New page here following my failed cataract implant. I had cataract surgery 4 weeks ago on non dominant eye with Panoptix. Unfortunately due to my short eyes the lense moved very forward causing myopia, it is also opacified so all is blurry. Today my surgeon decided that since I also have a lot of night vision disturbances it is better to remove it. After an analysis of my eye she told me I have two options. One is VIVIDY that is also her preference, in her opinion gives good quality of vision and life. Great far and intermediate vision. For the near vision I will need readers but in her experience many will use them only for detailed work which I do a lot so I will need them for sure. OR a monofocal for distance. Nothing wrong with it but clearly I will loose some of the function of the eye and will need glasses all the time for near and intermediate. I don’t mind glasse but vividy seems to provide a more comfortable vision, this is a new lens and she said every person she implanted is very happy even the ones with short eyes ( picky people with temperamental eyes I guess) Now I would like your opinion. What would you choose? Thanks!
Hi Claudia,
So sorry to hear that you have had issues with the Panoptix IOL.
Have you thought about getting a 2nd opinion from another surgeon since your 1st surgery had issues? I know you are in a bit of a time crunch to get the lens replaced but it may be a good idea. Where abouts are you located?
I can’t offer much advice on the Vivity. It is a new IOL and not a ton of reviews on it. I have a Monofocal set for distance put in 4 weeks ago. I have a bunch of side effects from it but I can say that my distance vision is good, intermediate and near vision are all very usable without glasses.
Thanks
I responded in the other thread before I saw that you started a new thread. I copied my reponse and will paste it here. The one further comment I would make is that I was quite surprised with my monofocal lens on how close I can see with it. I have 0.0 D spherical error when I had my eyes tested, and I have easy 20/20 vision with it. However, I can see down to about 20 inches quite well with it. Under that it starts to get difficult. In any case here is a copy of my other post.
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The AcrySof IQ Vivity lens is very new, especially in North America. If you want a presentation on the lens try googling this:
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“Clinical Outcomes of a Novel Non-Diffractive Extended Vision IOL CATHLEEN MCCABE, MD”
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The author is from Alcon and that needs to be considered. Another more detailed paper is available from Alcon if you google this.
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P930014 Package Insert AcrySof IQ Vivity
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I am looking at requesting this lens for my second eye. My first eye is corrected for distance with a AcrySof IQ Aspheric Monofocal lens. I will either go with another lens like this corrected for distance, and plan on using reading glasses for close up, or I will do some kind of monovision solution. If with a monofocal lens I will ask for a -1.25 D under correction for the second eye. That is what I am doing now with a contact lens monovision solution. I like it quite a bit, and almost never wear glasses for distance or reading. It works quite well at night too. No issue with flare or halos from lights. The third alternative is the Vivity lens. With it I would likely go with a little less under correction at -0.75 D.
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The Vivity lens compromises asphericity to give the extended depth of focus that allows good intermediate distance acuity. The down side of that should not be halos or flare, but it can compromise contrast sensitivity at night – ability to distinguish between shades of grey. The Alcon story is that if both eyes are done with Vivity then it is not clinically significant. I am still thinking about whether or not I want to take that risk. Right now I am leaning toward two monofocal lenses with my upcoming one undercorrected by -1.25 which is a mini monovision solution.
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With respect to the explant that I understand is a fairly tricky procedure and it is usually done by a specialist. I don’t know that much about it, but I believe you would not want to have the YAG done first. That cuts a hole in the bag that the lens is in and complicates things for the explant surgery.
“The one further comment I would make is that I was quite surprised with my monofocal lens on how close I can see with it”
Would agree with this. I’m starting to think that multi-focal IOL’s are over hyped just to make money.
Ron, with your great results with your monofocal, why wouldnt you just go with that in your other eye?
Do you experience any negative side effects with your monofocal?
