I think the same, but I am retired. I have noticed that I have gotten “much wiser” since I have retired. I really don’t care as much what other people think and no longer have an employer to “impress”, as we are now independently wealthy. One of the benefits of being retired. But, I understand also that those that are younger and not retired, still have other considerations…
you are so right.
thank you so much
you are right. yesterday my doctor said im the only one complaining about this. she said because i am young and i have large pupil. and she said the lens i have is best choice for me.
I think the underlying issue is that the condition is very rare and of no functional consequence if it does occur. The thought that surgeons should warn patients about it kind of reminds me of the US drug company adverts on TV. They say all these nice things about what the drug can do, and then spew of a list of 100 or so difference adverse reactions that can occur. Does anybody really listen to that stuff?
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On your suggestion that the issue can be avoided, I am not so sure that is practical. If it is really caused by a “high refractive index” then how high does it have to be? The natural lens is somewhere around 1.39, and varies quite a bit. The human body quality control is not as good as IOL manufacturers. The silicone lenses are about 1.41, so slightly higher. Tecnis is more significantly higher at 1.47. Alcon is slightly higher than that at 1.53. Is the effect that selective that it occurs with a refractive index of 1.53 but not at 1.47? I am not so sure. I tried to find your references and could not find the first one at all. The second one I found but I would have to pay to see the full version. The summary was somewhat vague. And on the large pupil size impact, that does not ring so true either. People have differing maximum pupil sizes in dim light, primarily based on age, but in normal light we all use pretty much the same pupil size even though we have different maximums.
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I really do not think there are other reasonable choices than the hydrophobic acrylics that both Tecnis and Alcon use. Silicone is only rarely used in North America. And there are much more important issues to consider such as how stable is the IOL in the eye? Do monofocals move off center, do torics rotate out of position? PCO is common. How resistant is the lens to PCO? What is the YAG rate of implanted lenses? How does the lens handle during the insertion procedure? How large of an incision is required to get the lens into the eye while minimizing the trauma to the eye? There are lots of issues that have a much higher impact on the lens implant outcome.
Ron, you make sweepingly general statements about a topic which you admit you know very little. The external reflection is a consequence of the higher refractive index IOLs. Full stop. Nobody knows the cutoff, because no IOL exists with an index between 1.43 and 1.55. But we know up to 1.47 does not cause the issue.
Functional consequence is subjective; there is a difference between 20/20 and 20/unhappy. Silicone is still very much used in the United States; the Sofport IOL is a “do no harm” silicone IOL surgeons use as an exchange option. It is aspheric and very unlikely to cause visual aberrations in most patients. I know of a person who just had a Sofport IOL implanted last month, it was the surgeon’s first choice. This is in Boston where surgeons do not need to shill IOL brands; they have enough patient volume that they recommend based on patient eye health and any pre existing conditions. The new LAL IOL is made of silicone as well.
Regarding your comments on pupil size, again, you are way off base. There are more factors than age when it comes to pupil size. Myopes have larger pupils than Emmetropes; the larger a pupil, the more lens is exposed and more surface to reflect. Not all pupils are the same in photoptic conditions. A myope is going to have larger pupils in all lighting. Large pupils will also come into play for IOL lens diameter.
All of the other concerns you mention are valid, but the answers are easily available to a patient. All foldable IOLs require small incisions. Stability is the combination of product, surgical skill and human anatomy.
Surface reflections do not impact a lens implant outcome, but it can certainly affect patient expectation outcomes. It is perfectly valid to be 20/unhappy because you were not informed of a cosmetic issue with an IOL which attracts unwanted attention. Now that more surgeons are discussing it, hopefully there can be an option in the future to eliminate it.
You may not be overly concerned about it, but it is rude to dismiss the valid concerns of others by contrasting it with issues you think are more important.
I have nothing more to say to you than I have said before. I wish you well in your IOL decisions, and I hope things turn out well for you. I prefer to base my decisions on fact, not opinions.
The effect you describe is a cosmetic reflection, which is different from the glistening problem. I recently received PanOptix and noticed it right away when I look in a mirror, and occasionally my family members have confirmed they see it. I even noticed it in my mother-in-law’s eyes recently now that I know what it is, but had never noticed it before. According to a comparison video Shannon Wong did of PanOptix and Synergy, Synergy lens does not produce a cosmetic reflection. Personally, although my lens experience isn’t perfect, the reflection was a less than pleasant surprise, but worries me less than the ghost images and peripheral flickers I see, along with vision that is 20/20 but does not appear as crisp as what I saw with contacts and glasses before surgery. I have a lot of mixed feelings and have second guessed my decision to address my cataracts (which I had just found out about) and have wished I had waited for better technology. However, if anyone makes a comment to me about a reflection I will simply tell them that I am gathering their data with my robot eyes. 
In all seriousness, though, it is rude of people to comment on it frequently; I imagine most would have the good sense and manners not to comment on someone’s use of a wheelchair or prosthetic limb, and maybe you should say as much. Or you could say, “I had my sight corrected with the latest high tech lens implants; isn’t that amazing?” I agree with others who suggest that you could end up trading a cosmetic problem for a more serious visual problem, so give it some time and think of some rehearsed responses to comments and maybe you will grow to accept it in time. Perhaps reflecting (no pun intended) on the benefits your implants give you will help you be more accepting of this unwanted effect. I completely understand the feeling, though; this is an expensive, emotional, and stressful experience and no matter how much we say we understand everything won’t be perfect, it is harder to accept when we discover what our unique set of imperfections are. My anxiety and perfectionism have made acceptance hard for me, but working with a therapist has been beneficial.I wish you luck and peace about your decision.
How about “They are my bionic eyes. I can see right through clothing with them!”
That is a good one; filing that one away for later.
Absolutely true. I have Alcon Acrysof IQ and have seen that weird “diamond eye”. My husband noticed it first. I didn’t until one day I was looking through a large mirror and saw the reflection. If that was the only issue I had with these lens, I would be happy. Unfortunately, that is not the case.
what other issues do you have?
Glare/flare, halos, streaks/starbursts.
that is positive dysphotopsia. you probably have large pupil.
glistening is a defect in the lens. gets worse time.
the cosmetic reflection like cat is called diamond eye.
Interestingly, not one doctor has come to that deduction. It’s very scary that these are the professionals we are entrusting our eyes to. That should be been an easy deduction BEFORE moving forward with a YAG. I am going to have to find someone who knows what they are doing which is quite the undertaking even in a city as big as Atlanta. I’ll need to call around and ask specifically for a doctor who is familiar with positive dysphotopsia. I recall on one visit the Opthamologist checking my pupil size and finding nothing troublesome.
I know this is common complaint with Multifocals, but I have a Toric. Could this have happened with a standard lens?
Have you tried pupil constricting drops such as Pilocarpine?
I had a weird reaction to Pilocarpine , and the MD said that he it’s not ideal for longterm use. I do use Brimonidine, intermittently, when I have to be out for extended periods, at night.
Let me sum it up. You have Alcon Acrysof IQ monofocal and you’re expirencing Postive Dysphotopsia, e.g. streaks, halos, glare, starburst. You sometimes use Pilocarpine or Brimonidine and both relieves your sympthoms completely for a few hours. Am I right?
Alcon Acrosof IQ Toric (for distance)
I would not say the Bromonidine relieves my symptoms completely. It helps. It increases the glare, but reduces the streaking.
I have noticed this once time looking in the mirror. My husband also noticed it. I’m not sure how often it happens. It also was my left eye.
I wonder if increasing the Brimonidine dosage might yield better results. Current dosage is 0.2%.