Hello! I have been considering an RLE for a couple of years and was about to commit to Panoptix but I just keep worrying over it. I am a -8.50 in both eyes and have been in glasses since childhood. I am 52 years old and wear progressive glasses 100% of the time. I can see perfectly about two inches from my face and can read my phone at about 5 inches, without glasses. Beyond that everything is blurry. I spend most of my day in the near to intermediate range for work. I am a weekend warrior with lots of water sports and outdoor activities. My night vision is poor and I do not drive after dark if I can help it. I am worried about losing my close vision even though it is so narrow in range. Is this something anyone is worried about, misses, or was able to adapt to not having post surgery? I would love to have less dependence on glasses and am not happy in my progressives most of the time. Contacts are not an option. I do not want to be in a situation where I have to tuck readers in every nook and cranny, but do not mind if i need them for super fine detail on occasion. I would rather be stuck wearing glasses for distance than for near. Would appreciate all feedback.
That is a significant amount of myopia and I can see why you would want to be correcting it without progressive glasses. However, there are issues with multifocal lenses like the PanOptix and Synergy. Some people adapt to them and others do not. Some even dislike MF lenses to the point they have them taken out and replaced with monofocal lenses. Of course once you extract the natural lens there is no going back to them.
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One alternative to MF lenses is mini-monovision. You fully correct the dominant eye to distance and under correct the non dominant eye to -1.5 D of myopia. This gives pretty much a full range of vision with only very occasional need for readers. It can be done with monofocal IOLs, but since you have no cataracts I would suggest trying this first with contacts. You may find that to be a good solution until you really need IOLs due to cataracts.
Thank you so much for your response. The mixed reviews with the MF lens exchanges are what have me in limbo. I did not realize mini monovision could be used for my needs. I am going to research this now.
If you don’t have cataracts and can correct your vision with glasses I would not do any surgery, personally. Current implant technology cannot bio-mimic the human eye (yet… it may in the future) so they all have big limitations when it comes to the trade off between image quality and focus range.
I understand that perspective. I can correct with glasses but I am unhappy with progressives. I have several different pair at big cost. I have such a narrow sweet spot for reading and it is depressing. I take my glasses off and read inches from my face but returning to glasses after this takes awhile for eye adjustment. Aesthetically, my lenses are so thick (thinnest money can buy) that I hate the way they look. I am distracted by the thickness out of my peripheral vision. Glasses are not ideal for me and my vision is the most upsetting aspect of my life.
Understood. Just understand that IOLs have drawbacks as well and you are considering an invasive, unnecessary, and irreversible surgery. If you understand that and still want to go ahead that is your decision. You may be very happy with the results! But if you are not, there is no going back. Not really (some surgeons will change a lens in extreme cases but the risk is much higher and a lot of surgeons will flat out refuse unless the issue is vision-threatening).
Since you are asking for opinions from know-only-what-we’ve-researched people on the internet or that plus the one solution they have… I wouldn’t have surgery unless I had cataracts and had to. No matter what you choose the best outcomes have decided limitations and the worst are worse than your present negatives. AND there are bound to be improvements in the next 5 to 10 years in what can be done.
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I tried progressives and hated them, didn’t feel safe driving with them. When I returned them, a woman in the optical department told me how she wore computer glasses for almost everything, even there at work, and urged me to try them. The difference is they give you intermediate – and that’s more clear distance than just for computer work. I’m hard put to say exactly how far, maybe 10 feet really clear, up to 20 pretty good. Further distances good enough for me. I walk my dog, even at night with them and don’t feel worried. I wouldn’t drive with them. They also go right down to reading strength at the bottom, but since I can read without glasses and like it better that way, I take them off to settle in to read. So you might look into something like that and see if that could help you in some situations where the progressives are an aggravation.
I really appreciate your perspective and will give what you said serious consideration.
I would add that not all progressives are made equally. The first pair I had were horrible. I hated them and couldn’t adapt to them at all. So I went to another optometrist and brought the glasses with me and explained the issues and they made me another pair and it was night and day. So much better. I got used to them very easily within a few days and ended up loving them.
It is such a crapshoot. The first pair I spent almost $1000 on and could not see a thing. I was made to feel a failure and was out all the money. The second pair I ordered online from a store that offered money back guarantee. I could see instantly, without any need for adapting. They are still my favorite pair and cost a fraction of the price as the first ones. I am just so tired of ordering new glasses (online or in person) and still not being able to see well. Sure, I can get refund online but in person is making me go broke. I now have four pair of glasses that I have only ever worn for driving. My vision gets worse every check-up too.
I have had many pairs of what Costco calls Accolade Freedom lenses, and within the limits of progressives are very good. They are made by Essilor and I believe identical to Essilor Varalux lenses. I see the latest version that Costco is selling here in Canada is the Accolade Freedom 4.0. They have cost we in the range of $350-400 depending on frames. The latest pair I got were Costco Kirkland Signature brand, and are about $100 cheaper. They seem ok, but now I have been spoiled with no glasses mini-monovision, so I almost never wear them.
A new no-line multifocal IOL called the ClearView 3 by Lenstec was approved by the FDA last year. It’s supposed not be plagued by the issues associated with the PanOptix and is described to be “progressive lense” like. Challenge is finding physicians and/or surgical centers using it at this time. Call customer service and they can assist.