Thank you! Yes i saw your other response. I have a couple of days to decide. Sure Vivity seems promising but we know very well how they make their story looking like gold. I know that if I go with monofocal lens I will see well at distance, cristal clear but not near on intermediate but Kevin says he can and I heard many saying that after their monofocal implants they were able to read even newspapers. I don’t mind wearing glasses and I know, because I used them for long time that progressive lenses are more comfortable and precise then readers. Said so, I have to decide: vivity = doct. opinion quality of vision and life and all of her patients are happy( my opinion yes it could be true but it might be risky) monofocal = straigh forward proven to work. Ah by the way I asked her if she had other patients like me with Panoptix failure and she said only 1, so I am number 2.
my 2 cents… how close one can see with monofocals depends on many factors, residual spherical aberration being a key one. Many people end up getting good intermediate and functional near with monofocals. Age is also a factor as corneal aberration increases with age with greater chance of ending up with positive residual aberration after the implant!and thus greater depth of focus.
claudia, i haven’t had an IOL implanted yet but a well respected surgeon I consulted with, gave me two options: PanOptix if I’m okay with night time disturbance, and Vivity if I don’t want to deal with such issues and had good opinion of Vivity. I’m not sure if you’re getting the lens implanted in one eye or both. if just one eye, one of the questions to ask the surgeon will be about quality of vision in dim light. another question for some people is glistenings but since you already chose PanOptix, i assume its a not an issue for you. and the lastly I wonder if the surgeon only uses AcrySof lenses? if not, Eyhance may be another consideration. but above all, the most important thing is to match the lens to the eyes, have proper power calculations, and implant and center the lens properly.
i wish you all the best with whatever decision you make for the exchange.
I am in North Florida. I know why surgery or better the outcome is not desirable. Unfortunately I have short eyes and the Panoptix lens moved forward creating myopia. It is also opacified and that is the reason of blurry vision, lack of details. I don’t know if this was predictable. My doctor is a glaucoma ( I have it mild) and cataract specialist. She has followed me for about 10 years so I think she knows me well. She performed the surgery. In this last days I was thinking that monofocal was the best and the safest for me despite its limitation but today she spent a couple of hours with doing an analysis of the eye and explained that in her opinion I would get more benefit with Vivity, Of course it has to be my decision. She described the lenses as acting like monofocals. Oh well, even Panoptix was described as excellent with only mild halos. Not really! What kind of side effects are you getting from your monofocals?
I am going to have both eyes done,either with Vivity or monofocal with distance. Panoptix was my first choice and I did first eye only to find out I got all the side effects. When they say mild halos and starburts beware that it may be like that or much worse, plus it is very subjective. For my personality they are very bad but I know I am not overreacting. the street lights in the parking lot have very wide starburst with spikes of glowy light that connect one to the other. It is like a canopy of lights. Interesting but I don’t want to see that. Driving was out of question. My doctor as an exchange offered Vivity or monofocal but said it was up to me. She also have very good opinion about this lens. I am considering if I want to be “safe” with monofocal ( can I go wrong with this?) or if I want a better broader vision, risking with Vivity not the halos but maybe loosing a bit of contrast sensitivity. I do have a controlled mild glaucoma and contrast sensitivity is important. . I just watched the video on youtube/zoom that you suggested. Very informative as I am just like case#2 they discussed. That patient could be me. Interesting that many of them in that discussion choose monofocal instead of multifocal or Vivity even though it was possible. They are expert and ruling out a multifocal, that makes me think twice about that.
Hi Claudia,
As long as you feel comfortable with her then that’s all that matters. I don’t know enough about eyes to say if she should’ve could’ve predicted this.
With my monofocal, I am experiencing flickering on the edge, distorted vision in my outside peripheral when I move my head and a bit of shadows on the outside edge. I’ve only had the IOL in my eye for a little over 4 weeks but I plan to go back to my ophthalmologist next week as it hasnt gotten better. I still by behind what I said about my range of vision though. Check my thread here where some people explain how their monofocal range of vision is: https://patient.info/forums/discuss/if-you-have-a-monofocal-set-for-distance-what-is-your-vision-like-at-close-up-intermediate-etc--727412?page=0#3665979
so sorry to hear of your experience.4 weeks is not s long time for your eye to heal from 1st surgery. My understanding is you have at least 6 months to exchange a lens.
