Symfony CLR

[miggman]

I have a question about clear lens replacement. I am 52 and I have Presbyopia as well as the following prescription. OD Sphere  +1.50 add +1.75    OS  Sphere +1.25 Cylinder -.25 Axis 175 Add+1.75
I wear bifocal glasses and contacts at times however I hate wearing glasses with a passion. I cannot read computer, cell phone, labels or basically any font without glasses and I wear my glasses or contacts 98% of my day. Distant vision is just ok however not sharp.
I am not a candidate for Lasik correction because of too thin of something I cant remember.
I have been given the option of a clear lens replacement at TLC on London with the new symphony lens with its extended range of vision and I've read people are having pretty good success with it. I understand there is some risks involved which is a bit scary I wont lie however as far as I understand they are very low.  
So I am wondering about getting some opinions on here to hopefully help with my decision whether I should go ahead. Its an elective surgery at this point and TLC tells me they have don't several CLR procedures and also to people with even a milder prescription than mine.

[SoftwareDeveloper]

I should note that although lens exchange has risks, even contact lens wearing has risks for instance as do progressive or even single vision glasses. We don't usually think about those risks since they are minor, and often statistics aren't yet available on say the impact on car accidents.  Over say 30 years they can add up. Progressive & bifocal glasses can be an issue in falls in the elderly:

http://www.medscape.com/viewarticle/724889
"Multifocal glasses have been shown to impair balance and increase the risk of falls in several studies"

http://bottomlinehealth.com/bifocal-and-multifocal-glasses-and-contacts-increase-risk-for-dangerous-falls/
"A growing body of research, much of it originating at the Falls and Balance Research Group at the Prince of Wales Medical Research Institute in Sydney, Australia, has demonstrated that when older folks wear multifocal lenses while walking and also performing a secondary task — like reading a sign — they tend to “contact more obstacles” (as in, trip or bump into something). The glasses focus differently for near and far, which means that the wearer’s ability to see obstacles near his/her feet gets compromised. The fact that falls are the leading cause of death from injury among older adults in the US makes this especially worrisome."

A presbyopic correcting IOL can reduce those issues. Although I haven't seen accident statistics, there are indications that during daytime driving glasses aren't as good as contacts in certain ways in terms of potential safety (meaning they are presumably not as good as an IOL as well), whereas with night-time driving contacts aren't as good as glasses (though I suspect neither are as good as the Symfony or an accommodating IOL usually, aside from the rare person who does have glare or halo issues with those):


http://eprints.qut.edu.au/31885/1/Byoung_Chu_Thesis.pdf
"The results demonstrated that the path length of eye movements while viewing and responding to driving related traffic scenes was significantly longer when wearing BIF and PAL than MV and MTF CL. The path length of head movements was greater with SV, BIF and PAL than MV and MTF CL.
[....] Progressive addition lenses were ranked as the most preferred vision correction, while MTF CL were the least preferred vision correction for night-time driving."

   I chose to take the risk of contacts before surgery. I don't know what the statistics are for eye damage from say glasses breaking during an accident (though likely negligible).  This is a 2012 article so I don't know if the statistic has changed, but one of the more major risks from contacts:

http://www.medscape.com/viewarticle/773026_3
"The annual incidence of all contact lens-related microbial keratitis was 4.8 per 10,000 wearers."

So if a 50 year old presbyope chooses multifocal contacts and lives  another 25-30 years the cumulative risk is 120 to 144 per 10,000 which is 1.2 to 1.4% risk for that side effect alone. (though granted over that time they will find ways to cut down on the risk, and presumably proper lens care has an impact).  

Most contact lens issues of course are resolved by not wearing them, but not all like keratitis or some infections that threaten sight.

re: "or damage to the IOL (which is no longer safe to exchange) "

Even after a YAG a lens exchange can be done, it merely means the odds are the lens will need to be place outside the capsular bag which reduces the number of options available since usually 3 piece lenses are used outside the bag (and 1 piece lenses are usually what is used in the bag which is the preferred location), but there are monofocals and multifocals for use outside the bag.

