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PanOptix IOL vibration or wobble, unilaterial performend 3mos ago

I had a PanOptix multifocal IOL implanted in my right eye three months ago. I saw two doctors and both recommended the lens due to my age and only doing the one eye at this time. I use a contact lens for the other eye. Everything has gone well and I am generally pleased with the results as my other eye picks up the slack while I adapt. But over the past two weeks I have noticed a vibration of the image on movement, as if the lens wobbles when I shift gaze. I also notice my iris moves as if rippling or flapping slightly.

I saw the surgeon this morning and he stated everything looks good. At the time of the exam I noticed that with my pupil dilated I didn't observe the vibration effect. But as the dilating has worn off I am now here again seeing everything around me quiver as I look around. "Rim effect" has been mentioned but I do not believe this to be the case. From day one I noticed a bit of vibration but assumed it would improve with time. Instead, it has worsened.

I'm making an appointment with another eye doc for another opinion, but is this a common phenomenon or complication? I'm not finding quite the same thing in my searching. Thank you.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
It would be important to be sure that the IOL is stable and not dislocated or firmly anchored.  Yes such problems have been described, more with multifocal than monofocal or toric IOLs.  Pupil size and mobility may have a role.  You are wise to get a second opinion.
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12 Comments
Thanks Dr. Hagan. It's odd that when my pupil is dilated, even just to the degree it is at night, the effect is present but much less apparent. And funny to have found this forum and yourself. I had actually sought a second opinion prior to surgery from Discover (I'm in KC) but unfortunately it would've been out-of-network. I have an appointment with my regular eye doc (I went with a different practice for the surgery as the doc is more experienced) in two weeks.
If you change your mind. Discover Vision Centers  have a national/world class consultant for difficult post eye surgery problems in John Doane, MD. He is referred patients from all across the US, South America, Europe and Asia. Far and away the most experiences with problems like this.
I just changed health insurance providers. You're now both in-network. I'll be making an appointment when the card arrives. Thank you.
Okay, when you schedule with Dr. Doane tell the scheduler the problem you are having and referral from Dr. Hagan
Hi Dr. Hagan. I met with Doane and I have to say thank you. I wish he had been my doctor from the start. My symptoms seem to have him stumped but he ruled out mechanical issues with the IOL and clearly explained why that is his conclusion. Piecing things together myself, I believe I am seeing the billowing in my iris. Again while dilated I did not observe the phenomenon. Testing this conclusion I note I do not see the effect when staring directly at a light source. Only when the light is entering at an angle. Perhaps the effect is magnified by the optical properties of the multifocal IOL.

Doane has suggested going with LAL for my other eye when the time comes. I am considering it as my profession is not compatible with doing the PanOptix in both eyes. Cost is the primary constraint but based on progression thus far I think I have enough time before my remaining cataract requires surgery.

Thank you again. I am very happy with the consult.
Thank you. Dr. Doane is one of the most gifted minds and surgeon that I have worked with. He is referred problem cases from all across the US and even Europe and Middle East.  The Light adjusted lens has been wonderful expecially for problem cases like post RK surgery.  Some of our surgeons have had the LAL put in their own eye by Dr. Doane who did the pionering research in USA.  
Hi Dr. Hagan. I've completed the LAL with Doane and my 1-month is scheduled with you. Final lock-in was last Thursday the 5th. Still have pink tint and my distance vision has noticeably worsened. We were targeting near-intermediate which was fantastic before lock-in, even distance was pretty good, but now is mostly just near. Following the second lock-in treatment it felt like my cornea had been scratched so I wonder if there was any UV damage. I called the office Friday morning but received no call back. Intermediate and distance improved somewhat as the day progressed Friday, but Saturday worsened again and is the same today. I don't have a profile set up yet so I figured I'd drop a note here as you're pretty active, in case you see this and are able to comment before I call again Monday morning.
I received a note that you were doing well and would be in for a final refraction. Given the changes you outline I would suggest you set up another appointment with Dr. Doane or his refractive optometrist. Like most medical practices we are very understaffed and not able to return every call same day.
Understood, hopefully I can be seen Monday. I think this is indeed related to my cornea as artificial tears provide significant improvement, but for only a minute or so.

Also, in regards to the original topic of my post here, the same vibration/flickering effect I experience with the PanOptix in my right eye I also now experience in my left with the LAL, since immediately after surgery. So I think it is unrelated to the IOL itself and all I'm seeing is my iris billowing a bit when I shift gaze. It's most pronounced when there is bright light in my periphery such as overhead lighting. I had gotten reasonably accustomed to the one eye, but now that it's both it's going to take some getting used to again.
try a variety of artificial tears to see if you can find one that last longer. Try also some 'gels'  these are thicker and last longer, when put in sometimes for 3-5 minutes seems like molasses in the eye. Some place on the bottle it will say "gel".   Ask Dr. Doane about "dysphotopsia" which is what it sounds like you are seeing post op in both eyes.
Hi Dr. Hagan. Apologies for not posting an update here, and seems I'm not getting notifications. I did start using gel drops that night. Turns out there was no scratch, but I did have an inflammatory response after the second lock-in. Treatment was basically just dumping pred into my eye the rest of the week, now tapering back off.

As far as dysphotopsia, in the general sense I get that from both the PanOptix and the LAL. But it isn't a problem. I get halos and starbursts in the PanOptix and lens flares in the LAL, tho the latter is a new implant of course, and combined it's a new process of adaptation. This flickering effect, whether it's a product of both lenses or my iris very visibly wobbling, ultimately is just reality now. A defined condition would be nice of course but for me not useful, now that I know it's not confined to the PanOptix eye.

Dr. Doane did remark on my last mention of the flickering that he doesn't have a good explanation and thinks I might just have a "very fast central processor." Granted my personality and profession actually make me a poor candidate for premium lenses, but I confess I kinda like the admission that I am now officially a cyborg.
Thanks. Because you are a patient of the practice I work in, and there is a potential for HIPPA violation, I do not think I can comment any further and you will need to communicate with Dr. Doane or his OD tech.  I have published on dysphotopsia following cat/IOL surgery.  The bright type usually fade over months, those that see 'temporal darkness' it takes much longer to fade and in some cases is permanent.
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