An interview with Michael P. Jones, MD, cataract and refractive surgeon with Quantum Vision Centers in Swansea, IL

QUENTIN B. ALLEN, MD: Tell us about your personal experience with the AcrySof^® IQ PanOptix^® Trifocal Intraocular Lens. What sort of impact has this lens had on your practice?

DR. JONES: The PanOptix^® Trifocal IOL is a game-changing technology. Those who have been using prior generations of presbyopia-correcting lenses recall there was a significant learning curve—not just for surgeons, but also for staff and patients. We had to decide which lenses to implant in specific patients and whether a mix-and-match approach would be appropriate.

The PanOptix^® Trifocal IOL is really a “set it and forget it” type lens. Most patients do extremely well with it. What’s more, because the surgeon’s learning curve is minimal, our staff—and even our patients—can understand the surgeon’s confidence in it.

The transition from prior-generation presbyopia-correcting lenses to the PanOptix^® Trifocal IOL in our practice was complete and immediate as soon as the lens was released.

DR. ALLEN: What presbyopia-correcting lens were you using in your practice prior to the PanOptix^® Trifocal lens?

DR. JONES: I’ve used all types, but my go-to lens for the last several years has been the AcrySof^® IQ ReSTOR^® +2.5 multifocal IOL with Active Focus (Alcon).

DR. ALLEN: Why did you switch to the PanOptix^® Trifocal lens?

DR. JONES: With prior generations of lenses, there were often trade-offs. For example, with the Active Focus lens, the distance vision and the contrast sensitivity were fantastic, but there wasn’t quite enough add for some patients. For certain activities, it was fine, but for more detailed work, patients still needed reading glasses. The PanOptix^® lens provides full trifocal correction at these various distances with reduced need for glasses.

DR. ALLEN: The PanOptix^® lens seems to have had quite an impact across the industry.

DR. JONES: Indeed. It’s been available in Europe for some time. When we saw what it was doing for the market there, we eagerly awaited for it to be released in the United States.

What’s interesting with these products is the market usually dictates what’s working. If something is working and it starts dominating a market, there’s a reason for it.

We talked with the surgeons who were involved with the trial and listened to their stories about their patients and how excited they were. As soon as the FDA approved it—within the next day—we had already switched patients in our practice to the PanOptix^® lens, and we haven’t looked back.

DR. ALLEN: Incorporating a new presbyopia-correcting lens into a busy ophthalmology practice can often be a daunting task. However, in my experience with the PanOptix^® Trifocal IOL, it has not been as difficult as I might expect for this sort of groundbreaking technology.

What has your experience with PanOptix^® been in terms of integrating the lens into your practice?

DR. JONES: Incorporating the PanOptix^® lens into my practice has been seamless. First, as it’s based on Alcon’s AcrySof^® lens platform, I was very comfortable implanting it during surgery. More importantly, it delivers on its promise of full range of vision. I’m more confident recommending it to patients.

DR. ALLEN: Let’s shift gears and discuss the patient’s experience. Who is an ideal candidate for the PanOptix^® Trifocal lens?

DR. JONES: I look for patients who don’t have any other significant ocular pathology that may limit their visual outcome. One factor that is often overlooked is the effect of dry eye on patients after cataract surgery. Before implanting any presbyopia-correcting lens, we need to make sure we have their ocular surface as tuned up as possible. Then, I look for motivated patients whose goal is to minimize their need for eyeglasses after surgery. The ideal candidate has a normal, healthy eye and is motivated to reach this goal.

DR. ALLEN: What surgical tips and advice would you give to surgeons who want to start using this lens?

DR. JONES: My surgical advice actually starts in the office with the patient. It’s critical to have a conversation about the patient’s goals after cataract surgery and make sure you’re both on the same page. It doesn’t matter how technologically advanced a lens is if you and the patient have disparate goals.

Let’s assume everyone’s on the same page, and the patient has decided he wants a lens that will fully correct his vision at all distances with minimal use of eyeglasses. For me, the answer is obvious—the PanOptix^® IOL with trifocal technology—because I’ve had consistently good results with this lens.

DR. ALLEN: What formulas are you using to calculate for spherical power and astigmatism?

DR. JONES: I use the Barrett II formula for spherical power, and I use Alcon’s Toric Calculator for astigmatism. However, I defer to ORA to justify those measurements during surgery.

DR. ALLEN: Do you regularly use intraoperative aberrometry?

DR. JONES: When implanting the PanOptix^® Trifocal lens or any presbyopia-correcting IOL, I strongly recommend that you use intraoperative aberrometry to ensure an accurate refractive outcome. If you don’t use intraoperative aberrometry, make sure you have the means to correct or enhance the patient’s prescription afterwards to achieve your preoperative refractive goals. I’ve seen quite a few second-opinion patients who were unhappy with their presbyopia-correcting lenses when all they needed was a touch-up to address some residual prescription.

DR. ALLEN: With some presbyopia-correcting IOLs, surgeons purposely aim for a little minus to help with near vision. Is that something you consider with the PanOptix^® lens?

DR. JONES: With the PanOptix^® lens, I try to aim for emmetropia based on my ORA measurements. If perfect emmetropia is not a choice, I would choose the IOL that would be closest to emmetropia, but on the minus side.

DR. ALLEN: What one word would you use to describe the patient’s experience after having had the PanOptix^® Trifocal IOL implanted?

DR. JONES: The word I’ve always used is natural. In my experience, this lens is a natural way for patients to see. It’s not artificial like with some of the older-generation multifocals with strict zones of vision. It’s the vision patients remember from when they were younger.

DR. ALLEN: Recommending the PanOptix^® Trifocal lens seems almost like a no-brainer.

DR. JONES: When you have that all-important conversation with patients about their goals and find out they want to minimize their use of eyeglasses at all distances, there’s no doubt in my mind that this is the lens you need to be offering. •