I have toric Symfony lenses in both eyes and my opinion is that these lenses should be banned from use. I was told there was good chance that these lenses would make me spectacle free but there is no chance of this happening for anybody who wants sharp eyesight at all distance. Far, intermediate and near are all blurred for me and so I need glasses all the time. These lenses are a complete disaster and a waste of money. I have been used as a guinea pig.
Again, many thanks. I think that the people complaining about poor near vision with the Symfony must not realize that, although it uses diffraction, it is not a multifocal and can't create a dedicated second focal point to target near vision. Since I don't mind using reading glasses for close work, this is not a great drawback for me - the improved mid-range vision is what I find compelling.
I hadn't thought about the possible benefit you mention that the Symfony's extended depth of field could help to keep things in focus even if the lens tilts or moves forward or back after implantation. Thanks for that observation.
The study you found that complained the most about lack of near vision improvement, where the author didn't notice that the subjects all wound up hyperopic, makes me wonder whether these people may have been correctly measured for monofocal IOLs, but in fact some allowance, or constant, or adjustment needs to be made to conventional measurement results when using the Symfony (and they didn't do it and used a too-powerful lens). This kind of possibility (along with my pseudoexfoliation/zonule issue) is why I would prefer to find a surgeon who has had a lot of actual experience with the Symfony. And, as well, a surgeon who takes time to really consider my eye's requirements, rather than a cataract-factory-type guy who has done 20,000 cataract procedures and has thereby achieved a dazzling level of surgical technique, but, who, in the interest of office efficiency and keeping things moving, simply slaps in monofocal IOLs whenever the alternative would require slowing down the assembly line.
I once listened to a podcast of a lecture given at a professional conference by one of these guys on the subject of "how to run a high volume cataract practice." He describes how he has three or four operating rooms running simultaneously, with nurses and assistants in each one finishing up the last patient and preparing the next one, allowing the surgeon to simply walk in and find an already prepared patient sitting in a chair, so that he can immediately do the procedure and move on to the next room where another patient is already set up and waiting. The guy said that he really likes the feeling of getting into the "rhythm" of moving from room to room without breaking his pace. I find this somewhat worrying, but maybe I am being too cynical. And I do place a lot of value on extensive experience, especially when it involves a manual skill. I know personally how much difference years of piano practice makes in performance technique, and I've been told that the same kind of practice is necessary for a professional athlete to get really good, so it seems obvious to me that the same principle applies to cataract procedures.
As far as the camera lens comparison is concerned, I didn't realize that IOLs were multi-element too. I thought that they were one solid piece of plastic. Thanks for cluing me in. As usual, there is a lot more to this than I had assumed. My level of photographic knowledge is pretty rudimentary, and I'm not sure I want to learn about lens designing anyhow; I mean, enough is enough. But I did fish out the patent you referenced, and it looks like it may well be the operative Symfony patent (although there may be other supporting patents too). It was applied for in 2008 by two Dutch inventors and finally granted in 2014 (six years!) and simultaneously assigned to the Dutch Abbott subsidiary. It claims to describe an IOL with a diffractive element having extended depth of focus. Sounds right. But it is 39 dense pages and looks like pretty tough sledding. The timing (2014) seems a little curious. But maybe they were testing it and applying for approval while waiting for the grant to come through. I think that, in the case of a patent, you have priority as soon as you file and thereby disclose your invention publicly. They certainly didn't wait until 2014 to begin putting the wheels in motion. I'll see if I can understand any of the patent description, although I don't know how much practical benefit it would be, even if I could.
Anyhow, it is nice to find someone who is as obsessive as I am about these things. And thanks again for taking the time to tell me - and everyone on this blog - what you have learned.
PPS - Forget the preceding comment/question. I just realized that camera lenses probably do all of their correcting by using multiple elements, while IOLs are still all (I think) single-element lenses. Sorry. Also, thanks for answering my question by pointing out that the slight loss of luminance in multifocals may, besides being due to the splitting of the light into two portions, be also due in part to the diffraction itself, or the widening of the depth of field (which may, for all I know, be the same thing).
