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my Symfony IOL results after cataract surgery

I'd posted before asking for information about lens options before surgery,  but thought I'd start a new thread now that I've gotten the lens where perhaps others can add their results as well with the Symfony lens. It is a  new type of "extended depth of focus" lens that uses a different design than   multifocal and accommodating lenses.

I had Symfony lenses implanted in both eyes the first week of December.  By 1 week postop my uncorrected vision at distance was between 20/15 and 20/20. At near my vision was already about 20/25 (but fluctuating a bit it had seemed better earlier that day). Given its improvement since then I'd guess its likely 20/20 or so, I can read the small print on my eye drop bottles for instance.  Not everyone achieves this level of near vision with the lens so people shouldn't expect to necessarily get quite as good a result, and should be prepared for the possibility for needing reading glasses at near. I suspect the fact that I'm comparatively young for cataract surgery, 52, might have   something to do with the results.

I had originally only planned on having 1 eye done (since the other was 20/20 correctible still), but when the patch came off the next day I discovered it might be hard to adapt to the difference in vision between the two eyes even with a contact lens in the other eye. I might have quickly adapted if I'd taken the time, but I decided I didn't want to risk it,  so I had the 2nd eye operated on a few hours later.

My intermediate vision hasn't been tested explicitly but I suspect is at least 20/20. That is  based on my subjective sense of it being better than near and because of the design of this lens where visual acuity drops off in a continuous curve from far to near, so intermediate should be around the same as far, definitely better then near. That is one of the differences between this lens and for instance a bifocal IOL where vision may be worse at intermediate than it is at near or far. I spend a large number of hours at a computer and was willing to risk needing reading glasses occasionally for near in order to get better intermediate vision. Most household tasks and social interactions occur at intermediate distance as well.

Unfortunately the lens isn't yet available in the US yet, they are starting a clinical trial here which is randomized with a monofocal lens (there is a 50% chance you would get a monofocal) so I went to Europe for my surgery.  I figured that at my age I hopefully may be using these lenses for a few decades so it was worth a bit of effort to get a better lens. This industry publication suggests it might be  generally available in the US in a couple of years, and that some US surgeons find it interesting:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/us-surgeons-anticipate-new-iols?page=0,1
"the Symfony IOL might be available in the US by late 2016 or early 2017...
Of the IOLs discussed at the ESCRS Congress, Dr. Olson and Dr. Packer concurred that the brand new Tecnis Symfony Extended Range of Vision IOL was the most interesting as it represents a new concept for addressing presbyopia that seems to overcome the limitations of multifocal IOLs....

from what I’ve heard so far from respected and trusted surgeons, patients implanted with this IOL are seeing 20/20 at distance and intermediate with very usable, J2 or J3 near vision and are not experiencing any loss of contrast or perceptible problems with glare, halos or other dysphotopsias. So, it looks like they are having their cake and eating it too.”

I had considered the option of getting a trifocal lens which targets far, intermediate, and near (also unfortunately not yet available in the US), or even a bifocal with a small add so its focused more at intermediate than near.  However the studies so far seem to indicate that the Symfony provides better quality intermediate vision. In addition multifocal lenses reduce contrast sensitivity which is useful for night vision, while reports indicate the Symfony is at least as good as a monofocal lens. The other thing the Symfony does is to correct for "chromatic aberration", an issue which is discussed in this industry publication which quotes one prominent surgeon noting:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "

Although the Symfony uses a high Abbe material (I'm assuming its the same Tecnis material that article lists as having a 55 Abbe), it also has other features to to correct for CA to improve image quality. It seemed like a good bet the image quality for distance would be comparable, and perhaps even better, than a monofocal lens, or an accommodating lens.

