What is better Synergy or PanOptix?

One further thought, Last March, just as covid was beginning to disrupt our lives, I took an acquaintance for cataract surgery. She was a -7 myope, and she opted for bilateral PanOptix. At her 24 hour post op appointments, her vision was 20/20 at all distances. Recently, however, she had YAG capsulotomies in both eyes. She was experiencing very large floaters in both eyes, Granted, her health is not the best, so she might have had YAG in both eyes no matter what iol she chose, but bilateral YAG in both eyes after just 7 months certainly gives me pause.

hi kathleen, its not an easy decision. On paper, synergy looks better (to me) but there are hardly any real life experiences that people have shared. If you'd like to read up a bit more about synergy, you can look up for Daniel Chang's recent presentation to Canadian Society of Opthalmologists. There is some interesting info in there but he falls short of talking about dysphotopsias, the key question I had about synergy. I'd also take his charts on MTF with a grain of salt... (he uses JJ's EYE model and not ISO bench model) which I think is biased in favour of their higher SA of -.27. Nevertheless, its interesting to note that synergy MTF is slightly lower than symphony.

The following search should bring up his video on vimeo:

tecnis synergy chang vimeo

All the best.

You have an interesting situation. Days after I had my cataract surgery done, my wife was diagnosed and referred to the same surgeon I went to. She is also amblyopic so no opportunity for a monovision solution. It also elevates the risk of "getting it right". We have a friend that has the PanOpix in both eyes and regrets it. She was expecting much better close vision and now uses readers for any close work. My suggestion so far for my wife has been to get a distance corrected monofocal lens, and then plan to use readers for close work, as she does now anyway. She will probably be almost as glasses free as she is now, and will have excellent distance vision, which she does not have now.

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That said I have been following the AcrySof Vivity IQ (EDOF)lens with interest. It probably would give her much more intermediate vision but still would need readers for small print. My and now her surgeon was very anti multifocal lens when I saw him. Vivity was not available at that time. By the time her surgery date comes it should be well established. I will make the suggestion to her and let her and her surgeon make the decision. I think it may be a good solution for her, with the only real bit of a negative being the contrast sensitivity at night. I also will consider it for my second eye, and possibly a bit under corrected to give me reader glasses freedom for all but the smallest print.

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I have an AcrySof IQ Aspheric Monofocal lens for a couple of months now and I am not at all worried about the glistening thing. I believe it was an earlier production quality control issue, and it has been fixed. My surgeon offered me the Tecnis lens, if I really wanted it. He said that he has rarely seen glistening, and they have never been a problem that had any visual impacts. His suggestion was that glistenings is an issue that the competition likes to distinguish themselves with.

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Studies have found that the AcrySof material is more resistant to PCO, and PCO is a much more common problem with IOLs. I also like the blue light filtering on the AcrySof lens. It gives a more natural colour rendition than the clear lenses do. If you need a toric lens the AcrySof material also seems to be more "sticky" and stays in place better than the Tecnis material.

i have watched both the Chang and Garbic presentations on Synergy. Garbic considers Synergy a real game changer in the iol market. It is Garbic who has a Symfony in one eye and now a Synergy in the other. Shannon Wong also has some very informative videos about Panoptix. So much of what we see on the internet is biased. I always try to look for any financial interest on the part of authors and presenters. Hopefully they're working with certain firms because they believe strongly in the company's products. I'm waiting to hear what my ophthalmologist says about AcrySof glistenings. I am very open to his professional opinion. Glistenings are a problem that takes months or years to manifest. The opacification that results happens so gradually that most people probably get used to it and don't complain about it. When the FDA approved Panoptix I was sure that was the way I would go. It seemed perfect. However, the even better near vision of Synergy (if accurate) certainly is of interest. My impression also is that Synergy provides better image quality than Panoptix, though the difference may not be appreciable to most patients.

