experiences with Symfony IOL, or trifocal IOLs?

[SoftwareDeveloper]

Has anyone here gotten the new Symfony IOL, or heard from others who have, or know more than the research you can find with google? It was just approved in June for use in Europe, but initial studies on the web seem to indicate it provides better odds of having good intermediate/computer vision, and better than the AT lisa trifocal except at very near distances. It refers to it as having an extended depth of vision rather than   calling it multifocal (perhaps because it doesn't divide itself into 2 or 3 discrete focal points but in essence it must still have a range of focuses to provide "extended depth").

I've seen detailed threads about the FineVision but only brief comments on the AT lisa trifocal.  Any more comments on any of these lenses? I'd  be curious if anyone has more comments on getting a multifocal in only one eye with the problem cataract and wearing a contact lens in the other (which is still correctible to 20/20 with only an early cataract). The hope would be that perhaps before it goes bad a new generation of lenses might come out, like an accommodating lens that is more likely to work well than the ones out there now.

Any suggestions for good doctors to get them from, preferably laser cataract surgery? I'm open to considering doctors in any country since I'm in the US and will need to travel to get the lens, the UK would be easiest since I only speak English, but I'll consider other options. I've heard the Czech Republic may be cheaper but still have   high quality clinics. Its worth a bit of hassle to get a good lens. I'm only 52 so I'll hopefully be using it a few decades, so thanks greatly for any information you can provide.

[SoftwareDeveloper]

PS, I should add for anyone who is outside the US and isn't aware of this, the reason I'm going outside the US is because the government here is remarkably slow about approving new lenses. There are options that have been available for a few years in Europe that we don't have. The FDA seems to be either extremely cautious and/or extremely  incompetent.

[rwbil]

I would have to go with FDA incompetence.  At some point the safety factor just is not believable. They are so afraid to approve anything, because their might be a news story about something bad happening over one of their approvals.   But the harm being done to the vast majority out ways the little and I mean little good they are doing.  Just common sense says that after a lenses has been approved and used in Europe for years it should be available for use here in the US..  This should be a decision between the patient and the doctor not the FDA.  Thank God the FDA does not have to approve operating systems or all of us in the USA would be still using DOS.  

[KayakerNC]

I think you may be putting the cart before the horse in trying to pre-select an IOL. I was also considering medical tourism (Tijuana Mexico looked like fun) but I finally decided that being close to home and support was my best option and made appointments for cataract evaluations based on recommendations from my primary MD and my Optometrist with ophthalmologists that have experience with all the IOLs, rather than a one-trick pony Dr who only implants one type.   I cancelled the 3rd appointment when the first 2 told me pretty much the same thing.  
Stay away from multifocals.
Best results (for MY eyes) would be with torics and laser assisted surgery.
Given that it will be about a month before your eyes fully heal, I wouldn't want to be more than a phone-call and a quick drive away from the surgeon for that time period....just in case.

[rwbil]

From what I have read the Tecnis Symfony is pretty exciting giving you vision at all distance with reduced halos and glare in comparison to other multifocal lenses.  But it is new so you would be a genie pig of sorts.

I will add I taked to another person that had cateract surgery and asked why he did not choose a multifocal IOL and he did not even know about the.  Apparently his Dr. did not do them so tell even tell him about them.  So in cae those Drs. do not do multifocal, you might want to talk to one more Dr. that does a lot of multifocal and get their assessment.

[SoftwareDeveloper]

re: "wouldn't want to be more than a phone-call and a quick drive away"

I have a very good eye surgeon here in the US who diagnosed the cataract and has no problems with doing the followups if I get surgery elsewhere. Fortunately it is possible for educated non-doctors to read the online  published literature about the various lenses and make an informed choice, which in my case is to decide that the lenses approved in Europe are a better bet.

re: "Stay away from multifocals"

The research on the multifocals in Europe shows they are much better than the older ones available in the US. Some surgeons in Europe I gather had stopped using multifocals due to problems with the older ones, but consider the newer ones good enough to use now.  Initial results with the Symfony seem to show little incidence of visual side effects, and better odds of good intermediate vision while still having decent near.

re: "rather than a one-trick pony Dr who only implants one type"

Most doctors do a variety of IOLs since one size doesn't fit all,and there are good doctors outside the United States. Oddly it turns out in some cases its also cheaper   to use an internationally prominent doctor (as judged by industry publications&invited panels, etc, not  just their own  website's claims), or an experienced one on faculty at a prestigious medical school, than it is to get this  done in the US using a lower quality lens option.

