Panoptix v Synergy - Which is the BEST lens for presbyopia-correcting premium cataract/lens surgery?

Links:
There is no perfect lens. How to manage the unhappy patient with a synergy lens. • There is no perfect le...
Over 45 and considering LASIK, lens replacement or cataract surgery? All you need to know. • Over 45 and considerin...
Symfony v PanOptix. Which is the BEST lens for premium cataract and lens replacement surgery? • Symfony vs Panoptix. ...
We discuss and explain how we use the panoptix, synergy and vivity lenses for presbyopia correction in premium cataract and premium lens replacement surgery.
0:01 Introduction
00:29 Personal experience with each lens - synergy and panoptix
00:54 How different ophthalmologists use various lens implants
2:31 Early experience with the synergy lens
3:37 Synergy lens use with prior RK (radial keratotomy), LASIK, macular degeneration, epiretinal membrane/macular pucker, macular hole, corneal guttata, and glaucoma
5:10 Performance of the Synergy vs Panoptix lenses - Comparison
14:19 Our optometrists - Kimberly Pham, OD and Christina Wenn, OD - share their experience with the patients that have received the synergy and panoptix lenses
20:14 Why do we use these lens implants? What are cataracts? How do lens implants work?
21:29 Preliminary conclusions
21:40 How do I decide which lens to use? Helping Unhappy patients
24:15 Can intraocular lens exchange be performed to upgrade from an older lens to a newer and possibly better lens?
26:55 How I manage the unhappy patients with synergy or panoptix as of 9/19/2021 - the vivity lens.
29:16 Final conclusion - which is my preferred premium presbyopia correcting lens?
29:45 The Panoptix material and lens reflection (glistenings)
31:22 Synopsis

[@tomwiles]

Here's a follow-up on my story. On Thursday September 30, 2021, I went ahead with cataract surgery on both eyes with Panoptix iols in both eyes. The remainder of Thursday and then all day Friday I was still recovering. This morning about 48 hours post-surgery my vision in both eyes is about as good as it has ever been using glasses and contact lenses. I can see seamlessly from very near, intermediate and at distance. I find it absolutely amazing that my uncorrected vision is now as good as it is. Are things perfect? No. I did see a bit of stop light/brake light ghosting when driving around last night in heavy evening city traffic in the drizzle but I found it quite tolerable. Keep in mind at that point the vision in my left eye was still somewhat blurry and had yet to fully recover like it has this morning. The other major effect I'm experiencing is a sort of "binocular effect" that I've only ever experienced before with my natural lenses when trying to focus on my finger an inch in front of my face "cross eyed." I know that I'm seeing a Panoptix focal ring especially when looking at things close up. It is somewhat akin to a glasses frame. Again, I find this effect quite tolerable, although I know that some patients are deeply disturbed by it. Overall, I'm extremely pleased with my choice. What I did getting both eyes implanted the same day with Panoptix trifocal lenses, even though I'm a truck driver that can spend lots of time driving at night was a bit risky, I couldn't be more pleased with the 48 hour post-surgery results. You never know what your result is going to be with this until you go through it. I'm amazed and happy with my results.

[@tomwiles]

Update to the update. I am now 19 days post-op with PanOptix lenses being implanted in same-day surgery to both eyes. I'm a couple of days away from ending all post-op prescription eye drops. My overall vision is amazing, better than I can ever remember it being with the best corrective glasses or soft contacts. I am an over-the-road truck driver and so far I've spent a substantial number of hours driving at night in a variety of different conditions, including dense fog and heavy rain. My night vision is more than adequate. On the other hand, I do see ghostly halos around some lights at night. These halos mimic the concentric ring structure of the trifocal lenses. I do not find them bothersome nor do they interfere in any way with my ability to continue to perform my job. I have zero regrets. That being said, I would caution anyone thinking about cataract or lens replacement surgery to become as informed as possible. Realize that none of these replacement lenses are perfect. In the end, I can accept the ghostly ring visual artifacts because my choice was voluntary and not as the result of external pressure.

[@Doubleday70]

I’m a otr and debating on which ones to get

[@hectorrivera4347]

This doctor is a real honest and optimum professional Thank you

[@GadgetGirl887]

Thank you for making such an informative and well-explained video. You use everyday language and well-done graphics and leave the pictures up long enough to read them. Two thumbs up!!

[@ShannonWongMD]

Glad it was helpful!

[@darylmorse]

Thank you for an interesting video and for being brave enough to actually state your opinion. I'm 60 with myopia, presbyopia and cataracts, looking at your video to help understand the pros and cons of the various different lenses. At this stage, it's not obvious which will be the best choice for me.

[@miggity6666]

Excellent information and presentation. As a potential patient, this format allows me to digest information better than the consultations with my local eyecare specialist. So much new information can come too quickly in office visits.

[@ckim420]

I'm early 40s and was just diagnosed with cataracts (more severe in one eye than the other). Your videos (and learning that there are using fresnel lenses in these implants) have made my day! I'll probably be looking for a doctor shortly. I may need to make a trip to Austin.

[@charlestonscvideo]

I am so grateful for your thoroughness and being so candid. Thank you for all you do and share! Please keep up the amazing work.

[@letranger5]

I chose SYNERGY on March 22, 2023 - and so very happy with it!!! So happy that hope to do the other eye on May 3, 2023 (although the second eye is not an emergency in cataract terms).

[@aniketnavalkar5974]

Thanks for the candid feedback and the OD experience. PanOptix has won in my opinion. Only reservation is lens scratching and glistening with PanOptix.

[@argon805]

Thanks for the honest explanation and opinions. I'm planning cataract surgery and doing my research.

[@MrFMANT]

I am an ophthalmologist with an extensive experience with both lenses. I completely do agree with Kimberly Pham about better vision quality with panoptix.

[@ShannonWongMD]

Since making this video, I am finding that what Dr. Pham stated is very accurate. The long-distance visual clarity with the panoptix seems to be slightly better than the synergy. The quality of far vision with the panoptix seems to be better than the synergy. The quality of the near vision seems to be better with synergy than panoptix. I am now recommending panoptix for half of the premium lens patients and synergy for the other half of the premium lens patients that want full range of focus.