I am not familiar with vividty - it is a new lens do not a lit of patient reviews on it. I do not always think manufacturers give all the details on visual disturbances. Given this is an exchange and you have other issues going on personally I would go for tried and true monofocal and not go with a new lens in an attempt to get more. Just my opinion on what I would only. Don’t substitute my opinion for an expert’s opinion.
I would also get a 2nd and 3rd opinion even if you end up going with surgeon who did your previous surgery. Exchanges are more complicated and riskier and do require a more skilled surgeon. I would want someone who regularly does exchanges.
Wishing you all the best
Going with a second monofocal and monovision is at the top of my list of considerations. Going with two monofocals for distance is going to require glasses for sure for reading. With monovision I can go 95% of the time with no glasses. I have been caught a couple of times in a store where I could not read something small, but other than that I only wear glasses when I take my contact out of my non operated eye. Monovision is not perfect vision, but it is very convenient vision. I would consider a Vivity in the second eye as an option that I will bounce off my surgeon when the time comes. I would only go with the Vivity if he thinks it will give me better overall vision than two monofocals and mini monovision. He is very negative on multifocals like the PanOptix, but I don’t know where he stands on the Vivity. It is new, but I think by the time my turn comes up he should have tried it on others…
Yeah I was just thinking, since you’ve had such great results with your Acrysoft monofocal, why risk it and go with the Vivity which has very little patient reviews, possibility for negative side effects. Can’t trust what these manufacturers say about their IOL’s and how great they are.
I would consider the Vivity a much lower risk option than something like a PanOptix. I have a friend that got both eyes done with PanOptix. Her outcome was much better than yours but she does have issues, especially for reading and fine work in lower light. She uses +1.75 readers for that. Also she does not feel that driving at night is safe due to the halos. She is not considering an explant, and has decided to live with it.
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There are all kinds of combinations to consider but with your doctor recommending Vivity and feeling confident it is suitable for you, I would think about doing Vivity in the explant process, and then deciding after that what to do with the second eye based on the outcome of the first. I would even think about doing this eye, which I recall is the non-dominant eye, with a very small under correction to improve the chances of reading with it. It is normal practice to target being -0.25 for under correction because they never know exactly what they will get and they don’t want you to end up on the + side. That gives both poor reading and poorer distance. But with the Vivity some are stretching that to be -0.5 to -0.75 D under, or a micro monovision. Then if this works out well for you although you might not get quite 20/20 for distance, then you could consider a full distance correction with the second eye. If you do not like the effects at night with the Vivity you could also go with a standard monovision for distance in the second eye.
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I agree with your thinking that progressives are better than readers. With readers you can’t see anything when you look up and across the room. Also with prescription progressives any residual errors in spherical and cylinder for distance can be corrected. There will always be some. I have progressives for my current situation with one IOL eye, and it does give me the best vision at all distances, but I almost never wear them because it is much more convenient to have no glasses. This is especially true now when it is cold and you have to wear a mask. No glasses fogging up so you can’t see at all!
I am with you. I know that Vivity is promising and from doctor point of view is not only quality of vision but also of life . Said so the quality vanishes right away if side effects are experienced. Also Panoptix is described as the magic wand but it comes with issues that might be bad as mine. My doctor was definitely pro Vivity but had nothing wrong with monofocal. I think some doctors are less conservative than others? I feel like I am already having an explant and I cannot risk further more and monofocal might sound “old and boring” but after this experience I cannot take risks in experimenting. When you go down to the small print, there you see that Vivity “might” give some night visual problems and also low contrast sensitivity compared to monofocal. That is exactly what you read for Panoptix. Mild disturbances that might go away. Probably for some, sure. I am concerned about explant surgery, she assured me that can be done safely after seeing the analysis of my eye, I had no YAG done, all is good and she has the equipment and knowledge. Surgery is going to be next Tuesday, we both agree that the sooner the better as the implant and everything else is still fresh/ not settled and that guarantee an easy explant. I hope so.
