10 years Rezoom in one eye- which IOL to match

[cataract49]

I had cataract surgery over 10 years ago (currently 59 years old), with a Rezoom IOL in my dominant eye. I have been very "balanced" wearing a multifocal contact in the other eye. My sight is excellent at distance and at 12-20 inches or so. Intermediate is slightly out of focus. I also have a minor single halo around street lamps at night that do not bother me at all.
Time is nearing for me to have cataract surgery on the remaining eye, and I am seeking opinions on which lens to go with. I am in the US but am willing to travel out of country as our FDA is so slow at approving new IOL's.

Top priorities with me are to have crisp distance vision while at the same time filling in my intermediate vision to have better overall range.
I am hesitant on another multifocal, and really think I would prefer an accommodating IOL but do not feel comfortable with Crystalens.

I am following with interest the outcome from the Symfony lens but am curious if there are other thoughts or ideas for my situation. Also, does anyone elase have one Rezoom along with a differnt IOL that you could share your experience?

[cataract49]

Update - I had a Symfony implanted two days ago to match my ReZoom lens that I had implanted nearly 11 years ago. Thanks to the FDA approval of Symfony this year, I was able to proceed in the US to have this surgery done. My surgeon and I agreed that of all the US choices, the Symfony IOL made the most sense to match my ReZoom. The objective was to have good distance vision while filling in the intermediate vision that my ReZoom lacked.

I would suggest that this choice was an overall success even at this early stage of my recovery following surgery.

I elected to have laser cataract surgery along with Drop-less procedure to go along with this advanced lens. Here are my observations so far;

Surgery was performed by a very skilled surgeon both accurately and efficiently. The doctor examined my implant about three hours after surgery and was very pleased noting I could already see at about 20/30 at distance. It only continued to get better as my eye began to return to normal. Day one post-op was a bit "cloudy" still from the drop-less injection.  

This is day two after surgery and the dialation has returned to normal and the cloudiness has subsided. Today I am very pleased with the results. I am balanced in my vision with both eyes and I am seeing very well at all distances with my Symfony. This new lens is a bit brighter and has a slightly whiter color hue than my Rezoom (and yes my ReZoom has had YAG surgery).

So far night time issues have been mild but I am noticing halo's that are larger and more faint than my single halo that surounds steetlights with my ReZoom. The Symfony lens though is quickly becoming my favorite of the two lens' due to my vision focus at all distances vs my bi-focal ReZoom.

I believe at this point that my surgeon and I made the right choice in selecting the Symfony. While I am no expert, I believe my vision is 20/20 today at distances from far into about 15 inches which very much compliments my ReZoom lens where the intermediate space from 18-30 inches is out of focus.

To software developer, I experienced the flickering effect you described, on only day one post surgery. Day two and the flickering is gone. My perception is that as i moved, the light was "flickering" between the rings of this lens. Once the dilation returned to normal, no more flickering has occurred.

I am open to any and all questions as I believe this forum helped me to reach my decision on a lens choice. My belief is my vision will only get better from here on out and I would be happy to update others in the future.

[SoftwareDeveloper]

I've posted my acuity results before and haven't seen a change. My distance vision is almost 20/15, near 20/25 at best near distance, and intermediate  in between (depending on what is considered "intermediate", for most of the range its seems subjectively as good as distance).  As I've reported before, I do see halos at night but they are so mild/translucent that I see through/past them and don't consider them a concern since my night vision is great overall (better than I can remember in the past). A surgeon who had been implanting the Symfony for a year reported his patients tending to have similar comments on halos:

http://eyesurgerysingapore.blogspot.com/2015/10/my-experience-implanting-symfony-lens.html

I don't seem to have any other issues related to the lenses themselves (an  issue I've had seems to be with my  iris jiggling, iridodonesis, not an issue with the lens).

Unfortunately I don't recall seeing any head to head comparison studies of the Symfony, and comparing different studies isn't as useful since the surgical results may vary and the methodology like questions asked about problems may differ. I'd recently seen a source looking at the FDA for the various lenses and it     suggests the Crystalens  actually has a higher issue of problems like halos than the Symfony. At first glance it  suggest its comparable to the Symfony regarding acuity at near  on average. However  other sources I've seen that suggest that around half of patients need reading glasses, though I hadn't tracked down data, whereas studies I've seen  far more report being spectacle independent with the Symfony (especially with micro-monovision), percentages in the high 80s or 90s depending on study. I'd recall seeing guesses of perhaps 15% of Crystalens patients not getting any better vision than a monofocal would have provided. It also has added risk of complications like z-syndrome (though I gather thats less of an issue in the latest model, I hadn't seen figures on it).  I figured a static lens was a safer bet.

