My Experience with the new PanOptix® IOL

Dr. Peter Bekendam

Prior to the FDA’s approval of the PanOptix trifocal intraocular lens, I was reluctant to convince patients that an advanced technology IOL would be a good idea for them. In fact, during the preoperative consultation I would spend a great deal of time and energy warning and educating patients about the limitations of the various types of “premium” IOLs on the market. If they were interested in a multifocal IOL such as the ReSTOR, I would discuss glare and halos with night driving. I would be careful to mention the likelihood of poor intermediate vision with the ReSTOR 3.0, the limited near vision with the ReSTOR 2.5, and reduced contrast sensitivity with either of these options. When the extended depth of focus Symfony IOL came to the market, I carefully lowered my patients’ expectations for spectacle-free near vision—especially in dim lighting. If patients wanted to know about the Crystalens, I would make sure they understood the unpredictability of range of accommodation and the possibility of the dreaded Z syndrome. If my patients still elected to invest in one of these options, I would brace myself for our encounters during the postoperative period. While the majority would be satisfied with their outcome, an unacceptable percentage (15-20%) would express some measure of disappointment despite my best efforts at having set reasonable expectations.

Now, thanks to drastic improvement in multifocal technology with the new trifocal PanOptix IOL, my pre-operative discussions have evolved. No longer am I reluctant to offer an upgraded option to most patients. Rather than discuss limitations in vision at various focal points, I am able to describe how the PanOptix offers focused vision at each distance that matters most, greatly increasing the odds of enjoying spectacle-free vision most or all of the time. I am able to report that more than 95% of my patients who have elected to have the PanOptix are very pleased with their outcome and feel their investment was worthwhile. While I still mention the possibility of glare, halos, or reduced contrast sensitivity under some lighting conditions, only a very small percentage of my patients have reported being bothered by these effects. I advise patients that the PanOptix is particularly sensitive to posterior capsule opacification, but if this occurs it can be easily corrected with a simple non-contact laser procedure. As with any advanced technology IOL, patients with retina pathology or irregular astigmatism are not candidates for the PanOptix. While I have implanted the PanOptix with good results in post-refractive patients who have undergone PRK or LASIK, not all post-refractive patients will be good candidates for this upgrade.

As a cataract surgeon I love what I do and find deep satisfaction in restoring patients’ vision. My task is all the more satisfying when my patients are happy with their results—especially when they elect to invest in advanced technology options. I am pleased to be able to offer the PanOptix IOL coupled with intraoperative aberrometry to fine-tune IOL power selection and astigmatic correction. This newest iteration of multifocal technology is a big leap forward for patients undergoing cataract surgery at Pacific Eye Institute.