Hello. I'm scheduled to have cataract surgery in a couple of weeks. The premium lens that my surgeon uses is Tecnis Multifocal. I'd like to hear about any experiences with that lens. Current Rx (SPH/CYL/Axis/Add): OD: -5.00/-0.25/092/+2.50 OS: -4.75/-1.00/088/+2.50
Tecnis makes many different types of multifocal and EDOF lenses. You will get better comments if you post what specific lens it is. Examples would Symfony, Synergy, and Eyhance. . I don't have experience with these lenses but they all have their pros and cons. I think the most important thing you can do is find out what the pros and cons are and be sure before you go ahead that you prepared to accept the con issues they have. All of them have issues. In the end it comes down to what you are willing to put up with to be glasses free. . And for what it is worth, I think the designation that certain lenses are "premium" is a bit misleading. They are different, but not always better for every individual. Each lens has their pros and cons, whether they are called "premium" or not.
I have a Tecnis Low add +2.75 MF in my left eye, but I got that IOL right after it was FDA approved and available as at the time IMHO it was the best premium option available in the US. But I would not be getting that lens today. I actual wrote about my experience on medhelp, but this site does not allow links. I could try and dig it up and repost, but honestly why would you not get the Trifocal or Symfony Lens? Neither was available when I had my left eye done.
Don't get me wrong the Tecnis MF was fine at the time. I just think there are better options out there Today.
I have written about this in other post you can look at. I have to do my right eye soon and am leaning toward the new Tecnis Symfony plus.
I plan to see a Doctor who did the Tecnis Symfony Plus Trials to get his assessment.
If you state what your goal is and why you think the Tecnis MF is the best option I will help where I can as I have done quite a bit of research on the various options.
Thanks, Ron. I should have waited until after my appointment this morning to post. The lens I'm considering is the Tecnis MF +3.25 (Model ZLBOO). Who knew there were so many different lens available? I don't see a way to edit my title question. Am I missing something?
I had already figured out that "premium" lens should be taken as you're paying an amount above the usual charge and that the lens may or may not be the best fit. And I have to give the cataract coordinator credit for making it clear from the very beginning that perfect vision is not to be expected. I've read about halos around lights, but as I've been seeing halos and rays around lights at night for several years now (and avoid driving at night anyhow) I feel like I can live with that.
Hopefully others with more knowledge of the Tecnis lenses will comment. About all I can say which comes a little research I have done is that it is one of the older lenses compared to the ones I listed above. It is like a bifocal eyeglass lens. It should let you read very well, and see in the distance, but it may leave a bit of a hole in the intermediate range where you may not see so well. For example if you golf or play tennis it might compromise the hand eye coordination in that 2-3 foot range. And, it sounds like you already know about the halos, starburst, etc issues.
Again from my limited knowledge, the Tecnis Synergy may be a better lens as it is more like a trifocal, and provides better vision in the intermediate range. A comparable lens in the Alcon brand line would be the PanOptix, which is also like a trifocal.
Also keep in mind that the other alternative to a multifocal lens is mini monovision. That is when you get a monofocal lens in both eyes, but the non dominant (usually) eye is under corrected by about -1.25 D. This eye gives you some reading vision, while the other eye gives distance vision. The best way to try out this option is to simulate it with contact lenses before you get the IOL surgery. You do have to have good enough remaining vision to give it a fair try though. That is what I am currently doing, and I am thinking that is the way I will go when it comes time to do the second eye.
This may be more information than you want to know about, but if you google the phrase at the bottom of this post you can find a presentation that gives some comparison of the various Tecnis multifocal lenses. It mainly uses "defocus curves" which simulate how well you see with the lenses at distance and then at closer and closer distances. Ideally you want to see 20/20 at all distances, but no lens really does that. However some are better than others. This presentation mainly tries to show how much better the Synergy lens is compared to some of the older one. One of the first graphs shows the Tecnis ZLB00 lens you are scheduled to get along with some others. This lens gives peak close vision at 40 cm, but goes down at closer distances and dips at further distances before it goes up to full vision at full distance.
