I've seen some very good discussions on the overall quality of vision and any impacts to contrast sensitivity with PanOptix (thanks especially to janus381 for her detailed descriptions of her experiences). What I haven't seen is any mention here of incidences of glistenings with this lens. I've read elsewhere that the Acrysof platform in general, and in one source the PanOptix specifically, had a moderately-higher incidence of glistenings than other "glistening free" lenses like Tecnis platform and (I think) the FineVision. Does anyone have any personal experience with these (either way), preferably with the PanOptix specifically? I'm also curious if a specific lens having glistenings is something that can be detected and caught prior to implantation, or if this determination is made strictly after implantation? Same question about "diamond eye" - although I'm not completely sure what this is, and have only seen one surgeon making a related blanket statement about all Alcon lenses.
Answer to one of my own questions:
I’m also curious if a specific lens having glistenings is something that can be detected and caught prior to implantation, or if this determination is made strictly after implantation?
From what I’ve read online, (at least circa 2012) detection of these cannot happen when the IOL is in a dry state. Takes 1 to 6 months after implantation for these to start to form.
I guess it is a good thing, that nobody seems to have any experience with that problem 
I would think that PanOptix have this issue figured out by now, otherwise it would make no sense, it is more than 10 years since the glistening was diagnosed as an issue.
The Panoptix trifocal is very popular and widely used, personally I would not have any concerns about glistening, even that I have got the Zeiss lenses myself.
I think “Diamond Eye” doesn’t affect your vision, but is where others see what looks a like a diamond in your eye.
I looked up “glistening” after I read Deb03 post that she had glistening problems with her Acrysof mono-focal and does not recommend them.
What I found is:
Alcon changed their manufacturing process around 2012, to reduce glistenings.They were a common problem before 2012. Alcon claims their changes reduced glistenings by 87%.So glistening is still a possible issue for Acrysof lenses. For most people they are not bothersome. Some people do find it bothersome.
Glistening cannot be detected before implantation.
There are pros and cons with every lens.
E.g. search: “Review of ophthalmology annual survey 2019 iol preferences”
This is a US publication (so only lens available in the US are mentioned). For mono-focals, Alcon is the most popular choice, but one who prefers Alcon does say the con is:“I do not like the micro-glistenings that are less than in the past but still exist."
For PanOptix specifically, search for this: “Evaluation of the optical purity of a new hydrophobic intraocular lens (IOL)”.
This compares glistening in the FineVision Tri-focal, PanOptix Tri-focal, and Symfony EDOF.FineVision and Symfony had very small levels of glistenings (Grade 0 on Miyata scale), while PanOptix had more glistening (Grade 1 – on scale that goes 0, 1, 2, 3).
I’m just one person, but I haven’t noticed glistenings in my PanOptix lens so far (just it’s been over one month now).
PS. I’m male! Some people’s names are obvious (e.g. WH is male, Sue.An is female, and ivan is male!).
I would think that PanOptix have this issue figured out by now, otherwise it would make no sense, it is more than 10 years since the glistening was diagnosed as an issue.
Yeah, I doubt that it’s widespread (at least at this point). I have seen reports from the last few years (post-2013) that the AcrySof platform and PanOptix still has higher incidences than the others, and that glaucoma medications may increase glistenings incidence independent of lens origin. Like everything with IOLs, it’s not going to happen to most people, and even then those who have it aren’t necessarily going to be bothered by it.
Still, the possibility is kind of disconcerting. Frankly, there are red flags on the issue out there: lots of independent papers and opinions out there claiming that when it’s bad, it’s bad. Meanwhile, lots of counterpoint sources appear saying that even high levels of glistenings are really no big deal (with every one that I’ve found written by authors with some sort of financial connections to Alcon) … and then Alcon proclaiming in 2013 to have improved their processes to reduce glistenings by 10x (currently still not validated by third parties) … which is nice, but a somewhat-incongruous move for a condition that Alcon was (mainly indirectly) claiming to be a non-issue.