Your have gotten a lot of helpful comments. After reading them all, I would add some more.
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First as was mentioned there are a few things which impact how close you can see with a monofocal IOL. One is asphericity. Some aspheric lenses (Tecnis ) attempt to fully correct for it, and others (AcrySof) under correct slightly. Some basic lenses make no correction and are typically the lowest cost option. A non aspheric lens is kind of a poor man’s Vivity lens as the depth of focus increases at the cost of a less sharp image at one distance.
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The other factor is astigmatism. Astigmatism also increases the range of focus at the cost of a less sharp focus at any one distance. Whether or not one should target zero astigmatism is a controversial topic as achieving it can result in a reduction of reading vision.
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Lighting level which in turn impacts pupil size is also a factor. With my -1.25 monofocal vision I can read the very smallest print on a reading vision chart if it is in full sunlight. However, as the light level goes down I have to move up a couple of print sizes to still read. Dim light is the real test of reading vision! Computer screens are quite bright so they are not as difficult as a printed page.
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In my case my IOL lens has corrected my spherical error perfectly to 0.0 D. But, I have been left with 0.75 D of cylindrical astigmatism. That error I am sure helps me read better. I have an aspheric lens which corrects for 0.20 of the theoretical (population average) positive asphericity of 0.27. This would reduce my reading ability. Overall I suspect my reading ability down to about 20 inches with my IOL is probably about average.
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I recall that glaucoma can reduce contrast sensitivity. It would be a bit of a flag in going with a lens which reduces contrast sensitivity. The PanOptix is probably worse in that aspect than a Vivity however. Since your surgeon is a specialist in glaucoma and as well as cataracts, she should be well aware of those issues. With the glaucoma factor it may however tilt the scales in favour of a 1 Vivity and 1 monofocal lens solution. It sounds like a split the baby solution, but I would see it as hedging your bets on the glaucoma possibly getting worse with age. The monofocal eye could make up for any loss in contract sensitivity in the Vivity eye. In a recent survey 25% of surgeons report using mixed lens solutions where the strengths of one lens makes up for weaknesses in the other. It is not an unusual or radical approach.
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I also recall you asking about adverse issues with monofocal lenses. I have the AcrySof IQ Aspheric monofocal in one eye, and cannot report one single adverse effect. The colours are amazingly bright and vivid, and my distance vision and vision down to 20" or so very sharp. Night vision is better than my non IOL eye which has a contact. Both eyes display a slight amount of flare from street lights and headlights, but the IOL eye has less. There is no halo effect at all.
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Hope that helps some
I think I responded to you in a different thread.
First North Florida. I live in North Florida. Where are you located? There are some top Clinical Trial doctors in Florida depending on your location.
You can have problems with any IOL including a monofocal.
If you go with IQ vivity I think doing micro-monovision of -.75D in the non dominate eye would provide pretty good vision overall.
You might check with Dr. Gulani, Jacksonville, FL, and get his opinion, as I have seen him post videos on implanting the IQ Vivity. You can search for them on youtube. I personally have never gone to him, but people come from all over the world to see him.
I am in Jacksonville, my doctor is Katheryn Freidl, she is at the Florida eye specialists, dott. Shetty is there as well. I think these are top ophthalmologists here. I will check videos on you tube, thanks!
I saw a video on youtube “extended depht of focus IOL” analysis of the Alcon vivity iol. It show the surgery but read the comments and you will see that few doctors are not that excited about it and one declared he already had to explant few! Multifocals lense are great but first not for everybody and need more improvement.
A small world it is. I live in Jacksonville (Mandarin) and when I had my first eye done I went to many Opthmalogist here. At that time they were all doing the Restor MF, which I was not interested in. I will PM you later tonight about the Doctors I talked to and the Doctor in Jacksonville I used to do my first cataract surgery.