  Unfortunately it turns out many doctors don't yet offer the Symfony. Its manufacturer  has poor marketing in that they don't list what clinics offer it, and many eye doctors don't list their IOLs on their websites.  I have found clinics that offer it and   I'll evaluate the doctors first.  I don't need the very top doctors, merely a high quality one to do a straightforward surgery.  I hadn't decided which country to go to yet, which is the main reason for checking on multiple clinics (since for instance there are good UK surgeons, but they are more expensive, and at least one was booked up until January).

[LisaTaylor]

maybe you want to schedule an appointment with the MyVisionCare team. they are situated in Canada. if you can't travel, you can still email them for your concerns

[Anomalychick]

I had a Synchrony implanted overseas. I can tell you that I definitely ran into trouble with follow up care. Doctors would look at my eyes and react with kind of like "what IS that?"
It got bad when I needed a YAG done. They were afraid to do it. They said that the design of the IOL made it look like it might be dangerous. One doctor wanted to explant instead of a yag when I developed PCO, another wanted to do a vitrectomy so they could access the back of the lens and manually cut the hole instead of using a yag laser. They told me it was extremely risky and I might end up blind.
So of course I did nothing, the PCO got worse, which caused my prescription to shift. In response a doctor told me the IOL was probably dislocating due to advance fibrosis and could end up just lying around inthe back of my eye.

So I finally had no choice other than to go back to Germany. Walked in with 20/200 vision from PCO being led by my sister while having a panic attack because I expected an explant/vitrectomy/iris sutured IOL/blindness.
       Turns out I just needed a yag. Which was perfectly safe synchrony or not. Which they had completed 20 minutes later and my vision was fine the next day save  for floaters. And I can still accomodate. The US doctors scared the living crap out of me for no reason other than I had the operation overseas. And you know what else? They  never suggested that I should go back overseas. They were going to explant an extremely difficult and dangerous to explant IOL (dual-optics) or vitrectomize me unecessarily, which would have caused me to lose accomodation. Either way I would have lost my near vision. The one doctor brave enough to try a yag was going to give me a 2mm opening. (Germany did 5mm, my vision would have been awful with 2mm)

The doctors in Germany were awesome. The clinic was awesome. Aside from really scary the experience was fine. And my vision is much better off  than what I would have gotten here. (Im 30, bilateral implants and near vision is STILL J1+ or 20/16 with distance correction.) But BE PREPARED TO GO OVERSEAS FOR FOLLOW UP!

I still need a lasik touch up, guess where I'm going? I was warned that due to my age the PCO could reoccur, if it does, guess where I'm going?

[Sunil111]

PCO is not a big deal to tackle, it is to be dealt with YAG laser. Only thing is to avoid formation of pits on lens surface. That is avoidable and in my practice i never had optic pits due to YAG laser posterior capsulotomy.Size of Opening has to be 2-5 MM depending on pupil size but patient with small opening can benefit with Pin Hole effect.IOL do not fall back into the vitreous cavity if Yag Laser capsulotomy is done.

[KayakerNC]

Evidently you've convinced yourself that the Tecnis Symfony is the best choice.  
It seems to be a modified Tecnis Multifocal to provide better intermediate vision which is the Tecnis Multifocal's weakest vision area.   The Acrysof ReSTOR 2.5, and the toric versions of the 2.5 and 3.0 ReSTOR multifocals are currently undergoing US trials. They also seem like excellent IOL options and received CE Mark in Feb 2012.
Hopefully you will provide updates when/if you get the surgery.
Good luck.

[SoftwareDeveloper]

Wow, sorry to hear about your troubles with US doctors doing followups. The eye doctor I have here seems to be very reasonable, I appreciate your warning, I will be sure to be prepared to go back for followups if needed. I do live in a decent size metro area,Boulder/Denver, so I'd hope  if my current doc weren't reasonable I could find other nearby docs who are. I had considered the Synchrony lens in the past but consider other options better, I had seen a comment on this site suggesting the lens may have been pulled form the market, but I hadn't followed up to confirm that since I had been reading good results.

