Both eyes at once

Eye care
1

I'm scheduled for Symfony tecnis for cataract with astigmatism in my right eye in two weeks. My left eye will need it eventually. It makes sense for several reasons to do both eyes at the same time , work being one of them.

My left eye was the problem eye and the right eye carried the load but I had torn retina in the right eye ( successfully repaired) which wound up requiring a vitrectomy. Cataracts developed and right eye is worse

Does anyone have experience or recommendations about doing two eyes at once?

I want to stay with the same doctor but he can't do the second eye for three more months.

Thanks

2

Hi Bmag, not a good idea in my opinion, interesting to see if anyone agrees with me, but if your Consultant thinks this is OK then so be it, I think your op might be different to the Cataract ops so that might make a difference, hope all goes well, please let us all know what you decide and how it goes

Regards Agnes

3

I will discourage having both eyes done at the same time.

A majority of the time, despite all the modern technology, the prescription of the lens for the eye for the first eye will probably be slightly off from the desired result. The best target for the second eye will depend on what is actually achieved for the first eye so that the combination works out best for the rest of your life. So, it may not be good to skip this important evaluation after the first cataract surgery before the second one is done.

4

Thanks so much for your prompt reply. You both make great points and sensible advice. The ability to correct inaccuracies from the first procedure in the second eye is very critical. The doctor himself didn't say no he wouldn't but he recommended against it.

Certainly I will follow his advice but I have some unique time constraints and my doctor can't do the second one till may. My work requires passing vision tests which I hope to and should be able to do after the first procedure but if I don't pass then I don't have work. The left eye is hanging in there but needs work sooner rather than later.

It sounds like sometimes the repaired eye doesn't always sync with the other one and that could be an issue for work also. (I'm a ship captain). I'd prefer not to wait for four months but......

Thanks so much again.

5

Hi Bmag, isnt there any way you could get another consultant to do your second eye sooner, May is a bit far off.  im glad that at201 agrees with me, your first eye should recover before getting the second one done, its bad enough having to care for one eye operated on without having to do it for two.

Could you get, if you dont have already glasses that would suit your operated eye and the other one so that you could pass whatever vision test that has to be done.  What a lovely occupation you have.

Again please let us know what you decide

Regards Agnes

6

Hi bmag78, since you are a ship captain, a good vision at night is probably more important to you than it is to an average person. Therefore, you should be aware of a night vision issue seen only with the Symfony lens. Please see a more detailed discussion of the issue under "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens." Essentially, at certain distances at night, looking at a  single light may result in your seeing not only a halo within couple of feet around the light, but in seeing about 10 different lighted concentric circles or halos covering a much wider area. For example, if I am looking at a car headlight, the outermost circle may be as wide as twice the width of the car. This has not been publicised by the manufacturer or the doctors involved in the lens study, but this is a unique issue for the Symfony lens. For me, I don't drive much at night and I like the vision with it during the day, so I am glad that I got it, but the tradeoff may be somewhat different for someone in your profession.

7

As others have noted, it can be useful to see what the refractive error on the first eye is before doing the second eye. The issue is e.g. if the first eye is on target for distance, you might target the 2nd eye for slightly nearer for micro-monovision to give a bit more near. However if the first eye is a bit myopic, then you might be sure to target the 2nd eye for distance. However that is based on the idea that you might target the eyes differently, if you wish to target both for distance then that is less of an issue.

It is possible that if the lens power is off on the first eye, they might use that as guidance to tweak the selection of lens for the 2nd eye. So the next issue is how high the risk is that the lens power will be off. For most people the lens power calculations are fairly accurate, close enough that even if the power is a little off, its unlikely information from the first eye will provide any useful information to guide the power for the second eye rather than merely sticking with the formula. 