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They next show the Symfony which appears to be an extended distance of focus lens not a true bifocal. It adds about 1D of closer vision. Further down they compare the Synergy to some other brands including the currently popular Alcon PanOptix. For some strange reason the direction of this graph is reversed, but it is basically showing the same thing for defocus curve data.
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In any case google this phrase to try and find the pdf presentation. Be warned it does appear to be a bit of a sales pitch for the Synergy. The range of focus does look impressive, and the loss of visual quality in lower light seems impressive too.
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presbyopia-international-chang-synergy-beyond-symfony pdf
Alright @RonAKA, as usual you present Top Quality information, which makes my decison that much harder.
I have been leaning towards the Tecnis Symphany Plus with micro monovision to boost the near. Just a a reminder I currently have the Tecnis Low Add MD +2.75 in my left eye.
But then I look at the graphs you provided and Tecnis Synergy from those graphs looks like it provides the best overall vision across all distance and if I am following those graphs it does it with have less issues in dim light.
My biggest issue with another MF is splitting of the light and night driving. But maybe Synergy splits the light differently or less than the old Tecnis MFs.
Do you have any information that shows the Synergy vs the Symfony Plus in regards to low light and halos and the like.
Also any information on the Synergy regarding clinical trials, FDA and Synergy. One would think it would similar enough to Tecnis Symfony and MF, it would easily get FDA approval, but FDA is insane.
This is also why I like the Synergy as I would think it would be based on those other designs and not some high risk completely new method like the Juvene.
At this rate I will never get my right eye done as I keep waiting for a "Better" IOL to come along. LOL!
Just look at JNJ site and the propaganda sounds GREAT!!
"TECNIS Synergy IOL creates a new standard in presbyopia-correcting intraocular lens (PC-IOL) technology, allowing patients to experience continuous high-contrast vision from far through near, even in low-light conditions.1,2,7 The Johnson & Johnson Vision R&D team changed their approach to IOL development – designing the optimal defocus curve for clinical performance, then developing the technology to deliver for it. The result – a revolutionary lens with optics that outperforms existing PC-IOLs on the market.††† "
As best as I can see, the Synergy IOL has not been given FDA approval in the US yet. However, it is approved in Europe, Australia, and Canada. It can't be far away. What I saw on the Juvene is that it has been in development since 2015, and is not expected to be commercialized until 2023, according to the manufacturer. . The Symfony Plus seems to be the Symfony with more reading power. Since the Symfony has issues with night halos and starbursts, I would expect the Plus version to potentially have more. It is approved in the US though.
That is why I was waiting on the plus to be available. Combined with micro-monovision might add a line or 2 at close. Plus they claim they added a filter that reduces halos and the like.
But now I am looking into the Synergy. If they figured out how to provide the defocus curves they showed while simultaneously this IOL has no worst night vision and halos than the Symfony Plus it might be the best IOL out there.
The problem is until the IOL is out there away it is hard to find articles on Real-World results between it and the Symfony Plus.
When I got my MF I was told the less add (+2.75 over +3.25) the less halos or at least smaller halos. I also have read on the EDOF best to go at Plano, so the more monovision one does the greater the halos. Not sure if the is 100% accuarate or not.
I looked at the FDA clinical trials site and searched for Synergy and I did not find anything, not a good sign for approval anytime soon.
Thanks for the info and defocus curves. I live in the US so the Synergy is out for me. PanOptix and Symfony look interesting, but so far I haven't found anyone that I trust in this area using them. Looks like I would have to drive 3 hr round trip for evaluation, surgery, and follow up for the Symfony. However, there's a possibility of evaluation and follow up in my area for the PanOptix with only surgery requiring a 4 hr round trip. I'll be checking on that Monday morning.
I tried monovision with contact lenses several years ago. It was fine when I was at home, but walking through an unfamiliar airport or busy shopping mall was toture. Crisp, clear vision on one side with a blur on the other was just not something I could handle. It's possible mini monovision might not bother me as much, but I'm not willing to risk it.
Thanks, rwbil. I've been reading your other posts. Although I've worn glasses or contact lenses for 53 years now, I've been able to read without assistance. The book may only be 6 inches or so in front of my nose but I can see it, so I think having to wear corrective lenses for all reading would be frustrating. I don't mind using off the shelf readers or grabbing a magnifying glass for tiny print, though. Having good distance vision would be wonderful.