[@jamesdesmond1301]

@@ShannonWongMD What do you mean by this: "I am now recommending panoptix for half of the premium lens patients and synergy for the other half of the premium lens patients that want full range of focus." So, implant panoptix in one eye (for far vision) and synergy in the other (for near vision)?

[@MrFMANT]

@@ShannonWongMD Near vision quality with Synergy is very good, But the lens' near vision function is extremely sensitive to post operative myopic shift. If the post op refraction of the patient shifts even minorly (let's say -0.25) toward myopic side, the near vision distance comes to 25 cm or less. So I am reluctant in implanting Synergy to my patients, and do prefer Panoptix for sharper far vision and an acceptable near vision quality.

[@gocarlisle]

Dr. Wong has replied to me via email on 2 occasions in less than 24 hours regarding general questions on lenses. Try to get that from your local ophthalmologist!

[@Kozmo260]

I learned a lot from your videos DR Wong! To try and help others: 54 year old male in USA who had cataracts I was down to 20/300 & 20/200.The J&J Synergy IOL's were just hitting the market place here and I asked & volunteered to be an early adopter with my surgeon. I thought the J&J material was better and if the Synergy passed thought more light then the PanOptix 88% I felt that was good plus to have. How much more light then Panoptix 88% do the Synergy's pass through I do not know exactly. No complications with Surgery. It took me about 50 Days to hit 20/20 up close I was 20/25 for a good while there. Distance took a while as well. Neural plasticity, Neural adaptation takes longer with Synergy. If I had to do it again I would go Panoptix but imho think they are very close. Coming from cataracts I am very happy and grateful! Also the general health of a given human being plays a role. High blood pressure, metabolic syndrome and diabetes all can affect vision. Lots of variables out there case to case. Hope this helps somebody!

[@elterrifico9522]

20/300 ???

[@ShannonWongMD]

Thank you!

[@michaelsigman8942]

I’m 40. I’m a high myope. I am trying to decide between these two for a posterior capsular cataract. Appreciate this video very much.

[@mikehenry89]

Thanks for letting us learn from your experience!

[@ShannonWongMD]

Thanks for watching!

[@Retiredmco]

Dr. Wong your video's are incredibly insightful! When the time come for my lens replacement surgery Ill be in contact. THANKS ☺️

[@RM-sf6pr]

Fantastic videos and honest explanation - Great Job, Dr. Wong

[@jasonmalone155]

Great video. Loved the format and information provided.

[@ShannonWongMD]

I now recommend the panoptix OVER the synergy: kzbin.info/www/bejne/raHJl3yanrZksK8

[@lorijaton4719]

I underwent a synergy lens implant after a cataract excision about 3 weeks ago. I was amazed within a couple hours after surgery how well i could see far distance. It was truly a "wow" factor. Close vision has also improved and I am extremely happy wth my syngery lens implant. I do very much so see a halo with driving but I can say I believe I am getting used to the new change with the halo as it doesn't seem to bother me as much any longer. very satisfied with synergy. thanks for the wonderful video Dr. Wong.

[@kedsheong]

Thank you very much for the video. Excellent information.

[@routereyes6408]

Thank you so much for this review, it helped me make my decision. I have very high myopia, slight astigmatism, slight presbyopia, and suffer from decompensating isophoria. This surgery will fix the first three and I a ok with this.

[@TheFerretHome]

Excellent comprehensive presentation - thank you!

[@montymuseitef53]

Thank you Dr. Shannon for all helpful information on cataract/lens surgery and the different options between lenses. My cataract lens surgery is next week Thursday and I opt for the Panoptix. You help me so much on deciding which lens to go with. Thank you !!!

[@ShannonWongMD]

Good luck!

[@tomekaridley6371]

Wow. I may have to come to Texas to see about the cataract/lens surgery.

[@lvedder2651]

Thank you very much for this video, it's very informative.

[@DeeAnnaArellanoRealtor]

Wow what great information! I am torn between the two lenses. I've seen 3 doctors and each has recommended a different lens. I play golf, work on the computer and read documents regularly. I need the best lens. I am very picky but I have been dealing with nearsightedness since I was 11 years old. I am 52 and now have to deal with losing my up close vision too! I just want the ability to have good vision without having to wear crappy glasses or trying to use different contact lenses to achieve optimal vision. The doctor from Ft. Worth recommended the Synergy because of my shorter stature. He said that I would have better up close vision with it, which is important to me. I am so glad to hear another doctor recommend the Synergy. This video is dated, however. It would be nice to see if you still recommend the Synergy today. I understand that the PanOptix has made adjustments to the lens material, I'm guessing to address the reflective issue. Can you comment on that? Thank you for your time.

[@ShannonWongMD]

We do not offer the synergy lens in our practice any more. In my experience, the synergy lens has a 10% chance of leading to a visual outcome that is unsatisfactory for the patient. What is an acceptable rate of lens intolerance for a presbyopia-correcting lens in my opinion? 1 in 200-300

[@bruisedcat]

I owe you a thank you. Tired of always looking for my reading glasses i finely took the plunge 6 months ago after watching most of your videos, i am 58 years old and my eyes were as you would expect for someone my age. My biggest worry was what lenses i might end up with. My eye surgeon was really great and in stead of having two of the same lenses in my eyes he said best for me would be a different one in each eye. I have a multi focal Panoptix Toric Lens in my left eye and a Acrysof IQ Vivity Toric (T2 to T6) in my right eye. My eye sight is absolutely wonderful now, i haven’t touched reading glasses since the day of my surgery. I drive trucks for a living and seeing things so much better now has really change my life. Keep up the good work Dr Shannon.

[@ShannonWongMD]

Thank YOU!

[@KC-qn4nl]

How is the mid-range quality of your right eye with Vivity lens? Can you read (right eye alone) the words in your computer without reading glasses? Thank you

[@peterhorak4127]

My eye surgeon reccomend me the same type of IOL's as some small issues on my right eye that Vivity could tolerate better than Panoptix. My operation is planned for November. Just let me know please, if you compare Panoptix and Vivity now, are there any noticable vision clarity differences between your eyes as well as could you read cell phone (even "long hand") just with Vivity eye? Thanks a lot.

