For the last 55 years I’ve worn contact lenses of various sorts. Initially it was “hard” lenses, and since 1985 or so it was soft lenses. I’ve had great results. As I’ve neared my 80th year, my eyes are drier and my lenses are increasingly difficult to remove at the end of the day. It may take as many as 10 attempts to kind of “scrape” each one off my eyeball. Probably not healthy. And as my hands get unsteady with age, I feel I’m increasingly likely to poke myself in the eye when inserting a lens in the morning.

During an eye examination a year or so ago, the doctor mentioned that I am developing cataracts in both eyes. I don’t experience any of the serious typical effects like poor night vision or cloudiness, so it really is not affecting my functioning, but it does mean that I am a legitimate candidate for cataract surgery. This procedure removes the natural lens from the eye and replaces it with a clear artificial lens. It can also correct for near-sightedness, which is why I wore contact lenses in the first place.

So I went onto my doctor’s schedule for cataract surgery, with the target date being April 8. My right eye will be modified on the 8th, and my left eye two weeks later.

The doctor provided several choices in terms of type of implanted lens. (These are generically called Intra Ocular Lens or IOL.) It seemed to me that the most common was to have one eye corrected for a distant version, and the other eye corrected for near vision. The goal there being to get the best possible result for each eye separately by using a monofocal lens in each case. That gives a sharpest correction to vision following surgery.

But he also offered me the option of an IOL specially crafted to provide three ranges of correction — near, medium and distant — all in the same lens. The common trifocal glass lens, which many people wear in their spectacles, is another way to address this. But this IOL, unlike spectacles, doesn’t require moving the head or adjusting eye angles to change its focus. Instead, it uses a ring shaped pattern on the IOL that provides all three ranges or focal lengths to the retina at the same time. The brain deciphers the three incoming images and “sees“ only one distance at a time. My understanding is that the brain learns to ignore the two that are irrelevant and pay attention only to the appropriate distance at any one time. Apparently, the brain and the eye work this way all the time, but it seemed a bit like magic to me and I look forward to exploring it and describing the process.,

Thus, this series of posts about my experience with the Panoptix Pro IOL.

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The surgeon who did my procedure operates only on Thursdays, and the schedules are set many months ahead. (In my case it was about five months ahead.) On each Thursday,they schedule the patients about a half hour apart, starting very early. They phoned me the day before my procedure and asked me to arrive at 6am for a 7:30 surgery time. Insanely early for me! I pleaded for a later start time. No success.

Several hours later, however, they called me and offered a 10:30 arrival. Took it.

On Thursday I arrived at 10:30 bright and shiny, all rested up, and dressed casually. Because it’s just the eye, they suggest comfortable clothing and short sleves (for ease in placing an I.V.). You’ll recall I had bladder cancer in 2016 and many procedures with I.V., so although I still don’t enjoy them, they’re not a terrible experience. The I.V. is necessary because they administer some light anaesthetic… aparently a benzodiazepine (like valium) and a pain-killer (like fentanyl). I have experience with both of those (from other minor surgical procedures). and I know I stay conscious and I remember a little more than expected. So I looked forward to experiencing the procedure and reporting on it.

Close Encounters — So after the I.V. is placed and they give me some time to just cool my jets waiting, they come to take me away. They’ve now put me flat on my back on the gurney and they wheel me like Mr. Toad’s Wild Ride down the hall and around a corner (don’t fall off!) to another hall, then left into the procedure room. They station me under the equipment which seems to be mobile on a sturdy “arm” — they bring the arm right over my face, center it over the eye. The business end of the apparatus appears to me a bit like the flying saucer in Close Encounters of the Third Kind with bright lights in a somewhat circular pattern above my face. Down it comes until almost touching. It occurs to me to become claustrophobic, but the medications nicely prevent that. It seems to me I’m remembering every moment.

First they remove my natural lens. I believe they used ultrasound. Looking upward thru the center of the lights, it seems to me like an ink blot appears in the center of my vision and spreads out a bit. Then they “blot” around the edges of that blackness until the center is pretty much darkened out. Then I hear “You’ll feel some pressure“ and yes, indeed I do feel him pressing on my eye. Then a kind of squishy visual moves in as he inserts the new IOL (lens) via a tiny incision. There are some fuzzy images, but quickly those go away as a small surgical dressing and plastic bubble are taped over the eye. To be removed the next day.

Here’s a video from a doc in Austin, Texas, not mine, showing an actual procedure with the type of lens I have. It’s pretty interesting even if you don’t like surgery movies. No blood.

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The optics of this IOL are magical. My understanding of them is partial and maybe by writing this they’ll come into better focus for me.

