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Lens Implants

The Alcon PanOptix Trifocal Lens Implant

Is the Alcon PanOptix Trifocal Lens Implant the best for my cataract surgery?

Alcon is the largest of the US companies specializing in just ophthalmology. They make the full spectrum of products for ocular surgery and in particular, cataract surgery. Just this month, September 2019, Alcon earned approval from the FDA (Food and Drug Administration) to sell their PanOptix lens implant which is designed to be used with cataract surgery.

 

The PanOptix lens has a long track record over the past years with extensive use in Europe, Asia, South America, and other corners of the globe. I have been speaking with a Canadian colleague about this lens for years and she is reporting excellent results. The PanOptix is a trifocal IOL (IOL = intra-ocular lens) which is designed to give good distance vision, intermediate vision, and near vision without the use of glasses in most situations.

The PanOptix works by splitting the incoming light by virtue of its design which looks like a bulls-eye target with its concentric rings. This means that it prioritizes the range of vision over the image quality to a degree.

How does the Alcon PanOptix Trifocal Lens Implant compare?

This graph shows the range of visual performance without glasses for different lens types. The very best, shown with the green line, is the natural human lens in a 25-year-old healthy person. Nothing beats mother nature and this is the proof when it comes to eyes. There is no substitute for youth.

The dark green line shows how age makes the natural human lens less flexible and this makes near vision difficult. We all know, either by personal experience or by observing friends and family, that as we approach middle age (close to age 50), our arms don’t seem long enough because we keep having to hold reading material farther away from our eyes.

Eventually, we just accept reality and start wearing reading glasses, start with +1.00 or +1.25, but soon progressing to +2.00 and beyond. This near vision becomes increasingly weak as we age, and by the time we are about 60 years old, the man-made lenses will start to outperform our aged, natural human lenses, even if we don’t have significant cataract changes. 

The yellow line is the excellent vision provided by a single-focus lens, also called a monofocal lens. This lens will give great quality vision, and great night vision, from far away to about 3 or 4 feet away from the patient’s face. Then, to see up close, the patient would wear something like +2 reading glasses which easily found over-the-counter and usually for $10 or less. The advantage here is great quality of vision, no splitting of the light, the best night vision after cataract surgery, and the same lens I would put in a pilot’s eyes. But certainly +2 reading glasses will be needed for near work like computer, cell phone, putting on make-up, and more.

The orange line is the good vision provided by the bifocal lens called the ReStor 2.5 ActiveFocus which gives a range from far vision to about 2 feet away. This gives better intermediate vision without glasses, than the monofocal lens which is important for tasks like using a computer or seeing the navigation screen on the dash of your car. The catch with this bifocal lens is that it splits like and this is what leads to the night glare and halo effect around lights. This lens is best for patients who wish to do far and intermediate vision tasks without glasses, but are happy to put on +1.50 reading glasses for smaller print or closer work and will tolerate night glare and halos.

The Alcon PanOptix is illustrated with the blue line, which shows that it gives the widest range of any of the lens implants without having to use glasses. It allows vision from far all the way to about 18 inches from the face. The quality of the vision is good and with normal lighting patients are very pleased. There is more of a challenge with dim light and there will be some night glare and halos. This lens is best for patients who wish to do most of their daily activities without glasses, but will tolerate night glare and halos.

So how do you decide?

If you are a patient, choose one sentence that best describes your desires:

Monofocal option: “I want the best quality vision at all times and I will happily wear over-the-counter reading glasses for computer, cell phone, and reading.”

or

Bifocal / Trifocal option: “I don’t want to rely so much on reading glasses, and to achieve that I will happily trade some of the quality of vision and tolerate some night glare and halos.”

Monofocal IOL:
  • best quality of vision
  • best night vision
  • great distance vision without glasses
    (4ft to far away)
  • will need reading glasses for intermediate work
  • will need reading glasses for near work

Bifocal IOL:
  • good quality of vision
  • some night glare & halos
  • good distance vision without glasses
    (4ft to far away)
  • good intermediate vision without glasses
    (2ft to 4ft)
  • will need reading glasses for near work

Trifocal IOL:
  • good quality of vision
  • some night glare & halos
  • good distance vision without glasses
    (4 feet to far away)
  • good intermediate vision without glasses
    (2 feet to 4 feet)
  • good near vision without glasses
    (16 inches to 24 inches)
  • will only rarely need reading glasses
    (usually for dim light)

Now this is just the start. The next step is a consultation where we will measure your eyes specifically and then determine which lens, along with your desires, will produce the best visual outcome. The PanOptix is a great lens, but it is not a perfect match for every patient. During your consultation and discussion with me and our team at Devgan Eye Surgery, we will help guide you to achieve the best vision.

For our friends who use the metric system, here is an equivalent chart:

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