[@bruisedcat]

@@KC-qn4nl I thinking if i had just the Vivity in both eyes that i might have to hold my arms out further than i would like. I just fired up my computer and loaded a word document , just sitting in front of my screen i can read it in Arial Nova font at size 4 with my panoptic in my left eye and i have to enlarge it to 6 to be able to read it with my Vivity lens in my right eye. I think that because the Panoptics multifocal is great for close, medium and far that the Vivity makes up for the in between ranges so by using both eyes everything looks clear and sharp and in focus. Hope this helps.

[@bruisedcat]

@@peterhorak4127 If i sit here with my iPad on my lap and cover my left eye i can read all this fine. With the Vivity in my right eye i have to hold my arm out a little further to read if i cover my eye. With the Panoptics i can read closer up .. Both combined its like everything is crisp, sharp and clear at all distances . Looking outside i can easily see bees and bugs flying around the plants . In my car what really does it for me is that i can see every dust spec on my steering wheel clear as. My surgeon sugested using both for me as he said combined they would give me better vision at all ranges and also help with Halos and starburst . I still see halos but i dont really notice them maybe my brain blocks them out . Hope this helps.

[@sammako4416]

Helping Us So much Thank you Dear Shannon Wong

[@nathandenkin2103]

As soon as the meds dilating my eye wore off, I was wowed by the vision restored. Six days after getting a PanOptix Toric lens, implanted in my right eye, I tested 20/20 both far and near in an eye that a week earlier couldn't be corrected even to 20/200 because of the cataracts. The cataracts in my left eye were far less of a bother and I had been in no hurry to have surgery on that eye--until I compared the results with the PanOptix Toric in the right. I hadn't realized just how blurry the left eye was. At night, I do see what appear to be more starburst than halo around bright lights with the PanOptix lens, but they are small compared to what I see with my natural left lens! Perhaps because I expected to see halos and starbursts, they don't bother me at all. Yes, I see them, and I know they are artifacts of a diffractive lens, but my vision near, intermediate, and far is so good, those artifacts don't bother me at all. When the lighting is good, I can read very fine print at about 10". I would be concerned about it taking as much as 2 weeks for Synergy implanted lens to wow people. I have to wonder if that time is reflecting getting use to that lens. In two weeks I am getting the PanOptix Toric lens implanted in my left eye.

[@t34bravo]

Great input! Any update on how the left eye went?

[@nathandenkin2103]

@@t34bravo Left eye took nearly a week after surgery to catch up with the right eye, but measured 20/20. Binocular, my eyes are 20/15 at distance with bright light and J1 for reading. I typically use my iPhone, iPad, and watch at about 30 cm by habit although my near vision is sharper at about 35 cm. With the watch up close, I see a fine halo surrounding the numbers on the black background and as expected when I look directly into headlights I see concentric fine line halos but no starbursts but haven't had any issues driving at night. Bright, but diffused street lights appear to be surrounded by a very fine, almost invisible mist that I only notice when I look for it. My left eye is once again dominant.

[@michaelmcginnin1126]

Amazing lens comparison videos Dr. Wong! I’ve viewed most of your videos in the last few months, and I’m beyond words in the vast benefit you are providing to millions of potential patients, who are struggling to make an educated decision as to which lens system to use. I’m 66 see fine far, and have early signs of cataracts. I have had three consultations from various eye clinics, to get a sense of my eye health and cost. My primary goal is to rid myself of reading glasses, period. Based on your outstanding and informative videos, I have decided to go with the PanOptix lens. Thank you for making this decision easy for me!! Regrettably I’m in NH, otherwise I would be booking my operation with your practice. BTW, do you think that there is any significant difference in the quality of cataract surgery with laser vs traditional surgery? The eye center I’ve decided to go with decided a few years ago, to forego the laser procedure because they couldn’t see any significant difference in the quality of manual surgery. Additionally the laser procedure would have added another $1500 per eye to the overall cost. Best Regards, Mike McGinnin

[@ShannonWongMD]

kzbin.info/www/bejne/oHarlpunmdiBetU

[@jim-knight]

Great video. Thanks

[@ShannonWongMD]

Glad you liked it!

[@tomwiles]

Incidentally I've been attempting to find truck driver cataract post-op experiences online, but so far have come up empty-handed.

[@45_47_and_2A]

Yep....me too! I have found through videos, that Panoptix lens are NOT good for night time, just for lack of light to the eyes alone, not to mention the Starburst, Halos, Glare..... Great for daylight though. ☹ Guess they don't realize that they are not providing information to many of us who could afford the surgery.... but can't get the real life info we need

[@valeriegould1769]

Interesting video. While Dr. Wong seems more impressed by the Synergy lense and I'm curious why when the optomitrists Dr.s Pham and Wenn are saying they think the visual acuity is better with PanOptix. I really appreciate you creating these videos. Previously, I had Ortho-k about 35 years ago. About 4 years ago, I started developing cataracts. I stopped wearing my hard lens (for about two years) until the cornea stabilized and then had a PanOptix lens place about two years ago now. I then stopped wearing my remaining lens and once the cornea stops changing I will then get a second lens implanted. Your video has been very helpful. Thank you! Oh, and you're welcome for watching the video to the end! I'll continue following your videos. I've had the same optometrist for over 35 years despite many moves.

[@NanciFranceVaz_artist]

Absolutely great video. Live Kimberly Pham’s response. My doctor had told me as an artist this is the new lens and I’m going to have amazing vision and I’m so upset I have to have this ex planted and put another lens in. I wish I would’ve seen this video earlier I never would’ve agreed with the synergy lens! The visual quality is not good at all it’s very compensated at all distances

[@Artpapacom]

Nanci France-Vaz,! It's great that I saw your post! I am also an artist and have been trying for a year now to find my colleague with a cataract problem. And you practically answered my question that I haven't asked you yet. I will have an operation in February so far I have only thought about Synergy It seems that now only Panoptics remains, because there are no other alternatives? Tell me please, when exactly did you have the operation? You did both eyes at once, or did you take a break, If- Yes, how long?

