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My experience with the Symfony IOL
One thing I found when doing research on cataracts was that it’s hard to find reviews from younger patients especially with the Symfony lens, so I wanted to write this, and keep it updated with my progress. I am not the best writer, and it’s a bit hard to describe exactly what you are seeing, but I’ll give it my best.
I am 27 years old, had Lasik surgery on both eyes in July 2013, and was diagnosed with September 2015 with cataracts in both eyes. My right eye(operated on) was really bad, my left eye is manageable, can still see fairly well.
I had my surgery yesterday February 25th, 2016 at around 3:30pm. Got home from surgery around 6:00 and went to bed right away until today at 9:00 am, February 26th. With my natural eye closed, I can see very well at intermediate distance(computer), not very well at close up, and distance vision is ok, a little bit hard to focus. My eyes are very sensitive to light. At first I thought I would be ok with just getting one eye done for now, but I am definitely starting to notice the cataract in my left eye more than before. I think it is giving me a bit of trouble adjusting with both eyes because of the differences with a natural(with cataract) and artificial lens.I will continue to keep this thread updated with my progress, and if anyone has any questions, please feel free to ask.
I am 27 years old, had Lasik surgery on both eyes in July 2013, and was diagnosed with September 2015 with cataracts in both eyes. My right eye(operated on) was really bad, my left eye is manageable, can still see fairly well.
I had my surgery yesterday February 25th, 2016 at around 3:30pm. Got home from surgery around 6:00 and went to bed right away until today at 9:00 am, February 26th. With my natural eye closed, I can see very well at intermediate distance(computer), not very well at close up, and distance vision is ok, a little bit hard to focus. My eyes are very sensitive to light. At first I thought I would be ok with just getting one eye done for now, but I am definitely starting to notice the cataract in my left eye more than before. I think it is giving me a bit of trouble adjusting with both eyes because of the differences with a natural(with cataract) and artificial lens.I will continue to keep this thread updated with my progress, and if anyone has any questions, please feel free to ask.
I had astigmatism and myopia, and went to see an opthalmologist, and he said Rle eye surgery is best for to see far and near and avoid glasses.. I agreed for surgery and I realised my mistake after see haloes and flashes.. I am in depression now, better wear glasses instead this haloes and flashes to take our brain if our natural lens is clear.. This is my opinion if anyone go for Rle surgery if they don't have cataract..
5 Comments
Thank you. I believe that so called 'premium' IOLs which cost extra and are pushed hard by many surgeons are oversold on this forum due to the "success" of some frequent posters.
What is Rle
Oh "refractive lens exchange" I have never recommended that and believe it way too drastic for most people
@Nicknicola, what IOL did you get where you have halos/etc at night, the Symfony? How long ago was the surgery?
Just an update on my eye. I know I kinda stopped updating as I got really busy with a project at work.
I went to my ophth complaining of bad halos and starbursts at night and also wanted to see if he though my PCO got any worse since my last follow up appointment (5 months ago). He said there was some PCO and I could remove it and it might help with the halos & starbursts. I decided to do it and immediately regretted my decision after the surgery. My sensitivity to light is way way way worse. I am now seeing starbursts off light during the day off every shiny object. I am also experiencing alot of glare. The ophth spent 45 minutes with me on an emergency appointment, did a bunch of tests and noticed nothing wrong. He said what he thinks happened, is that the capsule and the PCO was actually blocking some of the light rays caused by the multifocal lens, and now that he did the YAG laser and lasered off a portion of the capsule, that it's causing me to be more sensitive to light which is why the glare & starbursts are worse. So if you were to ask me if you should do a YAG capsulotomy, I would not recommend it.
