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Is the Synfony lens a good choice of IOL for someone who has had laser treatment?
Its a long story, so i will keep it short. I am going around in circles, as I have been told by 1 optometrist at a high st clinic, that I can have multifocal lens fitted, which is what I think I would like to have!
Because of the service that was offered I decided to go to another clinic/hospital. The consultant ophthalmic surgeon, who is well qualified, did all the various tests etc and I was told because I had previous eye laser surgery for distance that I would have a 2 out of 3 chance of the operation being successful and therefore that he would only consider mono vision IOL, one for distance and one for near. I did have a short trial of wearing daily contact lens, one short and one long sighted but did not like the result.
9 months later, I revisited the above hospital and saw another well qualified Consultant Ophthalmic surgeon and had all the same tests again. He suggested that if i didn't wont the mono vision option then he would be fairly happy to fit Synfony IOL, as he has fitted them before with good success but because of the my previous laser treatment there could be problems.
Because of the service that was offered I decided to go to another clinic/hospital. The consultant ophthalmic surgeon, who is well qualified, did all the various tests etc and I was told because I had previous eye laser surgery for distance that I would have a 2 out of 3 chance of the operation being successful and therefore that he would only consider mono vision IOL, one for distance and one for near. I did have a short trial of wearing daily contact lens, one short and one long sighted but did not like the result.
9 months later, I revisited the above hospital and saw another well qualified Consultant Ophthalmic surgeon and had all the same tests again. He suggested that if i didn't wont the mono vision option then he would be fairly happy to fit Synfony IOL, as he has fitted them before with good success but because of the my previous laser treatment there could be problems.
I should note that if it turns out that the Symfony or a multifocal isn't an option, that the Crystalens might be. Its flaws (like not providing more near than a monofocal in some cases) led me to prefer a static lens, but if I hadn't been able to get the Symfony or a multifocal I'd likely have gone for that.
One factor is whether you had refractive surgery long ago using older technology, or more recently using better technology with likely fewer aberrations. Here is a relevant article from a couple of weeks ago which goes into detail on surgeons attempting to develop objective criteria to decide whether a multifocal is an option based on the state of the cornea, which also notes that:
https://www.reviewofophthalmology.com/article/odd-couple-multifocals-and-postrefractive-eyes
"A history of refractive surgery doesn’t always mean multifocals are out of reach.
Dr. Chang, who notes that he is now trending towards Symfony extended-depth-of-focus lenses in post-refractive patients, ..
... Dr. Raviv has grown more willing to implant presbyopia-correcting IOLs into post-refractive eyes with the emergence of low-add multifocals and EDOF lenses. ...
Dr. Chang says that when considering an IOL in the post-refractive eye, the avoidance of “splitting light” is not the key factor. “The most important thing to consider is the quality of the image you’re putting on the retina,” he says. “When you look at some modeling and benchtop trials, the lenses that correct spherical aberration and chromatic aberration actually produce better image quality.” "
--
The Symfony is the one he is referring to that corrects chromatic aberration and spherical (though it depends on whether the refractive surgery addressed the spherical aberration or left it typical for your age). I'll note that although one surgeon in there refers to treating extended depth of focus lenses as a subset of multifocals, that is merely an easy way to talk about it for certain topics where they share similarities, the optics are different as I've noted in posts before, as this article reiterates:
https://www.mivision.com.au/cataract-surgery-and-iols-where-to-now/
"This IOL is frequently called a ‘multifocal IOL’ (MFIOL), which is incorrect. The optics are entirely different, using phase shift rather than constructive and destructive interference. "
However the use of diffractive optics and the fact that they do have more complicated optics than a monofocal lead to similar concerns over use in those with prior refractive surgery.
One factor is whether you had refractive surgery long ago using older technology, or more recently using better technology with likely fewer aberrations. Here is a relevant article from a couple of weeks ago which goes into detail on surgeons attempting to develop objective criteria to decide whether a multifocal is an option based on the state of the cornea, which also notes that:
https://www.reviewofophthalmology.com/article/odd-couple-multifocals-and-postrefractive-eyes
"A history of refractive surgery doesn’t always mean multifocals are out of reach.
Dr. Chang, who notes that he is now trending towards Symfony extended-depth-of-focus lenses in post-refractive patients, ..
... Dr. Raviv has grown more willing to implant presbyopia-correcting IOLs into post-refractive eyes with the emergence of low-add multifocals and EDOF lenses. ...
Dr. Chang says that when considering an IOL in the post-refractive eye, the avoidance of “splitting light” is not the key factor. “The most important thing to consider is the quality of the image you’re putting on the retina,” he says. “When you look at some modeling and benchtop trials, the lenses that correct spherical aberration and chromatic aberration actually produce better image quality.” "
--
The Symfony is the one he is referring to that corrects chromatic aberration and spherical (though it depends on whether the refractive surgery addressed the spherical aberration or left it typical for your age). I'll note that although one surgeon in there refers to treating extended depth of focus lenses as a subset of multifocals, that is merely an easy way to talk about it for certain topics where they share similarities, the optics are different as I've noted in posts before, as this article reiterates:
https://www.mivision.com.au/cataract-surgery-and-iols-where-to-now/
"This IOL is frequently called a ‘multifocal IOL’ (MFIOL), which is incorrect. The optics are entirely different, using phase shift rather than constructive and destructive interference. "
However the use of diffractive optics and the fact that they do have more complicated optics than a monofocal lead to similar concerns over use in those with prior refractive surgery.
