Another clinic had pointed out a traumatic cataract in one eye, and she first visited us for surgery. She had been injured in a traffic accident in high school, and a traumatic cataract in the left eye had been pointed out nine years earlier; there was strong anterior capsule fibrosis and posterior subcapsular opacity, and vision had fallen to 0.2 (not correctable). Besides the cataract there was strong corneal astigmatism in the left eye only; its cause was unknown, but since it was unilateral, trauma was suspected here too.
Being still in her 40s, she was reluctant to use reading glasses, and from the start wished for surgery with multifocal lenses using advanced medical care insurance. Because of her strong astigmatism we planned surgery with ActiveFocus Toric, whose astigmatism correction is stable, but about two weeks before the scheduled date we were notified that our clinic had been certified as an early-use facility for the trifocal PanOptix, so we contacted her about the additional option and discussed it again.
We had told her beforehand that a trifocal lens would be released at the end of October, but she found it unbearable to go on not seeing until then and wished for early surgery with a bifocal lens. Traumatic cataracts progress quickly once they start, so as a surgeon I wanted to operate early while it was safe; but since surgery with the trifocal PanOptix was possible earlier than originally expected, she chose to postpone for it.
Besides the trauma, the anterior chamber depth differed between the eyes by more than 1 mm, suggesting weak zonules, so the toric PanOptix Toric might not be usable; to be safe we went into surgery with three lenses ready: it, standard PanOptix, and a monofocal lens.
During surgery the zonules were firmer than expected, no CTR (capsular tension ring) was needed, and we completed the surgery safely with PanOptix Toric as planned.
The day after surgery near vision was somewhat poor at about 0.7, but now, two months after surgery, uncorrected vision is 1.2 distance / 1.0 near, and she is very satisfied, saying she almost forgets she had surgery.
Alcon's trifocal PanOptix seems the multifocal lens covered by advanced medical care best suited to people who do not want to use glasses, provided halos and glare at night don't bother them. In addition, Johnson & Johnson has announced abroad a new multifocal lens (TECNIS Synergy) that combines, as it were, the bifocal TECNIS Multifocal and the extended depth of focus Symfony, with good results reported.
Multifocal lenses are advancing rapidly, so if you are waiting for a better lens, deciding when to have surgery can be difficult. For those considering surgery, we will give advice taking into account the surgical risk as the cataract progresses, so please feel free to consult us.