I went to my ophth complaining of bad halos and starbursts at night and also wanted to see if he though my PCO got any worse since my last follow up appointment (5 months ago). He said there was some PCO and I could remove it and it might help with the halos & starbursts. I decided to do it and immediately regretted my decision after the surgery. My sensitivity to light is way way way worse. I am now seeing starbursts off light during the day off every shiny object. I am also experiencing alot of glare. The ophth spent 45 minutes with me on an emergency appointment, did a bunch of tests and noticed nothing wrong. He said what he thinks happened, is that the capsule and the PCO was actually blocking some of the light rays caused by the multifocal lens, and now that he did the YAG laser and lasered off a portion of the capsule, that it's causing me to be more sensitive to light which is why the glare & starbursts are worse. So if you were to ask me if you should do a YAG capsulotomy, I would not recommend it.
How are you eyes now? It's been over 6 months. I find this diary fascinating, as I'm getting cataract surgery as well in a month (I'm 40, but I've needed the surgery since I was 35 and holding out for Symfony to be available in the U.S.)
1 Comments
If you want to ask for an update, you might send the desm0nd a private message in case they aren't checking this site often. A private message will send an email to the user to tell them they have a private message. Its useful to see what patients say, though of course everyone's results differ which is why studies indicating average results are the best thing to rely on.
One concern with the cataract surgery for someone your age is that you likely hadn't yet hit presbyopia yet (though perhaps you hit it early due to the cataract) so the loss of near vision will be more noticeable to you. I've described the Symfony as being like early presbyopia, which I felt was a good tradeoff to get good intermediate&distance with lower risk of night vision issues.
I don't know if someone younger might be more concerned with not losing as much near. I was torn up until the last minute about getting a trifocal instead for more near, though I think I made the right bet for my needs (and the trifocals aren't approved in the US). This article:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/finding-ideal-mix-and-match-iol-strategy
talks about mixing and matching the Symfony with a low add multifocal to get a bit more near from the multifocal, while getting a bit more intermediate from the Symfony than you'd get from just a multifocal. They were just commenting on preliminary results, I don't know if they might share any further results via email. Of course that increases slightly the risk of night vision artifacts (and I know one poster on this site who got a low add Tecnis for one eye is bothered by them and waiting for the Symfony due to that).
One concern with the cataract surgery for someone your age is that you likely hadn't yet hit presbyopia yet (though perhaps you hit it early due to the cataract) so the loss of near vision will be more noticeable to you. I've described the Symfony as being like early presbyopia, which I felt was a good tradeoff to get good intermediate&distance with lower risk of night vision issues.
I don't know if someone younger might be more concerned with not losing as much near. I was torn up until the last minute about getting a trifocal instead for more near, though I think I made the right bet for my needs (and the trifocals aren't approved in the US). This article:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/finding-ideal-mix-and-match-iol-strategy
talks about mixing and matching the Symfony with a low add multifocal to get a bit more near from the multifocal, while getting a bit more intermediate from the Symfony than you'd get from just a multifocal. They were just commenting on preliminary results, I don't know if they might share any further results via email. Of course that increases slightly the risk of night vision artifacts (and I know one poster on this site who got a low add Tecnis for one eye is bothered by them and waiting for the Symfony due to that).
Update: 1 month
Vision is good. Close up is 10/10, intermediate and distance is 9/10. For distance, I would say I am just a little under 20/20. This is in good lighting sources. I am very happy with my vision when there is natural lighting. The problem I run into is in low lighting and at night. My vision is not very good and at night I still see really bad halos and lights in my peripheral vision bother me. Also, I think it doesn't help that I work on a computer so my eyes are staring at the screen, which is causing me some dry eye and eye strain. The toughest part through this process is trying not to panic, and remembering that your eyes take time to heal. I am constantly closing my good one eye and testing the lens. It's becoming a bit of an obession lol. I have been getting a bit depressed and anxiety at night time because my vision is not the best, but its worth the trade off to have great vision at all ranges during the day. I do have some hope that the halos might go away, as I have read that it can take up to 4 months for the eye to adjust. If anyone ever has any questions for me, I get the emails that someone private messaged me, so feel free. It can be helpful to have someone to talk to that has gone through the same experience.