Keep in mind that it can be more than the internet that is biased. My surgeon told me that some clinics get all their very expensive equipment used to measure the cornea topography etc "donated" to them by IOL lens manufacturers. They use the equipment with the obligation of course to recommend that manufacturer's lens. So, when you pick your surgeon you may very well be also picking what lens they will recommend that you use. The surgeon I went to said he would use Alcon AcrySof or J&J Tecnis, my choice. I picked Alcon based on the PCO risk reduction, the blue light filtering, and the improved stability of the lens in the eye. I think the one potentially more legit issue with the AcrySof material is the higher refractive index of the lens. That means it is thinner and can be easier to insert in a smaller incision, but it takes up a little less space in the eye than a lower refractive index lens. It is claimed that it can be more susceptible to dysphotopsias. That also is controversial and there are some reports which have shown it is not really the issue. I was also influenced by the fact that Alcon has the lion's share of the monofocal and toric market.

hi kathleen, ur situation is what i worry about for my daughter. she inherited amblyopia from her maternal grandmother and it went undetected as we were outside the US for work from her age 4 to 8 and it wasnt visibly different. she is not between 20/30 and 20/40 after patching and therapy. my mother got cataracts at 41 and i got cataracts at 41 so i hope she doesnt inherit this too. or maybe there will be cataract cure in another 26 years when she is 40.

i expect synergy to be available in July. it is kinda following the symfony schedule. i dont know how covid will impact the US release.

if glistening is still a problem for alcon lenses the worse part is that it surfaces after most people would have had YAG for PCO. hopefully it is fixed now but u never know.

garbic says that the synergy picture is smaller than the symfony vision. also synergy is yellowish. but chang also says that he will get his dad symfony in one eye and synergy in other eye so that is interesting.

well i have symfony and i had PCO at 5 weeks so it is not really IOL dependent i expect i will have early PCO with any lens

That's depressing being I plan on getting the Synergy IOL. He still shows visible reflection from PanOptics. If the Clareon PanOptics was available I think it would be a tough choice.

One thing he did point out is Synergy patients have more issue if they miss the refractive mark by more than +- 0.5 (D), which is concerning.

But one factor he did not talk about, which is an important factor for me and that is just how dark things look with my current MF IOL. And from what I have seen Synergy has a greater MTF.

I also want to gain more close up vision, which the Synergy should allow.

I am surprised Tecnis has not come out with a trifocal IOL yet.

i was getting this feeling from the forum posts and youtube video. that's y my opinion was that edof was failed technology. Tecnis is too obsessed with their Symfony innovation. Even the vivity is better than Symfony and without then side effects.

reflection from iol is not a big deal in my opinion the glistening is. i cannot wait anymore.

btw the US panoptix is not yellow. does that mean no blue light filter?? the blue light filter is more susceptible to glistening.

The US FDA information indicates all PanOptix models they approved (basic, and the torics) have blue light filtering (yellow lens). This is pretty standard for Alcon lenses. I believe there may be an older non aspherical monofocal IOLs available without blue light filtering, but from what I see, they are not popular. The Clareon material has blue light filtering from what I have seen. I plan to get one for my second eye.

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I have never seen any information linking the glistenings to the blue light filter. It is caused by micro voids in the material that fill up with fluid over time. Alcon claims it is a manufacturing quality control issue and it has been solved.

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I recall that the Synergy has violet light filtering, which I suspect is very similar to the blue light filtering that Alcon uses, but with a small shift in colour. Have not seen a light spectrum for the Synergy comparing it to a clear lens or to a human natural lens.

You could check on the status for the Clareon PanOptics. Also being you had issues with a diffractive IOL, I would talk with a few top doctor's before risking another diffractive IOL.

I have gone back and forth on Premium Monofocals IOLs or the Synergy or the Panoptics.

I am sticking to the Synergy and hoping for the best. If I did not already have a Tecnis MF in my non dominate eye I might make another choice. But I have had relatively good luck with the Tecnis, so I think they make a good product and the material they use is superior to Alcon's material.

I also look at the weakness of my Tecnis MF and trying to do a mix and match to offset those weakness and the Synergy, at least on paper, looks like it would do the bet job to address those weakness.

What is a bit scary is Dr. Wong's new statement that folks who miss the mark by more than +- .5 (D), which is like nothing, have more issue with the Synergy.

The EDOF does play a lot of tricks on the eye, so maybe it is more risky. But I also have seen where Dr. Wong has a patient that does not do well with PanOptics and he extracts and implants a Symfony and visa versa. Just no way to predict who will do better with which IOL.

