I have PanOptix in both eyes. In a [previous post](https://patient.info/forums/discuss/my-panoptix-experience-both-eyes-772617), I explained my reasons for choosing trifocals over EDOF and monofocals. In this post, I want to unequivocally address questions about halos and starbursts. Yes, I see halos and starbursts when I look at shining lights, especially at night. As far as I can tell, ALL PATIENTS who get PanOptix CAN experience these photopsias, or more precisely, they WILL experience them under certain conditions. This seems to be true about all trifocals. When will halos and starbursts happen and to what degree? The variables seem to be... (1) A patient's location and surroundings and how eyes are used are strong factors... For example, if a person is inside all day, in nice bright pastel rooms, that person probably won’t see halos and starbursts. (2) The qualities of the IOL trifocal and the surgeon cause some patients to have better outcomes than others. (3) Your personal aesthetic and the way you perceive visual experiences will influence what you see... One person’s pretty starburst may be another person’s disorienting light explosion. Alcon is tricky with their numbers that report photopsias because they ask patients if they had “not experienced (the phenomenon) or (were) not bothered at all”. They lump it all together and report 55.2% of patients did not experience or were not bothered at all by starbursts. An additional 16.8% were bothered “a little bit”, 16% “somewhat”, and the remaining 12% “quite a bit” or “very much”. Comparable numbers were reported for halos and glare (see PanOptix physician and patient literature). So 88% of patients fall into the categories of “not experienced or not bothered at all” to “a little bit” through “somewhat”. My guess is the phantom category of “not experienced ever at all” is probably zero or near zero. Speaking as a lay person, typing this while looking through two PanOptix, I suggest... What YOU need to know about PanOptix and every trifocal currently available is that you WILL PROBABLY (almost certainly) see halos and starbursts when lights shine directly at you. Typically, these are headlights and taillights, some streetlights, bistro lights, a bright flashlight, and so forth. It... will... happen. At least in my opinion. Will this necessarily be a problem? No. About 88% of people are NOT bothered “quite a bit” or “very much”. And (according to Alcon) about 99% would choose PanOptix again. Patients get good depth of field and no glasses, and happily trade off halos, starbursts, and other photopsias. That’s the deal. That was my deal, and I’m satisfied with my choice.
Yes. Everyone with multifocal IOLs will see dysphotopsia to a certain degree under certain conditions. That's just physics. When at least half the light coming into the eye is always out of focus (from your brain's point of view) plus some amount of light isn't focused at ANY point but diffused due to light splitting, you will get dysphotopsia. . The question is to what degree you will notice it and to what degree it will bother you. And that's different from person to person. It's also why the rule of thumb is to avoid these types of lenses in highly detail-oriented / meticulous type personalities (programmers, engineers, etc.). A "happy go lucky" personality is thought to be best for multifocal IOLs. . Glad you had a good outcome!
I have a friend that got PanOptix in both eyes 2-3 years ago now. She was initially quite disappointed with the night time halo/glare effects, and with reading in dimmer light. I would say she would be in the category of those that expected to get "premium" quality vision from a "premium" lens that cost a significant amount over the standard monofocal lens. She does not drive at night and uses +1.75 readers to read books. She has not considered having them explanted, but says if she had it to do over again, she would not do it. She feels the $4,500 of so that she paid to get the PanOptix was wasted. Her experience, plus the advice of my surgeon "I would not put those lenses in my own eyes, so I have a hard time recommending them for you", is what took PanOptix off my short list of lens choices. . I suspect that the "expectations" going into the surgery are largely going to determine satisfaction. Those with the highest expectations (perfectionists) are most likely to be disappointed.
Those with the highest expectations (perfectionists) are most likely to be disappointed.
Bingo. And that's exactly why I ruled them out. I'm a ridiculous perfectionist. I KNOW the halos, no matter how subtle, would drive me crazy. Personally. I zero in on that kind of thing and can't let it go. That's just my personality. So they're not for me. But a lot of people get them and love them.
" And (according to Alcon) about 99% would choose PanOptix again."
99% - I don't think I have seen that high a number for any IOL. Where did you see 99%.
And Yes you must watch the wording as they have a financial interest to make the clinical trial results look as rosy as possible.
The percent of patents satisfied is all over PanOptix website and published in the product info for physicians (excerpts below).
“Table 24: IOLSAT: Satisfaction with Your Vision (Collected at 6 Months) All Implanted - Given your vision today, if you had to do it all over, would you have the same lenses implanted again? - 99.2%”
PRODUCT INFORMATION Alcon Laboratories, Inc.
The statistics I quoted previously are from the same source.
The percent of patients satisfied is all over PanOptix website and published in the product info for physicians and FDA (excerpts below).
“Table 24: IOLSAT: Satisfaction with Your Vision (Collected at 6 Months) All Implanted - Given your vision today, if you had to do it all over, would you have the same lenses implanted again? - 99.2%”
The statistics I quoted previously are from the same source... "PRODUCT INFORMATION Alcon Laboratories, Inc." filed with FDA.
I provided a link in a separate reply that is "waiting to be moderated", or people can search directly at FDA's website.
The trade-off is clear, but the idea of "perfectionists are most likely to be disappointed" with trifocals is probably (I think) something invented and promoted by ophthalmologists who are trying to categorize patients easily without consulting psychologists.
For example, I believe that I'm a perfectionist. My choice was either monofocals and use readers or glasses for distance... or EDOF and probably still need readers... or trifocals and get halos and starbursts at night, but get a full range of vision. Plus halos and starbursts still happen with monofocals and EDOF.
None of these choices are perfect for perfectionists. They all are starkly imperfect. But what is the most perfect choice for me? Or for your friend? That's why I started this thread... to help perfectionists understand IN ADVANCE that halos and starbursts WILL happen. Using this information, perfectionists can measure the benefits of greater depth of field more appropriately against the possible problems in other areas.