[SoftwareDeveloper]

Actually I hadn't decided for sure if the Symfony is the best choice, partly since there is little study/data on it yet and it has just come out so there has been less time for more doctors to confirm the initial promising results.  I figured it made sense to book surgery with a doctor who offered that as an option as well as a trifocal so I needn't decide until the last minute in case new information comes out in the meantime. Unfortunately  I am hearing conflicting reports now about whether the FineVision or the AT Lisa is the best trifocal to consider as a backup option, which I seem to be a better fit than the ReSTOR for me.

[KayakerNC]

Just wondering.
What did your "very good eye surgeon here in the US who diagnosed the cataract." recommend for your eyes.
I'm assuming he did a cataract evaluation and measured your eyes for the needed powers and astigmatism corrections, if needed.  

[SoftwareDeveloper]

My local  eye surgeon is one who doesn't implant the US approved multifocals due to concerns with them.  Since he is in the US there is no reason for him to have explored the European options in depth. He does implant the Crystalens and seemed realistic about its questionable benefit, though it seems at least a better bet than a pure monofocal for those who don't want a multifocal (and won't leave the US for other accommodating lenses).

I only have 0.25D of corneal astigmatism, so that doesn't impact lens choice,and he did a thorough exam and didn't see any other eye health problems (my optometrist hadn't been sure what accounted for a rapid reduction of  visual acuity, and shift in prescription,  over a few months, so the MD   checked to be sure this was the only issue he saw).

[KayakerNC]

Wow.  The minimal astigmatism does increase your options.  
As long as you are looking at the Pros AND Cons, I'm sure you'll make the best choice for YOUR eyes.  
Good luck and keep updating.

[Anomalychick]

The  Synchrony was indeed pulled from the market. The lens was marketed all these years with the eventual goal of obtaining FDA approval as the first truly accomodating IOL, meaning not just effective for cataracts, but as a means of restoring accomodation. The FDA did not approve it, my understanding is that there was some debate over the definition of "accomodation" although I don't know  the details for sure. I do know that it was not a safety issue.
    Unfortunately, that limited the lens to the european market. And unfortunately, the european market likes tried and true. The germans love their glasses, literally EVERYONE wears them so very few of them are motivated to pay thousands of euros out of pocket for an option beyond a monofocal. Due to its limited niche market and lack of demand, the cost of keeping the IOL in production has been higher than the profit. The only reason they did it was with the eventual goal of US approval, which could instantly have turned it into a cash cow.
     Once that was taken off the table, there was no longer any reason to continue production. I did recently hear from someone that the lens is once again  being offered in the UK, although I know in Germany they told me they could not order it anymore and had to return their stock last april. So, I'm not sure. I'm sure it was pulled. I am not sure if it has been re released since.

[SoftwareDeveloper]

re: "that it was not a safety issue"

That is truly unfortunate obviously, if there isn't a safety problem they should leave it up to the patients (consulting with their doctors) to decide. A field of economics called "regulatory capture" theory explains that unfortunately often the regulatory process is controlled by the industry they are supposed to regulate, and existing companies use it to try to keep out competitors. I wonder if that was a factor then, regardless of whatever rationalization they gave for not approving it.

re: "limited the lens to the european market"

There are a number of non-FDA approved lenses that seem to be surviving in the non-US markets, the rest of the world is a large market. Some countries follow the lead of the FDA, but many   countries aren't as behind the times in what they allow. It seems likely there is more to the story we hadn't heard, perhaps the market wasn't accepting it. You had commented on a prior thread about hearing mixed results from some surgeons, it sounded like many showed no accommodation, even if others had good results as you did. I also heard that the lens wasn't as good for fairly myopic people (which was another reason I decided to cross it off the list, before the cataract hit I was a -9 or so  worst eye).

re: "so very few of them are motivated to pay"

Surprisingly if you hunt for cataract surgery trade literature you will see many people commenting on   a growing premium IOL market in Europe (and I thought one of those commenting was German, I can't remember for sure). I think its  partly  driven by RLE, patients who are getting lenses implanted even without a cataract when faced with presbyopia, and partly driven by awareness of better lens options slowly spreading.