Although some results for the Crystalens look like it will similarly do well for intermediate while providing some chance at decent near vision, some showed a lower chance of good near, e.g. some of the studies listed for the March 2014 update in this government review:

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/OphthalmicDevicesPanel/UCM346413.pdf

Part of the concern I had with the Crystalens was that in some patients the lens does well, but in some it doesn't accommodate, which leaves it effectively being  a monofocal lens ( but without things like the correction for chromatic abberation). There is also concern I'd read among some  over whether over decades of aging anything would interfere with the physical movement of the lens, something non-accommodating lenses don't require. There is no perfect lens, so its partly a matter of placing a bet on which might work out well, and I figured that it was better to bet on something that didn't require the accommodation to work (in addition to other concerns regarding problems people have with the Crystalens, though those may be fewer in the newest versions). I hadn't searched to find  the study behind the figure in this presentation, but it notes:
http://www.slideshare.net/alanglazier/accommodating-intra-ocular-lenses

that about half of Crystalens patients require reading correction. That may be in part because as it notes: ' "Pushing” does not equal “Sustaining” '. This issue is that someone with their natural lens still who is presbyopic for instance may be able to theoretically read a particular print size without glasses, but that the muscle effort to focus may be a strain to do  for an extended period of time, and the Crystalens at least partly seems to require the same sort of accommodative effort.  (though  there is speculation it may be benefit from some extended depth of focus, which is what the Symfony is designed to use to begin with). I'll continue this in another post in a few minutes.
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Avatar universal
Where did you have your surgery done?  In the US, or in another country?  I assume that you and your surgeon must be in the same, or a nearby, country (since you have been able to continue to interact with him to get explanations - and perhaps further examinations).  But maybe you travelled to get this done; it would be informative to hear whether you think travelling some distance has turned out to be a problem.

Was he a guy (or woman) who already had done a lot of Symfony implantations, or was this an early experience for him too?  I'm asking this in order to get some feeling for how important it is for a surgeon to have previous Symfony experience.  I know that Abbott (Technis) claims that the Symfony is precisely the same form factor as its existing and long-used monofocal lenses, but I wonder whether there might be some other kinds of differences beween the two types nevertheless.

Do you have any reasons to suspect that your horrible experience is due to (a) the Symfony IOL itself, or (b) shortcomings of the surgeon, or (c) something about the structure and condition of your own eyes that couldn't have been detected by anyone in advance, and might have happened with any surgeon and any lens?

Any first-hand information that you can supply would be very interesting and useful.
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3 Comments
I'm not sure if this is directed at me, but I'm in the US but had my surgery done in Europe since the Symfony wasn't available here, and only had the day 1 postop done over there.  Traveling wasn't a problem. I was the first patient to get the Symfony with the surgeon I used, but I wasn't concerned because he had done 40,000+ surgeries and the Symfony is the same physical shape&size and implantation method as other Tecnis lenses (their monofocal&multifocal).

I'm not sure who had the "horrible experience" you are referring to. If you are referring to me and the flickering side effect (which isn't "horrible" anymore), as I mentioned as far as I can tell it has nothing to do with the lens choice but is due to my iris jiggling  (iridodonesis) when the eye moves, a very rare side effect (not something they have statistics on, I get the impression that it may be only one out of tens of thousands of cases, or at least several thousands) that isn't something they couldn't  guess at in advance, especially  since only a subset of those who do have iridodonesis have a visual artifact.  The artificial lens is smaller than the natural lens and so in some people the loss of support for the iris after cataract surgery  can lead to movement of the iris.
No, no, SoftwareDeveloper, it wasn't you - I was responding to "789Chris", whose post appeared at the very bottom of the list when I responded to it.  Now it appears much farther up.  In any event, he had said:

"789Chris
I had both eyes done with Symphony IOL 1 month ago and still have significantly blurry vision (20/50 in one eye and 20/70 in the other). I also see extremely intense starbursts and halos so much so that i think i will never be able to drive at night. Extremely disappointing and surgeon does want to give me any explanation.
Jul 29
Report "

I haven't found any further posts from him, so either there is some interesting story that we will never know, or else he is some kind of troll.  It is certainly the most negative story involving the Symfony that I have seen yet.




















Sorry for the confusion, I didn't see the 789Chris post. I didn't think your post  was directed at me, but since I started this thread/page    I responded just in case as the default person replies are addressed to.