Anyhow, I promise not to write any more PSs or PPSs or PPPSs, etc. Thanks for being such a great sport and attending to everyone's concerns on this blog site.
P.S. - I understand - at least in theory - the tradeoff between chromatic correction and depth of field. But I figured that the use of diffraction to achieve the better chromatic confluence (and increased sharpness) might give rise to some other kind of tradeoffs. Contrast sensitivity was only an example, not my sole concern.
Do you know how the camera lens manufacturers correct for chromatic aberration? They have been doing it for a long time and I don't recall any photographers complaining about disadvantages. Do they use a diffractive technique? As you point out, a high abbe value is really a property of the material and not independently controllable. Anyhow, maybe you know about these things, and can shed some light by analogy with photography.
Thanks for the quick response. I'm in Tampa, FL, if that is any help to anyone. There are 2 or 3 "go-to" cataract surgeons in this area, who all do exceptionally high volumes of IOL replacements, so lack of experience with the currently existing lenses would not be an issue. However, the mass-production type of setup of their operations (and possible consequent lack of individualized attention) worries me a bit. As well, they may be slow to add a new lens to their existing familiar arsenal.
Also, I don't know their feelings about a square-edged one-piece acrylic lens (i.e, as you point out, any Tecnis lens) - although that would be the same question with any surgeon - either in general, or in my particular case. I do have some glaucoma and pseudoexfoliation (which is apparently a marker for weak zonules) in one eye, and I'm not sure how that affects the choice of IOL design for a potentially weakened capsular and supporting structure.
For that reason, I rejected the idea of the Crystalens (or any lens with moving parts) pretty quickly when I started thinking about this last year, and the multifocal solution seemed kludgy, especially since the intermediate range was the most compromised with those lenses, and they were apparently subject to halos and other artifacts. And I know I wouldn't be able to get used to a monovision arrangement with conventional monofocal IOLs (and would probably have trouble with the two focal points in a multifocal for the same reason). I don't mind using reading glasses for close vision,so the allure of improved mid-range vision with the Symfony (as well as its simple unitary structure) has kept me waiting while my cataract has grown progressively denser.
I was just about to settle for conventional monofocal lenses when the FDA approval for the Symfony finally was announced, so now I'm not sure how much longer I will have to wait, or want to wait. I'd like to feel comfortable that other unforeseen drawbacks of the Symfony will not begin to emerge over time. It is encouraging that there don't seem to have been many complaints reported on the internet during the recent 2 years of usage experience in other countries. Of course, I haven't tried to find (and couldn't read anyhow) foreign language websites. But your own experience seems to indicate a happy outcome with the Symfony.
I didn't feel as adventurous as you in terms of travel to Europe, especially if some problem cropped up due to my glaucoma/pseudoexfoliation that required repeat visits, plane trips, hotels, etc., especially with no one in this country really equipped to deal with the Symfony legitimately. So I nixed the European (or even, apparently, Mexican or Canadian) idea. However, now, of course, the picture is all changed and this will all be able to be done domestically, even locally. The real questions now are where and when. And if the Symfony is appropriate for my eyes.
Anyhow, I don't know why I have taxed you with so much detail about what are probably just some personal choices for me, but I figure that you might have some further words of wisdom. Thanks for reading all this rambling on, and please answer if you have any further thoughts.
Since you appear to have the most extensive information and experience with the Symfony IOL, perhaps you can tell me:
1. Is it "axis-independent"? I don't know the correct terminology for this, but what I mean is, if the lens rotates slightly, or is placed originally so that the north-south position is not exactly north-south, will vision be degraded? (Or is there even such a thing as a correct north-south orientation?) I am speaking of a non-toric version of the lens.
2. What optical characteristics are given up in exchange for the broader depth of field? For instance, does reducing the chromatic aberration affect contrast sensitivity? Or any other things? I understand, from the literature, that simply correcting chromatic aberration alone would result in better than 20/20 distance vision, and that the manufacturer has therefore also "dialed back" the vision sharpness down to 20/20 in order to widen he depth of field into the intermediate range. But it seems "too good to be true" that there are only advantages with this lens and absolutely no offsetting disadvantages.
