Received toric PanOptix yesterday

Eye care
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I’ve been lurking in the cataracts forum for weeks now – I’m 47, diagnosed with cataracts in both eyes (probably from taking a statin for at least the last 10 years - it’s a risk factor for cataracts). My left eye still sees pretty well, but my right was blurry enough that I couldn’t read with it and saw lots of glare during night driving. I spent the last few weeks trying to decide on the right lens. I had the surgery yesterday, so I thought I would pay it forward and describe my experience.

I was struggling to decide among a monofocal, the restor 2.5D, and the Symfony, and feeling pretty stressed about it. Then my doctor emails me that the PanOptix trifocal was just approved in the U.S., and it was now the best choice for me. I think the first surgery in the U.S. was 9/4, so I’m definitely one of the first. I have 0.75D astigmatism, which he said wasn’t worth fixing with a toric lens; better to do astigmatic keratotomy.

So, yesterday was my surgery, at noon. As most people have experienced, the surgery itself was not bad. The worst was probably waiting to be rolled in after being prepped. Though I was definitely sedated, I remember every part of the procedure. The most surprising aspect was my doctor says he’s now going to give me a toric lens after all, and not do the AK. But I went to one of the top surgeons in my area so I trusted him.

Afterwards, they did not give me an eye shield, saying it wasn’t necessary for small-incision surgery. The worst issue yesterday was the dryness and the scratchy feeling, like there was a piece of sand in my eye. I took a couple of doses of tylenol over the day. My vision was hazy and blurry, but I knew not to judge anything that soon. My eye looked completely normal to my girlfriend, maybe the area was just a little swollen. I took a 3 hour nap, and slept plenty that night as well. The doc called in the afternoon to check on me and told me I could use Refresh drops (the single use kind - no preservatives), which definitely helped.

This morning my vision was definitely improved, but still hazy and blurry, probably from the remaining dilation. I also saw flashes of light in the lower right corner of my field of vision, mostly when I moved my eye around and there was a bright light nearby. I also saw a dark floater on the very right side of my peripheral vision.

I drove to my 9am follow up, where they dilated my eye again (great). Doc said all of the symptoms I was experiencing were normal. The lens position was good, and there was a lot less inflammation than he would have expected – he even reduced the length of the steroid drops (those sting the most, so, score!). They tested my vision and I could read a good number of lines, but they didn’t say what my vision was. I asked about the last minute decision to go toric and he said he did an interoperative measurement and the astigmatism was now between 0.75D and 1D, and since AK was not a permanent fix, he decided it was worth the small overcorrection that might result.

As the day went on, my vision improved until my right eye could see distance as well as my left, which was great. The scratchiness is a bit better, now it feels like a hair instead of sand, and not quite as dry. The flashes are still there. With my normal contact lens in my left eye, by 8pm I could read about the same on the computer with each eye; maybe the right eye being just a tad worse. Doc said it will take a little time to adjust to the trifocal, and I should avoid using reading glasses if I could.

One thing I noticed comparing the eyes is I could really see the yellow tint from the cataract in my left eye compared to the right. There is still glare from lights in my right eye that just about matches the glare in my left eye from the cataract, but it is definitely better than my right eye had been before surgery. I assume this will improve over the next few days. Doc said it could take a week for all of the above issues to resolve, or improve.

So far I am optimistic and encouraged by my status. I will report again tomorrow or the next day.

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I should add that once I looked into the PanOptix all of my stress dissolved - I knew it was the right choice. I know I got lucky with my surgery timing.

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thanks for sharing. how is your near vision?

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Thanks for sharing.
I am so happy that the Panoptix finally made it to the US, here in Europe we have had trifocals since 2010, and you surely have got one of the best iols on the marked, within the premium iols.
You should expect somewhat longer adaptation time than one week.
Off course your doc is right, than in one week many of the symptoms from the surgery itself will be gone, but adaptation to the trifocals can take much more than a week.
So don´t stress if your outcome is not as you expected after one week, it could easily take a couple of month, before you really know what you have, and some of the visual side effects can still improve up to one year after surgery.

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Yep, great that a tri-focal has finally been approved for the US. I’m sure the PanOptix will quickly dominate the premium lens market in the US.When I first posted that FDA approval was expected late this year or early next year, I did think maybe I should buy some Alcon stock pre FDA approval!

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thanks for sharing your experience with PanOptix and all the best.

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I can read fairly small print at 18 inches. Bigger print at 9 inches. Not sure what to expect, frankly, but doc said it will take time to adjust to the trifocals for near and intermediate.

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Understood, thanks. I’m already pleased with the results so far.

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Today I experienced further improvement to scratchiness and dry eye. Both are very minor. I’m still seeing flashing in corners when there is a light source nearby and I move my eye around. Quality of vision is excellent. I do notice glare around light sources about on par with my left eye with mild cataracts. I haven’t really driven at night yet so can’t report on halos/starbursts. I do see some even during the day though, but very minor.

