Alcon India e-newsletter, December 2021

We think

vision at all

distances is pretty cool too.

PanOptix Trifocal IOLs: Innovative Lenses Offering a Full Range of Vision1 The AcrySof® IQ PanOptix® Trifocal (Alcon, Geneva, Switzerland) intraocular lens (IOL) delivers an excellent combination of near, intermediate and distance vision while significantly reducing the need for glasses after surgery. PanOptix Trifocal lenses are a safe and effective IOL option for cata� ract patients with poor vision. Designed for today’s active lifestyles, the lenses can be used for a full range of visual needs, from viewing mobile devices and computer screens, to high-quality distance vision in a multitude of lighting conditions.

Novel lens technology1-4 The lens uses ENLIGHTEN® Optical Technology, an innovative trifocal optic that optimizes interme� diate vision without compromising near and distance vision. PanOptix is built on Alcon’s proven AcrySof IQ IOL platform that has been implanted in more than 500 thousand eyes globally.

One of the main benefits of PanOptix Trifocal lenses is easier reading, without having to wear reading glasses. PanOptix allows for sharper middle and close vision to make reading and up-close tasks much easier. 96% of the patient reported complete spectacle independence and no longer used correction at far, intermediate or near distance.

In a clinical trial involving 243 patients, 129 patients were implanted with PanOptix Trifocal lenses, with 127 receiving the lens in both eyes. The remaining 114 patients were implanted with the control lens. After six months, the average best corrected vision for both groups was 20/20.

However, in the PanOptix group, the intermediate vision was better and was at 20/25 while the control group was at 20/40. The vision for near-distance correction with the PanOptix lens was approximately 20/25, compared with 20/63 for the control group. There were no safety concerns reported during the study, showing that these lenses offer the best results with minimal risks and side effects.

Why clinicians are choosing PanOptix Trifocal Dr. Shail Vasavada from Raghudeep Eye Hospital, and Dr. Saurabh Choudhry of ICARE Eye Hospi� tal, India, shared their thoughts and experiences in using PanOptix Trifocal lenses.

“The single biggest reason for choosing Panoptix IOL is the fact that it is based on the time-tested IQ IOL platform,” said Dr. Vasavada. “The hydrophobic material with square edges and C-loop design has shown to be exceptionally stable in the capsular bag, very good biocompatibility and extremely low posterior capsule opacification (PCO) rate. All of these are extremely important for a trifocal IOL and particularly trifocal toric IOLs,” he explained.

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Dr. Vasavada also noted that most of the other trifocal IOLs available on the market are based on a hydrophilic platform. The light transmission to the retina is highest with the PanOptix IOL com� pared to the other competing IOLs in the market. The decreased loss of light would mean a reduction in positive dysphotopsias at night, which can be bothersome.

Further, the Panoptix Trifocal has good functional intermediate vision distance at 60 cm, which is an arm’s length for most individuals, particularly in the Asian subcontinent, emphasized Dr. Vasavada.

“This gives them [patients] very good functional vision in day-to-day tasks including screen use.

The majority of the other trifocal IOLs have an intermediate distance vision at 80 cm, which is too far away from an arm’s length of an average individual,” he added.

The diffractive nature of the PanOptix Trifocal IOL also allows for better visual functioning that is less dependent on pupil size, and its unique ENLIGHTEN® Optical Technology is able to focus light in 40 cm and 60 cm, he pointed out.

Expanded range of patient suitability “The real-life performance with the excellent quality of vision across all distances with the Panop� tix IOLs has expanded the range of patients that can be offered this technology,” said Dr. Vasava� da. “Because it has a large central 'bull’s eye', the angle alpha has a limited role for patient selec� tion. I would offer it as a first choice to almost all kinds of patients; young or old, active or retired,” he explained.

Patients should not have any other ocular comorbidities such as retinal diseases, glaucoma, irregular astigmatism or ocular surface disease. “The only other patients that I would be wary about are the ones who do a lot of self driving at night particularly on dimly-lit highways, as the halos may bother them. But for someone who is driving in the city regularly at night, I would happily recommend Panoptix IOL,” added Dr. Vasavada.

“In my practice, I usually use the PanOptix in patients who do not have any other comorbidities, orretinal issues. I still use them for my glaucoma patients,” said Dr. Choudhry.

Unlike other types of IOLs designed to provide distance and near vision, PanOptix Trifocal lenses allow for improved near and intermediate vision, along with even better distance vision, which can be a big advantage.