One thing I'm curious about is what it's like to experience the less than optimal midrange vision with the older Tecnis MF. I don't golf or play tennis and I've been trying to figure out if there's anything I do that would be affected by the midrange issue. I really wish there was a way to see the difference before a decision has to be made.
Midrange - A lot of it depends on your starting point. I think one of the biggest issue is when someone does a clear lens exchange or only had a minor cataract and then get an IOL, so they notice how different it is.
When I first got my lens and my other eye had a minor cataract, I could notice it doing the cover one eye up thing.
But now that my other eye cataract is so bad I get use to it and there is nothing to compare it to. So when I look now it seems fine, but when I get the other eye done maybe with Symfony Plus which has better mid range and if I do the cover one eye up thing I will notice the difference.
My biggest issue with the MF is splitting the light and night driving. It definitely makes a difference in low light. I remember after getting the MF walking down my stairs and the stairs light was off but the downstairs light on so dimly lit. And then I rubbed my good eye and Wam Bam I could not see any steps out of the MF lens.
So for me, I want a lens that gives the best vision across all distances with the least light splitting possible, which is why I was looking at the Symfony Plus.
I would think the Symfony Plus does better in low light than a Trifocal.
Started looking at Synergy more as Ron and others mention it. The advertisement is great, but who knows the results will be as many patients get it and we get real world results over time. Reading here I have read some bad results, but maybe that is the nature of a forum like this.
There is an ophthalmologist who had synergy implanted who has a you tube video on it and according to him it is the greatest IOl ever. But he might be associated with JNJ; who knows.
But I can not help but think Synergy has to be worse in Low Light than the Symfony as it does both EDOF and MF.
I am waiting for more doctors who implant Trifocals, Symfony Plus and Synergy to start writing articles or making videos of there patients results.
If Synergy is truly leaps and bounds better, I would expect Ophthalmologist to start writing about it and saying how this lens is revolutionary. And being the lens is based on Tecnis Symfony and Tecnis MF and not some completely revolutionary design I would expect doctors implanting the other lens to start using it quickly to get results.
IMHO I think the Synergy (assuming it get FDA approval), Symphony Plus and PanOpTix Trifocal and IQ Vivity are the best options in the US. And the next revolutionary type of lens like Juvene are far into the future.
So as right now I plan to get 1 of those lens. Which one is the question.
Maybe you can be the Early Adopter and let us know your results, LOL.
"so far I haven't found anyone that I trust in this area using them."
What part of the US are you located?
If you want to do a bit of research on the various presbyopia IOL options, here are some articles that I found interesting. This first one is from 2018 so is a bit dated but it gives some statistics on what lenses were most popular at that time, and those that are less popular to use. It is based on a survey of surgeons, presumably in the US. It does not include the newer lenses like the PanOptix. The Symfony seems to be the obvious popular one for presbyopia in 2018. . Review of Ophthalmology PUBLISHED 10 JANUARY 2018 Surgeons Share Their Views on IOLs . This one is newer and includes the PanOptix. It is still second to the Symfony in popularity, but the PanOptix has been on the market a very limited amount of time in the US, so that could be the reason. In articles comparing the two lenses, it seems the PanOptix is preferred over the Symfony by some. . Review of Ophthalmology PUBLISHED 8 JANUARY 2020 Review’s Annual IOL Survey . And here is another article that talks about the newest lenses on the market. I see that the Symfony Plus is included and they say it was FDA approved in May. . ModernOptometry October 2020 IOL Roundup . This article talks about the Synergy, and AcrySof Vivity IQ which are also very new. The Vivity is supposed to be the one with least visual artifacts like halos and starbursts. But it is not a slam dunk for reading smaller text and would likely need reading glasses, or possibly one of the Vivity lenses under corrected for distance to improve reading with one eye only. . One option you may have is to use a different lens for each eye. Perhaps do the non dominant eye with the bifocal Tecnis ZLB000 that you were planning on, and then after 8 weeks or so do the second eye with the Symfony or Symfony Plus. That may address the intermediate distance loss with the ZLB00. Just a thought. . @Sue.An2 here uses the Symfony lenses and hopefully checks in with her comments. @soks I recall has done a lot of research on the Synergy lens, and was looking for a place to get it in the US. Sometimes manufacturers release the lenses before FDA approval to certain clinics. Not sure if that is the case with the Synergy or not. . Hope that helps some,
Found this video on Vimeo by Dr. Chang, a US Ophthalmologist on the Synergy. Spends a lot of time talking about Chromatic Aberration.
