Vivity and PanOptix - My real life experience
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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.
7 likes, 31 replies
paul08517 Eye33
Posted
@Eye33 @dennis63207 thank you for sharing your experience. I'm booked in for surgery in a month for a Panoptix trifocal in my non-dominant eye and Vivity EDOF in my dominant eye. My surgeon believes this will give the best visual outcome, and minimise halos and glare. Can I ask how long it took to adapt after the lenses were implanted? What is the range of focus with the vivity? Can you read a mobile phone? Difficult for me to know if this is the best lens choice - i'm going with my surgeons recommendation - he described it as the best of both worlds.
RonAKA paul08517
Posted
When targeted for distance the PanOptix should give you much closer vision than a Vivity targeted for distance. The Vivity really only gives good close vision when it is targeted for about -1.0 D of myopia. Then of course you are going to have very marginal distance vision in the range of 20/40 or so.
paul69633 Eye33
Edited
Thanks for your report! It really is helpfuI to hear real experiences. I had Vivity put in on my right dominate eye and still cant read this font very well at 18 inches. My left eye allows me to read this as well as my smart phone. I would be happy to live with this vision if I had no cataract in my left eye. I am doing a follow up visit this afternoon.
Do you have better distance vision with the Vivity vs Panoptix?
tjd123 Eye33
Edited
Thanks for the detailed report. I am one day post-op with a Panoptix in my non-dom eye. Saw Doctor today for post-op check and he proactively asked me to consider the Vivity in my dominant eye.
He said my two eyes are very different (my non-dom required a Toric for the astigmatism and my dom eye does not - and is generally in better condition). He knows that I'm a hunter and a golfer and has recommended the EDOF in the dominant eye to provide the best blend of clear longer-distance vision with fewer side effects (Halos, etc.).
He said if I come in next week for my week-after check and just love the Panoptix, he'd have no issue putting another one in the dominant eye, but he said he's had good results with the mix/match for people that fit my profile.
As background, I'm a 51 YOM and electively chose to have the IOL implants to reduce or eliminate use of glasses. Due to allergies and dry eye, contacts were never a good solution for me.
FWIW, I didn't have the same "wow" factor with the Panoptix the day after, in fact, I'm still quite blurry and light-sensitive. I'm not losing faith in any way, I know everyone has different experiences after surgery. Thanks for your perspective!
007Bond tjd123
Edited
I have the Panoptix in both eye and it took more than a week to fall in love so not sure you will really know next week if you want another. I got my left eye done several months ago (last year) and it took some time to get use to it. Note I did not need the right eye done right away and wanted to spread the cost into the next years FSA. I was on the fence for many months what to get in the right eye but finally decided the vision in the left eye had settled at 20/20 and I was happy with no real noticeable to me side affects IMO. I went for the Panoptix in the right eye a few months ago. No regrets totally love it great vision from 12 inch to infinity. No issue night driving, contrast, really could not ask for more at this point. No glasses needed for anything vision is clear, this is as good as it gets IMO. Again this is my opinion we were given two matching eyes at birth. Having matching IOL's would seem to be as close as you can get to original hardware as you were born with. This is assuming you are happy with the choice you made some ppl are very happy set to distance and use reading glasses. I am happy threading needles for my wife, driving, reading, watching TV, with no glasses. Took out a splinter the other day no need for magnifying glass I was impressed. But again it took me way more then a week to fall in love with the Panoptix. Oh and BTW I have astigmatism in both eyes and have no issues with sights or hitting small white balls.
tjd123 007Bond
Posted
Thanks 007. Happy with the Panoptix (week post-Op) myself. Going to proceed with the Vivity in the dominant eye next week, will report back. Thanks for sharing your insights - stoked that you have had a great experience with the Panoptix!
TimR321 Eye33
Edited
Thank you to all of those that have participated in this forum.
As a follow up to my previous entry into this forum, I wanted to share with you my circumstances and how I came about selecting lenses that I did.
I am a 70-year-old male in good health I have worn glasses for approximately 50 years and contact lenses for 45 years. In the last 15 to 20 years, I have worn bifocal contact lenses. I am a retired commercial real estate appraiser. I am also a private pilot, with an instrument rating but have not been active for some years. However, I did not want to shut the door on this chapter of my life because of selecting the wrong cataract lenses. (The FAA does not allow for monovision.)
My wife went through this same process of cataract lenses replacement last year. At that time, we interviewed three surgeons, paid for by Medicare. She selected the surgeon and facility we consider to be the best of the three. She selected, based on the surgeon’s recommendation, the Alcon Panoptix lenses for both eyes. She has been very happy with these lenses with excellent vision for all distances. She has always been an avid reader. But she hasn’t enjoyed driving at night for years, partially due to her cataracts in recent years. So, the Panoptix lens was a good selection for her. However, I would say she is more comfortable driving at night now after her surgery than before the surgery.
When it was my turn for cataract surgery, I reviewed what my wife went through last year and continued to research various options. Based on various videos that I watched on YouTube as well as information from people in this blog, it appeared that blending the lenses was a good option to enhance night time driving. I found this very intriguing. My wife’s surgeon did not address blending the lenses to her. During my consultation with him I asked him about it and he said that some people have had good outcomes by doing it but did not extensively discuss it with me. I thought with one eye having a Panoptix lens and the other with a Vivity lens I could achieve the best of both worlds. Of course, I still had concerns.