Although I personally wouldn't have done refractive lens exchange at the current state of technology, people do need to evaluate the risks for themselves. The lesson of posts here is merely that even if it is ok for most people, the worst case can be bad so people need to be sure it is worth the "worst case" risk since *someone* winds up being the "statistic" referred to when complication rates are mentioned. Those risks however need to be kept in perspective compared the rare worst case scenarios of a damaging fall or car accident due to eyeglasses or contacts or other contact lens issues. Unfortunately I don't think there are good statistics to compare since it likely isn't always possible to determine whether different visual correction might have prevented an accident.

[Garrry]

Or everything could go just fine with none of those symptoms As in my case and tens of thousands of others Who have lens exchange with no complications or pain and have achieved the predicted outcome

Anyone who is considering lens exchange I would say read Dr John Hagans posts Very balanced
Things can go wrong But it is far more likely that all will go well

  Gary  

[Anomalychick]

Just to follow the crowd here, what they list to you as a possible complication does not begin to cover the complications that occur that they dont tell you about. Dr. Hagan wrote "The "low risks" include infection, bleeding, inflammation, swelling of the retina, blindness, need for lens exchange, lens removal or still needing glasses."

Lets look at "need for lens exchange" These are very common things that can cause a need for lens exchange. Sometimes it is too risky to proceed with another lens exchange and youre are stuck with it, even if you do replace the IOL, it may not resolve these issues- positive or negative dysphotopsias-- feeling like you have tunnel vision because there is a dark arc obscuring your peripheral, or constant streaks/sparkles/flashes/halo's of varying degrees of severity off of all light sources. People commonly develop dry eye after cataract surgery which is not really cureable and can leave you in constant pain and make your vision worse due to tear film instability or even recurring corneal abrasions. What software developer mentioned, the jiggling and headaches from reading, as well as a myriad of debilitating visual complaints that your doctor will tell you they have never heard of before and can't possibly be as bad as you say, are mentioned all the time on this forum. Oh, damage to the pupil is also a possibility which will result in permanent severe glare.
        If you proceed with RLE, it is likely you will need a yag procedure done later. Then you can worry about permanent starbursting caused by the opening being smaller than your pupil, dislocation of or damage to the IOL (which is no longer safe to exchange) permanent floaters, huge quickly moving floaters like windshield wipers across your eyes that also seem to be permanent, debilitating glare, and an extremely elevated lifetime risk of retinal detachment.

How common are these things? I don't know. I do however know that it sure seems that most of them happened to me. (And none of them were mentioned as possible risks.) I also know that if you take LASIK as example, which is supposedly almost perfectly safe with  satisfaction rate of 97%, did you know that something like 30% of all people who have had lasik done complain of night vision issues? And 40% complain of dry eye (after 1 year)? These people are considered "successful" outcomes because they no longer need glasses. They can't see at night and their eyelids get glued to their corneas and peel off like bandaids every time they blink, but their surgeries were successfull and they are "happy" with their outcome. I read a website written by a woman who had triple vision in her eye after lasik but her vision was 20/20 and the response from her doctor was that she was just too difficult to please. She is also listed as a successful outcome.

I'm not trying to terrify you, I'm simply saying that it is very likely that at least one of the things I mentioned above will happen to you. No, you're not going to go blind or end up with detached retinas, but you will have some kind of dysphotopsia, or light sensitivity, or refractive error, or slow pupil which may or may not only be cosmetic, or dry eye, or floaters, or something. (I have all of them) Everyone does, but most of these people were half blind from cataracts and are much better off than they were. You will still need reading glasses afterwards, do you want to reduce your dependence on them so badly that you will be as willing to except these permanent imperfections in your vision as someone who was going blind?

[JohnHaganMD]

Thanks for the testimonial.
JCH MD

[rwbil]

I had cataract surgery with one of the best MF IOL, IMO, the Tecnis 2.75.  And in a million years I would not recommend doing a clear lens replacement.  There is nothing out there as good as your natural adaptive lens.  When you hear 98% success rate, that is based on people that had cataracts and can not function.  I was one of those and my doctor rates me as a great success.  With cataracts if I went out in the sunshine everything was a blur and dangerous for me to drive.  But after cataract surgery I have halos at night and floaters and there is always the issue of enough light at close distance for near vision.  I do not care what they tell you this is major surgery on your eyes.  

I had Presbyopia and wore contacts and would never have my natural lens extracted unless you absolutely have to.

[JohnHaganMD]

To: Miggman. This is elective surgery. Take you time and learn what you're getting into. Be sure you've read this article I wrote and the discussion that follows:

http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You


JCH MD