The Panoptix trifocal is very popular and widely used, personally I would not have any concerns about glistening, even that I have got the Zeiss lenses myself.
Yep, that’s the other side: I can’t fathom that this is a giant issue given the PanOptix popularity. (It is also unfortunate that Zeiss still isn’t coming here anytime soon, since this seems to primarily have impacted Alcon.)
PanOptix has otherwise indeed checked a lot of great boxes, compared to the other trifocals. I’m also very glad that @Sue.An2 and @janus381 have posted their detailed experiences with Symfony and PanOptix.
(BTW, janus381: apologies if I got your gender wrong above - I was on a monovision contact lens trial this weekend, and it was really messing with my head: “oKaY, tIMe To gEt Up aNd MAke a SaNDwIcH…”)
Cool - thanks for the refs. I’ll check them out. It’s the “maybe, sometimes” kind of problems that make these decisions difficult.
PS. I’m male! Some people’s names are obvious (e.g. WH is male, Sue.An is female, and ivan is male!).
Yeah, sorry again - I caught that once the contacts came out, and unfortunately we apparently cannot edit posts. Man, it would take me a while to be functionally effective with those contacts.
Janus, I thought you were female too until my wife corrected me. Hell I was even calling you Jane
Any info on Zeiss IOLs with regards to “glistening”?
Their ZEISS CT LUCIA monofocal- “Ultra-high purity acrylic and proprietary cryo-lathing process to minimize glistening”
I am also thinking that all these drops must have some impact on the IOL material?
Zeiss marketing materials uses pretty strong wording “Glistening Free”!
Found one study of 54 patients that found no glistenings after one year for CT Lucia. search for this:
**Long-term clinical results and scanning electron microscopic analysis of the aspheric, hydrophobic, acrylic intraocular lens CT LUCIA 611P
I have Alcon Acrysof IQ monofocals. Janus, I do not have glistenings. I’m sorry if I gave that impression. After selecting my surgeon, I discovered he only uses Alcon lenses. I researched them and had concerns with the high refractive index and glistenings. Like you Ivan, I found research on both sides regarding glistenings. Even though my preference would have been to not use the Alcon lens, I went ahead with the lenses and my surgeon. Part of my rational was that it’s the number one monofocal (in the US). So here I am 3 months out and I have positive dysphotopsia and PCO. It’s possible a YAG procedure for the PCO would resolve the positive dysphotopsia, but if not I would be faced with a risky post YAG lens exchange. For me, driving at night is very important (part of why I went with the monofocal), so I have elected to have my lenses exchanged to silicone. If I had to do it all over again, I would have picked the Tecnis monofocal as it has a lower refractive index and glistenings concern me. Who knows, I could very well still be in the exact situation though.
Regarding diamond eye, my family has commented on it so I’m sure other people see it. I have also read that it’s inherent in all Alcon lenses.
Well Hoya Vivinex page says "Glistening-free hydrophobic acrylic IOL material " too!
Yes I saw that Zeiss CT Lucia study too.
hi deb
when is your exchange? how confident is safran that the dysphotopsia will go away with softport? did you use alphagan or other miotic? your dyphotopsia started after 6 weeks correct?
did u get monfocal for both eyes and were they both set for distance? how much near could you see with them?
Currently have both monofocals set for distance. Ended with:
non-dominant RE: Between 0 and .25 no astigmatism (have measured both so I am probably somewhere in between)
Dominant LE: .5 .5 127
I do not have good near vision. It was slightly better at first, but as my eye settled I ended up more farsighted. I was 20/100/Jaegar 10 one week post op and am now 20/200/Jaegar 16.
I did not ask Safran how confident he was that it would go away. I used lumify (2 drops) one time and it did not make a difference. It started approximately 6 weeks post-op in RE and fairly quickly in LE although I can’t recall exactly when.
Right eye exchange is this Thursday. Targeting -.4/-.5. I am also having a vitrectomy so I’m not sure how long it will take to see clearly. I’m guessing there may be more inflammation, etc but don’t really know.