Vision is good. Close up is 10/10, intermediate and distance is 9/10. For distance, I would say I am just a little under 20/20. This is in good lighting sources. I am very happy with my vision when there is natural lighting. The problem I run into is in low lighting and at night. My vision is not very good and at night I still see really bad halos and lights in my peripheral vision bother me. Also, I think it doesn't help that I work on a computer so my eyes are staring at the screen, which is causing me some dry eye and eye strain. The toughest part through this process is trying not to panic, and remembering that your eyes take time to heal. I am constantly closing my good one eye and testing the lens. It's becoming a bit of an obession lol. I have been getting a bit depressed and anxiety at night time because my vision is not the best, but its worth the trade off to have great vision at all ranges during the day. I do have some hope that the halos might go away, as I have read that it can take up to 4 months for the eye to adjust. If anyone ever has any questions for me, I get the emails that someone private messaged me, so feel free. It can be helpful to have someone to talk to that has gone through the same experience.
A little over two weeks after my surgery. It's definitely an interesting experience. I find that my vision is better in the morning. Today this morning when I was testing my eyes, it felt like I was close to 20/20, maybe a little bit under, but now its about 6:04 and I am testing my eyes out and they are a bit blurry. I honestly think it might be the drops though i'm not sure why.
One thing I notice is that sometimes at night when I am looking at something, I see a huge pronounced ring around a light. Its different than a halo.
Also, if you've ever wore a contact and the contact is a little bit out of position in your eye, you feel it. I get that feeling sometimes, almost feels like the lens is shifting around in my eye? Not sure if this even makes sense. Hard to explain the feeling.
One thing I notice is that sometimes at night when I am looking at something, I see a huge pronounced ring around a light. Its different than a halo.
Also, if you've ever wore a contact and the contact is a little bit out of position in your eye, you feel it. I get that feeling sometimes, almost feels like the lens is shifting around in my eye? Not sure if this even makes sense. Hard to explain the feeling.
Also, dry eye can vary through the day and might be one cause of acuity seeming to be reduced later in the day.
Sorry to hear about the halos, again even monofocals induce halos in some people, especially during the early stages. Most studies of lenses ask about visual artifacts at 3 or 6 months, so most statistics on the issue are about lenses after initial healing and adaptation is finished. I don't know if PCO increases the risk of halos perhaps.
I think I mentioned before that Lasik/PRK will adjust where your best distance focus point is. So if you are somewhat myopic now, adjusting your eye's to move the best focal point out further will reduce your near vision.
Though I don't know if you have remaining astigmatism to correct, since correcting that could improve clarity (though it may also shift the "spherical equivalent" of your focal point in or out a bit which alters your near vision). What matters most of course is binocular vision, what your distance vision is with both eyes and not just one. With monovision people's near eye often isn't 20/20 at distance, but their distance eye gives them 20/20 or whatever at distance.
I think I mentioned before that Lasik/PRK will adjust where your best distance focus point is. So if you are somewhat myopic now, adjusting your eye's to move the best focal point out further will reduce your near vision.
Though I don't know if you have remaining astigmatism to correct, since correcting that could improve clarity (though it may also shift the "spherical equivalent" of your focal point in or out a bit which alters your near vision). What matters most of course is binocular vision, what your distance vision is with both eyes and not just one. With monovision people's near eye often isn't 20/20 at distance, but their distance eye gives them 20/20 or whatever at distance.
1 week 6 days after surgery.
I find that my vision is better in the morning and then starts to get more blurry towards the night. What I think may be the cause is that my vision in low lighting(night time) is not as good as during the day. I also find that the halos around lights is a huge problem. When I am outside at night with only my operated eye open, I can not see very well. Hopefully this gets better as my eye heals. I am optimistic so we'll see what happens.