Its those who had high prescriptions before surgery where there is a larger risk the lens power will be off. For those who are highly myopic, they suspect there may be some issues with the measurement techniques. In general though the lens power calculations aren't exact formulas, but are based on statistics regarding how prior patients with various eye measurements did with various lens powers. There are fewer people with high prescriptions, and more variations in eye measurements that combine to give high prescriptions, so there is more risk of lens power errors. In that case it also partly depends on whether both your eyes have similar measurements whether the results of the first provide much guidance as to how to alter the power for the 2nd.  Most people have eyes that are similar to each other, but not always. It isn't clear from what I've read how often though its useful to modify the power estimate for the 2nd based on the first.

 In my case where I had both eyes implanted with Symfony lenses a day apart, I was highly myopic, but   one of my eyes was noticeably more myopic than the other, and after surgery it wound up slightly hyperopic, +0.5D. The 2nd eye  was about on target at 0D (based on the first few months of postops), though at  about 2 years postop it just tested at about -0.25D this month. In that case going with the formulas as is worked out for the best, if they had tried to alter it based on the first sye then the power would have been off in the other direction. 

One advantage of having both eyes done about the same time is that neuroadaptation is faster since the brain is getting images processed by similar optics from both eyes. Also, I don't know how strong your prescription is now, or if you wear glasses or contacts. If you do one eye now and the other has a strong prescription, usually you'd need to wear a contact on the other eye (rather than glasses) after surgery. If one eye has good distance vision, but the other requries a strong correction, then with glasses the difference in powers leads to a difference in magnification of the image and a difference in image sizes sent to the brain that it can't reconcile. People can adapt to a small difference in image sizes, and there are special lenses that can try to balance the difference, but usually differences of a few diopters are more can be a problem.  A contact lens on the surface of the eye doesn't change the image size as much as glasses further from the eye do, so it usually works.

Usually people with an IOL in one eye can adapt to having a contact in the other. In my case when the bandage came off my first eye, I did feel an odd sense of imbalance between the two eyes. It may have been that I would have adapted to it quickly, but unfortunately I had traveled to get my surgery done and only had an hour to decide whether to get the 2nd eye done on that trip, so I decided to get it done just to be sure I didn't get back home and have problems adapting (and to avoid another trip soon  if the other eye's cataract developed rapidly). As soon as the 2nd lens was in, the sense of imbalance was gone. Again, it may be that I would have adapted to it quickly, perhaps even within a few hours, I just didn't have the chance to try. It may have been partly just paying attention to the difference between the eyes since I had to decide whether to get the other eye done (since its cataract wasn't causing problems yet, it was still 20/20, I was debating about seeing if I could wait for an even better lens to come out. The first eye's cataract had gotten bad within a few months when it appeared so it was good to just get it taken care of). 

 

8

The issue of halos isn't only with the Symfony lens, its shape merely differs from the halos with other lenses. Even people with monofocals or the Crystalens can get halos. Multifocals can lead to halos with concentric rings, just like with the Symfony, though the exact details vary with the lens. Even people with their natural lens sometimes have issues with halos (I seem to recall its more common with those who are farsighted than those who are  nearsighted).

Since this site moderates links, I'd suggest googling 

"High rates of spectacle independence, patient satisfaction seen with Symfony IOL" for information about studies on halos showing the low risk with the Symfony. Unfortunately low risk doesn't mean no risk, but then there is risk of problematic halos with a monofocal as well. Unfortunately no lens that exists that doesn't give people problematic halos.  The risk with the Symfony seems to be comparable to that with monofocal lenses, perhaps not as good as the best monofocal but better than others.

Whether those halos are centralized blobs or a single ring  or concentric circles isn't the  major issue to those who get them, the issue is whether the halos are considered a problem for the person who sees them, and often they aren't if they are mild and if you see through them.  For instance search for "My experience implanting the Symfony lens this past year" for comments from a surgeon regarding things like halos, most people don't see them, and most who do don't consider them a problem.  In my case I see concentric ring halos, but they are so mild/translucent that I see through/past them and haven't considered them a problem (even if obviously I'd prefer they weren't there). Overall my night vision is better than I can ever remember it being, perhaps partly since there is less of a glare issue than I recall from even before my cataract appeared, which balances out the mild halos.