I believe you have Symfony so I’d be more leery about exchanging it. I’d want to have pretty high confidence that it would make a difference. I suggest you also ask Safran if there is a way to do the YAG to make it less risky if you need an exchange. Seems someone posted about that on this forum before.
I think my surgeon said YAG is no big deal and he does lens exchange onYAGed capsule! Unless I heard wrong.
I believe you have Symfony so I’d be more leery about exchanging it. I’d want to have pretty high confidence that it would make a difference.
Why do you say that? As far as lens exchange is concerned monofocal or multifocal would not make a difference.
Sorry, poor wording choice on my part. Yes, the surgery is the same. It’s just that Soks would be losing the extended range from the Symfony when going to a monofocal. Assuming my surgery is successful, I’m not really losing anything since I’m going from one monofocal to another monofocal. In Sok’s case, I’d want to feel more confident that the exchange would correct the problem before undergoing the surgery. Hopefully I made sense this time!
Deb, yes you made full sense
Soks might even gain better monofocal quality vision although the PCO is already there so…
I wonder if plate haptic helps with dysphotopsia.
Tough game this cataract!
thats is what two surgeons told me: that you will lose whatever near you have. alphagan helps eliminate it completely.
this is all interesting to me.. I have cataracts that are ripe but I see fine.. so Md said wait. YEAH! after reading about all the issues people have with PanOptix- which she has offered me.. I am quite leary. I’ve worn distance glasses since age 14. I finally have to wear readers. I can’t decide whether to correct distance vision ornear.. So she suggested PanOptix.
it sounds like whichever I choose.. there are issues and sometimes long standing issues.. Geez.. I don’t want surgery to make my vision worse. I think the practice just uses Alcon lenses.
Don’t be too concerned about some of the issues attributed to Alcon lenses in this old thread. First, I am convinced that this so called “cat eye” thing is an internet fabrication. I can find no credible substance to it. I have one Alcon AcrySof lens and my other eye is natural with a mild cataract. There is no way I can create this “cat eye” thing. Both eyes reflect the same to a point light source. Glistenings are real. I was concerned about them and did a lot of investigation. I am convinced they were the result of quality control issues which Alcon has now solved. But even when they existed in lenses the impact was nothing that the user sees. The optometrist can see them with a slit lamp, but the user vision is not impacted. My surgeon confirmed this conclusion. He said he has seen them but in all of his practice it has never impacted vision. If you are really concerned Alcon has come out with a new Clareon lens material which is said to be glistening free. Not sure how available it is though as it is very new.
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If you want to be worried about something then think about blue light filtering. Blue light filtering contrary to what one may think provides the most natural colour balance. It is designed to replicate the balance of a young adult. In comparison a clear lens will provide a bluer than natural colour balance. Then there is the resistance to PCO, which is common and clouds vision like a cataract. Alcon claims their lenses are more resistant to PCO, and some studies have found that Alcon lenses have a lower rate of YAG (a laser process to correct PCO). And Alcon claims there lense are more stable in the eye and move less. Some studies do back that up. This is more of an issue with toric lenses which are extremely sensitive to rotation after lens insertion.
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And going to a Multi Focal lens like the PanOptix has issues too. Keep in mind that the premium lenses mainly have a premium price, not premium optical performance. They give you closer focus but at a price of reduced optical quality. Spent a good amount of time finding out what these quality issues are before you jump in to going for this type of lens.
Ron, the diamond eye effect is not an internet fabrication. Many patients have it, you can youtube videos of patients demonstrating it. All high refractive index lenses have this effect. All Alcon lenses are high refractive. You may not notice it but many other people do. Many patients complain they were not warned of this side effect and find it upsetting. Some patients are not bothered by it. Shannon Wong posted a youtube video demonstrating the effect in one of his patients to educate others about this side effect in Alcon lenses.
The human lens refractive index is 1.41. Alcon is 1.55. Tecnis is around 1.43-47. The closer you stay to the human lens index the more natural it will look in your eye.