I selected to have my non-dominant eye done first (June 8, 2023) as it had the most severe cataract. For this eye I selected the Panoptix as the surgeon recommended this for me, because of my wife’s great success with it and because I liked the trifocal effect of this lens. However, I wanted to hold off for at least one month to see how well I liked it before I had my other eye, the dominant one, done. I was not sure if I was going to have a Panoptix or a Vivity lens implanted in this eye.
After weeks of reviewing the clinical write-ups, watching as many hours of YouTube videos as I could find on both the Vivity as well as the Panoptix lenses, discussing cataract lenses with as many people I could find, as well as reading many blogs on the subject, I decided to go with Panoptix lenses in both eyes. My thought process, in random order, was as follows:
• If I go through all this effort and expense, do I still want to wear glasses/contacts?
• If I would need glasses for distance, I would need to pay additional money for prescription glasses. If I need glasses to read, I would have to have a pair of readers with me most everywhere I went.
• What is important to me from this point forward in my life in terms of my eyesight? Is it to be able to see “the eagle on the mountain top” in a once in a lifetime vacation or is it to be able to see in all facets of my life throughout any given day (e.g. reading, using the computer, watching television, exercising and driving. And maybe starting to fly again).
• If I started flying again would halos and starburst be an issue? Since I would not plan on flying at night, the answer was no.
• How do I envision my lifestyle as I get older? Would I be more apt to be driving at night or reading on a regular basis.
• To maximize the effectiveness of the Panoptix or Vivity lens, it appears that having them in both eyes may be important.
• The surgeon’s recommendation that I was a good candidate for the Panoptix lens. Since he does every day, maybe I should listen to him rather than try to “out smart” him.
• There are so many variables in deciding whether to blend the lenses, one must consider the circumstances for the individuals that have done so. What works well for one does not necessarily work well for someone else. Why aren’t there more studies regarding blending the lenses?
• Do I do a lot of night time driving? The halos and starburst that one would see with the Panoptix lens is also potential to be seen with the Vivity lens.
• Some people have reported to be able to read well with Vivity lens but based on clinical trials that percentage is a lot less than those that had the Panoptix lens. Was I willing to take this chance?
• Do I know more than the surgeon that recommends using the Panoptix lens in both eyes. If blending the two lenses (Panoptix and Vivity) is better for the patient wouldn’t the surgeon recommend it?
I finally concluded to have both eyes implanted with Panoptix lenses. On July 20, 2023 I had my second eye (dominate eye) implanted with a Panoptix lens. And even on day one after my second surgery, with my eye clearing up, it appears maybe my decision has been correct. My Day-1 post-Op visit indicated I had 20/20 to 20/25 vision at all distances (6 inches to infinity). My vision within 48 hours after the procedure appears to be as good, if not better, than any pair of contact lenses I have ever had in the 45 years of wearing contacts. My one-week checkup indicated my vision generally was 20/20 to 20/25. In addition, I could make out a letter or two on the 20/15 line for distance but had to squint. The doctor’s office tells me my eyesight could get better over the next 30-90 days. Even if it does not, I am totally glasses independent and am very happy with the results.
Both procedures were very easy and pain free. I hope this response helps someone to make their decision.
TimR321 Eye33
Posted
This is my 30-Day Follow-up since my last post. It has been 4 weeks since my last cataract procedure and have Panoptix lenses (Toric) implanted in both eyes. During 4-week checkup it was noted I had 20/20 for distance and closeup with either eye. I felt my distance was a “weak” 20/20 whereas I could make out 4 of the 5 letters. I actually see better with both eyes than I can with each individual eye. My reading or closeup sight is very good. Of course, all of this is predicated on good lighting. Nighttime driving is very good. Yes, I see halos around some light sources, such as LED headlights but this doesn’t seem to be an issue. Not all light sources create halos. I don’t drive a lot at night so I don’t see this being a problem. I am totally glasses free. As I noted before, I had been wearing glasses for about 50 years and contacts for 45 years. I see now as if I had a brand-new set of the best contact lenses!
I also must add to the list of “Thought Processes as to how and why I chose the Panoptix lens” that I noted in an early post. One other thing we did during this whole process from the very beginning, my wife and I Prayed. We prayed to be led to the right surgeon and the selection of the correct cataract lenses. Some who are not believers will discount this endeavor but those that are believers will acknowledge the validity of this effort. I am sure everyone reading this blog feels our eyesight is one of the most if not the most important sense we have in life. All of us want to “get it right” when we make the selection of surgeon and cataract lens. Personally, I felt I over-researched this issue because of its importance. So, including praying about the issue only seems correct to me. I am thankful to all who contributed to this blog, your insightfulness and experiences were very helpful. In some way I hope I have added to this insightfulness. Good luck to all.
paul69633 Eye33
Edited
I listened and researched the Alcon combo of Vivity and Panoptix. I had concerns about halos and decided to use the Vivity EDOF in my dominant right eye . After the first procedure it took about three weeks before some swelling subsided and I saw the limited close up vision was not going to work with my smart phone.
The Panoptics was put in about 6 weeks later in my left eye. The results were great! My brain seems to select the best of the two images. Vivity no halos at night light driving , Panoptix good for close up for my smart phone.
The best news is I am active doing trout fishing and am able to tie hooks on 2lb leader! I am also now able to shoot pistol with open sights at the age of 78! Night driving is no problem at all. I use non prescription yellow lenses when I feel tired driving at night to soften the worst LED lights from trucks.
I posted about my PEX condition and my concerns about decentering of the lens. I have to let time pass to know what might happen later. For now, I'm really happy with this combination.