Unfortunately I haven't seen much study on the issue of implanting the Symfony in eyes with prior refractive surgery. I did recall seeing one conference paper mentioning the results of a small study comparing the results of the Symfony between those who had prior refractive surgery and those who hadn't:
http://www.escrs.org/Copenhagen2016/programme/posters-details.asp?id=26409
I don't know if you are in the UK (a phrase you use suggests it) where the author of that paper is. You might try contacting the author, Dr. Amir Hamid (I think a new search would turn up his email address from some article or paper or at the clinic website perhaps) to see if he has any comments .
Many surgeons hesitate to implant multifocal lenses in people with prior refractive surgery due to fears that optical aberrations from the irregularity of the cornea may not play well with the diffractive optics of the lens. I've seen/heard comments that suggest surgeons are more likely to consider the Symfony in such cases, but unfortunately the IOL is still new enough that I think they are still trying to figure out how much more tolerant the Symfony is of the state of the cornea than multifocals. Although the Symfony isn't a multifocal, it still uses diffractive optics, albeit in a different manner.
Some surgeons automatically always rule out multifocals for those with prior refractive surgery, but others actually do scans of the cornea and run other tests to get a sense of whether there is likely to be a problem or not. Presumably a surgeon who is willing to do such tests for multifocals would be willing to do it for the Symfony as well to play it safe.
In cases where the lens power of a multifocal is off, it seems to be an accepted practice to do a laser enhancement to correct the issue so obviously some laser correction works with multifocals, though the alterations they make after cataract surgery are usually far smaller corrections than the large ones people usually get with laser surgery for high prescriptions.
Unfortunately as the doctor notes, they have more trouble deciding what lens power to use for someone with prior refractive surgery, which raises the odds that you'd need a a laser enhancement after surgery if the power is off a bit. Is this for cataract surgery, or clear lens exchange to deal with presbyopia?
http://www.escrs.org/Copenhagen2016/programme/posters-details.asp?id=26409
I don't know if you are in the UK (a phrase you use suggests it) where the author of that paper is. You might try contacting the author, Dr. Amir Hamid (I think a new search would turn up his email address from some article or paper or at the clinic website perhaps) to see if he has any comments .
Many surgeons hesitate to implant multifocal lenses in people with prior refractive surgery due to fears that optical aberrations from the irregularity of the cornea may not play well with the diffractive optics of the lens. I've seen/heard comments that suggest surgeons are more likely to consider the Symfony in such cases, but unfortunately the IOL is still new enough that I think they are still trying to figure out how much more tolerant the Symfony is of the state of the cornea than multifocals. Although the Symfony isn't a multifocal, it still uses diffractive optics, albeit in a different manner.
Some surgeons automatically always rule out multifocals for those with prior refractive surgery, but others actually do scans of the cornea and run other tests to get a sense of whether there is likely to be a problem or not. Presumably a surgeon who is willing to do such tests for multifocals would be willing to do it for the Symfony as well to play it safe.
In cases where the lens power of a multifocal is off, it seems to be an accepted practice to do a laser enhancement to correct the issue so obviously some laser correction works with multifocals, though the alterations they make after cataract surgery are usually far smaller corrections than the large ones people usually get with laser surgery for high prescriptions.
Unfortunately as the doctor notes, they have more trouble deciding what lens power to use for someone with prior refractive surgery, which raises the odds that you'd need a a laser enhancement after surgery if the power is off a bit. Is this for cataract surgery, or clear lens exchange to deal with presbyopia?
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I should note one concern with a study like the one I linked to is that at least the abstract doesn't indicate anything about patient selection methodology. It reports overall good results, though not quite as good in those with prior refractive surgery, but I'm wondering if there may be another reason for it. Those with prior laser surgery may be more likely to be those who had high prescriptions before surgery than the typical patient getting the Symfony (which impacts things like the IOL power used and other aspects of the eye), so it isn't clear if they controlled for that factor in the study, I don't know if that would make a difference in the results or not.
I'll try and find the reference for this but one of the free circulation ophthalmology panels. Discussed this. All experts agreed more complicated. Some did not do. One said only with ORA technology. Problem related to proper IOL power and irregular astigmatism on cornea. One said he had removed over 100 IOLs for this reason.
The reference for the above is EyeNet February 2017
Use the search feature and archives. There are many discussions here about monofocal, toric, multifocal, accommodating and Symfony IOL (not spelling m not n) You can also find people who have had trouble with every kind of IOL. Remember this forum attracts unhappy people. I'm assuming you have has cornea laser surgery (intracorneal lasik or surface lasik (PRK) This does not make the cataract surgery more difficult only makes the calculations of what IOL to put in your eye more difficult with a wider standard deviation than regular corneas that have not had surgery. This is more important with multifocal/accommodating IOLs than monofocal IOLs. There is no best IOL and no choice that is best for everyone. Start by asking yourself if your vision and symptoms are really bad enough to justify cataract surgery in the first place.
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