PanOptix IOL in a Highly Myopic Patient

This patient has a high degree of myopia (well over -10 diopters) and an axial length of more than 30 mm. The patient is also a physician and she wants the wide range of vision (without glasses) that a trifocal IOL can provide. Fortunately, her retina status, including the macula and periphery, is excellent and we even had her examined by a retinal specialist before cataract surgery.

The lowest power Alcon PanOptix IOL is +6.0 diopters, which is exactly what this patient needs. We did bilateral cataract surgery with the eyes done one week apart. Both eyes received the same +6.0 diopter PanOptix TFNT00 IOL and she achieved an outstanding visual result with 20/20 vision for far, intermediate, and near.

The entire case is shown, including the astigmatic treatment and the techniques used to achieve precise centration of the diffractive rings with the visual axis. You will also note that we minimize any barotrauma from changes in pressure — this is more gentle to the vitreous base.

Click below to learn from this complete cataract surgery case:


  1. Perfection. I watch your videos every day. Inspirational. 12 postop patients today. All 20/20 vision thanks to your tips!
    Greetings from Switzerland

  2. 1. How much prep astigmatism did this patient have? Did you consider using a toric Panoptix.?
    2. What were the special formulas you mentioned using for the high mope?
    3. Unrelated, in the setting of IFIS do you find intracameral phenylephrine or epinephrine more useful?

    1. 1. The patient had 0.5 diopters of K astigmatism. Lowest power toric PanOptix corrects 1.0 diopter at the cornea TFNT30
      2. for Ladas Super Formula 2.0 Artificial Intelligence or Barrett Universal II
      3. either is ok. most most IFIS cases I use neither.

  3. Dear dr Uday Devgan

    Thank you for this great video. I wonder what your approach is in case of a posterior capsule break in the second eye, If the first eye recieved a panoptix lens.
    In my Panoptix cases i order a Alcon MN6ad1 as a back up lens for the second eye. Recently I was informed that this alcon MN6ad1 will get out of production, there is no Panoptix sulcus lens available yet, so what should you do in case you need a sulcus lens implantation if you don not have a sulcus trifocal lens?


    Jocelyn Kasanardjo

  4. Outstanding as usual. Just wondering about your centration technique at the end. Some people will turn off the oblique beam, have the patient look at either the right or left co-axial light and then have the surgeon do the same so as to align everything on the same line. Any thoughts about that? Is that overkill?

    1. Multiple ways to accomplish the same endpoint. Your method sounds good too. The key is lining up the first and fourth purkinje images.

  5. thank you for sharing. it is comforting to know that one can still achieve excellent results with such a myopic eye. what was the expected spherical equivalent for this patient with the barrett and ladas super formula?

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