Unfortunately even with a monofocal some people can get problematic halos, there is no lens yet that doesn't give them to some people. Even those with a natural lens still can have halo issues. Also, most studies of halos are done at 3 months or 6 months or so postop because many more people have halos temporarily in the first few weeks/months postop, and the poster was only at 1 month postop. Even at one month, someone's eyes could still be healing.  In this case its also possible he might have residual astigmatism or PCO or some other eye condition unrelated to the surgery.  Unfortunately most people who have good results won't post afterwards, so its only those with issues that tend to post.

That post is recent so I doubt there would be any updates, if none are posted you could always try sending the poster a private message. In case you hadn't used them before, I'll note that Medhelp alerts the user that they have a private message via the email they registered so they are more likely to respond than to a public reply they may not notice.
Avatar universal
Now that Symfony has been approved by the FDA for use in the USA, does anyone know when it will be available, and/or what US cataract surgeons have experience using it?
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Avatar universal
Hi Roberto,  had the same issue and it was astigmatism. My right eye was not focusing colors correctly so I saw grey shadows, particularly on computer screens with black text on a white background.  Lasic on my eye fixed the problem.
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Avatar universal
Hi.

Thx for your reply and information. I saw infomercial on the panoptix last tuesday and it seemed interesting but also more like another trifocal. I wonder if perfecting  this approach will deliver vastly  better optics but like you say most trifocals are giving people great options and in general are a huge advance over mono or bifocals.

I find this subject in itself quite interesting and will look into the Panoptix and Rev IOL.

This day my near sight got better during rhe day but my work is behind a screen all day so may be it ajusts to it. When I came home and started to wrok again my nearsight was probably equal to yesterday. So I think in the end nothing has changed significantly.

I noted my eye feels dry when I wake up and it stays that way during the day. Got me some eyedrops and they alleviate it. Also note flickering when moving my eye which seems to be pretty normal and will take months to abate.

Still delighted with the results and happy.
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Avatar universal
re: "pretty regular lens in design"

Yup, I figured that lowered the risk of going with the Symfony even though it was fairly new when I got it. Its the same overall shape&material as the widely used Tecnis monofocals (and multifocals) so it was only the optics that was new, and much of that can be tested on an optical bench outside of the eye, and with some initial clinical studies showing good results to match.

The trifocals are also good choices still depending on whether people prefer good very near vision at the expense of slightly less intermediate (and a risk of halos). The reports I'd seen suggest the AT Lisa Tri and the FIneVision are fairly comparable, with some surgeons giving a slight edge to one or the other (on balance more with the AT Lisa Tri I think). I don't know how the  new Alcon Panoptic and the Rev-IOL tri-ed (forget exact spelling offhand) compare. It is true that there was at least one surgeon who is a co-inventor of the FineVision so there may be some bias.

As I posted earlier in the thread, I went to a top surgeon in the Czech Republic (a common medical tourism destination for the UK I discovered) rather than going to the UK  and paying more.


As I posted at the start of this thread, my eyes were done in early Dec. 2014, so about a year and a half. By my 1 week postop I was already at almost 20/15 distance and 20/25 at best near. Subjectively it seems there may have been a very slight improvement over the next weeks, but  since then for distance they just confirmed they were at least 20/20 and didn't get an exact acuity for distance.  I should sometime to see if I got past 20/15.  My near acuity hasn't budged from 20/25, though I hadn't checked it for a while (I should just get a near chart).
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Avatar universal
Well I have no trouble posting in two threads, One where I can be detailed and another (this one) to be shorter.

Not following up on an email for me is a strike against too btw. I think exactly the same. Which country did you go to btw?

I also considered trifocals. FineVision to be exact but changed my opinion.
I wasn't happy about the remarks on halo's. Also since Symfony is a pretty regular lens in design I figured surgery would be quite easy.

A may be strange reason of minor importance is the fact that I noted some surgeons affiliated with FineVision were being negative in various papers and on a congress on other lenses especially Symfony. I don't like that a whole lot....Minor importance but noted.....

How long has it been since you had your eyes done? When was the final result reached? Thx for your answers and the excellent information you already provided!
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