Most who do see halos initially see them fade away after the first few weeks or months. Others can see them fade over a year or more. I sometimes now don't see halos around lights where I always used to see them.  For various reasons I haven't spent as much time outside at night as I used to so it may be that it merely took longer to adapt since I wasn't spending as much time doing it. (and the same issue may be true for others who don't drive much at night, they may not see the halos fade as quickly as others who are out at night alot and adapt quickly).

 

9

I know that it is very hard to compare the unique type of halos associated with symfony lens with the usual type of halos experienced with monofocal lens, However, I hate to say it but I don't have much faith in the so-called studies showing that that the risk with the vision issues due to halos associated with the symfony lens are comparable to those with monofocal lens. All of these were done with the direct financial support by Symfony lens manufacturer. Even the surgeons who install IOL lenses tend to not highlight any unusual vision issues associated with the premium lenes because at least in USA, they can make more than twice the money installing a premium lens instead of a monofocal lens with minimal extra work.

10

Unfortunately even with an issue that is low risk, *someone* winds up being the "statistic" and its natural for them to not wish to believe they are unusual and to therefore question studies. It may just be bad luck, and not that the studies are off. Those who post online often tend to be those who have issues, so its hard to get a sense of the rate of problems from posts, and its impossible of course to get a senses of the rate of problems from 1 persons experience.

The studies for the other premium lenses show more of a risk of halos than for the Symfony. I don't see reason to assume the Symfony results would be more biased than those for other lenses (including other lenses from the same manufacturer).  The results reported at conferences post-approval are often by people with no funding from the company, and they seem to match the approval studies. The comments I see from surgeons using the lens, who have no connection to the manufacturer, seem to match the studies, e.g. google "My experience implanting the Symfony lens this past year" for the results from one surgeon who comments on the halo issue.

11

I guess we can keep on arguing about the percentage of people who have problems and whose data to believe. Based on the experience of my friends and my wife (which I observed first hand) with other premium lenses, the surgeons are not anxious to hear about any problems with the lenses. (my surgeon at least acknowledged the probem and did not seem surprised by the concentric circles which I see). It is in the financial interest of the surgeons (even if they are not subsidezed directly by the lens manufacturer) to push the patients into premium lenses because they make a lot more money from putting those in the eyes and thus, they seem to tell you all about their advantages and not their problems.

12

The makers of different premium lenses have  an incentive to discover  if their competitor's lenses have problems, and they have an incentive to fund studies to discover this. The potential for the profit incentive to distort results cuts both ways, and tends to be overblown by those who haven't dealt much with the issue of research studies.

In certain fields where there is difficulty or great cost involved in doing studies, some studies aren't likely to be redone by others and so there is more of a danger of studies being biased by those conducting them. In areas where studies are often repeated by others because they are relatively easy to do (since surgeons are doing cataract surgeries all the time anyway),  researchers have little incentive to risk their reputation by doing biased studies that may be proven wrong, leading their reputation to be undermined.  

Most surgeons involved in doing studies earn their living from their surgery primarily and not from doing studies, the studies tend to be things they do mostly since they wish to be involved in the leading edge of new products, and see it as good for their reputations. Most aren't going to consider it worth risking their reputations by doing a flawed study. 

Surgeons themselves need to know which premium lenses to use because they don't like dealing with patients with problems afterwards, so if one premium lens is better than another they wish accurate data indicating that. The surgeons involved in the study wish that information themselves, and that is what they talk about in the trade literature and at conferences, and what they participate in studies to find out. In addition, many doctors obviously got into the field not merely because the pay is good, but because they wish to help people, and they wish to find out the best IOLs to use to do so. Yup, there are some doctors purely motivated by greed, or at least subconciously biased by hope for profit, but the issue gets overblown since most are just reasonable people trying to study things to see what works.