[@Virtual-Media]

Your knowledge and experience are highly respected and appreciated. I have to make a decision tomorrow and very nervous about doing so. I'm 57 a musician and digital artist who spends a great deal of time on computers and performing music in the evening hours. I have cataracts and astigmatism in both eyes, no prior surgeries or issues other than poor vision quality. My ophthalmologist told me there are no physical issues or other maladies and my eyes would be an excellent candidate for lens replacement. I'm not a fan of bright LED lights however It's vital to see computers and smart devices clearly for my work. It's a decision between Synergy toric 2 and Panoptics. Your comment about the degradation of the Panoptics has me very concerned. I understand you cannot provide medical advice on a KZbin thread however your opinion is greatly valued. I have no issues wearing readers up close for clarity / accuity or shades to minimize halos. I would be forever grateful for any advice or suggestions.

[@joedoggity9400]

Dr. Wong, a wonderful listen. I went through the entire video, taking notes, and left with so much information and a grounded sense of direction. I am in the Detroit area and would very much wish to engage an eye surgeon in the Metro Detroit area who is experienced with Premium Lens Presbyopia-correcting surgery, whether with the established Panoptix or the newly emerged Synergy. I am 56 with prior Lasik and minor cataracts (1 out of 4) and my eye profile is otherwise unremarkable. If there are some practices that you could recommend in Metro Detroit (or Michigan), I would be greatly appreciative. Thank you again sir, for the time you took to create this well structured, informative, and clear video. You do the public a valuable service.

[@marilynpeterson6958]

Thank you for your videos! I have a question👉🏼👉🏼 I had the synergy lens implanted it in my right eye 2 months ago. I am not happy with the blurry vision both near and far and large halos and starburst at night making it hard yo drive at night. Because of that I opted to have the panoptix implanted in my left eye 2 weeks ago and already I have been very happy with the crisper vision, smaller halos and no starburst. I am seeing better now that I have the panoptix in my left eye. I see 20/20 with the panoptix with smaller halos and no starburst. My synergy implant is still blurry at 20/20 with more pronounced halos and larger starburst. I am considering removing the synergy lens in my right eye and replacing it with a panoptix because I feel I could see even better with panoptix in both eyes. Is there a high risk of complications removing and replacing a lens after 3 months? Is scar tissue an issue with the success of removing the lens implant?

[@TheShumoby]

I'm 45. No cataract. Just very high myopia and slight astigmatism. I'm fine with my Biofinity & /or Air Optix contacts, but I'm doing my research.

[@florenciaherrera7938]

Hi! Great video. Thanks for such relevant information. Only one doubt, with VIVITy, do you need lenses for cellphone? And what about dry eye. I suffer a lot of dry eyes is there any difference between vivity and synergy? thanks!!!

[@robmeyer7985]

As an amateur artist who has also digitally enhanced a ton of pictures, I would suggest you add another category to your comparison chart, i.e., contrast sensitivity. You videos quite properly focus on factors of practical importance to patients,not overly technical stuff. But contrast is very important when reading dim printing on a colored background, or trying to discern someting on your phone when out in the sunlight. One of your prior videos on the Synergy shows a graph with impressive contrast sensitivity relative to the other IOLs. I think they call it a MTF 50 rating. Keep up the good work Doc!! I'm about to pull the trigger on my replacements and your videos are VERY much appreciated.

[@ckim420]

I'd like to know this as well. I'm finding that the decreased acuity from my cataracts is bothering me less than the loss of contrast sensitivity, particularly in certain lighting conditions.

[@robmeyer7985]

@@ckim420 Thanks for the input, Sparks. I'm seriously considering going to monofocal just because of the anticipated loss of contrast (and glare-halos, i suppose). But I worry that in dim light the mono's will have a very narrow DOF (iris opened). I saw a post somewhere where a guy complained of having to have three sets of glasses for reading, phone and computer. Sheesh!

[@ckim420]

@@robmeyer7985 Between the Synergy and the PanOptix, the Synergy is *supposed* to have better contrast sensitivity, and should be less affected by pupil size, particularly in near, low light conditions. But this is all theory and at least partially from J&J's own marketing materials, so take it with a grain of salt. I'm going in on Monday and still leaning towards Synergy due to contrast and material of the IOL itself, but man, it's an agonizing decision.

[@robmeyer7985]

@@ckim420 Best of luck to you, Sparks. It seems the Synergy is a good option for you, given its greater contrast rating (MTF-50). If you decide to go with the PanOptics that should also be a winner. I face the same tough decision. The posts that I've seen suggest that outcomes are highly dependent on individual patients' eyes. You seem to be a young man and can expect a good outcome regardless. Let us know how it works out!

[@sougatah]

Thank you so much for this wonderful video. I am a phaco surgeon. What are your reservations in choosing either of the lenses after going through a biometry report? I mean, is there any parameter for which you would rather go for a monofocal one? Dr Sougata Halder, India

[@michaeltyrrell7123]

Now I'd like to know how the Vivity lens compares with the J&J Eyhance IOL.

[@kickstand2438]

Thanks for these excellent videos. I'm 58 and wear multifocal contacts which work really well for me. A few years ago i switched one eye to cooper biofinity (-4.25 add 2) and the other to Bausch & Lomb (-3.50 high). The two brands helped me see better up close than either brand in both eyes. So I'm wondering if you ever mix brands when doing this surgery and if so, does it have good results? Also, since I'm used to multifocal contacts, will that help with the adjustment to these lenses? I'm in the Phoenix area and have made appointments at two local doctors - looking forward to being contact / glasses free.

[@kandiecandelaria3134]

I got the synergy toric lens and am very happy with it. There were halos at first, now they are a little less and more like small star bursts. I am 5 weeks post op.

[@ShannonWongMD]

GOOD.

[@kandiecandelaria3134]

@@ShannonWongMD question? First surgery great, second one painful. Is the synergy lens thicker than the Vivity?