Typical IOLs (not this one) bring things into focus at a limited distance or range. The natural eye focuses actively on a distance by squeezing the natural lens, changing its shape, changing the focus point. The plastic IOL cannot do that. So an IOL has a corrective prescription (or refraction) built in.

Instead, my IOL will have three distances (thus “trifocal”) it will focus. (Each is actually a range, not just a single distance.) The corrective prescription for my far-vision is built into one of the concentric rings of the lens. The prescription for mid-vision is in the next concentric ring. And for near-vision, into the next ring. Then this far-mid-near ring pattern repeats across the active area of the IOL.

When I’m standing looking at something on the far horizon, only my far-vision rings produce a sharp image. The mid- and near- images of objects on the horizon are not focused on my retina, and my brain will learn to ignore them in favor of the far- image.

When I’m reading something up close, the near-vision rings are providing the sharp image on my retina. The other rings are providing out-of-focus images, and similarly my brain will learn to ignore them when I want to read.

What are those little wings? Apparently they keep the lens in place in the center of the pupil. Who knew?

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In the land of the blind, the one-eyed man is king.

The surgery took about 10 minutes. I pretty much remember the whole process and it was very interesting. At its conclusion they covered my eye with a dressing, which remained the first 24 hours. My first impression was that my eyelashes were kinda stuck and my eyes wanted to open and close together even though the surgeruzed eye felt scratchy due to the dressing and tape. The doctor later told me he expected my eyelid to stay closed, so if something wasn’t quite working as intended, but there seems to have been no ill effect.

Many people say those first 24 hours are really difficult. I found that being mentally “prepared” helped a lot. I just had to be really, really patient and resist any temptation to scratch or pull on the dressing to make it more comfortable.

When my eyelid was open, I could tell there was plenty of light and I could see areas of dark and light thru the dressing – corresponding to what my natural (left) eye was seeing. So it was pretty exciting to know everything worked but no hint yet about clarity of vision.

Let’s call that Day Zero.

Day 1

Next morning I visited the doctor to have then dressing removed and a quick check-up. Sitting in a eye-exam chair with a chart on the far wall, they removed the bandage. It was absolutely astoundingly clear and sharp. I knew immediately this was going to be a good result — maybe an excellent result. The letters on the eye chart were mostly sharp, and I could confidently read down to the 20/30 line. My understanding was that this is pretty good for the first post-surgery day. I found that reflective objects like chrome on the equipment was “delightfully sharp” and sparkly. It was obvious the lens was going to be excellent!

To rest my eyes prior to surgery I had had a pair of glasses made. (I previously wore contacts, not glasses.) But now with an IOL in my right eye those glasses were not going to work for me. So I went to an optometrist who knocked out one prescription lens and replaced it with regular glass. This barely worked, leaving me with dpuble vision (although it was sharp), but was going to only be temporary anyway.

Week 1

During daytime hours I wore the modified glasses at times, but rapidly discovered it was more restful to just leave them off and let the natural eye be extremely blurry — because my vision with the IOL was so good I could do almost any daily activity confidently. At night I wore a transparent plastic eyepatch taped on, to prevent scratching and injuring the eye.

I decided not to drive until both eyes were completed. Good decision.

The trifocal aspect of the IOL was fascinating, and brain adaptation kicked in by about Day 2 or so. I noticed immediately that the best vision was distance vision. This became spectacularly obvois as night fell. From our windows in San Francisco we see a lot of the city as well as distant San Francisco Bay and the Marin and the East Bay hills.

As the sun set on about the second day, I realized I clearly saw every distant window in Salesforce Tower, and even better I saw the decorative lights of the Bay Bridge. On the East Bay hills, about 15 miles away, I could see individual tall trees on that ridge. I was not seeing those with my natural eye and the glasses. The IOL was at times sharper than my natural eye.

The IOL slightly reduces optical contrast, and that was initially obvious to me, though it was only bothersome when I attempted to read grey type against a white background. I would say it was tolerable. This was also more noticeable at night and with low light levels. It did get better as I approached the end of the week. My guess would be that I was adapting to the light curve of the lens.

But by about the 4th day I could already tell that the IOL did not cause me any problem with glare, halos, or rays, around most bright lights at night. This was super exciting because it is one of the more common outcomes for many people, and I had problems only with the most super-bright lights (like a car headlight coming at me on a city street).

The trifocal aspects of this IOL began to become useful by Day 6. I found I could easily focus on a laptop screen and use the computer for a few hours without strain. Couldn’t use both eyes together, but the single IOL eye, as long as I stayed relaxed and didn’t attempt actively to focus, just kind of naturally was working.

I did not have much near vision, however, in that first week. It appears to me that relaxing and letting the eye and brain do their adaptation without straining, may be the trick.

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