To Panoptix or not to Panoptix that is the question?

I am scheduled to have the Clareon Panoptix implanted next Tue. I have been researching for a few months now and honestly it is very hard to decide on a lens since you want the first choice to be the right one. My story starts first part of this year when I noticed that my vision is my left eye was to me improving. I had to switch to an older pair of readers and my as my new RX (2 months old) was just too much power. But soon I noticed this cloudiness when I walked at night and then some halos around lights. So I go the eye Dr and she says you have a cataract. She says it is fast moving and I should see their surgeon. So I do and what a complete disaster, that day I waited 2 hours past my appt, nothing worked well as in the equipment they had network issues half the machines needed to be rebooted what a mess took forever. Then I get to see the surgeon he is looking at the results of the testing, confirms I have a cataract, discussed the option but seems very unsure about the readings from the machines as they don’t match up with some of the manual readings for my astigmatism. So, he makes this comment when deciding what to do “well I guess I have to go with what she wrote here it should be right” What red light alert is this guy joking , no he is not. I decided no way am I using this place and said thanks see you later. Then I start to think about it my reading vision has been slowing improving over the past 2 years. Then I read that this is a classic symptom of a cataract. So, IMO this place has missed the onset of my cataract for the past 2 years. Further I think hmm this visit for checkup was a different Dr and she picked up on the cataract right away. So yea other Dr I have been seeing has been missing it, so this place is a place to stay away from. I find a new surgeon on the first visit unlike the other place he only wants to see me for a consult. I think maybe they are just making more visits to make more money, but he has a good rep as this time I did my research. Turns out he seems very knowledgeable does his evaluation confirms the cataract in the left eye and it should come out soon and that I have one starting in the right eye that in his opinion can be done when it gets worse or whenever I am ready and lets me know the options. Totally no pressure says he is here to answer my questions, but I need to make my own educated decision on what to do. He says eye surgery has risks no matter what even if everything goes well. This is your eyesight you need to think about it and make a decision you can live with. He says no rush think about it do some research we can talk on your next appt. So, I go back for the next appt we get all the testing done, it goes all well, everything works as it should, we get all the needed test, very professional, and makes me feel like they know what they are doing. See the doc he says to give him a min to look things over to see what lenses are optional for me based on all the testing. He then says based on the testing you can get any lens you want and goes over all the options. I ask lots of question he answers just like he should on all the lens and is spot on with what can happen with each one. I tell him I have had good vision all my life and only in the past 10 years needed readers. I really want the best vision possible all ranges and I prefer to not have to use glasses if possible. He says you can do the EDOF Vivity or the Panoptix and goes over each one. I says really don’t want to depend on readers for cell phone use or to read a label in a store but not sure if I like the trade off with the possible side effect of the Panoptix. He says I can answer all the questions you have but I cannot tell you what lens you should pick only you can make that decision. I tell him I am undecided I don’t know. He says listen we have all the types of lens in stock for your RX give me one to pencil in and you have up to the time I start the surgery to change our mind. I say ok give me the Panoptix he says ok just let me know if you change your mind or if I an answer any questions you think of as this is a decision you should be willing to live with for the rest of your life. So I am scheduled for surgery next Tuesday. Even after reading negative posts here, I am on the fence but still leaning towards the Panoptix especially since I have confirmed no matter what I pick it will be the new clarion a lens. Here are some of my thoughts. I currently have halos and starburst at night, and I can drive no issue, if I am not thinking about them, I forget they are there. But they are mainly in my left eye and right eye very little so brain is maybe tuning out. I do work on small close-up tasks at times and I sweat a lot so glasses are a pain and sometimes can fall off when hands are full. So no glasses sounds really nice like it was 10 years ago. Most of the workday I am on a computer where I do where readers but again if I get up to walk somewhere I must take them off to see distance, yup a pain. If I have to pick just one concern it would be lack of contrast for night vision. I do notice the left eye has some lack of contrast with the cataract already and I manage. What I don’t want is to have total loss of contrast at night. As for brain adaptions I think I will do well as right now I have effectively mono vision and really don’t need any glasses. Reason is left eye sees quite clear at 12 inches and right still sees ok at a distance so everything seems in focus for the most part, it is what I would call functional. But I can see both eyes especially the left getting worse as time goes by. I have read many bad posts here and not so many positive ones. I found this site by searching for Panoptix reviews to see what was out there. I was looking for post by real people and not some sponsored study. I realize that people do have issues real issues but also that most people who have no issues don’t post anywhere. Anyways thoughts opinions?