[@markmw123]

Thanks this is VERY informative……have been contemplating Lens Replacement surgery for sometime now but, have been told I’m high risk so keep putting off hoping lenses and technology will improve to the point I can have the surgery plus a longer time to save up 💰💰💰 are these brands of lenses available in the UK? Perhaps you can give an updated video in 2023 👍

[@javl7421]

Hello Dr. Shannon. I would like to know if will be of any benefit to gain image quality the Vivity len for my far vision and the Synergy on the other eye to gain middle and reading.Or if will just be better to go with Synergy on the two eyes. Please, let me know.

[@JOCMEE]

Another Great video Dr Wong ! Have you had any patient with my scenario: ? 18 months ago I had clear Symphonies implanted , Im 52, eyes are hyperopic with astigmatism, RE weaker +6/-2.25 with max 20/30 corrected(toric), LE +4/-1.25. . With symphony achieved plano, toric had to be rotated 15deg after 2 weeks. LE 20/20 near/med/far RE 20/30 near/med 20/35 far. (very far is not crisp on any eye, i.e. far road signs). Extreme light sensitivity, often headache, halos around any lightsource , switched out all light bulbs, wear bluelight glasses indoors, moisturizing drops 2x day, always sunglasses outdoors, turned down TV's and monitors to min light and applied any bluelight filters. Problems visiting friends houses. Did any of your patients experience this and was anyone fixed with explantation, and with what lenses and what type of results ? What is your opinion Dr Wong (i know you have not examined me, just based upon experience/statistics) ? I have normal pupils. I made the choice for Symphony to get rid of glasses (readers accepted for min text). I work at computer screens. Rarely night driving. All the Best, John

[@jackhardt1]

AA+ video, Thank you

[@user-de1kn1wb5g]

Same here

[@tomwiles]

Thanks for the lens comparison. My cataract surgery is coming up very soon and I've been consuming hundreds of videos to try to determine which type of lens would be best. I'm a 66 year old over-the-road truck driver and do spend substantial amounts of time driving at night as well as during the day. With the presence of cataracts, particularly in my left eye, I experience glare and some starbursts at night. I feel as if my left eye has a bit of film over it even in the daytime. The left eye's distance vision is noticeably more blurry even with correction. That being said, even with my currently degraded vision, nighttime driving doesn't bother me in the least. Depending on what my Ophthalmologist says I'm currently leaning towards either Panoptix or Synergy lenses. I'd really like to ditch the reading glasses and contacts if possible! My surgeon will do both eyes at the same time, but I believe it would be more prudent from my own living-in-a-truck post-op management standpoint to do one at a time over a couple of months.

[@ShannonWongMD]

For truck drivers or occupations that require night time driving, you should understand that there will be a halo seen around oncoming headlights and with traffic lights and brake lights with a synergy or panoptix lens. So, I would not recommend same-day surgery to both eyes with cataract or lens replacement surgery. If you want to avoid or minimize night halos, then the vivity lens is worth considering. With the synergy and panoptix, you will have better reading vision without glasses than the vivity. There is no perfect lens. I would do one eye on one day with the lens that will deliver the vision that you are striving for, assess the outcome, then make a decision for the second eye to be corrected on a later date. Good luck.

[@dbd73310]

@@ShannonWongMD Have you tried mixing a distance only toric or monofocal in their dominant eye, and then a panoptix/synergy/tecnis multifocal in their non dominant eye for truck drivers and those with significant night time driving needs or who are afraid of haloes? I have done this in many truck drivers and others with high night time driving needs and they seem to do exceedingly well with it able to see at the expected near and/or intermediate distances, and no one yet has had any trouble with haloes affecting their driving. Something to consider trying for patients with that need if you haven't already tried it.

[@ShannonWongMD]

@@dbd73310 Been there. Done that. It works.

[@tomwiles]

@@ShannonWongMD I really appreciate the reply. Depending on my surgeon's input I am likely going to go for the Panoptix in my left eye and then reassess things about a month post-op. The cataract in the left eye does annoy me, but isn't considered bad enough for Medicare reimbursement, which I have yet to sign up for anyway. The right eye can experience glare with large white signs at night, though not nearly as pronounced as with the left. So far the right eye can still be corrected to a sharp 20/20 for distance with a -1.5 contact lens. The identical proscribed -1.5 contact in the left eye is still blurred at distance due to the cataract. I am happy to pay for the entire thing out-of-pocket. Thanks for putting the effort into making very useful and enjoyable videos.

[@tomwiles]

@@dbd73310 This is a good option for me to consider, perhaps a Vivity lens in my dominant right eye at the later date.

[@dianagiam]

Dr Wong, I finally found the answer I want from this video. I can see my own cosmetic reflection in my left dominant eye!! Is this cosmetic reflection the reason for the haziness in the near vision?

[@enduroexperiencedanko521]

Dr. Wong after a successful vitrectomy is it better to implant synergy or eyhance? thank you

[@tsbrownie]

Dr Wong, what do you think of the light adjustable lenses such as RxSight?

[@ShannonWongMD]

We do not offer the light adjustable lens.

[@physics4290]

I haven't seen any videos on this subject where there has been any mention of optic nerve head drusen (with associated visual field abnormalities) as a preexisting condition. When peripheral vision is already compromised by visual field defects, and there is already less night vision, are multifocal implants a good idea? The other thing I don't hear mentioned is the requirement for someone to accompany you to these appointments and drive you home. Why can't a patient just arrange for a taxi? For patients who want monofocal near vision, is it possible to have eyeglasses for distance vision made ahead of time? Can they make glasses with distance on top and a clear bottom?

[@chrischamberlain7628]

If someone has the vivity lense can they have one eye under corrected so they can read, look at a menu, read a text etc? Also, is this the lense that medicare pays for where there is no additional charge? The one optician on your video said people who had the panoptic appeared to see better at a distance than the synergy lense. But, you said you would choose the synergy. I don’t like the sound of the halos at night & possibly taking away any night driving, and I also don’t like how the panoptic lense can be seen in the eyes at certain angles. I think that would look very strange. I also am very near sighted with astigmatism.

[@snc122]

Panoptix near vision is 16” and Synergy is 13”. But my arm doesn’t even reach that far. I would call these distances intermediate vision. Now, with my natural lens I read everything at 5 inch distance, and I am happy with it. So apparently I will lose my near vision with Panoptix and Synergy. How about if I have monofocal adjusted for near vision, then I use glasses for far away? I am near sighted with perfect near vision.

