to all the dilation and drops. When I woke the next morning, I was equally amazed, as I was with the first eye. For the most part I had clear 2020 vision at distance and at 6” from my nose. For some reason, I thought with the Panoptix I’d be able to see breaks in my vision if I moved my eye around, like with trifocal glasses, but that wasn’t the case. Even with my left eye closed, I found that the Panoptix very closely mimicked my natural eye with seamless vision far and close and no distortion — at least during the day (see below for night result). I was also amazed that my brain automatically switches eye dominance with no distortion for close vs. far. I ran through my battery of tests at home (and later at the doc) and found my left eye vision to be 2020 at distance and 2020 at 8”. Amazing! On the first two days, I had a horizontal light line when viewing my “pen light in a dark room” test. That horizontal line would have been insane if I had tried to drive at night, but luckily it went away by day three. I also had a lot of peripheral flutter on day one and now at day five I still have occasional peripheral “sparkles” when moving through bright light, but they are going away more and more every day. One thing to note, at my “morning after doc visit” the interocular pressure was high in my left eye, so I got more drops to use for the next week.

The drops - oh, the drops:

As someone who wore contacts their entire life, drops are no big deal and are a very small price to pay for perfect uncorrected vision, but there are a lot of them. For my right eye, I used Pred-Moxy four times a day for the first two weeks and an anti-inflammatory drop once a day for the first month. I also added a lubricating/wetting drop 2-3 times a day to aid healing and keep things wet (suggest Oasis tears). For my left eye, I also have a drop twice a day for the interocular pressure and I’m using Oasis four times a day for a total of 11 drops a day in my left eye. I use an app on my phone to keep track of all the reminders. My right eye is now all done and “drop free”, although I occasionally give it some Oasis drops, because they feel so good in hot weather.

The good, the bad, and the amazing:

As I mentioned above, my vision is now AMAZING. I am in awe that I can see 2020 with no correction and colors are brighter and whiter than ever before. I can see perfect with no anomalies reading a kindle in bed, a menu at a restaurant, my laptop, phone, up close and at distance.

The only significant “anomaly” I have is related to night driving. When I drive at night, round lights (only round lights) that shine directly at me (really only headlights and stop lights and to a much lesser degree some brake lights) have a slight halo around them, due to the Panoptix in my left eye. The halos are apparent, but don’t impair my vision in any way. For example, a stop light at one full block away, appears about twice the normal size and as I get closer reduces to only 25% larger at 100 feet away. The Vivity lens in my dominate eye ensures that everything is sharp and crisp (“2020”), but there are still small halos around oncoming car headlights. That is the price I was willing to pay for perfect close-up vision and never needing to wear readers. I would have no issue driving cross country at night - I don’t feel impaired. My ability to read street signs at night, unlit signs, license plates, etc. is better than ever (better than pre-cataract days). I have not noticed any “low light” or contrast issues, even trying hard to create them with dimmer switches at home. I know other lenses are known to be “higher contrast”, but I honestly can’t find an issue with min. Maybe I don’t have a better basis for comparison? I actually expected more “light noise” with night driving and am delighted that there isn’t more.

I would do it again:

I know I am not that far into the process and every situation is different, but if I had to do it again, I would absolutely do it again. I’ll update this thread if that ever changes. If I was a pilot or if I drove for a living at night I would likely chose two Vivity lenses and use readers for up close reading, but for me the trade-off was worth it. Over correcting one Vivity lens is another option to get a wider focal range without halos, but I don’t have the first hand experience. On my second surgery day I wasn't able to wear a contact in my left eye (blind without correction). I was surprised that my Vivity lens in the right allowed me to read my phone perfectly at 18" for about 3-4 hours of waiting. Maybe one day they will invent a lens with true full range and no light distortion. They are getting close. We are all lucky to have modern medicine. I hope you find a good doctor, an IOL solution that works for you, and best wishes on your journey.

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