As announced in Case #98, we had the opportunity to operate on the fellow eye of a patient who already had the conventional PanOptix in one eye, using the PanOptix Pro. As a first report, we share our findings, including the differences between the two eyes of the same patient.
How she came to us and the course of the right eye
The patient is a woman in her 60s who had cataract surgery on her right eye at another clinic in 2024. In December 2025 she came to us for the first time, without a referral letter, because her left eye was now hard to see with. The right eye had a PanOptix, but with a refraction of +1.00 D it had a hyperopic shift (postoperative refractive error), so although distance vision was reasonable at 1.0p, near vision was insufficient at 0.5p. The left eye was a hyperopic eye of +2.125 D, somewhat different from the right, so she balanced the two eyes by wearing a multifocal contact lens in the left eye only.
The cataract in the left eye was not very advanced and corrected visual acuity was good at 1.5, but because of hyperopia and astigmatism, uncorrected visual acuity had fallen to 0.4p. After discussion she booked surgery, we gave her the preoperative questionnaire, and the first visit ended.
Lens selection and fit with her lifestyle
At the second visit she brought a referral letter from her previous doctor, including information about the lens. In the preoperative questionnaire she said that after surgery she wanted to avoid glasses as much as possible, could accept halos and glare to some extent, and wanted to see her smartphone without glasses; her priority of distances was near > intermediate > far. We therefore asked her to exclude extended depth of focus (EDOF) lenses without a dedicated near add, such as Vivity and PureSee, and recommended a trifocal or higher lens with a proper near add. In the meantime, conveniently, we had become able to use the PanOptix Pro ahead of its general release, so we told her about it as well and gave her time to consider.
At the third visit, during the preoperative explanation, we had her use our clinic's multifocal lens selection tool to visualize her wishes. The PanOptix Pro ranked first, with an overall score of 93.3 points and a lifestyle fit (coverage) of 87.0% (see figure below). Even though "worrier, cautious, meticulous" had been entered as personality traits, the score remained high because the PanOptix Pro, by maximizing light utilization, reduces photic phenomena while maintaining intermediate and near vision, making it easier to tolerate than the conventional PanOptix. She was already tolerating night vision with the PanOptix in her right eye, so she readily agreed to the PanOptix Pro, its upgraded successor.
Preoperative examination and power selection
Next came power calculation and selection. Here, the information about the right eye's lens from the previous doctor, which she brought at the second visit, was very helpful.
The right eye had a +23.0 D PanOptix. The Barrett Universal II formula, considered one of the most accurate formulas today, uses anterior chamber depth (ACD) and lens thickness (LT), so its results become inaccurate after cataract surgery, when the lens itself has been replaced by an artificial one. In this case, therefore, we deliberately compared the results of SRK/T, a conventional third-generation formula that does not include ACD or LT, to select the power for the left eye.
At our clinic, the final lens power is decided based on four sets of calculations in total: three intraocular lens power calculation devices plus intraoperative measurements with the ORA system.
We will explain the power selection for this case in a follow-up report. In brief, taking into account the patient-specific tendency toward hyperopic shift estimated from the referral data, and using a correction from our regression analysis of postoperative refraction with our past intraoperative wavefront values as the explanatory variable, we finally chose a +23.5 D lens, targeting −0.63 D, considerably toward myopia by the preoperative measurements. The pupil dilated somewhat poorly, but nuclear hardness was mild, and the surgery was completed smoothly without problems.
Postoperative course: changes in refraction and visual acuity
Because we had deliberately used a lens power targeting −0.63 D, considerably toward myopia, we were worried on the day after surgery about a myopic shift. Instead, the spherical equivalent was +0.50 D; simply compared with the calculated target, this was a hyperopic shift of 1.13 D, far larger than expected (thin blue frame in the figure below). Even so, uncorrected visual acuity was 1.0 distance / 0.6 near, slightly better than the right eye. Since refraction normally shifts toward myopia as recovery proceeds, we explained that both distance and near vision should gradually improve.
As expected, refraction (spherical equivalent) was +0.125 D on day 3 after surgery and exactly 0.00 D on day 10. Not only distance vision but also uncorrected near vision at 30 cm reached 1.0p, and she was very pleased that near vision was easier than with the conventional PanOptix (thick blue frame in the figure below).
With her cooperation, to examine the difference in the lenses' own performance and to compare the eyes fairly, we also measured distance, near 40 cm and near 30 cm visual acuity in both eyes under full distance correction. As shown below, there was no difference between the eyes in distance vision. At near 40 cm, the measured acuity was 1.2 in both eyes, but she said that subjectively the PanOptix Pro was easier to see with, and her answers were also quicker. Furthermore, at 30 cm, the PanOptix Pro reached 1.0p versus 0.9p for the PanOptix (and uncorrected it was even better, at 1.0), suggesting that the PanOptix Pro can be treated as a lens that provides vision down to 30 cm. The patient herself also said, "In every test so far, the PanOptix Pro in my left eye has been easier to see with."
Summary
Even with the conventional PanOptix, a meta-analysis of 13 studies and 513 cases worldwide reported a complete spectacle independence rate of 91.6%, among the highest of the major multifocal lenses.
The PanOptix Pro is an upgraded successor to this conventional lens. With ENLIGHTEN NXT technology it halves light energy loss from 12% to 6%, reaching 94% light utilization, the optical and mathematical limit for a diffractive lens. Less scattered light (noise) physically removes a major cause of halos, glare and reduced contrast, meaning fewer photic phenomena at night, so the PanOptix Pro is a lens from which we can expect a spectacle independence rate equal to or higher than that 91.6% track record. Personally, I find halving light energy loss (halving scattered light?) more striking than the 6% increase in light utilization over the conventional model.
Note, however, that "higher light utilization" does not necessarily mean "higher contrast." Recent reports have found that lenses with relatively lower light utilization had better MTF (≈ contrast), and contrast sensitivity depends greatly not only on light utilization but also on how the lens distributes light. In other words, the PanOptix Pro appears to enable better near vision and contrast through the combination of its high light utilization and a rational, proprietary light distribution.
This case is one example. Under objective conditions, comparing both eyes with full correction as early as 10 days after surgery, the left eye with the PanOptix Pro achieved good near vision of 1.0 at 30 cm. The patient herself clearly felt that "the PanOptix Pro in my left eye is easier to see with," and from early on she has been living her daily life without any glasses.
For patients who strongly wish to be free of glasses, I consider the PanOptix Pro to be one of the strongest options available today. However, any high-performance lens can only perform at its best when three elements come together: (1) an accurate judgment of candidacy, (2) a lens choice suited to the patient's lifestyle, and (3) accurate power selection.
We plan to report the comparison of contrast sensitivity and comparison of intermediate vision at 1 month after surgery in a follow-up, so please wait a little longer.
2026.04.03