[@bobbya9037]

Which lens options are for high prescription correction for nearsightedness

[@kseniyalisamen8263]

Hello. Thanks for your presentations. I have a question? Which of these IOLs would you choose for a patient with high myopia?

[@saeidsaeidi-cf6nz]

Dear Dr Wong, I have surgery for my left eye within 36 hours and my doctor suggested me vivity to avoid holes at night and suggested to have synergy in my other eye to see close better and see less holos. Because my job needs a good vision in all distances. Now, I have a question and I’ll appreciate it if you answer it: Using to different lens will fade the problems and give me less holos and ability to read without glasses, or it will make more issues by seeing holos and having not a good close vision? Thank you.

[@jfbaro2]

Thanks Dr. Please, is there anything like UNR844 (discontinued by Novartis) that is being researched?

[@KSunshine]

Great and very informative video, thanks. I just got the Symfony Toric lens on my right eye 3 weeks ago and my far vision is still blury. Aren't we suppose to see well after 7 days according to your chart?

[@LifeIt360]

My mom had similar situation...She was happy with near after 2 days and then ..after few months she started to see very clear far distance.

[@mariahlivingston490]

I have optic chiasm do to a pituitary tumor damaging the optic nerve, I'm in like a tunnel I can see close with no problem. Is either one of this lens would work for me? # would medical insurance cover this procedure? #Help#

[@yesenia7950]

Any suggestions please on Monofocal iols that are good and don’t have the cat-eye cosmetic reflection? I was initially recommended the Clareon then i mentioned the cosmetic reflection and they switched me to EnVista lens but when I got home I read that iol also has a high refractive index. it’s very confusing, any help is appreciated since my cataract is advanced and I have to have the surgery done soon.

[@gaillipson9281]

Question: the PanOptix is a trifocal, and not really analogous to a progressive spectacle lens. Are there "gaps" between the focal points that are noticeable to the patient? I'd guess this could not be a problem for the Synergy.

[@nhatnguyen2879]

I had surgery cataract 2013 now the lenses dislocated in the eye I have go Dr take out the lense because can't put it back now wait to heal my eye what kink of lense should I decide to put just advice please

[@michaellewis120]

Have you used Synergy Toric II? How does it compare?

[@WigendaReacts]

Sir i love u from india ❤️

[@JamesWilliams-sx8dh]

I'm 53 and have a cataract in my left eye. Dr said let's do surgery when you are tired of it. I am also being treated for glaucoma with drops. Would the multifocal lens work for me?

[@smozdemir]

Dr. Wong, thank you for your videos. I am a fan of this channel already. I have mild nystagmus. Can nystagmus patients have premium lens surgery? Do you have any statistics on the success rate of nystagmus patients. I would love a video on nystagmus and lens surgery.

[@ShannonWongMD]

Patients with nystagmus usually have slightly compromised best correctable visual acuity. For example, if your best correctable visual acuity was 20/30 with glasses when you were in your 20's, then the best you should expect to see with lens replacement/cataract surgery is 20/30.

[@dr.natarajant2668]

Dr. Natarajan, 52 yrs)male, anaesthetist and intensivist . H/O RK in 1994. Presbyopic +2.25 myopic -0.75 astigmatism 150° . Drive in the night to the hospital. I don't like to wear glasses. Suggest me the best premium IOL for me. Planning IOL in 10days time

[@jamieolson287]

Have you had any patient with the panoptix lens have constant "flickering" on the temporal side? I have that anytime my eye moves! Especially reading. After 3 months of that and poor vision at all ranges, and having to wear my old gkasses, I want an exchange. Thanks for all your videos.

[@user-qe1gi9hp7y]

Hi. Can u answer this question please? My story: Say 10 plus years a go I had my right eye cataract removed. After surgery, 3 days later surgeon removed bandages I was able to see clearly right away but double vision . Yes my left ieye had become lazy. Back than but after it corrected no more lazy eye. Luckily my vision corrected aon its own so both eyes worked very well no glases no glare no short Orr long distance issue. I went back to same surgeon last month for left eye. Yes I haD cataract in left eye even than was recommended to have it removed but I have waited 10 plus years yes my left I was very developed dense cataract. Removed bandaid 1 day latter absolutely no vision as if no surgery was performed I. My left eye. 5 days after surgery I have gained vision gradually has gotten better now 11 th day. However, left eye has the generic lense I chose, whatever my insurance paid. Since my right eye also has a simple lense from 10 years plus Now left eye yes was told by surgeon more astigmatism than right eye R is ..7 and l is 1.7 astigmatism. With normal lense I have 11 since my right eye has a near and far distance is vibrantly but no clarity in Either short or long distance. With both eyes I can see 20/15 to 20/20. But left eye I have only sharpness no details on short or long term. Can u help with this problem I need bifocals on left eye or need to put in multiform lense re cataract surgery?

[@Pras280]

Sir My self prashant 27 years I have done PRK surgery in the year 2017 and my vision not cleared and seeing double vision later I went to another hospital for second opinion they said that I have blue dot cataract by birth from 2 years I am using power glasses Present my eye sight is Right : 2.5 and Cylindrical power -3.50 and left - 2 , Cylindrical power - - 3,Sir my request is to which lenses you prefer sir

[@dgpretzel]

Dr. Wong, Might you be able to comment on whether conditions such as high myopia (-7) or lattice degeneration are factors which affect the choice of a premium IOL, such as Synergy or Panoptix?

[@ShannonWongMD]

If your macula is normal, then all intraocular lenses are valid options.

[@schibilio]

what about Previous RK and later lasik? Also are you considering Light adjustable lenses?

[@shekharangolkar587]

I had undergone Radial keratomy in 1994 by blade .Now I have cataract in left eye. Whether laser is advisable in my case.

[@user-sf7cc6se7l]

Dear Dr. Wong. Do you apply the "maximum plus technique " while considering Synergy IOL. Your team Panoptix optometrist mentioned the blurry far vision so I'm just curious about the way you handle the Synergy calculatio. Thanks for the effort you put.