[Anomalychick]

The method of accomodation that the synchrony used was only supported by a limited range of lens powers. It came in 16D-28D. I had a friend who tried to get it after me. The closest to plano they would have been able to get him was like a -10. There is no toric version. If  you needed glasses before you had cataracts chances are you aren't a candidate.

In 30% of cases, there was no accomodation. It depends on the size of the capsular bag. The lens comes in different powers, but they're all the same size. Not everyones capsule is the same size. Dr stated it was not possible to tell pre surgery who it would work for and who it wouldnt. 30% end up with a very expensive monofocal, and see below for what else they win.

Because it shifts inside the eye after implantation, refractive outcomes are VERY unpredictable. They only hit target refraction in 7% of cases in a study I read. You're going to need glasses or lasik. In my case, lasik because not only did they miss target by over 1 D with both eyes, but they also landed them 2.5 diopters apart.

The size of the lens means explantation is only considered in SEVERE cases. Its nearly impossible to remove safely. It is guaranteed they will tear the capsule at least partially, and there is a frighteningly large chance they will completely wreck the capsule and you'll need the new IOL sutured to your iris. Its not something they would do for refractive reasons.

Due to its size, a piggyback IOL is also not an option, there is no place to put it.

The surgery is much more difficult to perform than other IOLS. And they need to paralyze your eye temporarily which carries some additional risk.  You always need a backup IOL as an option should the capsule tear in surgery, which is more likely due to the additional manipulation required.

Those are the reasons to stay away. Now for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. (Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field) When I look at a piece of paper, its a blurry mess for a second. Then it shifts into focus. I got what I was after.

[KayakerNC]

"Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field."

I have the Trulign IOLs, the toric version of the Crystalens.   After reading for 10 - 15 minutes or so, when I look up at something distant it is a little blurred for a minute or so, and then gets clear.  Same situation going from distance to close reading.  So, for me, it is a lot more than just depth of field.  It is accommodation.  

[SoftwareDeveloper]

When I was first diagnosed with a cataract a couple of years ago I was checking on the Synchrony, and contacting them about  clinical trials in the US. Aside from limited power availability  I recall getting the impression that some aspect of the Synchrony's  accommodation  might not have worked well due in most  myopic eyes due to some physical attributes they tend to possess,  but unfortunately I can't recall what the issue was so I might be wrong. I  just remember the impression there was a reason there weren't lens powers available for myopes other than simply focusing on the most common powers required. If it had higher odds of accommodating than it does, even  for myopes,  but merely weren't in the right power, it might have been worth just getting laser enhancement (or  contact lenses),

re: "for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. "

I can understand the desire to have good vision at all distances. I had hoped I could postpone surgery until  a future   generation  accommodating lens that works well is approved.

I am curious   as to why you didn't think the trifocals might be a better bet to get useful vision at a variety of distances  given the odds of trouble with the Synchrony. I see a reference in a prior post of yours to reading speed, but it was only regarding some version of the Restor, and lenses differ of course. I'm not sure which paper you were referring to, I see one that notes reduced speed in Restor vs a monofocal , but not quite as much as you indicated. I also  only saw the abstract  (I hadn't searched to see if there is free version of the full text) and can't confirm things like how long postop the reading speed was measured  (e.g. did they give the patients enough time to adapt).  I see other papers that suggest for instance:

http://www.sciencedirect.com/science/article/pii/S0886335012011625
"Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions...

Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL."

I  hadn't seen the full text of that, or  researched this issue in depth. I didn't have the impression reading speed was a reason to avoid the newest multifocals.  If anyone does know of a reason to be concerned about their impact on reading speed  I'd appreciate input since I read a great deal (mostly at computer monitor distance), I may try searching a bit more this weekend.

People's priorities vary obviously, I'm just trying to figure out of there is any drawback I've missed aside from the commonly mentioned ones (like halo risk, etc). Was your concern  a strong a preference for trying to get more natural accommodation since you were hesitant to trust that using a different method to achieve   functional vision at different distances  due to multifocality was going to really feel close enough to natural vision to be worth it?