Now that the Symfony IOL has been approved by the FDA for use in the USA, does anyone know when it will be actually available, and/or what US cataract surgeons have experience using it?
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I may be getting a symphony IOL for my right eye here in Pune, India. This lens seems to be common place in India. It is going to cost Rs. 60,000. ( slightly less than 1000 $ US).
re: "it's that question of does it go from clear to blurry fast"
That is the difference between a monofocal and the Symfony, the monofocal gets blurry much faster than the Symfony, the range of good vision is smaller. The range outwards from the best focus is about the same in both cases (e.g. if the best focus is set at 10 feet, the vision further out would be about the same with a Symfony and a monofocal, and it still might actually be 20/20 for far distance). Unfortunately the studies only give average values, some people have better or worse results, but the studies give some clue what might work.
It is difficult to know what the various numbers like 20/40 translate to in terms of visual quality, but this site I found lists the print sizes you can see for various levels of vision at near, which suggests e.g. 20/40 isn't bad:
http://www.teachingvisuallyimpaired.com/print-comparisons.html
For instance if you had an eye set to focus at far distance with a monofocal, then according to info on the Tecnis website:
http://www.tecnisiol.com/eu/tecnis-symfony-iol.htm
with their monofocal your vision would have dropped to almost 20/40 by around -1.5D = 66 cm = about 26 inches, whereas with the Symfony it wouldn't drop that far down until about -2.5D = 40 cm = about 15.7 inches. With a slight bit of monovision, you might be able to have one eye set just a little bit closer in and be able to hit your "one foot" mark with the Symfony while still having great distance vision.
10 feet is about 305 centimeters. The formula for determining the diopters required for a particular focal point is -(100 / distance_in_centimeters) so that would be focused at -0.33D. So one eye could be focused there (giving you perhaps 20/20 still at far distance) or at perhaps -0.5D or -0.75D (since you get good vision a little further our).
1 foot is about 30.5 centimeters, so that would a focal point of -3.3D. If you had 1 eye set at -1D with the Symfony, that would give you better than 20/40 vision at 1 foot, -1.5D with the Symfony would give you better than 20/30 still at 1 foot, or if you had it set at -2D that would give you 20/20 vision still at 1 foot. The level of difference between the two eyes would impact how much loss of stereopsis (3D binocular vision) you had. The level of monovision required would be less than with a regular monofocal. Unfortunately again those are average study results, so to play it safe you might wish to have one eye set a bit further in than you need.
thanks for the input. as i work as a hair stylist/barber my need for best vision is in the "foot to ten feet" range-- or close enough for a good men's hair cut and out to the mirror and back.... i have worn didstance glasses since 9, so that's not an issue, i'd be fine still wearing them. it's that quesiton of does it go from clear to blurry fast or is there that 'range' where like normally, it just gets blurry from the distance? if the makes sense. the monofocals sound like it's "focus at one foot and anything 13 inches and out or in is blurred" or "get good distance, but trying to see the dashboard while driving is like looking trough wax paper.... that depth of focus and binocular vision loss...
The lenses come in different powers, just like glasses or contacts. You'll see discussion on this site and elsewhere of people getting monofocals where there best focal point is set for intermediate or near instead of for distance. The same can be done for the Symfony. The difference is that if you had the Symfony and a monofocal both set to the same best focal point (whether intermediate or distance), that the Symfony will give you a wider range of clear vision, you will be able to see well closer in with the Symfony than a monofocal by a diopter or so (unfortunately that isn't a fixed distance in inches or centimeters, the distance a diopter translates to is different depending on where the focal point starts).