My question that I have for anyone that can answer: My close up and intermediate vision is great. My distance vision is OK. Are they able to do a Lasik/PRK touch up to increase my distance vision to 20/20, while leaving my close up & intermediate vision the same, or if they do the Lasik/PRK for distance, will it take away from my close up and intermediate making it a bit blurry?
I find that my vision is better in the morning and then starts to get more blurry towards the night. What I think may be the cause is that my vision in low lighting(night time) is not as good as during the day. I also find that the halos around lights is a huge problem. When I am outside at night with only my operated eye open, I can not see very well. Hopefully this gets better as my eye heals. I am optimistic so we'll see what happens.
My question that I have for anyone that can answer: My close up and intermediate vision is great. My distance vision is OK. Are they able to do a Lasik/PRK touch up to increase my distance vision to 20/20, while leaving my close up & intermediate vision the same, or if they do the Lasik/PRK for distance, will it take away from my close up and intermediate making it a bit blurry?
So I saw my ophth today. He said everything is healing fine. He said there is a tiny bit of PCO but nothing to be worried about right now. Close up I am reading at J2 and my distance vision is 20/25. It's weird because sometimes I feel like my vision is 20/25, like when I was driving to work from my appointment, but then for example, I am walking through my office looking around, and everything is a bit blurry.
1 Comments
I can't recall if you've mentioned if your other eye has some degree of cataract. Is its visual acuity less than the operated eye? If so perhaps your brain isn't always tuning it out, perhaps it was the default eye used for that distance in the past and you just need to get used to using the better image from your IOL eye. Obviously PCO could be reducing the distance acuity, in addition to the need for more healing and perhaps even neuroadaptation still. Unfortunately I haven't seen any studies on neuroadaptation time with the Symfony, and its possible since you only have it in one eye that its slower. I also had multifocal contact lenses before my surgery, I don't know if having been through visual adaptation once made it easier for my visual system to adapt to yet another new change.
I finally get to see the doctor tomorrow for my 1 week followup. I'm honestly not sure if something is wrong. When sitting at my computer, my eye feels normal, but when I try and look at long distances, it sort of feels like there is a bubble over my eye. When I am standing 3 feet from my gf, when looking straight at her, it's clear, but everything around the center of my focus is a blur. Overall it just seems like my peripheral vision is not working properly? I'm also not sure if I am getting dry eye from my drops, but at the edges of my eye, they feel a bit heavy.
2 Comments
Dry eye is a potential side effect of surgery, often it goes away, it can take weeks or several months. The suspected issue is that nerves that report the eye is dry are cut. It wasn't a big deal for me but I did use lubricating drops a few times a day for a while, after a few months it was perhaps once a day, now its once every few days. (though that may be less dry eye than a bump under my eyelid, GPC from contacts before my surgery that still hasn't quite gone away and occasionally its noticeable but drops help, though it may be the eye being dry is why I noticed it ).
I'm not sure what the peripheral vision issue is, it doesn't sound like anything I've noticed. I don't know if you are holding your eye too steady when doing that, is it an issue with both eyes? It could be something about the visual system needing to get used to differences between the IOL eye and the natural eye and how to scan. In reality even young natural eyes only have a fairly narrow cone of the sharpest vision and they constantly move to direct that central sharp vision all around what we are looking at to piece it together, e.g. see:
http://www-personal.umich.edu/~itm/688/wk8%20-%20Psychology%20and%20Design/designing%20with%20the%20mind%20in%20mind/science-05.pdf
"Our Peripheral Vision is Poor"
http://www.rondexter.com/professional/operation/vision_for_photography.htm
"The FOVEA "sees" an angle of only 1.7 degrees, about the size of a pen held at arms length. Outside of the fovea the eye's resolution is very poor."