[@ShannonWongMD]

I target the closest refraction to plano.

[@k.ramachandrankrishnasamy2777]

targeting iol power first plus will help to see better near to distance

[@physics4290]

How often do you do only one eye, or do the eyes some years apart?

[@HCC747]

I enjoyed your video. Very informative as I am considering soon having cataract laser surgery. I'm 66 years old andI have had both RK and Lasik done years ago. I also have some astigmatism. Have you had any patients with all these conditions?

[@ShannonWongMD]

Every surgical day we operate on patients that have had prior RK and prior LASIK and often time both procedures.

[@HCC747]

@@ShannonWongMD Thank you Dr. Shannon; That gives me confidence that I have a fair chance to benefit from laser assisted surgery and maybe a Vivity lens.

[@getyogeshraichura]

Hello Sir. My father recently got treated for catract and as per doctor's advise and our best judgment, we opted for Symfony Toric lens on one eye and Synergy in the other. I am from India and the Toric lens in Synergy isn't launched here yet. So we chose the best available lenses in India for both eyes. Now, I wonder if choosing symfony for both eyes would have been better. Even though synergy is more advanced that symfony, but i m left to wonder if i have taken a wrong decision in pursuit of the best. I hope making sense. Please tell me if choosing symfony in both would have been better or Synergy and Symfony is better

[@drj6418]

Wonderful video as always. Many of my colleagues are now using the Tecnis Eyhance as their go-to monofocal IOL. Would you be kind enough to comment on this IOL. As a myope my surgeon is planning to use the Eyhance and leave me at hopefully -2.00 diopters as most myopes prefer to stay myopes and I understand that I will need glasses for distance and I am OK with this. Comments if you would, sir, please?

[@ShannonWongMD]

If you are a -2.00 myope naturally, then having an enhance or monofocal lens to keep you a -2.00 myope would be reasonable. Alternatively, you could have a synergy/panoptix to give you the near vision of a -2.00 diopter myope AND great far vision. Just a thought.

[@bp-ob8ic]

Going for my first consult tomorrow ... what questions should ask?

[@patriciaheath4587]

Dr Wong. Thank you so much for these on-going enlightening videos. As an aging 77 year old that is just now qulaifying for cataract surgery, I am ready to ask for the Panoptics Toric for my left eye( mid level astigmatism) and the Synergy for my dominate right eye (low level astigmatism). I do a lot of reading and computer work and would expect that the difference in the 15" and 13" focal points would allow me to be in focus in one eye for each of the activities. Would you recommend such a procedure?

[@ShannonWongMD]

The panoptix gives slightly sharper far vision than the synergy. The synergy gives slightly better near vision than the panoptix. Combining the two lenses can work well. In patients that I have combined these two lenses - panoptix in one eye and synergy in the other eye - the vision seems comparable to the patient.

[@patriciaheath4587]

@@ShannonWongMD Thanks for your advice

[@patriciaheath4587]

@@ShannonWongMD I went to a different surgeon today who had not used the Synergy lenses but when I asked about using a synergy in one eye and the Panoptix in the other he did not recommend it and said it would confuse the "brain". Sounded to me like BS. He also said that he could correct the astigmatism with his laser instead of needing the PanOptix Toric. He acted offended when I asked about it which makes me unsure of his advice. Difficult to know the right questions to ask to decide between surgeons.

[@nathandenkin2103]

At 74 I had PanOptix Toric lenses implanted in both eyes and see no real difference in focus at 13" and 15". I suspect any practical advantage of implanting two different IOLs would be less than the effects introduced by the surgeon. I like having binocular vision again (after cataracts!) and I can't complain about 20/15 at distance and J1 for reading. I suspect that halos and starbursts may vary a lot from person.

[@gregsides3572]

Interested in your reference to epiretinal membrane. I have mild, non-puckered epiretinal membrane in my left eye and Dr. does not want to use Panoptix in that eye, recommends Vivity in left and Panoptix in right. I prefer bilateral lens use for more consistent vision and eyeglass independence. Generally, what is the problem in using Panoptix in an eye with epiretinal membrane?

[@ShannonWongMD]

An epiretinal membrane can or may limit the vision improvement after cataract surgery with any intraocular lens.

[@SensSword]

Love the videos. However I'm a guy with massive myopia and glaucoma. I'm not even forty. I'd like to hear more about edge cases like me. Can any of us help you elucidate on these sort of things?

[@KC-qn4nl]

Hi doctor Wong, Having tired of putting reading glasses on and off and after watching the video about the cataract surgery on your own eye, I decided a year ago to have my left eye replaced a Panoptix lens. The near vision is excellent, mid vision is ok and far vision is bad (blurry with shadow). But with the help of my natural right eye (slightly farsighted) I am good for all visions and very happy with it. Recently I noticed my natural eye’s near vision declined significantly. Before the words remained individually (Chinese), now they linked together like Arabic…. What happened doctor? Will it affect the result if one day I have my natural eye’s lens replaced? Which lens would you recommend in this case? Thank you.

[@KC-qn4nl]

Oh mid- range means computer not TV, then that’s excellent too. Sorry.

[@emmaqueen8935]

Hello doctor I asked my doctor about this lens. But she said it’s a multi focal lens which is in general contraindicated in eyes with iritis. I had uveitis in past and had cataract surgery. I hate cosmetic appearance of my Alcon lens as I have very large pupil. Is there any chance for me to get a replacement? And where are you located in USA?

[@ShannonWongMD]

Uveitis is not a contraindication for a multifocal lens.

[@ektalon1]

First, thank you Dr. Wong for this and your other excellent videos. I had a Vivity lens placed in my right, dominant eye with cataract surgery and am very happy with it. Now realize that I do not want to deal with reading glasses. I am debating going with a monodical lens in the left eye for near vision, or a PanOptix lens, with the possible glare/halo/starburst issues. Do you ever do IOL and monofocal lens for an approximate monovision result?

[@ShannonWongMD]

Either option that you mention may work. If you have never experienced mono vision, then I would be reluctant to set your 2nd eye for near with a monofocal IOL unless you are willing to wear glasses full-time if you don't like the imbalance between the two eyes. A panoptix for the 2nd eye would be a great option in my opinion. You will see halos around lights at night with the panoptix. However, because you have a vivity in the other eye, the halo effect will be modest.