 

13

Let us just agree to disagree on this. You can continue to believe that the visual issues at night with Symfony lens are not worse than monofocal lenses and I will continue to believe that the very design features that give the Symfony lens the extended focus capability make them prone to giving the people the unique visual false image of many concentric circles extending over large area around lights, which is completely different from monofocal lenses. Thus, if a very good night vision is important, then symfony lens may not be the best option.

14

Thanks for all the replies. Glad someone who did two back to back replied.

I met with my doctor today and doing two at once is no longer an issue since he can't schedule it both for Jan 29th so that's moot. I was about 99% sure i was going to wait a short while between procedures basically for the chance to make slight corrections in the second eye if necessary.

As it turns out my doctor is able to do the second eye in three weeks time on the 21st of Feb so it's like the best of both. First eye mostly healed so they can get a good read on it before doing the second.

I'm hoping that the eyes are somewhat in sync for the three weeks. I been married twenty years , I can put up with anything for three weeks right. If I need glasses so be it for three weeks

I've encountered three people who've done the symfony lens recently here in new York and they're all thrilled with the results. All describe halos tho at the minor nuisance level. They seem to be a result of every eye procedure.

Thanks for your respect for my profession Agnes The life of a sailor is tedium interrupted by terror , tho we do get to a nice place now and then. Next time I'm expecting to actually see it tho. Thanks to everyone for writing. I'll add more after the procedure.

15

Hi bmag, way over there in NY, couldnt be further away up here in the Highlands of Scotland.  

You are sounding so much more relaxed and ready for your procedure, Im so glad to hear everything is working out for you now and again your problem is significant to other in this site.

Here in Scotland or at least in my area of Scotland they generally wont do a second eye until the drops for the first eye have been completed and that takes 4 weeks, then of course if there is anything wrong with the first eye they wont do the second eye until the first one is OK, maybe its got something to do with different lens, I couldnt tell you what lens I have in either of my eyes just that whatever they are they work fine but im not so lucky in that my eyes are uncomfortable re itchy, gritty, and a bit of pain in my left eye, Im going to have to live with that but before I had the cataracts removed my sight wasnt good.

Enough of my moans and groans, please let us know how your first and subsequently the second op goes and happy sailing

Regards Agnes

 

16

Even if only 1 person out of 10,000 had a particular problem with a lens, they might think it must be common because they had it, be upset that the risk   wasn't stressed even though its rare, and people reading an online forum would have no way of knowing the issue's prevalence prevalence merely from anecdotes.

Science has often discovered that intuitions don't match reality, and that anecdotal data points can be misleading, even if they are very emotionally compelling,  especially when they happen to you. I see the concentric ring halos (though some are fading) and so its natural to assume "that makes sense because of the diffractive rings on the IOL" and to be puzzled as to why others wouldn't see them. However  in reality most people don't even if that may seem surprising to someone who sees them, and many who do see them disappear. Diffractive multifocal lenses also have   rings, and can lead to halos with concentric rings, thought the exact pattern of halos will differ between lenses and people, and again with those not everyone sees them. The only way to determine how many people, if any, see a visual artifact is through studies. 

It is important for people to be skeptical of all studies (I'm a skeptic by nature and have been concerned about junk science and studies for decades, I subscribed to the Skeptical Inquirer when it first appeared in 1976, though thats focused on more obvious junk science). However   again the degree of skepticism should take into account the likelihood of people trying to do studies to find a contrary result.  It is natural for lens proponents to try to bash other IOLs and that makes it likely for any potential flaws to be uncovered, though there is a need to skeptically evaluate those claims as well.

