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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.
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.
Glad you are having good results. You might just direct people over to your page/thread on this rather than posting on both, this one is a bit long as it is.
People seem to vary in terms of how long it takes for their near vision to come in with the Symfony (or multifocals). I had good near vision within a couple of days, but that might not be typical. Unfortunately I haven't seen any studies on the issue. Before surgery I was considering a trifocal, and a surgeon who had compared the Symfony with the AT Lisa Trifocal told me in email that neuroadaptation on average took longer with the Symfony to get the best results. Unfortunately he didn't followup with a request to be more specific on that issue, and since I didn't choose to get my surgery there afterall I didn't try emailing again. (the lack of response was a mark against using him, but I wound up choosing to go to a lower cost country or I might have given him another chance)
People seem to vary in terms of how long it takes for their near vision to come in with the Symfony (or multifocals). I had good near vision within a couple of days, but that might not be typical. Unfortunately I haven't seen any studies on the issue. Before surgery I was considering a trifocal, and a surgeon who had compared the Symfony with the AT Lisa Trifocal told me in email that neuroadaptation on average took longer with the Symfony to get the best results. Unfortunately he didn't followup with a request to be more specific on that issue, and since I didn't choose to get my surgery there afterall I didn't try emailing again. (the lack of response was a mark against using him, but I wound up choosing to go to a lower cost country or I might have given him another chance)
3rd day after surgery:
Everything is fine. Had a dry eye waking up yesterday and walking through the Woods with sweet made my eye a bit irritated. Today I woke up with no strange feeling.
Difference with yesterday (see above) is that the continuous snowshower of floaters has abated a lot. I would call these sinker, they are not floating they seem to be falling down all the time with some larger fragments. The larger fragments have gone, now only very tiny ones reamin. And they are much less in number.
The very smallest pri
Nearsight has become quite a bit better now. Might be because I do not wear a contact in my (good) left eye. It is about -2 (-2.25 actually) and at 45-50 cm the print on the screen becomes blurry. Great! My rigth eye has to take over and it does and I can see now almost perfectly from 45 cm onwards.
Intermediate and long range sight is fantastic!
The finest print like on contactlens fluidbottles is not readable. Almost readable at 90 cm distance (armslength). May be it will get better too. Who knows.
If it stays this way I am 100% satisfied. Finger crossed!
Everything is fine. Had a dry eye waking up yesterday and walking through the Woods with sweet made my eye a bit irritated. Today I woke up with no strange feeling.
Difference with yesterday (see above) is that the continuous snowshower of floaters has abated a lot. I would call these sinker, they are not floating they seem to be falling down all the time with some larger fragments. The larger fragments have gone, now only very tiny ones reamin. And they are much less in number.
The very smallest pri
Nearsight has become quite a bit better now. Might be because I do not wear a contact in my (good) left eye. It is about -2 (-2.25 actually) and at 45-50 cm the print on the screen becomes blurry. Great! My rigth eye has to take over and it does and I can see now almost perfectly from 45 cm onwards.
Intermediate and long range sight is fantastic!
The finest print like on contactlens fluidbottles is not readable. Almost readable at 90 cm distance (armslength). May be it will get better too. Who knows.
If it stays this way I am 100% satisfied. Finger crossed!
Had my surgery yesterday 15.00 h. One eye had a retinal tear in sept 2012. Slowly developped a cataract. Wanted to wait as long as possible to get the latest greatest.
Was set on the FineVision in 2015 but found about the Symfony in the fall. Seemed to be the best option.
I live in NL so we have a lot of choices here. made an oppointment in January. The cataract was not bad and the optometrist doubted if needed one but believe me: It was very foggy in my eye.....So the surgeon checked my eyes in april 2016 and yesterday was the day.
I never felt any pain, I used my own benzo to calm me down (pyrazolam, a research chemical that is purely anxiolytic, I become a very irritable person with midazolam which they still used but in a minute amount).
Operation went fine, just the surgeon didn't want to push the polishing since there was no vitreous gel in my eye The operation was absolutely painless in fact I never felt any discomfort.
Results:
1-2 hours: no Eyesight)
2-8 hours hazy Eyesight. Extremely bright halo's and extremely wide pupil.