You know, if the Eyhance IOL had been around ten or fifteen years ago, and I was aware of it’s capabilities, or even of just IOL replacement surgery itself, I would have jumped on it despite no cataracts in sight! Compared to wearing glasses or contact lenses with high degrees of myopia, I’m not experiencing any negatives here. It is such a freedom to be able to just get up and decide to drive my car somewhere, without having to go through the extended dance of just getting my gas permeable contacts into my eyes without making a mistake that will make them even more uncomfortable for the rest of the time I’m wearing them. And that doesn’t take into consideration all of the hassles and fear that you might blink the wrong way at the wrong time and flick one out, lose it and then the knowledge that if after crawling around on the floor for an hour looking for it, you aren’t successful, that you’re out $150 and might not be able to get yourself home. And then there’s the always making sure that your eyes are half closed when leaning over an open toilet, or a sink with running water… just in case (still doing that now - old habits, lol). Having to avoid sitting in front of a fresh air fan, or whatever is blowing out of the vents of your car, or just having to worry about being outside without wearing sunglasses when there was a brisk breeze, let alone a wind. Remember the old Highlander films, “there can only be one”? Well that applies to wearing hard contact lenses. You can have the lens in your eye, or an eyelash or a piece of dust, but you cannot have both! At the least, it’s really uncomfortable, and you have to find a safe place where you can take it out and rinse it, but at the worst, it’s like someone is slicing your eyeball open with a knife to have both in there – and if this happens when you’re driving, well… And that’s on a good day when your eyes weren’t really dry so they felt itchy and scratchy just from wearing them.
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And then there’s the glasses for high myoptics… even with high indexed lenses, they can be heavy and you have to be careful what kind of frame you choose, as larger or flimsy frames make everything worse. Glasses usually cost me around $1,000 every two years – around $200 for a solid pair of frames and $800 just for the lenses. And for me, even when I was only around -9.00, everything I saw through my glasses was around a third smaller than it’s actual size which made it really difficult to just walk down a street wearing them, or go for a walk in a forest, let alone ever learn to drive a car while wearing them. Sports were also a joke since once again, your depth perception was so screwed up.
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Now don’t get me wrong, wearing hard contact lenses were once a huge freedom for me since despite all of the potential drama, I was at least able to learn to drive a car, and able to play sports competently, etc, but, man, that doesn’t begin to compare to the kind of freedom I feel now. I’m like, so this is what it’s like for all of those other people… wow!
I called Customer Service and didn’t receive much information. Alcon has study results on its consumer website. I was looking for outcomes since ClearView 3 received FDA approval in August 2022. These outcomes are available for surgeons only. There aren’t any surgeons where I live who are knowledgeable. The “lens” convention is in May and Lenstec will have a booth.
I have not seen information on any multifocal lens that would suggest they are free from the optical side effects that are common with MF lenses. I suspect this ClearView lens will have the same issues. You can fool optical science. Some people that are fully prepared for the side effects seem to be more tolerant of them, while others that are sold what they think is the ultimate perfect premium lens are more likely to be disappointed with the outcome.
You can find some information on that lens at the FDA site. Try googling this to find it:
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FDA P200020B SBL-3™ Multifocal Intraocular Lens SSED
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This is a bifocal with a fairly high 2.5 D near add in about half the lens like a bifocal eyeglass. One thing I noticed is that the lens has poor contrast sensitivity at distance. The MTF is 0.25 or less depending on pupil size. This seems to be even lower than the Vivity which is known for poor contrast sensitivity. See Figure 3 from page 10. This is probably not the best lens if you intend to drive at night.
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Very interesting new lens. I did a quick Google and noticed this at the bottom of the consumer page.
“Several prospective studies have been performed on the ClearView 3 with results identifying a high level of near, intermediate and distance vision, very limited amounts of visual side effects and extremely high patient satisfaction and spectacle independence ratings.”
Notice “very limited amounts of visual side effects” so as normal there are side effects as with any MFIOL.
Also from what I could find they don’t use rings but straight lines to get the MF and claim this leads to the less side effects. But wow this design could open up a whole new area of side effects. I found a video of the Dr saying (who was involved in the trial) that due to the lines if this lens is not placed by an experienced Dr with this lens the patient could have an undesirable outcome.
I have the Panoptix in my left eye past 6 months and I am happy. Getting a Panoptix in the right eye next month no reservations.
I skimmed the 110 page FDA report on the lens. Yes, the lens is split into a distance half and a close half. It is a true bifocal lens like you have in eyeglasses. It has poor contrast sensitivity at distance and the optical side effects like halos, glare, flare, etc were 2-3 times higher than the control monofocal. My post on it is waiting to be moderated.
Wow, so the “ClearView 3” has a vertically changing acuity, as in progressive glasses. The upper area for far, the lower area for near?
Makes me dizzy, just by thinking about it.
Sounds to me like reinventing the wheel, by making it square . . .
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well, i guess i didn´t get that right, as the visual axis stays the same in any eye position. So it´s rather brainwork again thats required, instead of eye movement.
Yes it is presenting two views that your brain has to put together. It is kind of like an exaggerated case of significant astigmatism. See the following snip from the report. The bottom red half is the near add of +3.0 D, and the top green is the distance portion. It is very unnatural, but I guess the eye/brain can adapt to many difficult views of what we are looking at. I would think double vision would be a significant risk.
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