It comes down to your philosophy or temperament about decisionmaking when the results of a decision are not predictable with certainty. Do you like to minimize your worst-case risk? Or maximize your probable outcome? From what I read, the multifocal PROBABLY will give you a better outcome than a monofocal. But the worst case is far worse with the multifocals.

My philosophy on a decision like this is to choose the option with the least-bad worst case. I haven't heard of any really bad outcomes with the Eyhance, or minimonovision or plain old monofocals set to equal targets, or the IC-8 that are attributable to the lens choice. I have with multifocals. So, I'm staying away from multifocals.

First I think you made a good decision to ditch the disorganized doctor. I got into this cataract thing a couple of years ago. Vivity was not available then, and the discussion was between monofocal or PanOptix MF. My surgeon frankly said he would not put the MF in his own eyes so he had a hard time recommending it to his patients. I ended up getting a monofocal AcrySof IQ lens as Clareon was also not available at that time. A year and a half or so goes by and I see the same surgeon again. His business model had changed. He now operates out of a clinic as well as a hospital, and his father who was also an ophthalmologist has passed away and give his office and practice to him. Now he splits his time between the hospital, his inherited office, and the clinic he uses to do the out of hospital surgeries at. As a result he has stepped backwards in technology with the equipment his father left him, and he also seems to have signed up with Alcon to push their lenses; Vivity, PanOptix, AcrySof, and now Clareon. When it came time to choose the lens for the second eye, he now was quite willing to recommend PanOptix. I said "no" as I had done enough research by this time to know that I was not willing to take the risk. His ability to view data and images on his computer was not up to the standard of when he practiced out of the hospital. And as a result of this I am now sure the wrong lens type and power was selected for my second eye. It should have been a toric monofocal with one step more power. Long story, but you are wise to go to a surgeon that has up to date equipment that takes measurements efficiently and can be shared on their computer system. . Like your doctor, I can't make a decision for you. The PanOptix has a significant potential to have optical side effects like halos, flare and spiderwebs (combination of flare and halo). Some put up with that to get the glasses free convenience, and some regret it. . In the end I decided to go for mini-monovison to get eyeglasses free vision but without the risk of optical side effects. If your vision is still pretty good, you really should try simulating it, as you might like it. Not everyone does. It is best done with contacts. Your dominant eye is fully corrected for best distance vision, while your non dominant eye is under corrected to leave you at -1.5 D. That is enough to give you decent reading vision. If the contact lens trial goes well, then you can do the same thing with IOLs. This will take some time of course, so you would have to defer your current surgery date. Remember getting an IOL is kind of for life, and it is worthwhile to make a good decision the first time. Exchanging lenses can be done, but there can be complications....

RonAKA thanks for the reply. I sort of have this mini-monvision now as the left eye with the cataract sees good from 12 to 20 inches and the right eye sees will past 6 feet not perfect but actable. So I mostly get by now without any glasses it’s been ok just the cataract is getting worse and hazing up during the day now so it has to go soon.

I don’t know if these places get a kick back from what I see they are making more $ on the premium lens for sure. I did ask this Dr if he need an IOL what would he pick he said he too is on the fence and could see himself getting the Panoptix or the Vivity as both have their own set of pros and cons. He said he just did his moms cataract and she got the Panoptix. I said you would not get a mono vision he said no not when there is a better option but again, he said he is not me and I have to do what is best for me.

So sound like your Dr is working with outdated equip like this first guy I seen wow seems a lot of Dr are making guesses with eyes when extreme precision is needed to hit this spot on. Very scary and maybe the cause of some unhappy cases.

One of my surgeon's recommended using preservative-free eyedrops and nightime eye ointments several days/weeks before getting biometry. Most people have some dry-eye, especially after driving a car a substantial distance. Dry eyes are hard to measure and are frequently causes of inconsistent biometry. If you are getting ORA or similar biometry readings after your cataract lens is removed and before the IOL implant, make sure you clear up any dry eye before the surgery so that you get the best readings possible and your surgeon picks the best power of lens for you.

