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.

[JohnHaganMD]

Typo "Thank you'

[JohnHaganMD]

Thanks Gary.  For some people it will be worth accepting fully informed risks for others once they understand the risks they will bail out.  Both are acceptable.  Some people think climbing Mt. Everest and K-2 are acceptable risks.  I personally climbed Mt. Rainier and summited Mt. Kilimanjaro (by the Machame Route).  Those risks were acceptable given my physical condition and skill level. I was asked to join a group trying to climb Mt. McKinley (Denali) in Alaska. Those risks were totally unacceptable to me.

Again that you
JCH MD

[Garrry]

Great post John

Im sure it will help many to decide weather the risks are worth taking
Its very hard to achieve balance Most posts or articles are very one sided
one way or the other
Great post  
     Gary

[JohnHaganMD]

=

[SoftwareDeveloper]

The issue of calculating IOL powers is an important one. Unlike determining the power of eyeglasses or contacts, they can't determine the IOL power exactly in advance. They use various formulas to try to estimate the right lens power based on statistics from past patients. Usually those with low prescriptions like the original posters lead to fairly accurate results, not there are exceptions. If they don't get the power right, then you may need to either wear correction, or add further risks with   a laser enhancement, a lens exchange or a piggy back lens.

There is a new paper out on the issue which mentions a lower rate of hitting the refractive target than I'd have expected, though unfortunately those numbers vary quite between studies, countries, and surgeons:

http://www.touchophthalmology.com/articles/refractive-lens-exchange
"Refractive Lens Exchange
European Ophthalmic Review, 2015;9(1):17–8
...Complications do occur in RLE. The mean incidence of retinal detachment is 1 % while the mean incidence of cystoid macular oedema is 0.1 %. ..In hyperopic RLE, 88 % of low hyperopes were within 1D of the target refraction while only 58 % were within 1D of the target refraction. ... On the other hand, a different bundle of complications occurs in eyes with a short axial length. These include suprachoroidal haemorrhage and malignant glaucoma."

Experience helps with this sort of surgery, which is useful for cataract patients to remember as well, since practice helps (though skill is a factor also, not all high volume surgeons are created equal), a recent article mentions that in Canada:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/does-practice-make-perfect?page=0,1
" In Ontario, Canada, for example, the adverse event rate varied with the number of patients operated on by the surgeons in a year:

            Cataract surgeries per year                      Adverse event rate
                        50 to 250                                           0.8%
                        251 to 500                                         0.4%
                        501 to 1,000                                      0.2%
                        >1,000                                               0.1%"

Again however those are just statistics, and someone winds up being the statistic. Even with the 0.1% complication rate *someone* winds up being that statistic. However  of course most adverse events are treatable, even if you have a complication things may still work out fine in the long run. In life you often need to make risk tradeoffs, though many are small enough people don't think much about them, many people never consider the risks of say infection from contact lens wear or injuries from glasses breaking.

[JohnHaganMD]

I received an e mail at my practice asking for more information and to justify my position. So here goes.  The risk benefit of a procedure changes when you are doing an operation or using a medicine to save a life or save vision.  Thus people with ultra serious diseases like cancer make take medications that might kill them knowing no treatment will result in death and if a certain cancer is 100% fatal and a medicine had 25% fatal results but cures 75% that 75 people's life are salvaged.  As illnesses are less severe the medications used need much better safety profiles. Who would be willing to take a decongestant with serious or common side effects? No one.

Thus the risks for say cosmetic surgery needs to be very very low because no one dies from looking old, tired or wrinkled.  There are many respected surgeons including in our practice that do clear lens exchanges.  This is how these patients are approached:  try and take care of the refractive problem with glasses or contacts or external refractive surgery.  Make sure the person understands the risks involved and has a reason other than pure vanity for which glasses/contacts/external refractive surgery will not suffice.  Favor individuals who have early cataract formation or a strong family history of cataracts.  Decline people with unrealistic expectations or who imply that if a complication occurs "somebody did something wrong and I'm suing!"  This attitude is rife in the USA and fostered by the unremitting advertising of trial lawyers trolling for dollars.

If you go back through these eye forums there are discussions about great new eye procedures that in retrospect did not turn out well at all and most or all people who had them wished they had not gone with "the newest surgery or device on the market.    Examples include radial keratotomy (RK)  many of whom now are extremely over corrected or have debilitating glare due to cataracts and their corneal scars;  hyperopic thermal keratoplasty; corneal "intacts"; anterior chamber semi-flexible IOLs such as Azar an Stableflex; glass IOLs, generic voltarin eye drops to name a few.  

If a person is this far and wants to take these risks then by far the most important thing is the skill and experience of the surgeon. This type of surgery does not lend itself to the occasional surgeon or anyone whose team for computing IOL powers is anything less than spectacular.

JCH MD