PanOptix experience 4 weeks after cataract surgery & advise on IOL for other eye

Eye care
1

I am very glad to have found this thread! It helped me understand the benefits and drawbacks of trifocal IOLs and helped me decide on which IOL to use for my right eye.

I am 60 and started having problems with cataracts in both of my eyes in the past three years. The main problem was a deterioration in my vision, primarily in my right eye, which went from -8 to more than -16 in a couple of years. My other eye had -6 and it started getting worse too, but at a much slower pace. I have been wearing contact lenses for most of my life. During the past year I realized that I was seeing primarily through my left eye for everything in intermediate to far, while using my right eye for close up vision (even with contact lenses I could not see well past 6in!) - a kind of extreme monovision. It was difficult to watch TV or work on my computer, since my right eye was always blurry at those distances. I think that my brain has been trying to block my right eye and my left became the dominant (not sure which one was initially the dominant).

I decided to have a cataract surgery as things became quite unbearable and even dangerous while driving or running on trails. I do a lot of outdoors activities, such as mountain biking, trail running, sea kayaking and hiking, so I don’t want to wear glasses for far vision. I also use my cell phone and AppleWatch a lot, so I needed an IOL that would keep me free of glasses, at least for everyday and outdoor activities.

After discussing my needs with my ophthalmologist and after lots of reading of individual experiences and clinical trials, I decided to use the PanOptix IOL. My ophthalmologist had the same suggestion and told me that since my vision before was so poor, I would see a great improvement and would not be dissatisfied with the results.

I felt quite prepared for the surgery and the vision during the initial adjustment period. the surgery was done on June 9. The surgery was successful and without any complications. It was quite strange experience but I felt no pain or discomfort. Initially everything was very blurry with a reddish curtain covering my vision. This got clear quite fast but the grey curtain remained for a few days. Within hours I could see far much better than before, so that was encouraging.

Within the first three days my vision improved, things became quite clear and the curtain got reduced. There was still some distortion in my vision, straight lines looked slightly bent.

Vision kept improving, especially for outdoors and distance vision.

Now, a month later my far vision is very good. using an eye chart I have progressed from 20/63 the first days to 20/30 in four weeks. Night vision is fine, with small starbursts that do not cause any problems when driving. My left eye with mild cataract has about the same size but different shape starbursts. During the first couple of weeks there was a strong lineburst going from upper left to lower right, but it has now been reduced. Intermediate vision is still not very good, but it slowly is improving.

Close vision is already lot better now, in terms of text becoming readable up to 12in - 30cm, but there is a halo around the letters, keeping the image still fuzzy. I can read the text but it is not very sharp with low contrast, when compared

I am overall quite happy with eye’s progress and the quality of vision for far. Also night driving is not a problem, something I was worried about.

What concerns me though is that nothing is very sharp and high contrast any more, compared with my left eye wearing a contact lens. For example, reading text on my smartphone, I see the letters clearly, but they have a light halo around them. Even when I tried a pair of presbyopia glasses (+1.50), the fuzziness does not go away. Is this something that will go away eventually, as my brain goes through the neuroadaptation? I am planning to have another surgery for my other eye in a few weeks putting another PanOptix lens, but I want to make sure that I will not loose the ability to see sharp images for ever!

Does anyone had a similar experience that got improved after 4 or 6 months? Would things get sharper with more contrast later? If not, would it make sense to use a monofocal lens in my other eye and rely on the principle of monovision for close up?

I would appreciate any advise you might have to help decide on the second IOL.!

2

About all I can suggest from my experience is that a monofocal in the second eye will most likely sharpen up distance vision and especially if the second eye is the dominant eye. The monofocal I have allows me to see very sharply down to about 18". You would have to count on the PanOptix for sharp vision under 18-24".

3

Without knowing you eye conditions including astigmatism, I can only provide general ideas based on perfect eyes before developing a cataract.

You stated your distance is 20/30. Did you shoot for Plano? What is your current measurements? It seems like you are a bit myopic. Now this is a guess as I am not looking at a Defocus curve to PanOptics. But if you shift that curve to the right, it would move both the intermediate and close to the right also, which might be the reason for the intermediate vision not being perfect, but should result in superior close vision.