If I had any other eye issue than cataracts and minor astigmatism, I would not be getting a diffractive IOL.

If my vision is just the same as my MF and get a little more brightness at night I would be happy. I will find out soon.

One last note, even though Dr. Wong now favors PanOptics the studies, including a head to head study showed More patients were glasses free with Synergy and Synergy provide sharper vision day and night. So who knows. I think the 2 are very very close.

hi ron

the CRST article on glistening that i believe you referred me to in another post mentions the blue filter to have more occurence.

"Although microvacuoles can occur in any lens material, they are significantly more prevalent and dense in AcrySof blue-light–filtering hydrophobic acrylic IOLs."

Shannon Wong says the US Pan Optix is not yellow. so did Omar Krad. i will try to dig that.

clareon panoptix is not available in Europe so it will take ages to get to the US.

safran like symfony/synergy and does not like panoptix.

shannon wongs says that in the comment on the video 'would you like to have your symfony removed and replaced with panoptix?'

he says "our panoptix are clear (not yellow)".

if you have it, can you direct me to the information where alcons says they have resolved it?

ron

see omar krad's youtube video part one comparing synergy and panoptix at 7:39. he has a message saying he used panoptix CLEAR variant TFATxx.

My suspicion would be that they are not saying the blue light filtering causes the glistenings. They are just saying that AcrySof material is blue light filtering. It is coincidental not causal. The sentence structure is misleading I think.

For the PanOptix information try a search on this:

FDA PRODUCT INFORMATION Alcon Laboratories, Inc. AcrySof® IQ PanOptix® Trifocal IOL (logo) Model TFNT00 AcrySof® IQ PanOptix® Toric Trifocal IOL (logo)

Models TFNT30, TFNT40, TFNT50, TFNT6

Depending on what page you get with the search, there may be a link at the bottom which says "physician information" which gives more detail on the lenses. The approval seems to be from 2019, so possibly they have come out with other versions without the blue light filtering. My choice would be to get the blue light filtering as it gives more natural colours, and the filtering reduces chromatic aberration to some degree.

See this article below. There is a graph in the article which shows the reduction in glistenings through the years from 1990 to 2020 with the Acrysof material compared to now with Clareon. My personal opinion is that glistenings are a zero factor in making a decision today about whether or not to get an Acrysof lens material. I am going to ask for a Clareon material lens on my next eye, not because of glistenings, but mainly because it is classed as a premium lens (extra $300 cost) where I am in Canada, and it is the ticket to get a much shorter wait time for the surgery (I hope).

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David J Apple Laboratories Glistening through the years Feb 05, 2021

" I have had relatively good luck with the Tecnis, so I think they make a good product and the material they use is superior to Alcon's material."

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There are studies which show the AcrySof material is less susceptible to PCO based on the YAG rate of the Tecnis vs AcrySof. There are also studies which show the AcrySof material in toric lenses is less susceptible to lens rotation when compared to the Tecnis. Stability of the lens in the eye is critical with a toric lens.

Had to do a search for Dr. Safran and it led me to any interesting forum with Opthamalogist discussing Synergy and PanOptics.

One person wrote:

"In 2+ years using Panoptix, I have already seen 2 Acrysof Panoptix lenses start to calcify."

I hope that was an anomoly.

Dr. Steven Safran wrote something that I have thought:

"The quality of vision with ALL multifocals is so much worse than a monofocal that if a patient has any frame of reference it will be difficult for them to accept"

This is one reason I did consider the Tecnis Eyhance. As crazy at it sounds, in some ways this might be a plus for me as it has been so long since I had my non cataract natural lens I have only the MF to compare it to.

Gee I just read something else Dr. Safran wrote that I never read anywhere else:

"It's hard for doctors who implant multifocals to accept just how poor the optics of these lenses are relative to monofocals and how easily the complex wavefront of these lenses are disturbed by vitreous floaters, guttata, dry eye or a wee bit of refractive error but that's just the way these lenses roll."

Uh, could my floaters be magnified by my MF IOL.

