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.

[CBCT]

I would like to add that any lens replacement (clear or cataract) is not the same as natural vision.  You sacrifice any accommodation, and glare and halos could become a
problem.  It is also possible that the surgery will induce additional astigmatism.  I chose cataract surgery because I was not comfortable driving at night.  After cataract surgery, I still had serious night halos and glare which continued to precluded night driving. Additionally, I became very sensitive to light to the point that I wore sunglasses and a visor even when indoors.   I ultimately had both IOLs exchanged -- which was complicated and had subsequent retinal issues.  My conservative advice is to give it time.  At some point, you will likely need cataract surgery; and you will benefit from improved technology.    Best wishes.

[SoftwareDeveloper]

Oops, I meant visual acuity was *almost* 20/15 early on at distance, and since its improved since then its probably there by now but I hadn't checked.

I had good luck with multifocal contacts back before I had cataracts, you might consider trying different brands since different ones seem to work better for different people. You could also try monovision with contacts, though I personally much preferred multifocals. I didn't notice the reduction of 3D vision with monovision since I started that when I first was presbyopic and got used to it, but when I switched to multifocals I noticed how much better my 3D perception was.

In terms of the actual statistics of problems, they vary depending on the country and the clinic and doctor. You could try asking your doctor for stats.  I don't have more time to post now, but perhaps I'll find a general link to typical states tomorrow if no one else has done so by then.

[bwalters56]

rgp multifocal contacts work better than soft because the lens moves on the eye. When you look down the botton eyelid will push the lens up and offcenter to put the reading power in front of the pupil. Also one gets accustomed when blinking to allowing the upper lid to pull the lens into the desired positon. It takes about a month to overcome discomfort and another couple of months to get to the point that you are not always aware of them, but it is worth it for the better vision. I would recommend doing the rgp multifocals if you are motivated not to wear glasses. I  would not do a clear lens extraction until or unless I had a cataract.
That being said now that I have a cataract I will be going with a Symfony most likely and maybe an AT LISA trifocal. Leaning toward the Symfony.  

[bwalters56]

rgp multifocal contacts work better than soft because the lens moves on the eye. When you look down the botton eyelid will push the lens up and offcenter to put the reading power in front of the pupil. Also one gets accustomed when blinking to allowing the upper lid to pull the lens into the desired positon. It takes about a month to overcome discomfort and another couple of months to get to the point that you are not always aware of them, but it is worth it for the better vision. I would recommend doing the rgp multifocals if you are motivated not to wear glasses. I  would not do a clear lens extraction until or unless I had a cataract.
That being said now that I have a cataract I will be going with a Symfony most likely and maybe an AT LISA trifocal. Leaning toward the Symfony.  

[etrader]

Hi, from what I understand JohnHagan is an experienced cataract surgeon, he advises you against clear lens extraction.

To me your prescription of is not very long-sighted at all - I think you would be nuts to go under the knife for this small correction.

[Garrry]

I would go and see a consultant Then have a good think about what he or she tells you
Statistics do vary depending on who you ask
Mine was a great success As were many before me and after
But realise that it is quite rare for patents with a good outcome to bother posting on a forum
So you will mainly hear from the 2% that didn't have a happy outcome to there surgery
As I said in my previous post It took me ten years to decide to go ahead
For very similar reasons that you have stated
  Gary

[SoftwareDeveloper]

re: "from what I understand JohnHagan is an experienced cataract surgeon, he advises you against clear lens extraction. "

This is an issue where large numbers of surgeons are on each side of the issue. Merely citing one surgeon's views doesn't settle the issue, it is merely a reminder that there are surgeons who are opposed to the practice and that patients therefore should be particularly sure to evaluate the risks in consultation with doctors that have examined their particular case (perhaps getting more than one opinion).

Many experienced cataract surgeons perform clear lens extraction. While I wouldn't have chosen lens replacement if I'd never had a cataract, each person needs to make their own risk assessment, even if we may disagree.  

Here is a journal paper from a couple of years ago from some experienced surgeons in the Survey of Opthalmology going over the topic and some of the issues and studies:

http://www.researchgate.net/publication/262193174_Refractive_Lens_Exchange
"Refractive Lens Exchange"

It mentions for instance that:
"Small hyperopic eyes with shallow anterior chamber are more predisposed than other eyes to angle-closure glaucoma. This makes moderate hyperopia an indication for RLE, offering a good risk/benefit ratio"

The original poster only has mild hyperopia so that may not be a factor consider in their case, the point is merely that the risk/benefit ratio differs for each person. Unfortunately I don't have time to gather statistics on refractive lens exchange issues. One problem is that although for the most part the risks are the same with cataract surgery, some of the statistics may be misleading since the average cataract patient tends to be much older than the typical RLE patient, and more likely to have co-existing other eye problems which may lead to different complication rates. Even many of the statistics for cataract surgery don't break things out by age, and unfortunately studies are often out of date and based on older surgical techniques.

Here is an overview of cataract surgery which talks about some of the complications and rates:

http://www.allaboutvision.com/conditions/cataract-complications.htm

Here is a study published this year on surgeries in the UK (and again rates can vary by country, and by doctor, with experienced surgeons having lower complication rates):

http://www.nature.com/eye/journal/v29/n4/full/eye20153a.html
"The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications"

[Wolfhall]

Hello, you may wish to consider the higher risk of a PVD after cataract surgery, especially since you are relatively young, and male (larger eyes probably) factors which both increase your level of risk.    Although the recognised risk for you would be slightly above 6%, successful cataract patients are hard to monitor over a timescale of the decade during which the risk is greater of a PVD, than for someone who has not had cataract surgery.  This is  because the IOLs are smaller, the older bit of vitreous in the middle may already be liquid, and there is more room for it to 'slosh around' hence pulling the jelly off the retina, I have read the real risk could be as high as 20% in your age group.  Older people have probably already had a Post Vitrekus Detachment and got on with it, floaters, risks and all.  Although not serious in itself, PVD floaters can be very annoying and of course there is a small associated risk of retinal detachment to consider as well.  

I'm sure you are also aware of lower levels of vision in poor light, in an IOL, as opposed to in a natural lens.  At  night time I can almost imagine my cataract is in the other, operated, eye, the levels of my vision are reversed, (yep, I still have an op to go).  Just food for thought, you asked for comments so here are mine.  I really wish you well, but if I were you I would wait as long as you can , the rate of change in this field is A MAZ ING