9-16 hours (slept)
Woke up had to let my eyes checked: lens was centered well, eyepressure was alright, Pupil was still hure though.
During the day Eyesight got better and better. Pupil started to shrink a lot and no more halo's even not around bright lamps and lights.
End of the next day: vision at distance is extremely sharp. I have had -4,5 in that eye since age 12. It is now as sharp as it was with a lens on it.but colours are so beautiful and better than in my left eye.
Intermediate vsion (say1 metre to 4 metres) pin sharp!
Near vision: 60 cm-1 metre is good closer than that is also getting better. I can read at about 40 cm or so but it is quite blurry.
The lens is set to -0.5 D but it is wait and see if that target was reached.
For the first day I'd say the results are really well. If near vision enhances a bit I am already perfectly satisfied. But I think PCO will come since not all cataract could be removed....
In short;
Very happy since there are no halo's or glare (there is some glare btw), sharpness of vision and colours are great from 80 cm onwards.
Again?; early days, will keep you posted!
Was set on the FineVision in 2015 but found about the Symfony in the fall. Seemed to be the best option.
I live in NL so we have a lot of choices here. made an oppointment in January. The cataract was not bad and the optometrist doubted if needed one but believe me: It was very foggy in my eye.....So the surgeon checked my eyes in april 2016 and yesterday was the day.
I never felt any pain, I used my own benzo to calm me down (pyrazolam, a research chemical that is purely anxiolytic, I become a very irritable person with midazolam which they still used but in a minute amount).
Operation went fine, just the surgeon didn't want to push the polishing since there was no vitreous gel in my eye The operation was absolutely painless in fact I never felt any discomfort.
Results:
1-2 hours: no Eyesight)
2-8 hours hazy Eyesight. Extremely bright halo's and extremely wide pupil.
9-16 hours (slept)
Woke up had to let my eyes checked: lens was centered well, eyepressure was alright, Pupil was still hure though.
During the day Eyesight got better and better. Pupil started to shrink a lot and no more halo's even not around bright lamps and lights.
End of the next day: vision at distance is extremely sharp. I have had -4,5 in that eye since age 12. It is now as sharp as it was with a lens on it.but colours are so beautiful and better than in my left eye.
Intermediate vsion (say1 metre to 4 metres) pin sharp!
Near vision: 60 cm-1 metre is good closer than that is also getting better. I can read at about 40 cm or so but it is quite blurry.
The lens is set to -0.5 D but it is wait and see if that target was reached.
For the first day I'd say the results are really well. If near vision enhances a bit I am already perfectly satisfied. But I think PCO will come since not all cataract could be removed....
In short;
Very happy since there are no halo's or glare (there is some glare btw), sharpness of vision and colours are great from 80 cm onwards.
Again?; early days, will keep you posted!
I had Symfony IOL's implanted on both eyes. My far and medium distance sight is very good. Watching TV is a delight as I can almost see the pixels on the screen (very sharp sight and colors).
My problem is with near vision. Words on a label, a book, my cellphone, my computer screen have what I call "a shadow". I basically see double. Now, for some unknown reason when I use my 1.5 over the counter reading glasses the shadow simply disappears and I don't see double anymore. It is weird since I know those glasses should not correct any astigmatism. Reading glasses are basically "loupes". I got the Symfony IOL's because they are supposed to be the latest technology (extended depth) and I wanted to get rid "completely" of glasses (a bit disappointed).
Probably monofocal IOL's are simpler in the way they work and so results are better in terms of consistency (good results I mean).
Good luck with your operation.
Regards
My problem is with near vision. Words on a label, a book, my cellphone, my computer screen have what I call "a shadow". I basically see double. Now, for some unknown reason when I use my 1.5 over the counter reading glasses the shadow simply disappears and I don't see double anymore. It is weird since I know those glasses should not correct any astigmatism. Reading glasses are basically "loupes". I got the Symfony IOL's because they are supposed to be the latest technology (extended depth) and I wanted to get rid "completely" of glasses (a bit disappointed).
Probably monofocal IOL's are simpler in the way they work and so results are better in terms of consistency (good results I mean).