“as my brain goes through the neuroadaptation”

IMHO no if you are getting the same IOL in the other eye and you have the same quality of vision.
My advice is to put off the other eye surgery and give that eye full time to heal and for you to adopt to the IOL and then make an informed decision. Not to mention to give time to experience this IOL in all types of condition. Real World results and in a perfect office environment isn’t the same. How does it do in a dimly lit theater or at an indoor basketball game.

Sadly there is no perfect IOL. It is all about tradeoffs and after a bit of time you will decide if the tradeoff is worth it.
The best vision you can get with an IOL is a monofocal paired with reading glasses.
If the contrast loss does not improve and it is unacceptable then you might think about a monofocal for the other eye. Then you might get neural adaptation. There are other options like Synergy, which I am getting, but not sure that will be any better than PanOptics.

If you search youtube. Dr. Wong recently did a Panoptics in one eye and Synergy in the other. Again not sure that would be beneficial in your case.

I give one last bit of advice. One of the biggest complaints I hear is young people when they get a cataract and then get an IOL. They had such great vision, so they are super picky and notice every little difference. IMHO, this is one reason some doctors want to do bilateral implementation. For me, my vison was so crappy by the time I got my first IOL, my Contrast might be off and I would never know it. Maybe the question is not how the contrast compares to your good eye, but can you live with it to get close vision. Just a thought.

4

Thanks for the reply rwbil!

My prescription before my vision started deteriorating was:

Right eye: -8.00, astigmatism -1.25
Left eye:-6.00, astigmatism -1.50
The right eye is the one with the PanOptix lens implanted. In 2019 it went to -10.00 and before the cataract operation it was probably -16.00 (that’s a guess, my doctor didn’t tell me the power, I will ask them next time for my records). The right was practically blind, even with a -8.00 contact lens.

My plan was to have the best vision possible for far and intermediate, but my doctor said that due to being very myopic it would be difficult to get the power right.

As was your case, my vision on my right eye now seems so much better than before, especially far vision. I can now see the line of 20/25, using an eye chart on a wall, but there is still some haziness over the letters and the contrast is low.

Before, even though my intermediate and far vision was very poor, I had a perfect close vision, very sharp and good contrast. That is what worries me now. It could be that this is also due to my astigmatism. What I want to make sure that I would be able to see images and text at good contrast and sharpness, at least with the help of glasses. If not, I will consider the idea of getting a monofocal IOL. I am doing to discuss this with my doctor this week before making a decision. I would prefer though to have the other eye done before the end of the summer, if possible.

5

Thanks RonAKA for your reply,

That sounds like a good option for me, if I can get a monofocal to have a good vision down to 18in.
What is your far vision? And what is your other eye’s vision? Did you have a trifocal IOL?

6

This is where is all gets tricky. You had astigmatism. I am guessing you did not get a toric IOL. I think there needs to be about 1.0 of Astigmatism before they use a toric.

I am not an Astigmatism expert, but I think it might be causing part of your contrast issues, but again not an expert, so something to discuss with the doctor.

I don’t have significant astigmatism so never researched it. Others here might know more about and it effect after cataract surgery.

And as you mentioned there are also power and power step issues regarding what is available in that IOL.

7

I have 20/20 vision in my IOL eye at distance. My eyeglass prescription for it is 0.0 D spherical, and -0.75 cylinder. The residual astigmatism is probably helping me see down to 18", and YMMV. 24" may be more typical for most monofocal users. The most critical thing with a monofocal is selecting the right power. My surgeon estimated I would have -0.4 D for spherical, and it turned out to be 0.0 D. If he had tried to get 0.0 D I may have ended up far sighted and positive for correction. That is when you start to lose more close vision. I think a reasonable target for selecting the power of a monofocal is to be between -0.25 D and -0.50 D. This is not going to significantly impact distance vision, and it will improve close vision range.
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My other eye has a mild cataract and has not been operated on yet. I plan to go with a mini monovision solution and target an under correction to leave me at -1.25 to -1.5 D - near sighted. I am currently simulating that correction with a contact lens and it seems to be working quite well. 95% eyeglasses free.

8

Did the doctor use a PanOptix toric lens to correct the astigmatism? It is always hard to predict what IOL power lens is used based on a eyeglass prescription. The eyeglasses are correcting for error in the cornea plus error in the natural lens. With cataract surgery the natural lens is removed and the only correction required is for error in the cornea. So if your astigmatism was in the natural lens only then a toric lens would not have been necessary. I would guess that an eye test for distance would indicate what your residual post op astigmatism is.