I haven't seen study comparisons on contrast sensitivity and low light vision between the two lenses. I only had one anecdotal comparison with someone about my age who has the Crystalens:

http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
and complains about how much his reading vision is reduced in low light levels. We live in the same city and talked  after a lecture in a well lighted auditorium and he had a near eye chart. He showed me that merely holding a file folder over the chart to cast a shadow  was enough to reduce his near vision by some lines, whereas it didn't have any impact on mine. That may merely be the result of individual variation in our eyes rather than anything meaningful. It could be that the chromatic aberration correction in the Symfony helps improve contrast sensitivity.

[JohnHaganMD]

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[cataract49]

To SoftwareDeveloper , Jorginho, and any other Symfony patients, I am nearing time when I will need to decide on my next IOL implant. As you can read in this thread I am now 11 years with a ReZoom implant in my dominant eye. My distance vision and near vision are outstanding but I lack intermediate with the ReZoom IOL. I do see one single very defined halo around street lights at night. Because I am wearing a multifocal contact (with no halo) in the other eye, I have learned to tune out this halo so night driving is not an issue. Daytime vision is great.  

I am leaning heavily towards the now FDA approved Symfony IOL to balance my vision by targeting -.5 to Plano to keep my distance vision and hopefully fill in my intermediate vision.

The challenge is my surgeon has no experience with the Symfony IOL. He is highly recommending Crystalens but will insert the Symfony (I will be his first patient) if I so chose.

So for my sanity would those that have had the Symfony implanted for more than a couple of months please update me on
Distance vision
Intermedaite vision
near vision
night time halos or starbursts
any other issues you may have experienced

Thanks to all for replying.

[JohnHaganMD]

This is happening all over the USA as the Symfony has been released (belatedly as usual by the inept (my opinion) FDA)   Use the search feature this has been discussed being a good surgeon's first case.  The Crystalens is a great lens and our practice has used it for a long time. Leaving the eye -.50 to -.75 would likely help mid and near. Experienced surgeons are not going to have problems using Symfony, it is much easier to use and less experience driven than Crystalens

[Jorginho]

Well....I cannot say when I see flickering. Seems strange but I do not notice it all day. I think it happens more at the end of the day than at the start for instance...Unsure. It certainly however has got something to do with eyemovement, that is correct. We'll see.

Day 10 no further improvement seen. The feeling of itchiness and some sort of infection which I felt on day 6-7 is gone. I would like to add "since I upped my dose of nevanac" but it may  also be coincidence since the opthm noticed not a single sign of infection.

Another point: ever since my retinal surgery I Always felt my eyes felt a lot nicer WITH contacts in than without. I know this for sure since I had to keep the  contact out for more than a week before an exam of the eye. It Always felt a bit scratchy, like something was in it. Contact lens in = problem solved. But now I no longer seem to have that problem.

[JohnHaganMD]

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[SoftwareDeveloper]

The sort of flickering that people still have a few months after surgery is rare. I'm guessing this only occurs when you read, or when your eye is moving to scan a field of view? Although this doesn't describe it as flickering, I'm guessing your doctor is suggesting its  due to what is described in this ebook:

http://david-richardson-md.com/wp-content/uploads/ctb.pdf
"It's okay to read, but your vision may seem "jiggly". Because the lens capsule has not yet contracted around the IOL, there may be a slight jiggle of the lens with each eye movement. This is most noticeable when reading and will improve over the next few weeks."

Within the first 6-8 weeks the lens should heal into position within the capsule, as mine did (which indicated that wasn't the issue).

[JohnHaganMD]

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[SoftwareDeveloper]

I heard a couple of weeks or so ago from someone who had contacted one of the doctors who had been involved with the Symfony trials who had the impression the Symfony might be approved within the next 6 months or so, though I have no idea how reliable the estimate is, I wasn't sure any outsider would really have much of a clue what the FDA's schedule would turn out to be.

In terms of the risk of halos, the studies so far show its roughly comparable to a monofocal. Unfortunately there is no lens yet that doesn't lead someone to have problems with halos, its matter of what the odds are. The Eyeworld Video Reporter site had a few minute interview with James Loden where he discusses his analysis of the aggregate study data on the Symfony and halo issues, here is the link:

http://ewreplay.org/node/1274?v=4884644449001

I seem to be one of the rare people that does see halos, but they are mild&translucent and aren't a problem for me since I see through/past them (which I've seen surgeons saying is a common description). My overall night vision is better than I can remember it being before cataract surgery (though its possible my memory is flawed due to wearing multifocal contacts before my cataract since those cut down on low light vision, but it still seems like its better than it was when I wore single vision contacts).