I'm not sure what the peripheral vision issue is, it doesn't sound like anything I've noticed. I don't know if you are holding your eye too steady when doing that, is it an issue with both eyes? It could be something about the visual system needing to get used to differences between the IOL eye and the natural eye and how to scan. In reality even young natural eyes only have a fairly narrow cone of the sharpest vision and they constantly move to direct that central sharp vision all around what we are looking at to piece it together, e.g. see:
http://www-personal.umich.edu/~itm/688/wk8%20-%20Psychology%20and%20Design/designing%20with%20the%20mind%20in%20mind/science-05.pdf
"Our Peripheral Vision is Poor"
http://www.rondexter.com/professional/operation/vision_for_photography.htm
"The FOVEA "sees" an angle of only 1.7 degrees, about the size of a pen held at arms length. Outside of the fovea the eye's resolution is very poor."
My dry eye has always been bad, I think it was from the Lasik. I'm not sure if the cataract surgery made it worse or not.
Its been about 4 days(based on time) since my surgery. I am a little bit worried about my vision. I feel like my brain is adjusting better now, I have less eye strain. My intermediate distance is still good, but my distance vision is about 6-7/10. I can't wait for my 1 week post op appointment. It's giving me a bit anxiety because my vision isn't where I want it to be and I would love to hear what my ophth has to say about my results so far.
2 Comments
If your intermediate is good that suggests, as I suspect you realize, that you were left myopic to some degree. If it isn't too myopic, you might consider viewing that eye as the near eye for some level of monovision. Monovision does take some adaptation. I don't know if the error on the 1st eye usually can be used to better target the 2nd, it may depend on how similar the eye measurements are, sometimes people's eyes can be fairly different (mine were about 1mm different in axial length, 25.96mm and 26.9mm and a 13.5D lens in one and 10D in the other, which in hindsight perhaps should have been 10.5 or 11D since it was left +0.5D hyperopic).
Yeah, I will definitely take that into consideration. Thanks for the reply.
Yeah, definitely going from having great vision at all distances, to what I have now is definitely going to take some getting used to. Unfortunately I don't have my appointment until next week, so for now I can really only use rating system. But thanks for the articles about people not having a day after visit, only a week after. Gives me a bit of reassurance. Eye feels like it's healing fine, no issues that I am aware of.
My distance vision is still a bit hard to focus, I think it might be because of sensitivity to light. I am still having trouble adjusting to fast movements, its giving me a bit of a headache. Close up had gotten a bit better, I would say 5/10, and intermediate is still 9/10/
As for him doing Lasik, lets say I end up with 9-10/10 intermediate vision, can he do a Lasik correction only for distance to get me up 9-10/10, and leave my intermediate distance vision the way it is?
My distance vision is still a bit hard to focus, I think it might be because of sensitivity to light. I am still having trouble adjusting to fast movements, its giving me a bit of a headache. Close up had gotten a bit better, I would say 5/10, and intermediate is still 9/10/
As for him doing Lasik, lets say I end up with 9-10/10 intermediate vision, can he do a Lasik correction only for distance to get me up 9-10/10, and leave my intermediate distance vision the way it is?
1 Comments
I recall the brightness not bothering me after a few days, though it was still very noticeable for many weeks even though it wasn't a problem anymore.
I'm not sure if you are talking about fast movements of your eyes or of objects. I wonder if it might take longer for someone who was pre-presbyopia for your visual system to get used to the fact that one eye can't change focus anymore even though it tries (especially if the other eye can). At least with some presbyopia our visual system is more used to running into its limits in its ability to accommodate.
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Your eye has only 1 best distance focus point and laser surgery adjusts that. It doesn't separately alter distance vision and intermediate vision, that would require some sort of multifocal laser surgery which is still a new technology in its early stages and it might not combine well with a non-monofocal IOL.
I'm not sure if you are talking about fast movements of your eyes or of objects. I wonder if it might take longer for someone who was pre-presbyopia for your visual system to get used to the fact that one eye can't change focus anymore even though it tries (especially if the other eye can). At least with some presbyopia our visual system is more used to running into its limits in its ability to accommodate.