9

No, I didn’t get a toric lens. My doctor told me that with my astigmatism it is not required, but he didn’t mention anything about where the astigmatism was in (and I didn’t know it could be associated with the natural lens).
I will try to find out in my next visit.

I was originally planning to have my second eye on July 14th, but I may postpone it for July 19th or later.
Can anyone with a PanOptix lens tell me how long did it took them for their vision to get to a point where they could judge how successful it was?

On July 21st it will be 6 weeks since my IOL implant on my right eye. Is this a sufficient time? As I said my main concern is the halo around letters, the fuzziness in general and the low contrast. Are those something that gets improved through neuroadaptation? Are they caused by the additional images superimposed on the selected image (far, intermediate or close) and if yes, would the brain be able to cancel them out and improve the contrast and remove most of the halos?

10

That sound great! From most things I read you don’t really get close vision with monfocals and you have to use glasses. Reading down to 18" would be perfect for me.

Do you see a halo or glow around letters?

I tried to recreate the glow I see around letters on both a white and black background. This is what causes the low contrast and a sense of things not being very sharp (hopefully the images will be displayed):

11

I uploaded two images in my reply above of a simulation of the halo/glow I see around letters and is causing the loss of sharpness and contrast.

12

I don’t have PanOptix but I’ve had a multifocal IOL since 2007 and can tell you the glow around letter (particularly white text against black backgrounds) never goes away. I have no IOL on my other dominant eye, so with both eyes open my brain filters out the disturbances of the multifocal eye about 85%. Over time, the ability to filter (i.e. neuroadaptation) has improved, however if i isolate my multifocal eye the issue is still 100% present. The images never go away but your brain learns to ignore them over time with both eyes open. I’m also in a similar situation considering monofocal on my dominant eye (cataract is starting to bother me). I’m rather young though at 31 today.

13

I would also agree with the notion that the glow around text/objects is caused by the overlapping simultaneous images (near,int,far) but your brain selecting the proper one (and effectively ignoring the other images; seen as a halo/ghost)

14

Thanks for your input gmag22.
Does this glow also affect the contrast and sharpness of photos, computer screen, smartphone screen?
Also, if you use corrective lenses, can you make the glow go away or be minimized?

15

I definitely notice with corrective lenses for distance, the effect is minimized (the glowing edges get closer to the primary image). In general I have issues with contrast due to the nature of my multifocal lens design (it splits the incoming light rays) but not necessarily in relation to the glowing edge situation. Sometimes i have issues with the edges/halos getting in the way of other nearby images but sharpness hasnt really been problematic. If you have sharpness issues it could be PCO related (which can be addressed with a YAG laser in-office treatment). But be careful with YAG laser since removing the IOL in the future (if you’re not happy with it & want to swap it) becomes much more difficult for the surgeon.

16

By the way this is how mine looks

17

I can read a computer screen at 18" but reading books or magazines would not be comfortable. There are no halos and the text is sharp. If I got distance monofocals in both eyes for sure I would need reading glasses. Keep in mind there is a range of close vision that people get with distance monofocals. My 18" seems to be on the closer side of the range that gets reported here. I think my residual astigmatism helps in reading as close as I can.

18

Its good to hear that the glow is minimized with glasses for distance. Can you also minimize it for close vision, for example letters and images on a cell phone or computer? That is where I have the most difficulty with, as nothing looks sharp with my right eye at this point. Text is readable, but the quality is low.

The glow I showed in the images was for large text, as I make the text smaller, the glow becomes proportionally larger. On my cell phone for small text it is equal to the width of letters. But it does not look like yours, as a number of images superimposed on each other, it is just one fuzzy glow around letters.

PanOptix also splits the image into three, one for each distance, so it is probably same as your lenses.

19

Has anyone tried to combine a Panoptix in one eye with a monofocal IOL in the other? Are there any issues to be concerned with?

This is what I am thinking right now as an option to maintain the ability to see images and text in high quality resolution and sharpness. If I have close vision with the PanOptix, than I would not mind having the monofocal focus only down to 18-24".

20

I am very curious as to why your doctor did not recommend Toric for both eyes. My mother has the exact same Cyl powers of 1.25 and 1.5(astigmatism), and doctor suggested the Panoptix Trifocal. Curious as to why he didn’t remmend Toric instead.