I'm guessing  I might have had more of a concern over multifocals if I hadn't already tried multifocal contact lenses to deal with presbyopia. (though I do know the optics is different than those of the IOLs). Unfortunately at your age I'm guessing there would have been no easy way to usefully try multifocal contacts since you still had enough accommodation.

I can't wait any longer to get one eye done (difficulty merging images now, I should have had it done already), but I'm hoping they might be available by the time my other eye's vision degrades (though I can't know how long I have before that,  my left eye lost quite a bit of visual acuity within a few months when it first caused trouble. My right eye showed the beginnings of a cataract two years ago  but has stayed 20/20  so far).

[SoftwareDeveloper]

PS, in the last paragraph when I said "hoping they might be available" I meant of course the next gen accommodating lenses, I'd moved the paragraph, I need to go and didn't take time to proofread. They should let you edit posts on this site.

[rwbil]

I thought his interest was in the Tecnis Symfony not the Synchrony IOL.  If you are willing to cutting edge, what is the latest news on the Light Adjustable Lens.  I called AMO and they said they haves some trials for Symfony in the US but I have not followed up it yet.  Might be something to explore

[SoftwareDeveloper]

Coincidentally before I saw your post I had gotten into contact with the person running the trials in the US. The details are still being worked out, but they will be randomized trials with 50% getting this lens and the others a control lens (it didn't sound like they knew what that would be).  I would rather not risk that, and I'd rather not  wait for the trial regardless I decided since this has started interfering with vision.

I will note that i have been cautioned btw by an experienced US surgeon to be sure if I use a non-US doctor to be careful of the fact that in even in good  European clinics their standards may not be as high as US doctors in terms of things like complication rates and hitting the refractive target.

As with anything however, prices vary for many reasons between countries and there are good surgeons who are lower cost, but it is best to be cautious of course to ensure you are getting high quality treatment.

[rwbil]

One of the problems is the dollar is so weak that the price in Europe for the lens is expensive.  Has Canada approved this yet?  Let me know what you decide and your experience.  One other thing is I am confused about how this lens actually works.  I under multifocal that create 2 or more focal points but how this lens is able to provide distance to close vision is not clear to me. I keep putting off the surgery as long as I can hoping for better options.  I hate how you hear news stories such as below and then you never hear any follow up.  
http://www.scotsman.com/news/health/scots-scientists-develop-laser-cure-for-cataracts-1-3242146

I doubt I would do a trial where I might be given some unknown control lens.  That is ridiculous, unless it is the Tecnis multifocal.    

[Woodvillewomble]

Even living in the UK I considered going to Czech Republic, to the Gemini Clinic in Zlin, where they use the Femtosecond laser for the incisions and Astigmatism correction. This was for CLE, with no cataracts or other anomalies.

I eventually found a very local, and very experienced surgeon who used the Finevision, although not with the Femtosecond. I looked at the Symphony accommodating but the few reports available suggested limited accommodation with varying degrees of success.

With the Finevision having had a two year history, no negative reports and a very high probability of a spectacle free outcome I chose this as my preferred option, assuming the surgeon thought it a suitable lens for me.

I am spec free as hoped, with very little effects in some very minor situations, as per my diary on this forum. The holy grail of full accommodation is, I believe, some way away, and I wanted rid of specs.

Best wishes in your research before making this enormous decision.

Phil

[SoftwareDeveloper]

re: "I looked at the Symphony accommodating but the few reports available suggested limited accommodation with varying degrees of success. "

I'm guessing you meant the Synchrony lens, the Symfony isn't an accommodating lens and was only CE marked in June.  It does seem to provide some of the advantages an accommodating lens has   like lower risk of haloes & glare than multifocals. It seems to provide better near vision than the accommodating lenses that are approved anywhere at the moment, though unfortunately perhaps not as good as trifocals for near (though often good enough it appears, and unfortunately no lens is perfect at the moment).

It sounds like surgeons are divided over whether the FInevision or the AT Lisa tri is the best trifocal option, though it seems like those with experience with both give the AT Lisa tri a slight edge overall, that it may vary with the patient which is best.