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Your eye has only 1 best distance focus point and laser surgery adjusts that. It doesn't separately alter distance vision and intermediate vision, that would require some sort of multifocal laser surgery which is still a new technology in its early stages and it might not combine well with a non-monofocal IOL.
One thing I was concerned about, that maybe someone can give me some reassurance, is that I was checked 1 hour after my surgery, but I do not have a day after follow up. My next appointment after surgery is for 1 week. Everywhere that I have read said that you should go for a follow up the day after.
1 Comments
I had thought that was standard practice, the folks I know a postop the next day as did I. However a quick search shows it seems to depend on the surgeon, and perhaps the country. The UK for example seems to have decided a while back that there weren't risks in holding off a postop (presumably the intent is if you have a problem to call and get in earlier):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771096/
"This document includes protocols relating to postoperative visits suggesting that there are no additional risks to patients who are not reviewed on the first postoperative day.
So for instance the general NHS guidelines in the UK say:
http://www.nhs.uk/Conditions/Cataract-surgery/Pages/Recovery.aspx
"The follow-up appointment will usually take place at some point between two and six weeks after the operation."
and one UK hospital notes:
http://www.guysandstthomas.nhs.uk/resources/patient-information/eye/your-guide-to-cataract-surgery.pdf
"The timing of your next appointment depends on your surgeon, and is usually either the day after surgery or one to two weeks after surgery."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771096/
"This document includes protocols relating to postoperative visits suggesting that there are no additional risks to patients who are not reviewed on the first postoperative day.
So for instance the general NHS guidelines in the UK say:
http://www.nhs.uk/Conditions/Cataract-surgery/Pages/Recovery.aspx
"The follow-up appointment will usually take place at some point between two and six weeks after the operation."
and one UK hospital notes:
http://www.guysandstthomas.nhs.uk/resources/patient-information/eye/your-guide-to-cataract-surgery.pdf
"The timing of your next appointment depends on your surgeon, and is usually either the day after surgery or one to two weeks after surgery."
I'm going to change to a rating system, I think that would be easier to follow
1 Day Post OP
Distance: 7/10
Intermediate: 9/10
Close: 3/10
Just wanted to add that ophthalmologist said he will do a lasik corrective surgery once my eyes have healed to get the best possible results.
1 Day Post OP
Distance: 7/10
Intermediate: 9/10
Close: 3/10
Just wanted to add that ophthalmologist said he will do a lasik corrective surgery once my eyes have healed to get the best possible results.
1 Comments
Since you suggest he will do lasik, that suggests you might be left with some refractive error (myopic/hyperopic/astigmatism) which will impact the quality of your vision at different distances of course so that makes your ratings harder to interpret. So it'd be of use if you find out what your refraction/prescription is. You might also ask them to check your visual acuity, 20/? and your "best corrected" acuity.
In my case my near vision fluctuated quite a bit the first day or two, then it stabilized and was 20/25 at one week postop. Others take longer to get better near vision. One thing you need to be aware of is that of course at your age you had a wide range of accommodation, very good near vision so your comparison point will be different from presbyopic patients who already lost some (or all) near. I suspect unfortunately even with a bifocal many young people would take a bit to adjust to the level of near they have compared to their natural near vision. To me it seems a monofocal lens would likely have been a great shock to a younger patient who hasn't had any presbyopia to be used to the idea of losing any near.
In my case my near vision fluctuated quite a bit the first day or two, then it stabilized and was 20/25 at one week postop. Others take longer to get better near vision. One thing you need to be aware of is that of course at your age you had a wide range of accommodation, very good near vision so your comparison point will be different from presbyopic patients who already lost some (or all) near. I suspect unfortunately even with a bifocal many young people would take a bit to adjust to the level of near they have compared to their natural near vision. To me it seems a monofocal lens would likely have been a great shock to a younger patient who hasn't had any presbyopia to be used to the idea of losing any near.
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