Interesting the first place asked me to do this I thought it was a good idea so I also did it for the second visit too. However I only did it for the week before the measuring. I wondered why or what it would do.

Thanks for the reply.

That's the dilemma a monfocal has the best chance of a positive outcome as it should give you good distance 99.9% of the time. This option would give the safest risk is min. But you need glasses for everything else for sure low reward.

A EODF is a medium risk/reward option but kinda falls short on most fronts. You get the distance, good mid, and maybe if you are lucky some functional but not great up close. So this sounds safer than a multifocal still has some of the multifocal risk/reward but much lower. Where this sounds like a good option you really half solved the issue but agreed safer bet. For me I think if I still have to wear glasses then just save 3k each eye and get the mono.

Then we have the multifocal this offers the most reward with the most risk. You have the potential to be glass free but also the potential of more issues than you would like in of all things your eye.

What multifocal lens do you have?

I guess that gives you some idea what mini-monovision is about. But, to really see how it works I think you would have to try the contacts. If you have a current eyeglass prescription, places like Costco are quite liberal with giving out free contacts on a trial. The one I go to has a good stock of most brands and powers in 5 contact sample sizes. . My surgeon kind of regressed with respect to equipment. He now has an IOLMaster 500 in his office, but has access to an IOLMaster 700 in the hospital. However, he has connectivity problems and seems unable to view all data from his office. When I went for the final consult to select the lens on my second eye, he had to defer the decision and we made the choice by two follow up phone calls from the hospital where he could see the data. He actually hit the target he was trying to get to, but in retrospect it was the wrong target. I blame it on a lack of a fulsome discussion of the available options. . It sounds like the surgeons you have seen are Alcon advocates. Alcon makes the AcrySof IQ, Vivity, and PanOptix. Some of these are now available in the newer Clareon material. The other popular supplier is J&J. They offer the Tecnis 1, Eyhance, Symfony, and Synergy. Without going down the rabbit hole too far, the Tecnis is a monofocal like the AcrySof IQ (or Clareon). The Eyhance called a monofocal plus as it has a small amount of EDOF, but not enough to be technically called an EDOF. It is similar to the Vivity, but does not provide as good closer vision as the Vivity. It also probably has fewer side effect issues. The Symfony is a combination EDOF and MF lens, and Alcon does not have a similar current lens. Their latest MF is the Synergy. It is comparable to the PanOptix and likely has the same potential optical side effects. What I have gathered here is that the weak point of the PanOptix, besides the side effects, is that in some it does not provide enough reading vision. I have a friend that has the PanOptix in both eyes, and needs to use +1.75 readers for many things. The Synergy is said to provide more reliable reading vision, but at a cost of weaker distance vision. I believe some have used the Synergy lens in one eye for the superior close vision, and Symfony in the other eye for the better distance vision. However, you still risk the optical side effects with both of these lenses. Here is an update from one participant here, @Jennifer_Guess, that did the Synergy/Symfony combination. . https://patient.info/forums/discuss/symfony-synergy-six-month-update-788537 . The problem is that you likely would have to switch surgeons from an Alcon loyal one to a J&J advocate. They seem to go into one camp or the other. That will take a bit of time. But, as far as I know it is not more difficult to remove a lens with an advanced cataract compared to a less advanced one. The big issue is in getting accurate measurements when the cataract becomes dense. However, with a good instrument like the IOLMaster 700 they have the capability to measure accurately with much more dense cataracts than they could before. . Hope that helps some,

Thanks this is helpful

Yes I have noticed the Dr’s are only offering one brand or the other depending on what camp they are in. My original Dr was J&J and I was thinking of the Eyhance since it seemed ok actually was mid cost between STD and MF. But since his office fumbled so bad I looks for a better Dr all together. Found a guy that works at Wills eye hospital and seems to be top of the line. He happens to be in the Alcon camp so I thought let me pick among them since I now feel the skill of the Dr and his equipt is a big factor in the success of the outcome.

One thing that is a bit different is at this time I only need my left eye done and that is my non dominate eye. The cataract in the right eye is just beginning and he says it could easy be ok vision into next year or even more. So he says eye surgery is risky business even as common place as it is so there is no need to rush you get it done when you are ready. I asked why do most get it done back to back and he says most people’s eye are progressed about the same. He says he does have many other patients that only need one eye but love the results so much they cannot wait to have the second eye done. But he says truthfully there is no rush you do what you feel the most comfortable with. So I do like the no pressure let’s wait and see take your time attitude.