Good luck with your operation.
Regards
2 Comments
re: "reading glasses the shadow simply disappears....those glasses should not correct any astigmatism"
Even if the glasses don't correct for astigmatism they do change the overall focal point and make the image clearer . Even if there is still distortion due to astigmatism, the added clarity may make it easier for the brain to tune it out. Monofocals wouldn't be any different in terms of astigmatism, they would merely require you to wear reading correction even more of the time. If you have astigmatism, they can correct it via incisions now, some doctors do it even with the patient sitting at their exam slit lamp since it isn't as big a deal to do a surface level incision as it is to do something like cataract surgery where they need to work inside the eye, or even lasik where they need to deal with a flap.
All the studies and comments from doctors involved with them suggest consistent good results with the Symfony and a risk of visual artifacts similar to a monofocal. There are a small % of people with glitches even with monofocals I recently watched this video
http://eyetube.net/series/daily-coverage-caribbean-eye-2016/onoga/
talking in part about the Symfony where it mentions a point I've seen other surgeons make: that diffractive optics are used in high quality camera lenses and other places where optical quality is important. Diffractive optics may not be "simple" to lay people, but they can provide consistently good results:
Even if the glasses don't correct for astigmatism they do change the overall focal point and make the image clearer . Even if there is still distortion due to astigmatism, the added clarity may make it easier for the brain to tune it out. Monofocals wouldn't be any different in terms of astigmatism, they would merely require you to wear reading correction even more of the time. If you have astigmatism, they can correct it via incisions now, some doctors do it even with the patient sitting at their exam slit lamp since it isn't as big a deal to do a surface level incision as it is to do something like cataract surgery where they need to work inside the eye, or even lasik where they need to deal with a flap.
All the studies and comments from doctors involved with them suggest consistent good results with the Symfony and a risk of visual artifacts similar to a monofocal. There are a small % of people with glitches even with monofocals I recently watched this video
http://eyetube.net/series/daily-coverage-caribbean-eye-2016/onoga/
talking in part about the Symfony where it mentions a point I've seen other surgeons make: that diffractive optics are used in high quality camera lenses and other places where optical quality is important. Diffractive optics may not be "simple" to lay people, but they can provide consistently good results:
Roberto, what is your current manifest refraction?
I have Symfony IOL's in both eyes. The problem appears when using either eye independently or with both eyes at the same time. My doctor says that he has not heard of this "shadowing" from other patients and that he will do some research with other doctors on the issue. I think I've waited long enough for both eyes (and the brain) to get used to the lenses so I'll go to see my doctor this week and see if there is something to be done.
I'll keep on sending feedback since I think this site is very important for other people to be informed. Thanks Software Developer.
I'll keep on sending feedback since I think this site is very important for other people to be informed. Thanks Software Developer.
1 Comments
I have that same "shadowing" and I've not yet had cataract surgery. I suspect it might be residual astigmatism, but that's just a guess. I was highly myopic but had ICL implants a few years ago.
Tnx man. At least in this regard, you made me confident.
Yes, the contacts had been like glued to her eyes. They were not melted but I don't know how to say it.
And I guess what you said about both eyes being done with far IOL and afterwards, both are done with raindrop inlay, could be a good option for me. I have to ask if Dr. Stien confirms and agrees upon this. no matter if I lose 1 or 2 lines in Snellen chart for my far vision, as long as I can drive and read without glasses, it worth it.
I've read stories of people explaining Symfony or any multi focal to have a monofocal.
But, again, I'm totally confused.
Yes, the contacts had been like glued to her eyes. They were not melted but I don't know how to say it.
And I guess what you said about both eyes being done with far IOL and afterwards, both are done with raindrop inlay, could be a good option for me. I have to ask if Dr. Stien confirms and agrees upon this. no matter if I lose 1 or 2 lines in Snellen chart for my far vision, as long as I can drive and read without glasses, it worth it.
I've read stories of people explaining Symfony or any multi focal to have a monofocal.
But, again, I'm totally confused.
1 Comments
The Raindrop inlay is not indicated for use in people who have had cataract surgery. There may be surgeons who will do it, though.
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