A co-inventor of the FineVision trifocal for instance did an optical bench study comparing chracteristics of that vs. the Symfony to try to show its benefits vs. the Symfony. The study was misleading  as critiques pointed out since  it was done using 1 wavelength of light rather than the broad spectrum of light that we use to see in the real world. Other lens manufacturers presumably would like to have studies that undermined the Symfony in comparison to their products, e.g. to say "use our multifocal, don't bother with the Symfony since the low halo&glare statistic claims are bogus in addition to our lens giving better near".. yet such information hasn't appeared (though of course there is no guarantee it won't).

The Crystalens is another premium lens targeted at better intermediate vision (with not as good near as high add bifoclas).Due to the fact that it is single focus, but claims to accommodate,  you'd guess the rate of halos would be low, and your view of studies as being biased would suggest the results should say that. Yet the FDA data for that lens suggests the rate of problematic halo&glare issues is higher than it is for the Symfony. It would be in the interest of those who profit from the Crystalens to undermine the Symfony's claims of  low halo&glare issues, if you were merely focused on the superficial issue of biasd studies, yet I don't see results indicating that. Surgeons have multiple IOL options, if there are flaws in one then info wil come out about it. (such as flaws in the Crystalens, which led me to decide on the Symfony).

Despite the   potential for profit, many surgeons are conservative and shy away from multifocals due to problematic side effects, and so it makes sense to consider the views of those who lean that way (especially since some of them therefore push options like the Crystalens instead). I cited a blog post from one such surgeon above. Before I had my impants, I  had email contact with the surgeon  from Singapore I mentioned above who made the post "My experience implanting the Symfony lens this past year" . I know he has no connection to AMO since we were comparing notes trying to figure out the pros and cons and technical details of the Symfony lens before I got it back in 2014, since he wasn't involved in the studies and was also trying to find out about it before it hit the market in his country. When googling for info on the Symfony I saw   he'd posted a blog entry indicating he initially heard about the lens through family who'd seen a writeup in a UK paper and was surprised that he hadn't yet heard of it since its his field, and was skeptical of the hype in the popular media and was investigating.   I'd emailed out of curiosity to see what he'd found out about it and compare notes, and while considering where to go outside the US to get my surgery in case he was an option  to consider when it was available there (valuing the idea of  rational skeptical surgeon). His posts after he had experience with the Symfony are merely anecdotes from more than one patient, not a formal study, but its one data point from a non-AMO funded surgeon.

 

17

3 weeks should be enough time to stabilize vision to get a good sense of the outcome. Although some people see a shift after that, its likely not much if it does happen. Mine was the same refraction from the 1 week postop onward, up until a  check a couple of weeks ago with only a slight shift that might even merely be due to differences in doctor doing the refraction or the equipment used (e.g. lenses aren't to perfect tolerance exactly the specific measurement).  

 

You mention wearing glasses in between surgeries, but that might potentially be a problem, many people need to wear a contact lens on their unoperated eye between surgeries.  I'll guess that may mean you typically wear glasses, and its a reference to perhaps not needing them after surgery on both eyes. The  question is how strong a prescription you have now for your glasses. After surgery the your eye will likely either not need correction for distance, or only minor correction. People who were have strong prescriptions before surgery then have a major difference between the prescriptions for their two eyes, e.g. 0D vs. -6D, which can cause problems with trying to wear glasses since glasses don't just change the focal point, they also change the size of the image (magnifying it or reducing it, depending on whether you are nearsighted or farsighted). The amount the image size changes depends on the lens power. If both eyes need around the same lens power, the image sizes are close enough that the brain can combine them without a problem. However if the difference is e.g. over 3 diopters or so, most people can't deal with that much difference in size. If your presription is lower than that then you can likely deal with glasses in between.  There are special glasses that attempt to compensate, though I'm unsure how how much of a difference they can compensate for. The magnification effect is less the closer the lens is to the eye, so contact lenses tend to work ok. (btw, some folks who wear glasses haven't tried contacts recently, they are much better than they used to be a couple of decades ago in terms of comfort).