My vision is  crisp with the Symfony. By one week postop it was almost 20/15. Although it subjectively improved after that,  checks after that   just confirmed it was at least 20/20 at distance and didn't test further to find out how much better it might be, I suspect its at least 20/15.  At near its been 20/25 whenever tested.  I can't remember my vision seeming as crisp at distance in the past (before cataracts) when corrected with contacts or glasses, but its hard to be sure how accurate my memory is, but I'm fairly sure I wasn't corrected to be better than 20/20 in the last several years at least.

As I posted in my thread, the flickering issue (which is reduced, perhaps neuroadaptation,  but not entirely gone yet) in my case seems to be a rare side effect most surgeons never run into  with iridodonesis (iris jiggling, which usually doesn't cause visual issues when it does occur) and not related to the lens choice. There seem to be multiple possible explanations for the vague description of "flickering", there are a few threads around the net with puzzled people who sometimes find answers, and sometimes never do, as to the cause, and often they are people with monofocals (or the single-focus but possibly accommodating Crystalens).

[JohnHaganMD]

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[cataract49]

Thank you for your extensive reply. I do appreciate as I, like you, have been doing extensive research on my next lens choice. I read with interest your previous posts regarding "flicker" and can tell you that 10 years ago when my Rezoom was first implanted, I experienced some "flicker" and soon discovered that it occurred when in rooms with overhead florescent lighting. As I recall, it took a few months but when the edges of my lens finally "healed" the flickering subsided and no longer an issue at all. So I feel that the flickering was an edge glare issue. Hopefully yours will subside with time also.

I am very interested in your experience with "halos" as well as crispness of vision with the Symfony lens. I have little or no astigmatism and am a -6.75 in the eye that needs surgery.

The Symfony looks to me the most interesting lens available outside of the US. I am located within driving distance of Canada and flight to San Diego should I choose Mexico. Ultimately it would be great if the FDA would approve in the us. I have been waiting patiently for 10 years now for a new lens to be approved, but will need surgery within the next year at most as my cataract increasingly is clouding my vision.

Please keep updating your Symfony experience and thank you again for your input.

[JohnHaganMD]

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[cataract49]

Thank you for your reply. additional information on my situation. -6.75 with very little or no astigmatism in my eye that needs surgery. I have been patiently waiting for a new lens approval from our fabulous FDA but will likely need to do something within a year. I will keep watch for your updated posts on how your Symfony is doing for you. In particular I am interested in the halo (or lack of) effect.

[Jorginho]

Hi. On day 8 with my Symfony. You can read my detailed report in one of the recent and frequently updated thread. I only say halo's the first day and these were related with the extremely wide pupil. When it was near its normal size there were no halo's and since then none ever occured.
Flickering is seen though. According to my opthm this isn't rare and usually stops after a couple of months...We'll  see.
My far vision is 110% and I can read easily from 35 cm onwards. But it does depend on contrast and with my unaffected left eye reading is calmer and easier. But again: only on day 8.
The reason I went for Symfony was surely the standard design (less complex) and the fact that halo's etc are less frequent than with most trifocals...

[SoftwareDeveloper]

oops, typo, its the Finevision trifocal (not Finsvision), I figure spelling of lens models is useful to correct in case anyone tries to search for them.

[JohnHaganMD]

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[JohnHaganMD]

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[SoftwareDeveloper]

There are a few accommodating lenses in the clinical trial state, but the only next generation accommodating lens I've heard that is currently seeking approval for use outside of trials is the Akkolens Lumina which is reportedly currently seeking a CE Mark (Europe's equivalent of FDA approval) and expecting to receive it, though I've no idea of how long that might take.

One of the posters on this site, AnomalyChick, received the Synchrony accommodating lens, which seems to have been pulled from the market due to a sizeable minority who have had problems with it despite initial promising results. Static IOLs like multifocals and extended depth of focus Ienses don't need to move and so their optics can be tested well outside of the eye using optical benches (though the results of course need to be confirmed in clincal tests with patients, it doesn't take many to get a sense of whether they work or not). In contrast, a major part of the functioning real accommodating lenses can really only be tested in actual eyes since they rely on the eye's accommodation mechanism to change their shape. I'd suggest that the fate of the Synchrony should be viewed as a cautionary note indicating the reality people might wish to be cautious about whether to be an early adopter of a new accommodating lens until it has been used in lots of human eyes.