re: "then to find someone versed enough to to the surgery"
Any competent surgeon will be able to do the surgery with the Symfony since the procedure to implant it is the same as other IOLs. The lens material and the overall lens shape and size is the same as the widely used Tecnis monofocal and multifocals currently available in the US. The only difference is the optics of the lens, which doesn't matter to the surgeon implanting the lens. The only issue that might be new to them is helping you decide where to put the best focal point because of the fact that it does have a wider range of good vision than a monofocal, but that is a simple matter they can understand from looking at the defocus charts and data.
re: " "liquid vision" lens to be out sooner for better"
The next generation accommodating lenses are a ways away from approval in the US. The only one I'd heard trying for approval anywhere is the Lumina which is reportedly trying for approval in Europe, trying to get a CE Mark (their equivalent of FDA approval). I haven't seen any estimate as to when that might happen, and after it does it'd likely be quite a while before its approved in the US. More importantly, I'd suggest caution before considering using a next generation accommodating lens until they've been widely used in human eyes. Their functioning relies on the eye's accommodation mechanism, which means that the only way to test them well is with humans. They need to be sure not only that the lenses move properly, but that all the movement doesn't lead to problems over time (e.g. the lens moving out of position, some bad interaction over time physically wearing out part of the eye through its movements, or whatever other complications might arise when there are moving parts at work). The new accommodating lenses are also often different sizes, shapes and materials compared to existing lenses, so any issues that might arise from that need to be tested.
Static lenses that don't need to move or change shape (like the Symfony, monofocals, and multifocals) only differ in their optics, which can be well tested on optical benches outside of the eye. The major issue they need to test for in human eyes are subjective factors like halo&glare, which can be done well with fairly small clinical trials.
The Synchrony lens was an accommodating lens that showed promise, but seems to be off the market (or at least not used by anyone) due to a sizeable minority having problems (one of the posters on this site, AnomalyChick, got the Synchrony lens in Europe). I tend to be an early adopter of technology, but someone who tries to take educated risks and I'd personally be cautious to ensure a new accommodating lens was used a fair amount before I risked it, but everyone's risk tolerance is different. The issue would be to figure out what the potential risks are, e.g. if you did need a lens exchange from an accommodating lens due to problems, would there be a greater risk that the capsule might be damaged, which would limit the sort of replacement lens you could get (since most premium lenses are for placement in the capsule).
I'd originally hoped I might wait for an accommodating lens, but I later realized that I'd have been more cautious about it than a new static lens like a new extended depth of focus design or a trifocal.
just wondering -- i have cataract in rt eye caused by a vitrectomy from another issue so am "looking forward" to surgery to replace lens. trying to wait till symfony is approved in the US (sounds like 2017 or earlier now)
question
do they come in different "flavors" or strengths? i.e. can it be set for more close/intermediate rather than intermediate/far? i have worn distance glasses since grad school and have no issue with continuing-- but i need far more close and intermediate clear vision for work and hobbies.
how do they set the extended depth of focus?
i really hope they get approved in the US soon. and then to find someone versed enough to to the surgery.
i was hoping for the "liquid vision" lens to be out sooner for better but this seems the best current solution and as it's the non dominant eye less strict?
in L.A. area
I am a retired 69 year old GP in Scotland and am 2 weeks after having Restor IOLs . I had been reading SoftwareDevelopers posts with great interest , and asked my Ophthalmologist for Symfony - his advice was to go for Restor 2.5 in the dominant and 3.0 in the other eye. I had confidence in his assessment of my needs ( good vision when sailing , running and hill walking in Scottish weather - and reading ) so went with his suggestion.
I have had excellent results for my needs - 20/20 or slightly better distance , smallest font size on Kindle perfect , laptop easy to see. Night driving - 3 hours on a particularly wet night was fine , and much better than using multifocal contacts. Less haloes than with contacts . Yes , at a temporary red traffic light I did have a particularly beautiful spider web of concentric fine rings , but if I diverted my attention the web disappeared - part of my neuroadaptation ? I am posting this because I feel there are good results out there which should be reported.
Very grateful to SoftwareDeveloper for his input.
