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.
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.
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.
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.
"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.
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).