“I am using it for myopes as well, which I was slightly skeptical of earlier, by using the traditional multifocal and bifocal lenses. Now I have started using them for myopes and most patients are doing pretty well,” added Dr. Choudhry.

No surgical learning curve The best part about using the PanOptix IOL is that there is no learning curve in using the IOL, said Dr. Vasavada. “It goes through the same 2.2 mm incision and it behaves in the same way as all Acrysof IOL platforms, a slow controlled unfolding of the IOL inside the capsular bag,” he explained.

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Dr. Choudhry also feels that there is no learning curve in using the PanOptix IOL. “It is no different than putting the IQ lens or the other traditional bifocal ReSTOR lenses which we were using earlier. So, as a surgeon, no, there's no difference, only as a physician. That means once you are choosing around, you do have to keep a few things in mind once you look at the calculations. Because, like any other multifocal, you do have to choose the patients right other� wise you might land up with dissatisfied patients,” explained Dr. Choudhry.

On patient outcomes and satisfaction According to Dr. Vasavada, he was initially skeptical as to how the IOL would perform in patients.

“This is simply from some of our experiences with the previous generation bifocal IOls, and because a trifocal IOL would mean adding another foci in the IOL, we were worried about adding dysphotopsias, or a further drop in contrast and quality of vision,” he explained.

But to his pleasant surprise, the patients’ acceptance and satisfaction far exceeded his expectations, with most patients experiencing fantastic results within the first week. “The biggest wow factor has been that the patients have been able to see their WhatsApp messages and read the newspaper without glasses very quickly,” shared Dr. Vasavada.

Furthermore, Dr. Vasavada shared that hardly any of his patients have been really dissatisfied after the Panoptix IOL, particularly if the pros and cons have been explained to them preoperatively. “The most important observation is from patients who have been moderate to high myopes.

They find that their rereading distance has receded (40 cm) compared to very close reading that they are generally used to. So that is one thing we have started forewarning the patients preoperatively, that their reading distance may change,” said Dr. Vasavada.

Dr. Choudhry had a similar experience. “Earlier on, whenever we used to use the ReSTOR or bifocals, or other traditional multifocal, we were always skeptical about the results and I wasn't doing too many cases but my practice has traditionally changed quite a bit after the PanOptix has been launched. There are hardly any problems using the PanOptix,” shared Dr. Choudhry.

He also reported a few adverse effects or dissatisfaction among patients.

“We had hardly any adverse effects or dissatisfied patients because we have learned the hard way. Once we are using the bifocals and the other lenses, we learned the hard way by choosing patients who were not the right patients, but I think we have come to a stage where we are choosing our patients well,” said Dr. Choudhry.

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About the Contributing Doctors

Dr. Saurabh Choudhry, chief executive officer and medical director of ICARE Eye Hospital is a renowned ophthalmic surgeon in cataract and refractive surgery. Dr. Choudhry is a pioneer in propagating the technique of phacoemulsification in India. He is a leading refractive surgeon proficient with a wide variety of laser- and lens-based vision correction procedures from LASIK to PRK, and ICL (phakic IOLs). Dr. Choudhry spearheaded the training program at the ICARE Eye Hospital and hundreds of practicing ophthalmologists have undergone training under him. He has conducted several live surgery demonstrations in the remotest locations in India to teach and popularize the technique of sutureless cataract surgery.

[Email: drsaurabh@icarehospital.org]

Dr. Shail Vasada is currently a consultant ophthalmologist at Raghudeep Eye Hospital in the Cataract and Refractive Surgery Department. After complet� ing his post-graduate training in ophthalmology in India, Dr. Vasavada did a fellowship in cataract surgery and phacoemulsification at Raghudeep Eye Hospital, followed by two years of training in general ophthalmology at L.V. Prasad Eye Hospital and a fellowship in cataract and refractive surgery at the Moran Eye Center (USA). Dr. Vasavada has an interest in newer advanced techniques and technology in cataract surgery, particularly femtosecond cataract surgery.

[Email: shail@raghudeepeyeclinic.com]

Reference 1. Clinical Investigation of the AcrySof IQ PanOptix IOL Model TFNT00. Alcon Data On File. TDOC-0055352. Effective date: 20 Dec 2018 2. Kohnen T et al. Innovative trifocal (quadrifocal) presbyopia-correcting IOLs: 1-year outcomes from an international multicenter study. J Cataract Refract Surg 2020;46(8):1142-1148 3. Böhm, M et al. Defocus curve of four presbyopia correcting IOL designs. J Refract Surg 2019;45:1625 4. Alcon Data on File 2020 (REF-08986)

IN-ACP-2100020

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