[@ektalon1]

@@ShannonWongMD Thank you, Doctor.

[@ektalon1]

Dr. Wong, I have not seen a discussion by you on the Crystalens. Do you use it? If so, when is it beneficial. Once again, I am debating the lens to get for near vision for my non-dominant left eye. The right has a Vivity and I am very satisfied with it. Thanks.

[@bradleykatz4861]

Dr. Wong, with Symfony I have been targeting -0.1 to -0.2 with my IOL calculations. Are you doing the same with Synergy or are you shooting for emmetropia?

[@ShannonWongMD]

The synergy works best if the refraction is plano to +0.25. Patients do not like to be -0.25 with synergy. Panoptix on the other hand works well if the patient is +0.25 to -0.25. For symfony (which I no longer use), I target plano to -0.50.

[@taragibbons6616]

Are the costs of both Panoptix and Synergy the same?

[@sharmahw]

Ist time cataract surgery with Panoptix in left eye 1 week ago. Night time driving is nightmare...Halos, Spiders... priority is computing as I am in IT and almost spend 15 hrs everyday...Surgeon says try Synergy. Have you done mix of Panoptix and Synergy? I love your videos. Thank You.

[@ShannonWongMD]

Maybe consider the vivity lens for your 2nd eye?

[@sharmahw]

@@ShannonWongMD Surgeon did propose Vivity but agreed if I am spending time on small print in 12 inch tablets all day, Synergy has better near vision and contrast. Halos etc will become tolerable with time.

[@jayholiday256]

I’m getting a synergy for my reading eye to compliment my distance eye which has a symfony. My doctor says that’s better than panoptix for near vision

[@Luis-df2kt]

Dr. Wong, what is your opinion of the RayOne EMV?

[@ShannonWongMD]

Never used it. Don't think it is FDA approved in the USA?

[@vasionok]

I was wondering you have an opinion about monofocal IOLs. It seems they give a better visual quality at the expense of needing glasses. Some of the patients with Panoptix say they feel more comfortable to use glasses when working on computer, even though they can see clearly without glasses. This may have something to do with Panoptix using 50% of the light for the distance vision and only 25% for each of the two other focal distances. If I spend most of the day working with computer, then monofocals might be a better option?

[@ShannonWongMD]

The vivity lens may be an even better option than a monofocal if you stare at a computer all day long. Vivity gives a broader range of focus - far and mid-range - than a monofocal which is far only.

[@Phw239]

Hello Dr what is your opinion about TECNIS EYHANCE TORIC II IOL which will correct astigmatism and give long and intermediate clear vision without glare halos or low contrast sensitivity. Reading glasses must for near vision. We were told that we are good candidates for Toric multi focal lens implant but because of the halos glare and low contrast the Trifocal makes we would like to opt for EYHANCE.

[@Dakol-1]

I've watched a number of these videos and its seems mixing different types of lens is the way to go. What are your thoughts about this?

[@ShannonWongMD]

Mixing different lens types is a good option.

[@reaganenglish]

Enjoy your videos

[@n3evpn3evp]

Would a polarized lens reduce or eliminate the "halo" seen on these lenses during night with a bright light ??

[@ShannonWongMD]

No.

[@steveneese4210]

Does the pupil size play a role in lens selection. I have small pupils.

[@ShannonWongMD]

The smaller the pupil, the better the vision and depth/range of focus. So, in general, the patients with small pupils see better with all lenses.

[@BC-qs5pu]

Hello Dr Wong, Thank you for your excellent video report and analysis of PanOptix vs Synergy. Since July I have been looking into getting a Synergy IOL in my right eye. I already have an Acrysof IQ Toric in the left. The results in your report surprised me, based on earlier reports that I had seen. Your report in this video rated the two all As for vision quality at far, mid, and near distances. Could you please comment on two issues I had heard several months ago that started me looking at Synergy? 1) “Synergy has better near vision performance than PanOptix.” (Is this just based on the 3” difference you highlight?) 2) “Synergy has better continuous range vision vs tri-optic IOLs, like PanOptix, that have gaps.” I am also worried about the “glistening” problem with Alcon lens, which you address in this video. Like you, my ophthalmologist says he has never had a patient with this problem. Thank you for any help you can provide.

[@ShannonWongMD]

Synergy seems to give slightly better near vision than PanOptix. PanOptix seems to give slightly sharper far vision than Synergy. As of 10/21/2021, I am now using PanOptix in 50% of patients choosing a premium lens and Synergy in 50% of patients choosing a premium lens. There are subtle differences.

[@lpn06777]

Symphony?

[@kbalch]

@@ShannonWongMD So, 50/50 PanOptix and Synergy in late 2021? Where does Vivity fit in? I've read and watched a great deal of info (thanks for all of your great videos!) over the last several weeks and my interpretation is that Vivity and PanOptix both provide excellent distance and intermediate vision with the tradeoff being the necessity for near vision readers (closer than ~2') with Vivity vs. the greater prevalence of halos, etc. with PanOptix. I'm 55 years old, have cataracts (obviously), and have been severely myopic and astigmatic for my entire life. Presbyopia is also well under way at this point. :-) If I've understood all of that correctly, then I'm going to opt for Vivity bilaterally. I'd much rather minimize halos and accept the necessity for readers up close than the other way around. Provided, of course, that I can still achieve 20/20 or better in each eye individually (an FAA requirement), as well as excellent intermediate vision (for airplane panels and car dashboards). Given my requirements (and zero desire for monofocal IOLs), should I be considering Synergy, too?

[@aadjunior]

Hello, how are you? I live in Brazil and I want to undergo cataract surgery and put the Synergy Toric, but here it has not been approved by the regulatory agency (ANVISA) and there is no forecast when it will arrive here. Can I have the surgery there in the United States? If you can, could you tell me about the costs I would have if I had the surgery with you? Thank you very much for contacting us in advance. Sorry for my English, I'm using Google Translate.

[@ShannonWongMD]

If you are willing to travel to the US, you can have surgery in the US.