My thoughts would be that if you already have a MF that you can read with, then why not just get a monofocal toric in your second eye with a power for full distance. It would be ideal if that distance eye was also the dominant eye, but not absolutely essential. My plan is to do crossed monovision because I already have a distance monofocal in my non dominant eye.

That's the million dollar question. Sadly there is no way to try out different options and see which is best before surgery.

The main reason is the dysphotopsias have not really bothered me and I only get functional close vision. I can read my cell phone or a menu, but to do any serious reading I need readers.

Maybe, I should be happy with that and you are right. If I got the Eyhance I would get the best day and night time distance, dramatically lower dysphotopsias from my other eye and get no contrast loss and would have pretty good vision down to 2 feet or so and the rest can come from my left eye.

On the other hand Synergy could provide great distance, intermittent and close vision in day and night time.

It all seems like a roll of the dice.

One other important note, from talking to my doctor and reading articles, I do believe 90% of the people that get the Synergy or PanOptics are Happy.

And my own believe is if you eliminate people that are doing clear lens exchange and people who had other eye issues, who should never have been given a diffractive IOL in the first play, that number goes up.

But if you fail into the Unhappy camp it is He double hockey sticks.

Now I am curious. From what I understand Alcon's goal is to eventually switch to the Clareon. Would Alcon then be losing the advantages you have pointed out?

I have trouble getting excited about the Eyhance over the standard monofocal. It seems to me that all the lens is doing is varying the correction power over the radius of the lens. The outside is not providing the same power as the middle. Well to my thinking that is playing with the asphericity of the lens. An aspheric lens provides the same point of focus from all areas of the lens to give you the sharpest possible vision. The non aspheric lenses do not give you that same sharpness of focus. It makes me wonder if an older (and cheaper) non aspheric lens would not do something similar to what the Eyhance does. I guess it should show up in a comparison of the defocus cures, but I am not interested enough to do that. And I think they may be playing a bit of a marketing game with the lens (as well as the Vivity). I think they both claim to be aspheric lenses while at the same time playing these optical tricks that smear the image over a range instead of to a point of focus. Would it be possible that they manufacture the lens with one surface that is aspheric, and then do their optical trick with the other surface, so they can claim the lens is aspheric? Seems like a dirty marketing trick to me if that is what they are doing.

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The other issue with the Eyhance and to a lesser degree the Vivity is that they really do not give you enough close vision to assure good reading vision unless you offset them. The Eyhance needs as much as a -1.00 D offset. That is not going to do good things to the distance vision if you are depending on that eye for distance vision.

clareon panoptix was fda approved july 2020. why arent they making it available?

Just a few wild guesses.

1. They don't have their production facilities in order, maybe due to Covid and / or
2. They are doing limited testing, maybe in monofocals first, to see how this new material does before mass marketing.

After Ron's Statement I did a quick search and saw an article stating the Clareon has even lower rates of PCO.

That is a good point. The AcrySof material has a reputation of being "sticky" which is said to help prevent PCO and movement/rotation in the eye. It would seem longer term experience may be required to determine if that is still true or not.

below is the full text. they are not concluding any cause but question the yellow chromophore which if it is the cause would be absent in the TFATxx and present in TFNTxx.

"Although microvacuoles can occur in any lens material, they are significantly more prevalent and dense in AcrySof blue-light–filtering hydrophobic acrylic IOLs.3,4 Colin et al reported the formation of glistenings in 86.5% of eyes implanted with AcrySof lenses, and the majority of the microvacuoles were moderate to dense in subjective severity.4 In addition to decreased visual acuity and contrast sensitivity, some investigators have suggested that this type of lens may negatively affect driving habits.5 Although it has not been conclusively proven that these difficulties are related to either the yellow chromophore pigment or the impact of glistenings on retinal stray light and disability glare, no other explanation has been offered.5 It is likely that both significantly contribute to visual disability."

that's a great article. thanks for sharing.

My wife needed toric lenses and we were planning on getting a Clareon version as it has been approved. However, the surgeon said that he can't get them. He suggest that Alcon may be holding them back until the get more experience with the non toric versions -- to work out any bugs, as he put it. I think the bottom line is that even when a lens is approved, they may not actually produce it, or not for general consumption -- perhaps just limited trial use.