Alcon PanOptix trifocal lens

What is the Alcon PanOptix trifocal lens?

For many years, both patients and ophthalmologists have wanted a trifocal lens that could be implanted at the time of cataract surgery. The ideal trifocal lens would correct vision at near, intermediate and far distance for the greatest breadth of spectacle free vision. Dr. Gicheru has seen this lens internationally and has been waiting for it for 5 years. That option is finally here. In 2019, the FDA approved the Alcon AcrySof IQ PanOptix trifocal intraocular lens. It is the first and only FDA-approved trifocal lens.

What is Presbyopia and the 3 zones of vision?

Presbyopia is an age-related deterioration of the natural lens of the eye, which results in worsening near vision. It typically occurs at age 40 and worsens with time.

Typically, with Cataract surgery or Refractive Lens exchange, we think of vision at 3 zones: near, intermediate and far distance. With the PanOptix lens, we can confidently provide this for our patients.

With the other commercially available lenses, there are 2 non-ideal workarounds:

  1. Use an EDOF(extended depth of focus) lens in both eyes and intentionally leave one eye slightly myopic: the problem is the myopic eye is blurred for far distance.
  2. Mix and match lenses using an intermediate-biased lens in one eye and a near-biased eye in the other eye: the problem is 1st eye has trouble with near and the 2nd eye has trouble with intermediate distance.

But now, we have a lens that can provide near, intermediate and far distance vision in each eye: The Alcon PanOptix trifocal lens. It is now available at LaserCare Eye Center.

Why is LaserCare Eye Center excited about the Alcon PanOptix trifocal lens?

The Alcon ReSTOR was a multifocal lens that was first approved in 2004. Over the years, the surgeons at LaserCare Eye Center used all the various iterations of the ReSTOR (Restor 4.0, 3.0 and 2.5) lens with a lot of success and each iteration was better. Recently, the improvements have been small and incremental. But now, we have the PanOptix trifocal lens which offers near, intermediate and far distance in each eye. Effective immediately, at LaserCare Eye Center, the PanOptix lens will be the lens of choice for patients wanting maximal freedom from glasses.

Even though the PanOptix lens is new to the U.S., it is part of the Alcon AcrySof lens platform, which has been implanted in over 120 million patients. Further, the PanOptix has been available in Europe, Asia and the rest of the world for over 3 years.

What is the advantage of the PanOptix trifocal lens compared to AMO Technis Symfony?

In 2019, the Alcon PanOptix became the first trifocal intraocular lens (IOL) to be FDA approved in the US. PanOptix offers true correction of vision at near, intermediate and far distance.

Regardless of what you may hear, the Symfony is not a trifocal lens. The Symfony is an EDOF (extended depth of focus) lens that has been available in the US recently. While EDOF lenses provide far and intermediate distance vision, they usually do not provide optimal near vision. In some cases, the doctor will leave one eye slightly myopic to provide better reading vision, but this results in reduced distance vision in that eye4. In other cases, the surgeon will mix and match with an older generation lens that is more near-biased4.

But don’t take our word for it. Look at the research:

One clinical research paper1 from Europe concluded “The PanOptix and Symfony IOLs showed comparable visual performance at distance and intermediate. However, the PanOptix IOL provided better near and preferred reading distance visual acuities and showed a more continuous range of vision than the Symfony IOL”.

In another clinical research project2, the Panoptix trifocal IOL was compared to Technis Symfony and the FineVision Micro F, another Trifocal IOL that is not available in the US. The authors found “All three IOLs provided good visual acuity at all distances, a high percentage of spectacle independence, and little or no impact of visual symptoms on the patients’ daily functioning. Near vision was statistically better for both trifocal IOLs (PanOptix) compared to the EDOF IOL (Symfony).”

If you are okay with just intermediate and distance vision and never read, an EDOF lens such as Technis Symfony may be okay. If you require near vision, in addition to intermediate and distance vision, then the Alcon PanOptix lens is your lens. Be sure to make sure your surgeon offers the lens and is experienced using the AcrySof platform lenses, including the ReSTOR. You can be confident about the surgeons at LaserCare Eye Center since we have used the ReSTOR since 2004.

What is the advantage of the PanOptix trifocal lens compared to the Alcon ReSTOR?

The ReSTOR lens has been our go-to lens implant at LaserCare Eye Center for patients wanting vision at near and far. It comes in 2 versions: The ReSTOR 2.5 is optimized for far and intermediate vision and the ReSTOR 3.0 is optimized far and near vision. To provide great vision at all 3 zones, we usually would mix and match the lenses: Restor 2.5 in the dominant eye and ReSTOR 3.0 in the nondominant eye4.

With the PanOptix, we can correct vision at all 3 zones with one lens in both eyes. Additionally, the Panoptix is a non-apodized diffractive lens so its ability to focus is independent of pupil size. The ReSTOR is an apodized diffractive lens and thus it works better in patients with smaller pupils.

What is the advantage of the PanOptix trifocal compared to Crystalens?

The PanOptix trifocal lens, which was recently FDA approved, allows excellent near, intermediate and far distance vision.

On the other hand, the Crystalens is an accommodating IOL with FDA approval dating back to 2003. The lens was designed to flex with your focusing muscles to provide vision at near. The challenge was the natural bag that holds the Crystalens tended to scar sometimes resulting in reduced ability to flex. There are many reports of variable and suboptimal near vision with Crystalens.

How to select the lens implant for your surgery?

The decision about which lens implant to select for your cataract surgery or refractive lens exchange is important and should only be made after consultation between the patient and their surgeon. In terms of selecting a surgeon, you want to select one with experience and also experienced in the lens platform you are interested in.

Please remember the following:

  1. The Alcon PanOptix is the first and only FDA-approved trifocal IOL. It provides excellent near, intermediate and far distance vision.
  2. It does this without the need to undercorrect one eye as is sometimes done with Symfony and Crystalens4.
  3. It does this using similar lenses in both eyes and without mixing and matching lenses as is sometimes done with Symfony, Restor and Crystalens4.
  4. The Surgeons at LaserCare Eye Center are not only experienced with PanOptix but also with the Alcon AcrySof lens platform that preceded the PanOptix trifocal IOL.

References

  1. A comparative study of the visual outcomes between a new trifocal and an extended depth of focus intraocular lens. Eur J Ophthalmol. 2018 Mar;28(2):182-187. doi: 10.5301/ejo.5001029. Epub 2017 Aug 9.
  2. A Comparative Evaluation of a New Generation of Diffractive Trifocal and Extended Depth of Focus Intraocular Lenses. Ruiz-Mesa R1, Abengózar-Vela A1, Ruiz-Santos M1. Beatrice Cochener, MD, PhD; Guillaume Boutillier, MD; Mathieu Lamard, PhD; Claire Auberger-Zagnoli, MD. Journal of Refractive Surgery. 2018;34(8):507-514
  3. The use of the Alcon PanOptix trifocal lens for Refractive lens exchange is an off-label use of the lens.
  4. Mixing and matching and leaving one eye myopic as workarounds are off-label use of the above lenses.
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