The PanOptix delivers distance, intermediate and near vision.

In late 2019, the AcrySof IQ PanOptix Trifocal IOL became the first and only such lens available for U.S. patients undergoing cataract surgery.

Alcon says the PanOptix delivers good vision at distance, intermediate and near without the need for spectacles.

A UNIQUE DESIGN

Built on Alcon’s AcrySof IQ IOL platform, the PanOptix uses proprietary ENLIGHTEN Optical Technology to create a diffractive lens designed to optimize light energy distribution, allowing for three focal points. A 4.5-mm diffractive zone reduces dependence on pupil size in different lighting conditions. The result, according to Alcon, is optimized intermediate vision without compromising near and distance vision.

According to the company, its design also features important differences from the other trifocals available in foreign markets.

More traditional trifocals have a near zone around 40 cm or about 15 inches, says John A. Hovanesian, MD, FACS, with an intermediate zone of approximately 80 cm, “because there’s a doubling effect when you create these multifocal zones. If one zone adds 1 diopter in power, the next zone has to add 2 diopters of power,” he explains. “So, the range of near vision would be either 80 cm — or 40 cm. Forty is good for near, but 80 cm is really too far for intermediate for most users. Through some clever optics, the folks at Alcon designed the PanOptix lens to offer an intermediate zone at 60 cm instead of 80, and still retain good optical performance at near, at 40 cm, and, of course, at distance.”

The PanOptix is available in both spherical and toric designs (the toric form can correct between about 1 D and 3 D of corneal astigmatism).

ADVANTAGES START BEFORE SURGERY

PanOptix’s advantages first manifest themselves during the presurgical consultation, according to clinicians familiar with the lens. “Patients don’t want to have a complicated conversation about their vision,” says Dr. Hovanesian, a specialist in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, Calif., and a consultant to Alcon. “They just want to see at all distances, and they want to do it binocularly like they did when they were young.”

For the first time since 2003, when presbyopia-correcting IOLs were introduced in the United States, he believes it is possible to skip that complicated conversation. With this trifocal IOL, “We don’t have to discuss monovision; we don’t have to discuss the frequent need for readers or the need for adjustments for intermediate vision,” he says. “We can tell patients they can get distance, intermediate and near, in both eyes, binocularly.” Patient conversations have been so successful that Dr. Hovanesian implanted the PanOptix bilaterally in six patients in the first month of offering the lens.

A GOOD MATCH IS STILL IMPORTANT

Not that careful patient selection is no longer necessary. Elizabeth Yeu, MD, a cornea, cataract, anterior segment and refractive surgery specialist at Virginia Eye Consultants in Norfolk, Va., and assistant professor of ophthalmology at Eastern Virginia Medical School, says managing patient expectations and choosing the right patient is still “so important.”

Appropriate candidates for the PanOptix lens should have “a more ideal ocular surface — those who have 20/20 visual integrity and potential within the macula, where we know the decline in their vision can truly be attributed to a cataract,” she says. Dr. Yeu was a clinical investigator for the PanOptix.

Dr. Hovanesian agrees that the “perfect” multifocal patient is a prime candidate for the PanOptix. However, the lens’ good performance in a variety of eyes makes him suspect it will turn out to be “more forgiving of imperfect eyes than previous multifocals. But that’s going to take some time to understand.”

NEAR-VISION EXPECTATIONS

While Dr. Yeu has found patient conversations about this IOL easier than the alternatives in the premium lens category, she says it is critical to keep expectations realistic. Although the PanOptix will enable patients to significantly reduce their need for glasses, she emphasizes that they probably will still need them for some near tasks.

“I explain that does not mean they are going to have this new ability to see in the dark, in poor lighting conditions,” Dr. Yeu says. “They are still going to need lighting to read in bed.” Likewise for tiny print, such as that on the back of a sugar packet. “Such things are not meant for us to see easily, and they won’t be seen easily without extra lighting, pulling the object back or using magnification.”

Dr. Hovanesian has found success holding a similar conversation with his patients.

“I’m not going to say no patients are using glasses for anything; I’m going to say no patients are complaining about needing glasses more than they expected,” he says.

He is also careful to discuss the possibility of glare and haloes, as he has with other multifocals. So far, though, Dr. Hovanesian says his patients have not reported those.

Even with this caveat, Dr. Yeu is confident in what the PanOptix can deliver.

“The majority of patients in this lens will be able to see from the elbow length of their arm out toward distance with a very smooth, continuous range of vision,” she says. “That functionally means a lot. That means they will be able to see their iPhones, their iPads, the dashboard, themselves when they put on makeup in the mirror, the fishing line when they cast it out or the ball when they hit it when golfing.”

SO FAR, SO GOOD

Dr. Hovanesian calls patient feedback on the IOL “remarkably positive. We’re getting J1 or J2 near; we’re getting similar at intermediate, typically 20/20 distance vision — unless the patient has some other problem with the cornea or capsule opacity or something else that would interfere.”

Dr. Yeu is seeing happy patients post-surgery as well. “Overwhelmingly, patients are extremely pleased with having this range of vision that many have not experienced in their lifetime without correction.” OM