I am a 37-year old female, high myope with the Symphony IOL in my right eye as of October, 2015. No near and no intermediate vision after the surgery. Distance vision is near perfect with limited peripheral vision. My cataract was pretty advanced in that eye, so this outcome is still better than it would have been with the cataract, but I expected much better results, at least for intermediate vision.
I'll post a summary, but I'll note I started a new thread to focus on my experiences with the lens:
http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258
which is likely too long for many to wade through by now, partly with details of some visual glitches that seem to be due to back luck with my eye anatomy after surgery (like iridodonesis and/or phacodonesis) and nothing to do with the Symfony lens, which I think was a good choice. I have excellent visual acuity, i was almost 20/15 for distance by 1 week postop, and am probably there by now I'd guess, and 20/25 for near (at the distance I hold the reading card). I'd guess I'm between 20/15 and 20/20 for intermediate like computer distance, and I can read my phone's email and browser (though for multi-column newspaper pages where they use a small font sometimes I need to double-tap a column to read it more easily).
I am one of the rare people that see halos with the lens, but they've never been problematic since they aren't very bright so I see through/past them and since my night vision overall is better than I remember it being in the past (I always felt my night vision wasn't as good as others seemed to be). I don't have a problem with glare at night, I think I had more trouble back before i had cataracts. I think for very near a trifocal might have been better, but that this was a better tradeoff in my case to make to get likely better intermediate than I would have had with a trifocal.
The only option I'm wondering if I should have looked into more is the idea of a Crystalens in combination with the Raindrop corneal inlay which provides more depth of focus, but I hadn't seen any studies on that (only studies of a monofocal IOL with the Raindrop). The Crystalens by itself which risks not accommodating, and by itself is more likely to leave a need for reading glasses than the Symfony so I didn't consider it as good a choice. However the results I'd seen for the Raindrop corneal inlay placed over a monofocal IOL seem comparable to what the Symfony provides. So I have to wonder if the Crystalens did accommodate if that would give even better near vision with the Raindrop, and if the Crystalens didn't work if the Raindrop would then provide usable near vision. I'm not sure if the Symfony and Raindrop would work in combination to extend depth of focus even further, or if there is a limit to how well that would work, I hadn't explored the idea since the Symfony is good enough for the moment.
There are other risks with the Crystalens (like z-syndrome, which might not be much of an issue with recent lenses so I hadn't looked further into it) so it is something to be cautious of before considering that approach. I also don't know how contrast sensitivity would compare with that approach, but it sounds like the Raindrop may not reduce contrast sensitivity much (unlike the Kamra inlay where that sounds like perhaps more of an issue). The Symfony is simpler obviously than that approach since it doesn't require 2 lenses and the added expense and risk.
Can you give us an update on your vision and experience with this lens?
What clinic did you visit for your Vision ICL surgery?
I had the Vision ICL implanted in both eyes a few years ago overseas, because I wanted the toric version, which is still only available outside the U.S. This is a phakic IOL, so it is inserted into the posterior chamber and does not affect the natural lens. I spent a few months researching the lens (along with other treatments for high myopia with astigmatism) and various surgeons. I selected one who has extensive experience with the Vision ICL and routinely presents at conferences and publishes papers.
The surgeon and all the staff spoke perfect English and the surgical facility seemed top-notch. Each O.R. has positive air pressure, all staff switch to O.R. shoes before entering. The surgeon rewashed and changed gloves, smock, mask, etc. between eyes.
I am now developing a cataract in one eye and am considering the Symfony for when my vision deteriorates to where I need surgery. I would no concern with again going overseas if best lens for me is not approved in the U.S.
