Editor’s note: This article is adapted from an episode of the podcast Ophthalmology off the Grid, hosted by Blake Williamson, MD, MPH, MS, and Gary Wörtz, MD. The conversation has been edited for length, clarity, and flow. Click here to listen to the original conversation in full.
Blake Williamson, MD, MPH, MS, and Gary Wörtz, MD: Please tell us about your practice and how you adopted the Clareon PanOptix lens (Alcon). What convinced you it was a game changer?
William B. Plauché, MD: My practice is in Sherman, Texas—about an hour north of Dallas—with seven physicians in our group. Even though we’re in a more rural location, we practice as if we’re in any major city. We’ve prioritized access to cutting-edge IOL technologies, and the PanOptix really marked a turning point.
When it was launched 5.5 years ago, I had a waiting list of patients—friends and family included—who I knew would benefit from it. The outcomes were so impressive that even my colleagues in the office would crowd around the chart in disbelief. It’s hard to overstate how transformative it was. I was blown away.
Drs. Williamson and Wörtz: You were clearly satisfied with the PanOptix. What motivated you to try the Tecnis Odyssey lens (Johnson & Johnson Vision)?
Dr. Plauché: It was tough to look beyond a lens that was working so well, but I was frequently doing minor enhancements for residual cylinder in the 0.50 to 0.75 D range. My enhancement rate was around 8%, which I could manage, but I was curious whether another lens might reduce that need.
The Odyssey representatives pitched the idea of a larger landing zone. That caught my attention. I wanted to know whether these lenses would give patients better uncorrected vision despite small refractive misses.
When I looked at my data, I found that distance vision was better in a significantly larger percentage of my Odyssey compared with PanOptix patients—at least early on. Their near vision wasn’t quite as strong, and some patients noticed that at about 1 month postoperatively. Overall, however, the initial “wow” factor on distance visual acuity was real.
Drs. Williamson and Wörtz: When the enVista Envy lens (Bausch + Lomb) entered the market, what did you hope it might offer beyond what the Odyssey and PanOptix provide?
Dr. Plauché: I was intrigued by claims of better night vision with the Envy—closer to a monofocal IOL profile. A Canadian group had reported minimal nighttime issues (data on file with Bausch + Lomb), and while I didn’t fully buy that at first, my own experience supported it. One of my pilot patients even told me his Envy eye had better night vision than the eye that still wears a contact lens.
Distance vision with the Envy was comparable to that with the Odyssey, although my patients with the Odyssey had a stronger “wow” factor early on. Their near visual acuity was better with the Envy—not quite on par with the PanOptix level of J1+, but J2 with good reading speed, which is what really matters for day-to-day function.
Drs. Williamson and Wörtz: How have these lenses affected your enhancement rates, and what role has testing with a near vision card played in your strategy?
Dr. Plauché: The PanOptix gave me great results, but the enhancement rate was still around 8%. When I switched to the Odyssey, my enhancement rate dropped to 2%. It stayed at 2% with the Envy.
As for near testing—it’s more psychological than people realize. Back in my Tecnis Symfony (Johnson & Johnson Vision) days, I noticed patients were thrilled in the hallway but disappointed in the lane. Why? Because they couldn’t read J1+ on the near card. So, I just cut it off at J2. Patient satisfaction skyrocketed.
Ironically, I brought the full card back when the PanOptix arrived because many patients could actually see J1+. Even then, however, not everyone did, and testing with a near vision card reintroduced anxiety. I now strongly recommend against showing patients what they can’t read if it doesn’t reflect real-world function.
Drs. Williamson and Wörtz: How are you managing astigmatism in these patients, both intra- and postoperatively?
Dr. Plauché: All of our patients who elect a premium lens receive femtosecond laser–assisted arcuate incisions with the Victus platform (Bausch + Lomb). If they have a small residual refractive error postoperatively, I perform manual enhancements, either mini–radial keratotomy (RK) or limbal relaxing incisions, in the clinic. I rarely resort to LASIK or PRK anymore.
Drs. Williamson and Wörtz: Can you explain the mini-RK technique and why you favor it?
Dr. Plauché: Inspired by lectures given by Jay McDonald, MD, I learned the mini-RK enhancement technique from Doug Mastel. These aren’t full RKs;1.5-mm incisions are created between the 5- and 8-mm zone, and each incision treats about 0.50 D of astigmatism.
I’ve used the same $15,000 worth of instruments for over 15 years. The technique does not cause dry eye disease. The incisions heal predictably, and the results are amazing. One day, I enhanced a dozen patients who all had 20/30 to 20/50 UCVA. The next day—every one of them had 20/20 UCVA. That was the moment I knew this was my go-to enhancement technique.
Drs. Williamson and Wörtz: What do you call this procedure when you talk to patients? The term mini-RK tends to make people nervous.
Dr. Plauché: Exactly. I don’t call it mini-RK in clinic. I rebranded it as microincision enhancements. That’s the terminology we use internally in my practice, and it is used on the Mastel Instruments website. No patient wants to hear RK in 2025.
Drs. Williamson and Wörtz: You have said that fewer patients complain about halos but more seem to be bothered by floaters. What’s your take on that trend?
Dr. Plauché: I’ve never explanted a lens because of nighttime dysphotopsias. I have patients who notice halos, but that is not what’s bothering them. The problem is the low-grade, persistent floaters that mess with their contrast sensitivity or visual clarity even when everything else seems perfect.
My practice now has an optometrist who performs Nd:YAG vitreolysis procedures every 2 weeks in Oklahoma. We work closely with a retina specialist who does vitrectomy when necessary. We’ve also started exploring new tools, such as the Vista 1-Step Needle (Microsurgical Technology). That device could change everything.
Drs. Williamson and Wörtz: Do you use any imaging tools to diagnose floaters or vision quality complaints?
Dr. Plauché: I have an OPD-Scan III (Nidek), but I don’t rely on it for this. I’ve seen HD Analyzer (Visiometrics) images that are compelling, but honestly, it’s still mostly a diagnosis of exclusion in my practice.
I recently had a case where a retina doctor said the floater wasn’t significant enough to cause symptoms. The patient insisted. I asked the retina doctor to do the vitrectomy anyway. Postoperatively? She’s ecstatic. The retina doctor texted me: “You were right.” These lenses are sensitive to everything. Floaters matter, and vitrectomy works.
Drs. Williamson and Wörtz: What’s your outlook on the future of presbyopia-correcting IOLs?
Dr. Plauché: We’re lucky. This is a golden age of technology. We’re splitting hairs between PanOptix, Odyssey, and Envy—three lenses that each would have been revolutionary a decade ago.
If I had to use just one of them, I’d still be delivering outstanding results. These companies are giving us tools to succeed—and our job is to learn how to use them wisely.