He did confirm all the stock they have is all the new Clareon material and 100% my lens will be the new Clareon.

I did find some articles that the new Clareon material lowers any possible side effects but who knows if this is true or hype.

So since there is no rush for the second eye I have plenty of time to see how things settle in and think about what lens I will choose for the right eye.

My biggest fear is really that all 3 targets are hit. I explained my expectations that are in alignment with any MF. I want to see close things cell phone, hobbies, detailed small work close up 12-16 inches, I want to see my computer that I work on all day long clear, I expect anything past 6 feet to be clear TV, street signs, things like that. I do understand that a MF that splits the light has some disadvantages you are dividing light photons. You cannot cheat physics so there will be tradeoffs for sure. I understand that one of the main will be when light is low as this is where the division of light matters the most. The Dr did say that in the cataract eye no matter what lens I pick that eye will get more light then it currently is. So he says from that perspective no matter the choice there will be an improvement. I do know at night when I close one or the other eye the left eye has much less contrast, appears dimmer, however I am able to work with it safely.

Sure we also have the other issues some exp spider webs, halos, glare. He said I will have some if not all and they may or may not bother me no one can predict. I may or may not get use to them everyone is different. Right now I have glare and halos with my left I quite noticeable if I think about it. But when driving I generally forget all about it and just drive. Granted I do have the right eye that has this to a much lesser extent and most likely the brain is tuning out the left to a point. All these little factors make the decision more complicated not less.

At this point I am banking on him hitting all 3 target ranges and hoping I can deal with any of these possible issues related to my choice of lens. I have accepted the fact that no matter my choice nothing is going to replace my natural lens and anything I pick is substandard compared to what I was born with.

0007Bond This is not an easy decision or even one where you can be 100% comfortable. Your surgeon sounds like mine. He would not make decision for me even when I him to give me his thoughts. Given pros snd cons to each IOL I guess it comes down to your priorities and risk tolerance. I made a list of work activities sports hobbies with times spent at these. I was also 52. My surgeon said people of normal cataract age have something to gain whereas I had to make a compromise on what to lose. I had fast growing cataracts too likely due to steriod creams for eczema used years. Both surgeries were done in 2017 so the 2 lenses you are considering weren't on the table for me.

i heard some offices do a personality test for cataract patients. Type A / perfectionists generally don't like the compromises of premium lenses. Vision not as sharp, lower contrast sensitivity to monofocals. But you can be glasses free - however not guaranteed. in healing process you could be + or - .25 diopters either way while lens settles. You could also still have astigmatism. If the readings at all off power calculation could be off and IOLs come in increments of .50 vs glasses that come in increments of .25.

Jokingly I read somewhere the surgeon's worse nightmare of a patient is an engineer whose hobby is photography and has a Jewish brother in law that's a lawyer and he wants to be able to see a gnat on the back wall!

All to say it is a hard choice. But there is much advancement and has a high rate of success. Fortunate to have IOLs. Our grandparents had their natural lenses removed and handed a pair of coke bottle glasses.

I wish you all the best.

Oh perhaps I will throw another alternative into the mix. Some get a monofocal targeted for best corrected distance in their dominant eye and a premium lens in their non dominant eye. The monofocal will mitigate the halos and glare of premium lens as your brain will chose the better view. Since your other eye sees well and doesn't need surgery you will already be simulating that scenario

some surgeons do not like to mix and match but it can work well. Something to consider and maybe discuss with your surgeon.

Oh yea my father had his done in the 70's it took him months to heal and he had the coke bottle glasses.

Thanks for your thoughts I think you are right with your last paragraph where I put the latest Panoptix in the left non dominant eye and see how things go. If all good maybe get the same in the right eye next year or if not so good go for the EDOF for the mix.

I was just driving, night, raining like crazy. Left eye sees crazy halos, glare, star, but right eye still ok with both open vision is still good to drive safely and see everything needed so the brain does do a good job of filtering out the unwanted images.