When dabbing my eye after applying eyedrops last night I did accidentally apply pressure directly to the front center of my eye. I felt a dull ache, and felt that ache a couple of times since. But, I’m also feeling an ache in the non-operative eye - probably from the fact I’ve been doing a lot more computer work last night and today. I assume a little direct pressure (as opposed to side-to-side rubbing) can’t cause any damage, even this early. Anyone know?

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I asked my surgeon about what would happen, if something put pressure on the eye, I was thinking during sleep or something like that.
He said absolutely nothing will happen, other than it will hurt, that was in the old days it could cause harm he said.
The cut they make today are very small and self-closing, and even a blow to the eye would not cause any harm he said, unless the blow is so hard that it would damage the eye anyway.

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thank you for your post! I was just informed about panoptix today on this site when i posted a question about restor 2.5. I am scheduled for my first eye with restor next week. i was feeling unsure the past week and called my surgeon with questions two days ago. Will ask him about Panoptix when he gets back to me.

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I was thinking more about disrupting the lens itself. Even a small shift would cause problems.

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Read some reviews and studies, especially the FDA study. I believe over 99% would opt for the PanOptix again. That says it all.

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what is the distance at which you can clearly read normal iphone font?

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With just the operative eye, about 14 inches. With both eyes open, maybe 9 inches. With the operative eye alone, the text appears lighter. I don’t know if that’s a consequence of loss of contrast sensitivity, or the splitting of the light. Or, the fact that it’s only been 56 hours since the surgery.

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Yes, I understand.
I guess that would be hard to say, even for the surgeon, but I really don´t think you need to worry.
The iols have a self-centering design, and within the weeks of healing, the iol will actually move a tiny bit around, therefore the refraction can also shift a little bit within the first weeks, depending on how the iol settles.
So I think it would be hard to mess it up, even if you tried.

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Question about toric vs non toric trifocal.

I assume as toric trifocal are aligned a certain way to match the eye measurements, so that mean if it rotates the vision will be thrown off???

What about non toric trifocal. If they rotate, I assume nothing changes? Correct?

Also if operation induces some astigmatism then won’t the trifocal measurements get severely thrown off?

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“What about non toric trifocal. If they rotate, I assume nothing changes? Correct?” - correct

“Also if operation induces some astigmatism then won’t the trifocal measurements get severely thrown off?” - surgery induced astigmatism is usually small -0.5 to -0.75. and such an astigmatism would impact vision regardless of lens used.

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Yes, toric iol needs to be aligned, although there is a bit of margin, but if they are rotated the astigmatism will not go to zero.
Non-toric can be rotated with no problems.
It will be measured at the follow up checks, where they measure the actual result.
You will never hit theoretical zero, but you won´t find that in the healthy population either.
The lenses, both monofocals and trifocals, are made in a way that they have some margin for errors, and still produce good results.

And if the lens is way off, it is just as bad for a monofocal as for a trifocal. Monofocals are not easier to hit target with, but people are more forgiving about monofocals, because you often need glasses anyway.
If you pay for premium iols, you would not accept glasses to correct refraction errors, so you could say in this way it becomes more critical.

Again, after surgery, it really does not matter that much what the theoretical eye numbers are saying, what matters is the actual vision you have gotten.

In real life the trifocals in most cases gives the desired vision result if their refraction hit within +/- 0.5, so there is quite a margin for error, without everything is lost.
I don´t know the error margin for astigmatism, but the same way, even some astigmatism will be tolerated well in most circumstances.
As a rule of thumb, with natural lenses astigmatism will give half the “trouble” compared to refraction error, so 1.0 astigmatism will impact vision as much as 0.5 refraction error. I don´t know if this is the same with iols, but I am guessing it must be in the same area.

My Lisa have hit -0.25 refraction and 0.25 astigmatism is left (from 3.0) and it works perfect, it delivers more than expected, I would take that result any day.

My Lara have according to measurements hit +0.5 and 0.25 astigmatism is left (from 3.0) and in terms of visual outcome, it delivers just as Zeiss promise.
If I put on a pair of -0.5 glasses on Lara eye, that in theory should make it theoretical perfect zero refraction, I really have trouble seeing any difference at all.
This tells me, that somehow these lenses absorb the errors, I don´t know how or why it works, but it does.

In studies with big numbers of patients, refraction normally hits within +/- 0.5 in 90%. And some of the people that choose trifocals have had laser done before, where it is tricky to calculate iol power.
Some surgeons have much better refraction results than that, I have seen some claiming to be around 98%, so again, the odds are in your favor :slight_smile:

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danish

if you hit +0.5 in the lara eye then that means you overshot and i would assume you need to wear +0.5 glasses. those glasses would keep plano clear and make near a little better. with +0.5 ur distance without glasses would be great anyway but near would be worse then what it could have been.

i am confused. r you 0.5 myopic or hyperopic in the lara eye.