I contacted AMO directly and they provided to me the clinics conducting the trials in my state. My understanding is they where selecting people in Dec. and performing the operations in January so I think the trials are closed, but you can contact them and check. I was not interested in the trials as they would not tell you if you were in the control group or not and the other lens was a mono-focal lens. I will give you another option that I am now considering. I contacted the person heading the Symfony trials and he recommended to me the newly approved Tecnis low-add lens. He had also done the trials with that lens and he was very impressed with the results. I am still researching it but I feel there is risk (imagined or real) with having an operation of this nature done overseas, so I am now leaning toward the Tecnis Multifocal low-add lens. From all my research it is a superior lens over Restor's Multifocal. Anyway another option for you to consider. I would recommend finding the clinics in your area who did trials for both the Tecnis Symfony and the Tecnis low-add lens and talk directly with that Ophthalmologist and get his assessment. The person I talked to called me on the phone and went into great detail about the 2 lenses. I also heard the Symfony is on the fast track for FDA approval. Of course the FDA idea of fast is usually slow to everyone else.
Could you provide info about how to contact clinics in the Symfony trial?
re: "that seems so promising."
I'm still waiting to post more until after Friday postop with US eye doc when I've had some recovery time. However I was pleasantly surprised to discover that I can already read the small print on medicine bottles (like the eye drops I'm using) if I concentrate a bit, and I can use my smartphone. The vision is fluctuating a bit so I suspect I'm still recovering from the surgery, but since it can take a few months to fully adapt to the lenses I'm hopeful that I'll have useful enough near vision even without reading glasses usually.
Thanks for the update, Please let me know which center you went to and the Dr. you used and your experience as time passes. I did finally call the Clinic doing the trial closes to me. Like you said 50% chance you get the Symfony lens, but the other lens is a mono-focal, not a multifocal, so not crazy about the idea. Plus they require a lot of follow up so a lot of traveling back and forth. Also still waiting to hear back from them on what the cost would be. You still have to pay for surgery, surgery center and other things.
BTW, I want to thank you for being brave enough to try out this rather new lens that seems so promising.
re: "Might be worth calling this surgeon who has experience with both. "
Actually I had contacted him first, , and after an initial reply he didn't respond to a followup query. He'd suggested that neuroadaptation is much faster in the AT Lisa tri, and so I hoped to get him to quantity that a little bit but never heard back. That article also gives a defocus curve for the AT Lisa tri which doesn't match any of the ones I'd seen in other articles with far larger numbers of patients. I'm not sure if its an artifact of the curve fitting software he used along with a random statistical fluctuation due to the low number of patients, or what explains it. The fact that he both didn't get back to me with even a quick reply made me consider going elsewhere, as did the fact that he didn't address this odd discrepancy in the article.
I'd contacted other doctors who used both lenses who suggested that the Symfony was a better bet.
I decided to get the Symfony, and things appear promising. I just had the surgery a couple of days ago so still recovering/adapting so I wanted to hold off on comments (especially since I'm also not fully awake after major jetlag doing a weeklong trip to Europe for the surgery, with 8 hour time difference and long travel time with little sleep). I'll give an update in a few days after a postop with my usual eye doc where I'll try to get more detailed results.
I hope I adapt well since I actually got both eyes done, even though I'd hoped to wait on the other and get to decide later. One eye barely had a cataract and was still correctible to 20/20, but after I had the first eye done and had the bandage off the next day, it appeared hard to get the vision in the 2 eyes to merge even though each eye seemed to have good vision by itself . The other eye was using a contact lens, -6D. I'd read of others just doing one eye and wearing a contact lens on the unoperated eye. So its possible I may have adapted to it quickly, it may simply have been the issue of adapting to the new lens. However I didn't have much time to wait to see if that would happen if I were going to get the 2nd eye done on this trip. I figured perhaps I'm myopic enough that its harder to adapt to, and I didn't want to risk getting home and having trouble, so I went ahead and got the 2nd eye done a few hours after the bandage came off the first eye.
After the bandage came off the 2nd eye, I didn't feel any trouble merging the two eyes. I will note that the day the bandage came off the 2nd eye, when I tried a few hours later I was able to read gmail on my phone (with concentration), without changing font sizes, though the vision still seemed to fluctuate a bit still recovering from surgery. I figure that is a good sign that with adaptation I'll be able to read it without struggle. (perhaps even merely after I've recovered from surgery, and caught up on sleep, within a few days).