Audience Poll for my Next Steps

Eye care
1

44 years old. symfony in left eye in 10/2018. PCO getting severe since 8/2019. poor near vision since surgery. contrast loss noticeable compared to natural eye. positive dysphotopsia PD due to large pupil. can see lens edge in dark. miotic drops help with the PD. right eye tanking fast. double vision. distance prescription from -2 to -3.5. options as follow.

A. get another symfony and YAG the left eye
B. YAG the left eye and wait for synergy of symfony plus to hit the US or get synergy in right in Europe. synergy and symfony plus have the yellow tint for UV filter so may mismatch with symfony in the left.
C. get synergy in right eye and if liked then exchange left to synergy. then YAG left eye.
D. get monofocal or eyehance in the right eye and YAG the left eye.
E. get Aspira AXA monofocal in the right eye in europe which is a 7mm iol and will prevent PD in right eye. YAG left eye or exchange it to Aspira AXA and then YAG it.
F. Get Pan Optix in right eye. if like exchange left to Pan Optix.
G. get pan optix in right eye. YAG the left eye.
H. get BnL sofport in both eyes.

What do you vote for?

2

I hope your poll doesn't confuse you more and I may not even follow this thread so i don't start second-guessing myself. My vote is for A and if it is so bad then wait for the Eyhance to get approved here and then exchange it. Hopefully you can get good daytime vision and then just live with the nighttime issues. We are in the same boat with the same issues except i already did YAG on my first symfony and this is what I am planning on doing so at least you will have someone else on here that is going through the same thing.

3

Was your vision every good with the Symfony? If not then I definitely would not put another Symfony.

4

I don't know anything about the lens, but if it's a good lens, then I pick option E.

5

I have the Symfony in Feb 16 on my right eye, got YAG, regret it big time as it caused a shit ton of side effects.

Now June 2020 I'm planning to get a monofocal for distance because I cant stand the side effects of the symfony.

what is this eyehance lens you speak of? do we know when it will be approved in Canada?

6

eyehance is a new tecnis monofocal which gives a little bit more intermediate than a monofocal. the way they advertise it is eyehance is like someone in their 50s while symfony is like someone in their 40s.

7

it was decent. near vision was always poor. and PD was present since day 5.

8

so, i am 46 i had bilateral catarac surgery in October 18. had symphony in dominant right eye & tecnis multifocal in left. I immediately got pco in both. He yagged both big mistake. I had issues after yag with a crystaline material in my eye causing me ti have to get vitrectomy in both eyes. cleared that up great. problem now is i just cannit see good at all with either lens. This is the most painful thing ive ever gone through. before surgeries bith eyes were 20/10. My symphony eye near vision is TERRIBLE. the tecnis multifical is only good around 18-22 inches. I am meeting with him to see what to do. He wants to do prk but i dont think will fix probelm beacuse i then lose distance with symphony. I am so frustrated now. I wamt to do a bilateral exchane and would love to get the panoptix trifocal. I dont know if this is even possible. Any advice would be greatly appreciated. Im desperate for improvement . Best George

9

My vote would be to do the YAG in the left eye, and get a distance monofocal for the right eye. I believe the Alcon AcrySof material is less susceptible to PCO.

10

Hi Soks I vote for D. From what I understand through your post, I really don´t think you will be happy with the side effects from any type of either edof or trifocal. Don´t believe any trifocal is better than the others when it comes to side effects, it is all the usual marketing crap. In my own case the two different lenses do help to cancel each others side effects out, because side effects are different. Side effects are reduced a lot now after 6 month, to a point where I often don´t even think of side effects when I drive in the dark, but concentric rings and some small haloes are still there. Personally I am happy with my vision, but given the problems you have had all time with symfony, I don´t think you should risk more of the same. So my advice would be, to have your second eye done with either monofocal or eyehance, and then use the experience you get from that, to decide what to do with your symfony eye.

11

i think all alcon lenses have the yellow tint. so for monofocal i would probably go with tecnis or the aspira. i think the pco is a foregone conclusion.

12

the bothersome side effect from Symfony is the lens edge and now the PCO. the glare, star burst and concentric circles are not bothersome. i worry that i will see the glare with a 6 mm iol as well.

also the lack of near vision is frustrating with Symfony.

i have been holding off the yag for the reason you mention. see what happens with right eye and then decide on symfony eye.

13

sorry you are experiencing this. if you are in the US dr. safran is experienced with lens exchanges after yag. it is risky procedure as it exposes the vitreous to the anterior chamber (front side of the eye). it can lead to retinal issues.

14

i mean i worry that i will see lens edge with a 6mm monofocal as well.

15

one thing I noticed after I had yag was that the PCO/the bag really helped mask some of the negative effects of the multifocal lens. as soon as I had the YAG, all the side effects got worse and the broken off pieces of the bag cause light rays to move around all over my vision.

16

I believe that Alcon did make a non blue light filtering lens (SA60AT) but it may be discontinued now. I wonder if having the eyes matched with or without blue light filtering is an issue? Right now I have a significant cataract in my right eye, and fairly insignificant one in my left eye. My right eye vision is blurry, double images, and whites are turned to a light tan/yellow colour. My left eye still has crisp focus, no double vision, and the whites look bright white. I notice the differences most when viewing whites on TV while closing one eye at a time. However with both eyes open, everything still looks pretty good. It may be worth asking a professional if having the blue light filtering matching is an issue or not. . Here is a graph of a study which compared the AcrySof material to other for risk of post op PCO. I believe the hydrophobic one highlighted in yellow is the Tecnis material -- about 3 times higher risk. And the Aspira is potentially the hydrophilic? one at 9 times the risk... The AcrySof material is represented by the risk level of "1". . image . You should be able to find the full report with this search: . "Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis"

17

Ok, I understand. Well, in my own case the trifocal have less side effects than the edof, and the trifocal does deliver the near vision we are searching for in these lenses, with the much higher add for near. As you know Symfony has plano and +1.75, where the trifocals have the near focal point in the 3´s, my Lisa have 1.66 and 3.33, Panoptix have 2.2 and 3.2. But off course contrast is somewhat compromised, because the light have been split up, so a monofocal with glasses that makes +3.33 will always beat the 3.33 focal point in the Lisa regarding contrast. If you are not bothered by the "normal" side effects, I must say the mix I have, that you can replicate with other brands of lenses, works very well.

18

Hi soks - no matter which lens you decide for the other eye personally I would hold off on the yag.

Once your other eye has the IOL your brain will choose to see out of that one (provided all goes well and your vision is good from that eye). I say that based on fact I have been living for months with blurred vision out of LE but with both eyes open i see clearly as brain is choosing better view. I thought i had pco causing the blur but with this new diagnosis I may always have to live with it.

Depending on outcome of 2nd surgery you may want an exchange.

As for lens option to choose that is a more difficult decision. Personally with my situation I am glad my RE has a Symfony or vision would be more poorer now that LE has Epiretinal membrane.

Hoping whatever you decide turns out well.

19

Keeping in mind I'm no expert, I've read that a there is typically a myopic shift after a vitrectomy, search for this and you will find several studies. My first thought is now your prescription is off, but if it's typically a myopic shift (.5 to 1.5ish), I'd think your near would be better, not worse. Perhaps with prk he wants to try a minor correction to make up for that? I've also read that the vitreous is more stable than after you've had a vitrectomy, were either of your lenses toric? They could have rotated and need to be rotated back. Hope this helps.

20

Authors of that report are sponsored by Alcon, it is typical marketing stuff. Alcon hydrophobic acrylic lenses have had big issues with glistening, every manufacturer have their strong and weak points.