Indeed, I imagine that some NON-perfectionists happy-go-lucky souls may be more likely to wave away the bother of trifocals and get the cheaper IOL monofocals and wear glasses... because who really cares about extra depth of field except a perfectionist?
do you work for alcon?
I do not. Do you?
All I can say is that I am a perfectionist and I know 100% without a doubt (based on other experiences) the halos would drive me bonkers. But yes of course it's just a general rule of thumb and everyone is different.
Call me suspicious when I see a 99% Plus diffractive IOL satisfaction number. You have to be really careful when looking at numbers like that, such as what clinical trial is the number coming from, how was the clinical trial conducted (example was there a control group), and how was the question asked in relationship to the goal of the trial.
Looking at Table 24 it shows 99.2% would have the same lenses implanted again, yet in the same table it shows 1.6% were very dissatisfied and 1.6% where dissatisfied. Yet most those people (in order to get to 99.2%) would have the same lens implanted again. Hmmm!
The funny thing is I am looking at implanting the Synergy IOL and its propaganda says higher patient satisfaction, from clinical trial results, than PanOptics. So I guess depending on what data one uses, one can make the numbers come out any way they want.
But let’s ignore all that for second. Here is why I am very very suspicious. I have talked to sooo many Ophthalmologist and many will not even implant diffractive IOLs due to the number of unhappy patients.
Again I am suspicious of how the number was obtained and triple suspicious that this represent the population (IOL implanted population) as a whole.
I will give you a wild example, and in no way am I saying this happened, but shows how the numbers can be misleading.
Example – Purely hypothetical:
Maybe in this clinical trial they did a super good job of patient selection. That means first they did not accept any questionable or borderline cases. If you had any eye condition other than cataract you were rejected. Even extreme short and long eyes thrown out. Too much astigmatism OUT! Then maybe they did a great job with simulations, showing the potential subjects the worse cases of halos, glare and starburst and if you did not like it you were rejected. Thus creating the best possible outcome. In other words this group is not representative of the population in whole, who get the PanOptics implanted.
I currently have a monofocal IOL in one eye, and use a contact in my other eye which still has a natural lens. If anything there is less flare with the IOL eye, and no real halos with either eye.
no but you sound like one.
Maybe in this clinical trial they did a super good job of patient selection
These studies are typically funded by the manufacturers so there is certainly some truth to that. They choose favourable patients and top Surgeons for their studies. Surgeons have their own biases too though. Many who say they'd never use a diffractive IOL are basing that opinion on designs from 10 years ago like the ReStore which really were not very good. Or they only work in public health so would never have a chance to use them anyway. . The only thing you can say for sure is that THESE patients in THIS study with THESE endpoints and THESE surgeons with THESE financial disclosures and the survey questions worded in THIS way asked at THIS point in time = "99% happy". It's not meaningless data by any means. But you should also probably take it for what it's worth. Ultimately every patient and every set of eyes is different and you should listen to the advice of your surgeon and perhaps get a few opinions and then make what you think is the best decision for you.
Perhaps I sound that way to you because I’m satisfied with my PanOptix (so far), and you work for J&J. You seem to know a lot about J&J Tecnis products.
OTOH... You’re probably real because you wrote, “i would give anything for distance vision with natural lens and age induced reading glasses. i m 45. sorry u r going through this.”
Either way... I’m real. And if you're real, then I’m genuinely sorry that your eyes don’t work as you wish. My surgery has been a success so far, and now I’m trying to give back to future readers the same way I benefited from people here previously who helped me. If everything goes bad and my IOLs explode in my head, you’ll be the first to know.
At this point, my right eye has improved to 20/30 and my left to 20/25. I can read my cell phone easily at 14 inches. No pain or discomfort. No remarkable visual disturbances. Only the halos and starbursts I have described elsewhere. Cataracts eventually would have caused me to be blind. Now my eyes work better than at any previous time IN MY LIFE! So ya... I’m pleased with PanOptix.
u have 2 posts documenting the same experience and in this one where the topic mentions other trifocals u compare nothing but post manufacturer garbage.
glad ur reaults are great!!
No need to be "hypothetical"... On page 12 the literature clearly states that selected patients "had no preoperative ocular pathology or macular degeneration at any time, and no major protocol deviations."
My problem with the research is that I think the sample size was too small. Nevertheless, Dr. Shannon Wong says his rate of IOL exchange for PanOptix is about 1 in 300, roughly comparable to what Alcon reports and what J&J reports for Synergy.
I certainly wouldn't recommend that anyone choose an IOL based only on one source, the rate of satisfaction as reported by the company selling the product. But judging from multiple sources, I think 1-in-100 to 1-in-300 is probably realistic. About 4 million IOLs are implanted annually in the United States. Even 0.3% still represents 12,000 failures in the US every year, and about 84,000 explantions worldwide.
I have no idea what you mean by "manufacturer garbage". Are you referring to material supplied by Alcon to FDA? If you have special knowledge that it's "garbage", please don't waste time telling me. You should contact FDA immediately and let them know that Alcon has been dishonest about their filings. Don't wait. Do it now! Do it for the good health of all of us! Thanks!
For those of you still reading while soks is calling FDA... The purpose of my original post in this thread was to provide a "Reality Check about Halos and Starbursts" when trifocals are implanted. To recap... Halos and starbursts WILL happen! I direct gentle readers to the original message in this thread for details and my first-hand analysis of halos and starbursts while using PanOptix. Will halos and starbursts always be a deal-breaking problem? Spoiler alert... No. Not necessarily.
dont tell me what to do. u r now boring me with ur garbage