"Tecnis Synergy IOL: The Newest Member of the Tecnis Family – Dr. Chang Presentation"
He showed this chart on Optical Quality for various lens in day and dim light.
That is an interesting presentation, but I would suggest with quite a pro Tecnis bias. What I found most interesting was how he quite clearly showed much of the theory of lenses and what they do. Some points of bias I noted: . 1. He talks about spherical aberration but does not explain that not everyone is the same. A -0.27 correction may be more appropriate for a person of Asian descent, while a Caucasian may benefit more from the Alcon -0.20 aspheric lens. He also ignores the fact that some aberration error may increase the depth of focus. 2. He goes on about the problem of chromatic aberration at length and the refractive index of lenses, and the impact of the Abbe number. My experience over the years with high index eyeglass lenses (poor Abbe) and normal index (better Abbe) is that it makes no practical difference in real life. I notice that a high index lens is ligher and thinner, but see no impact on optical quality. He also glosses over that the blue light filtering on the AcrySof lenses reduces the chromatic aberration, and the impact it has on aberration. 3. He goes on at quite length on the light filtering and how violet filtering is better than blue light filtering. It seems obvious to me that Tecnis has added the violet filtering to try to deal with the halos. And he makes a big point of saving the blue light. What he does not show on his graph is the what the natural lens in a young healthy eye does. It does not let in nearly as much blue light as the Tecnis lens with or without the violet light filter. The natural eye is much closer to the AcrySof curve. . My thoughts are that the Synergy is a very good option especially if one wants good reading, but the weak point may be halos, starburst effects at night. The Symfony is not free of them, and it sounds like the Synergy may be worse. I think it comes down to what one is prepared to accept for issues to get good reading and distance in one lens. Suspect the Eyhance and Vivity are better options to avoid the halos and starbursts if one can accept reading glasses for finer print. He did not discuss those two at all. I guess he said up front his objective was to fully address presbyopia.
I currently have the Tecnis MF and even though I see halos and glare they do not bother me. I guess if they got a lot worse they might. What bothers me seeing in low light condition and what, If True, I liked was this lens is supposed to be much better than my current MF and according to his presentation about the same as as the Tecnis monofocal.
If I had the same halos and glare I currently get with my MF, yet could see clear at night then this lens would be a winner for me. But who knows the real truth as you pointed out many doctors are associated with the company in one way or another, which can bias ones objectivity.
One of the things I have found about cataract surgery is that it does not have to be a single one time decision, but more of a plan than a decision. I have had one eye done with a distance monofocal, and I am probably more than a year away for my second eye. I am keeping my options open for the second eye. It probably will be another monofocal but with a target of -1.25 residual to give me some reading, or possibly the Vivity. . In your case one option you could consider would be to go ahead with the Tecnis MF +3.25 (Model ZLBOO) in one eye and then wait 8 weeks or so to see how you like it, and what the intermediate vision is like. Then if you like it, you could go ahead with another one in the second eye. It could even be a +2.75 to boost the intermediate vision a bit, if you can read well with the +3.25 in the one eye. Or if you don't particularly like it then you could travel to get the Symfony for the second eye. The combination of the MF and Symfony would probably give pretty good vision at all distances.
How is your reading with the MF eye? If it is good, then would a possible solution be simply getting a monofocal with the power selected for distance, be a good solution. An aspheric monofocal should give the best night vision with no halos etc. I believe that is called a hybrid monovision solution, and it seems to work well for some. I suspect it is less distracting than traditional mini monovision. . I find my night vision with my AcrySof IQ Aspheric Monofocal to be very good. It is much better than with my other non operated eye. However it is not a real fair comparison as it has -1.25 under correction, and distant objects are not in sharp focus, and I am wearing a contact, which I think does not always give the crispest vision.