New implantable trifocal lens sharpens world view

It’s the first and only implantable trifocal lens in the U.S. that improves near, intermediate and distance vision.
July 20, 2020
Jan Roehl-Anderson rides her bike after getting an implantable trifocal lense.
Jan Roehl-Anderson received an implantable trifocal lens known as PanOptix that improves close up, intermediate and distance vision. Photo: Courtesy Jan Roehl-Anderson.

Near the end of her high school years in the Seattle area, Jan Roehl-Anderson saw an ophthalmologist who checked her vision. You don’t need glasses now, he told her, but see me after you finish your first quarter at college. With that, she began her studies at the University of Washington in Seattle.

Sure enough, when Jan attended introductory classes with hundreds of other freshmen in large lecture halls, she found herself squinting to make out the words projected on distant screens. Just as her ophthalmologist had predicted, she returned to him to get corrective eyeglasses. The following year, Jan got contact lenses and continued to wear them faithfully for the next 40-plus years.

She needed good vision. Jan earned her undergraduate degree in business management and followed that up with an MBA from the University of Southern California. She went on to a lengthy career in management consulting, focusing on mergers and acquisitions and implementation of database and package software with computer technology corporation Oracle. The jobs meant reading plenty of small print and long stints at the computer.

Over time, Jan found she needed to don reading glasses to see things clearly close up. Help arrived in the form of multifocal contact lenses, which enabled her to see objects distinctly both near and far. The lenses worked well for more than a decade, but around the time of her retirement in 2019 as a partner with Deloitte Consulting, Jan’s vision began to deteriorate again.

She had to switch back to contact lenses that corrected her distance vision alone. That meant going back to reading glasses, which seemed always to be misplaced or under her when she sat down. She also began to notice distracting halos around the headlights of oncoming cars.

There was nothing unusual about the deterioration of Jan’s vision, which begins for many people in their 40s. It turned out that Jan, now 63, also had cataracts, or clouding of the eyes’ lenses, which accounted for the headlight halos. The unusual part is that today, she sees clearly without the help of reading glasses or contact lenses – and likely will continue to do so for the rest of her life.

Triple vision with an implantable trifocal lens

Last May, Jan visited the UCHealth Sue Anschutz-Rodgers Eye Center on the Anschutz Medical Campus, where she met with Dr. Richard Davidson, a professor in the Department of Ophthalmology at the University of Colorado School of Medicine. Davidson recommended cataract surgery and also gave Jan information about a new trifocal lens, dubbed PanOptix, that the FDA approved in late August 2019. It’s the first and only implantable trifocal lens available in the United States.

Davidson explained that the implantable trifocal lens is a further modification of so-called multifocal lens implants that have worked well in improving distance and near vision, or distance and intermediate vision, but not all three.

“The PanOptix offers patients more range of vision,” Davidson said.

Of course, some people wear conventional eyeglasses fitted with bifocal or trifocal lenses, but Davidson emphasized that the lenses he implants in the eye work differently. With regular glasses, the wearer’s eye muscles do the work to adjust for viewing from different distances through the glasses, which are divided into zones for distance, intermediate and near vision. With implanted multifocal lenses – including the PanOptix trifocals – the brain does the work.

UCHealth ophthalmologist Dr. Richard Davidson removed cataracts from Jan’s eyes and put in a new implantable trifocal lenses. Photo by UCHealth.
UCHealth ophthalmologist Dr. Richard Davidson removed cataracts from Jan’s eyes and put in a new implantable trifocal lens. Photo by UCHealth.

“It’s not like looking through different segments of glasses,” Davidson said. “It’s a neuro-adaptive process. Some people adjust right away. For some people, it takes time to figure it out and for their brains to adjust. When it clicks, things are natural.”

In general, with multifocal lenses, he estimated that 1% or less of patients he and his colleagues have implanted have struggled to adjust, with 10% to 15% still needing glasses only for prolonged computer work or reading. Although he and his Eye Center colleagues have only implanted approximately 50 lenses so far, the results with PanOptix appear to be even better.

Quick change to implant trifocal lens

The procedure is straightforward. Patients first get a complete eye exam to rule out problems like glaucoma or retinal issues that may preclude them from getting the trifocal lens. If the patient qualifies and chooses them – insurance covers the cost of the cataract surgery, but the trifocal lenses require out-of-pocket payment – the ophthalmologist measures the patient’s eyes to determine the strength of the new lenses, orders them and schedules surgery.

After preparation, the procedure itself takes only about 10 to 12 minutes, Davidson said. It’s done under topical anesthesia with sedation and involves making a small incision, removing the cataract and inserting the new artificial lens. Davidson said he’s implanted PanOptix lenses in both eyes of all his patients, although it’s possible in certain situations, such as a patient with only one eye, to consider implanting only one.

Dropping the drops after cataracts eye surgery

Davidson said the Eye Center is also moving closer to eliminating the need for eye drops after the surgery. During the procedure, the surgical team injects antibiotics and Omidria, a non-steroidal medication that keeps the pupil from constricting and reduces pain and inflammation. They also implant an insert called Dextenza in the tear duct that delivers a measured dose of a steroid, dexamethasone, for up to 30 days after the surgery. These steroid inserts have freed some 90% of patients from having to use eye drops to relieve inflammation, Davidson said.

“That’s been a huge stress relief for patients,” he said. “We found that many of them were more stressed about having to put drops in after the surgery than they were about having the surgery itself.”

Jan compared the vision in one eye before cataract removal to the view in the right lens of these glasses. Graphic by Getty Images.
Jan compared the vision in one eye before cataract removal to the view in the right lens of these glasses. Graphic by Getty Images.

Jan had the two PanOptix implant procedures with Davidson on consecutive weeks in early and mid-June. She has the toric version of the lens, which corrects the astigmatism (blurriness) caused by irregularities in the shape of her corneas. She said she saw a dramatic improvement in her vision immediately after the first surgery on her right eye, both from gaining the new lens and losing the cataract.

New view through an implantable trifocal lens

“I hadn’t noticed the cloudiness in my vision before the surgery on the right eye,” she said. With her repaired right eye, she saw clear, vivid objects and colors. She compared looking through the uncorrected left eye to viewing objects through yellow Saran Wrap. Davidson cleared that up with surgery on her left eye the following week.

The new lenses have sharpened Jan’s vision and improved many other areas of her daily life. She’s no longer hunting for balls on the golf course because she sees where her drives go. Colors are more vibrant, driving much easier, and she believes her reading comprehension is better without the burden of squinting to see the words. It all came without post-surgical pain or an adjustment to the lenses.

“It helps in so many aspects of life,” she said. “It was like a miracle.”

Gone also are the hated readers and the ever-increasing need for more powerful contact lenses, Jan added.

“I have one set of eyes and that’s it,” she said. “This surgery was amazing and I feel very blessed to have had such a wonderful experience and great doctor.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.