There were posts in the last few months from someone going to Mexico for the Symfony to a very prominent cataract surgeon, and its also available in Canada in addition to much of the rest of the world. It wasn't approved anywhere closer when I had my surgery so I went to Europe for it. I'd initially been considering a trifocal lens, but when the Symfony came out I decided it was a better fit for my needs since it has better intermediate than the trifocals, a risk of halos fairly comparable to a monofocal, and contrast sensitivity comparable to a monofocal.  A trifocal may be a better bet for really near vision than the Symfony, for those concerned about that,  but I figured for the rare times when I need that I can use readers.

Although the Symfony is the most widely used and tested extended depth of focus lens, there are others in the works, though I don't know how widely used they are or how the results compare since they don't seem to be studied as much.  The IC-8 is likely the next most widely used and uses  a pin-hole effect extended depth of focus lens from AcuFocus, which is sort of like an IOL version of their Kamra inlay used for presbyopia. The visual acuity results I'd seen look fairly decent, though I haven't seen a head to head comparison with the Symfony to see how they compare for sure. The concern I'd have is contrast sensitivity reduction.   The Kamra tends to be implanted in only one eye  usually since the pinhole approach tends to lower contrast sensitivity, and I think  the same is true of the IC-8. The reports I'd seen on the IC-8 seem to downplay concerns over contrast sensitivity, and of course you are are only looking for a lens for 1 eye, though the IOL you already have likely has lower contrast sensitivity compared to a monofocal already.  The Symfony reportedly has contrast sensitivity fairly comparable to a good monofocal.

The Sifi Medtech "Mini Well" IOL does seem in some studies I've seen to be fairly comparable to the Symfony, and possibly to have a very slight edge over it, but I hadn't seen enough comparisons to be sure, and I'm unsure how widely used it is. There is also the Swiss Advanced Optics Info lens, Sav-IOL.com, which doesn't seem to have been studied much, and the WIOL-CF lens which also hasn't much written about it yet. (though I'd heard from a surgeon who is concerned about its lack of haptics to hold it in place, it relies on filling the capsular bag and it was suggested that might be a questionable approach).

Although I'm an early adopter, I prefer to have enough information to take an educated risk, and I'm not sure if there is enough out there yet about the other extended depth of focus lenses. One nice thing about the Symfony is that its physically overall the same size&shape as the widely used Tecnis monofocals and multifocals, and the same lens material, so those aspects of the lens have been well tested. Its only the optics that are different, which as I said can be tested in the lab, and has been by now well confirmed in clinical trials to show good results.


Outside of the US there are a variety of trifocal lenses, the AT Lisa Tri and the Finsvision have been around the longest and seem fairly comparable (surgeons differ regarding which is best overall, though my impression is there may be a slight edge for the AT Lisa Tri). However as another poster pointed out, major lens company Alcon has come out with the Alcon Panoptix trifocal  (billed by some clincs as a quadfocal, but in practical terms its a trifocal since although internally its designed that way, the  4th focus is apparently redirected to 1 of the other three so its functionally a trifocal). It *might* be a slight improvement over the existing popular trifocals. The RevIOL tri-ed, which has had less written about it.

[Jorginho]

It depends on how much time you have. FluidVision and probably some others are doing studies on a accomodating lens, which is seen as the Holy Grail in general by researchers. I believe initial results with the FluidVision are very good, 5 D range is really good. But more studies needed.

I also wonder if it is truly the best thing, this accomodation. Because now it probably hinges on the muscles within the eye to focus or not. What if these become less effective? Just a thought...

Like John says: Software developper has a nice and thorough thread on (mostly) the Symfony lens and about 1,5 yrs experience with it. Mine is only 5 days in my eye so I cannot tell you anything conclusive on my experience at all....

Reason to go with Symfony for me:
- Reasonable to good results at all distances
- A very standard design which make it a standard procedure
- Reduced chance of seeing halo's and glare

New addition:
- Alcon Panoptix
- RevIOL tri-Ed lens

The Panoptix seems comparable to other trifocals, but is different though and very new.
- RevIOL if I remember correctly is a sort of a hybrid of the Symfony and a trifocal. I find it interesting.

I would not take your experience with an old design as a proxy for how a future new implant will work.

[JohnHaganMD]

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[JohnHaganMD]

Be sure you've read this article: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You    ; ReZoom is not one of the IOLs that has had good long term success and its popularity has significantly waned.  I'm glad you did well. Use the search feature, archives and peruse the discussions over the past couple of months. This topic has been discussed at length. The discussions by Software Developer are extensive, in depth and also based on personal experience.  There are different options.  There is no "best" option. Many people do well with an accommodating or multifocal IOL in one eye and a monofocal or toric IOL in the other.