Usually they actually don't tend to prescribe glasses until after vision stabilizes in the operated eye, but if your prescription is low, it'd probably be a safe bet to either remove the lens on the side with the operated eye or perhaps get an optician to replace the lens with a 0D non-prescription lens for esthetics.  

If you are going to wear a contact lens, if you don't now, you might just go into whatever the cheapest optometrist is to get trial ones before your surgery. Usually they require you to be out of contact lenses for a few days before a pre-op visit to get the eye measurements exact, so if you were going to wear a contact lens on the other eye you might try asking if they can do the pre-op measurements for both eyes before the first surgery.

 

Some of the argument for waiting seems to be "but what if something goes wrong in the first eye". However if someone needs surgery in both eyes, even if something went wrong in one eye, the other eye would still need to be done, and of course in this case 3 weeks is more than enough time to know if there is anything major going on. In my case even doing the 2nd eye the next day allowed a postop check to see that I already had good distance vision (and near that was somewhat good, it fluctuated a bit for the first couple of days, going in and out and then seemed to stabilize and seemed to remain the same).

 There is actually a rise in the number of surgeons outside the US doing both eyes on the same day since there are some benefits to neuroadaptation to getting both eyes done at the same time, in addition to the convenience of only going through one period of doing eye drops and postop visits. Apparently the major reason it isn't as common in the US relates to lower insurane compensation for that approach, rather than an explicit consideration of its pros and cons. In places where that is done they use seperate operating rooms and equipment to ensure if e.g. there is some source of infection or an equipment problem in one room, that it doesn't impact the other eye.

I'm assuming they must not require bandages afterwards, in my case I wore a bandage after surgery over each eye until the postop the next morning, but I've seen people posting indicating in their surgeries even on just one eye at a time they didn't have a bandage afterwards, so I'm wondering if it might be an old protocol established before modern surgical techniques and it isn't really needed.

 

18

"I've encountered three people who've done the symfony lens recently here in new York and they're all thrilled with the results. All describe halos tho at the minor nuisance level. They seem to be a result of every eye procedure."

I had one eye done using the Symfony lens and haven't had any halo issues at all.  I had ICLs (an implanted lens that's removable) in both eyes; the one in the operated eye was removed during the cataract procedure, I still have the one in the other eye.  I did notice halos with the ICL, especially looking at lights in the dark (streetlights, or even LED lights on deviced in a dark room).

19

Thanks for everyone's participation.

I actually haven't worn(needed) glasses until about 4 months ago. That's why this is all new to me.

The chronology of my experience begins about 8 months ago with a small retinal tear which was repaired by laser sealing a perimeter around the tear. A couple of months later it happened again but inside the perimeter of the previous repair so no additional remedy was necessary. In August it happened a third time , also inside the previously repaired perimeter. This time tho it tore a blood vessel and the eye filled with blood. This required a vitrectomy , the removal and replacement of the vitreous gel.

After the vitrectomy all was as well as could be expected. A side effect however is a rather rapid onset of cataract , which had debilitated my right eye beyond the limits of my occupational standards.

Prior to this all , my right eye was the better eye and compensated for some cataract development in my left eye. Together my eyes had developed a "working relationship" with each other and I didn't need glasses.

Currently my right eye is 20/400 and my left is 20/80 and is correctable with what I'm told is a very strong prescription in the right eye . I'm currently using the glasses about 80% of the time but find them to be very dizzying if I'm moving about , ok for driving and watching TV. Unnecessary for closer than 16 inches (40 cm in the Scottish Highlands lol)

I'm hoping that after the first procedure my vision will return to the previous functional arrangement for the three weeks until the second procedure.

20

Sorry , somehow I spontaneously posted . The left eye has been very steady and mediocre for several years. My doctor does recommend the surgery since there are cataract and it's not getting better . I hope for an easy three week wait.

Halos seem to be a constant theme. I think I'll take what happens with the new lens. I have pretty significant halo now.

Thanks