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Bilaterally implanted PanOptix trifocal
Although we use all of the modern presbyopic IOLs In our practice, two lens types now dominate our presbyopic approach. The first is the Alcon PanOptix, and the second is the RxSight Light Adjustable Lens with monovision. Although both lenses do a fantastic job, there are differences.
If it were my eyes, I would choose the PanOptix trifocal, implanted bilaterally. I believe we were designed to have both eyes working together for distance, as well as for intermediate and for near, and this is substantiated by the results in my patients in addition to the fact that more than 99% of patients who had the PanOptix in the FDA clinical trial would have this lens again. Confident that this is the lens that would give me the widest range of vision, I would be willing to trade off some glare and halo (generally minimal with the PanOptix lens) in exchange for independence from spectacles. Another important feature of the PanOptix lens is that it is available also in the toric model, and this addition allows us to reach almost all our patients. The data from the FDA trial show that contrast sensitivity is good and almost comparable with the monofocal lens. But more than anything else, it is patient satisfaction in the FDA trial and my personal experience with happy patients that drive my decision. The final factor in my equation is that all of my surgeon partners, as well as myself, are comfortable with an IOL exchange if needed. This means that if I were one of the rare cases that experienced intolerable glare or halos, I would simply have this IOL explanted and replaced with an LAL.
John P. Berdahl, MD, is OSN Refractive Surgery Section Editor. Disclosure: Berdahl reports he is a consultant to Alcon, Bausch + Lomb, Johnson & Johnson, RxSight and Zeiss.
Mini-monovision using light adjustable technology
Up until now, I have always been hesitant to offer monovision or mini-monovision with a traditional IOL for several reasons. Some factors include not truly being able to simulate loss of accommodation to the patient before surgery, difficulty in determining optimal focal distance for near, and variability in refractive outcome in each eye due to healing and effective lens positioning. The Light Adjustable Lens technology (RxSight) has taken the guesswork out of this equation and allows our patients to have a hands-on approach in deciding how they want to use their vision.
Personally, as presbyopia sets in, I want to be less dependent on glasses. Having excellent distance vision with some extended depth of focus/mini-monovision, without loss of contrast and halos at night, would be my goal. Being an active surgeon and mom of three, I am constantly on the go. I love to travel, get out on the water, be involved with the kids’ activities and paint. The LAL is a disruptive technology that gives that customizability and precision in which I could decide whether a mini-monovision correction or monovision correction fits my lifestyle best. I could be able to understand how I best use my vision on a day-to-day basis after a visually significant cataract is gone. Another positive is that the fine-tuning takes place in the lens itself without touching the cornea, especially for those of us with dry eye. Today, I would choose a mini-monovision correction using the Light Adjustable Lens.
Deborah Ristvedt, DO, is from Vance Thompson Vision in Alexandria, Minnesota. Disclosure: Ristvedt reports she is a consultant to Allergan, Glaukos and Sight Sciences.