I think in a few years they will have improved the EDOF to the point of the MF and that may become the new state of the are IOL with the best bang and the least chance of issues.

hello 007bond, I developed core cataracts in both eyes at about the same time, a little worse in my dominant left eye, which ended up being operated on first. Interestingly, this type of cataract forms a type of lens in the center of the lens of the eye that, for those who already suffered from presbyopia, brings back the near vision that they had lost. At first it seems like a miracle, but as she progresses, her distance vision becomes double and blurry, in addition to the nocturnal dysphotopsias. In the opinion of all the ophthalmologists consulted, the surgery should be immediate, but I managed to get my optometrist (a friend) to spend some time with me and I even got prescriptions for glasses that allowed me to postpone the surgery for about 3 years, until night driving became dangerous and risky. The eye doctor I saw for the surgeries, after reviewing my scans, said I could choose any lens I wanted. By analyzing my profile he suggested the ZEISS AT LISA (trifocal). I spent a lot of time researching everything I could find about this IOL, and for some reason I didn't really like what I read. Later, I learned that, although my doctor had suggested ZEISS, the clinic where I would have the surgery did not work with the ZEISS brand (only Alcon and J&J), so I started a new search, but with little time until the surgery. I believe I made my decision based on very dated articles, coming to the conclusion that J&J's Symfony would be the better option. Approved by many surgeons, years on the market, less loss of contrast (MTF) compared to other lenses, lossless linear vision at all distances due to EDOF, close functional vision from 20" (for some patients). surgery scheduled and without much time to think, this was my choice. The end result was +0.5D sphere and 1.0D cylinder (spherical equivalent 0.0D). This eye tested 20/20 from a distance and I have very good vision at all distances, being able to read texts with normal font on my cell phone at 20", but to see photos and videos in HD is bad. I spent 4 months to decide what I would do in the second eye (non-dominant right), that's when I found this forum and made posts here. In the time I had the combination of the operated eye together with the non-operated eye, I never needed to wear glasses for anything else! My eye not yet operated on gave me functional vision from 6", due to the nucleus cataract that made it myopic. I confess that I got used to this range of vision (6" to infinity) and I realized that I would not like to lose it. For a while I was torn between Synergy (J&J) and PanOptix (Alcon). After a lot of uncertainty, I ended up choosing Synergy, driven by its +3.0D ADD which, based on its blur curve, could give me good lossless vision (also EDOF) from 13" to infinity, and also because some studies show that it has less loss of contrast (MTF) and, I will add that, I was so satisfied with the quality of vision of the Synfony, that I trusted to put another lens of the same manufacturer and of the same type (EDOF). The final result was sphere +0.5D and cylinder 0.0D. With this eye I can use my cell phone to read texts from 13", I can even read medication inserts, if I have a good light source and find the best focus at the shortest distance , but it is not an immediate read. To view HD photos and videos on your cell phone, it's better to zoom out to 16", but if you want to see the smallest details, I need +1.25D glasses. For everyday tasks I can go 100% without glasses, but for tasks accuracy and reading with small fonts I still need glasses. One problem I've noticed with this Synergy lens, also reported by others, is that the vision from a certain distance is not very clear! I can say that with certainty, because, I can compare it with the vision of my Symfony eye whose vision is very sharp and clear. I would love it if I could know what my vision would be like if I had chosen PanOptix...

Good luck with your choice, I know it's hard...

Great reply really appreciate the details.

Me too at first I thought my new diet I had just started was so healthy that I was getting my close up vision back. What an idiot I am it was a cataract forming like yours.

One issue in this area there really is no one Dr that offers all the brands they seem to stick to one only. So with my initial issues with the J&J Dr and finding a guy I really like who only does Alcon has kinda made me want to pick an Alcon product.

Like you I have done my PhD on this topic and the more you research the more you find both pros and cons for any of the lens no matter the type or manufacturer. So I was glad for find this forum with real people and not studies and internet propaganda.

I have read that there are sweet spots with all the trifocal type IOL’s but yes seems the one you have is 12 vs the Panoptix is 16.

My worries are that they get the 3 ranges spot on that I think it one of if not the most important mark to hit. I am also worried about the loss of contrast in dark places but another area you can find some people that don’t have any issues and other people that say they cannot even see at night. So it’s very hard to choose based on conflicting data points for contrast.

You mentioned something interesting I was not really aware that linear vision could be or would be affected and to what degree. I must look up some info as I would want good linear vision it would be a mess if that’s off.

"You mentioned something interesting I was not really aware that linear vision could be or would be affected and to what degree. I must look up some info as I would want good linear vision it would be a mess if that's off."

I remember reading something about vision loss in some points of intermediate vision in trifocal lenses and that made me choose EDOF...but it doesn't seem to affect all patients, some don't notice this loss...

"My worries are that they get the 3 ranges spot on that I think it one of if not the most important mark to hit. . Keep in mind that the surgeon has only one distance that they can control. That is the peak visual acuity or LogMAR value. The other points where vision improves or deteriorates is locked into the MF design of the lens. So if for example if the surgeon expects that the PanOptix will not deliver the desired reading up close with distance vision set at 0.0 D they can under correct you to leave your distance vision somewhat myopic. This will cost you visual acuity at distance but increase visual acuity up closer. But, there is no way to fiddle with anything other than the overall power of the lens in 0.5 D steps at the IOL plane which are about 0.35 D steps at the eyeglass plane. The last thing you want with a PanOptix based on user experience I know about is for the surgeon to leave you in the "+" zone. That will cost you both distance vision and near vision. For that reason you want the measurements done with the best instruments, like the IOLMaster 700, and the best formulas used to do the power calculations. They are probably the Hill RBF V3.0, or Barrett II Universal if you have reasonably standard eyes. The RBF formula is based on artificial intelligence, while the Barrett is vergence based, and are considered to be the newest generation formulas with the best accuracy. I think it is best to have them both run and see if they come up with the same power. Ask to see the IOL Calculation sheet from the IOLMaster 700 to see what it says. I would also ask for the target refraction to be set at -0.25 D to minimize the possibility of a "+" outcome. If you want to be assured of good reading, and are willing to sacrifice some distance acuity, you might even want to go a bit more negative.

Thanks I need to look into this again thanks for this detailed info I feel a bit better to understand that they only need to hit a single mark.

I agree 100% with all of RonAKA's posts and suggestions! I should have asked for the results of my exams with all the measurements and calculations, before the surgeries. I was afraid of not being able to understand the information present there, and of being useless, still creating a feeling of distrust between me and the surgeon. If it were possible to go back in time, maybe I wouldn't go for surgery again without first "checking the calculations". I say this because I believed that there was a refractive error in the Synergy eye since the distance vision was not as good as that of the Symfony eye, and even though my doctor claimed to have reached 0.0D in both eyes on every visit follow-up, I decided to do tests at another clinic and also with an optometrist, who measured a refraction of +0.5D in each eye. I don't feel that it affected my vision too much, as I didn't notice much difference with corrected or uncorrected vision. Even so, after the surgeries, I requested all my exams and calculations, and I learned to use the formulas (Hill RBF and Barrett Universal II and others) and I redone the calculations, reaching the conclusion that my surgeon could have corrected the refractions of the my eyes, if I had followed EXACTLY the results obtained in the calculations. I even sent him an email with my calculations, asking him to check them and try to explain his choices for the powers of the lenses. He simply replied that my calculations were correct, however, I failed to consider his "SF" (surgeon's factor). According to him, his implant technique tends to position the lens with a slight tendency towards myopia, which he corrects with his own SF. In short, the final word always ends up being that of the doctor. It is easy now, knowing the real results, to claim that he could have chosen the EXACT potencies, if he had chosen exactly the results of the formulas, without using "his SF". I keep asking myself if it could have really interfered with the surgeon's choices, since he is the ophthalmologist...

Thank you so much for your reply.

I think this is one of the things that I am learning from many posts the choice of surgeon may be the largest determining success factor. I think this surgeon factor as your guy says has to do with many different doctors having their own opinions they differ from standard formulas or recommendations slightly. It brings home the point that years of experience can certainly make a difference but where inexperience and going with the exact measurements sometimes can be have a better outcome.

Somebody once told me they are all practicing physicians, they're all still practicing on you and me, maybe someday they will get it right and stop practicing on us.

Hindsight is always 20-20.

If the surgeon had asked you before the surgery, "Should I include my SF in the calculations or not?" would you have said "not?"

Thank you for sharing your journey. I have 2 Symfony IOLs - Synergy not available when I had surgery. I like the seamless vision and rarely wear glasses. Do have readers +1.25 for small print and if I do extended reading.
I do see concentric circles at night around light sources. Wondering if you have that with Synergy?