Symfony IOL expectations

Eye care
1

Hello I posted earlier on these forums regarding my prep for cataract surgery sometime later this year. I would just like to hear how people implanted with the Symfony IOL lens are holding up after their eyes have have healed abit and settled down. Im still having a very hard time deciding if Symfony IOL is worth the risk of having the possibility of glare and halos at night for the extended depth of focus. How is the range of vision and is it really sharp and contrast compared to a monofocal? I'm also concerned about the widely discussed issue about having circles around lights during nighttime. I hear people say they see them on tailights of cars and some also say streetlights as well. I can only imagine what if you were to stumble upon a traffic jam freeway full of lights and cars or in a crowded city at night that those concentric circles multiplied by several dozens would be quite overwhelming. For people with Symfony, are you all seeing these visual webbed circles with the majority of lights at night? At concerts or sporting stadiums (with bright overhead projections ad what not) And how are you guys with watching at the movie theater since those situations are in a dark surroundings with sometimes very bright cinematography. I saw some posts saying people see a white glow around lettering in black/dark backgrounds on tvs or monitors. And another saying there's a halo around the moon! I would think that monofocal IOL lens would be more sharper contrast of detail when it comes to viewing lighting at nights. Eventually I really want to become a 3D concept artist, but if the Symfony might give me extra ordinary artifacts when working on a project on the computer that's gonna be a problem for me. I know a lot of people say their excellent for computer intermediate distance but what about seeing that clarity and contrast of light/dark figures on a screen. Will there be a suspectibiliy to glares and halos in that line of work?

I have a lot of factors to consider still and would highly appreciate some personal experience for everybody here that has had the Symfony IOL for cataract surgery. Since I am planning to work a lot with computers for my career i do like the convenience that the Symfony has and that it's good for intermediate range and some for distance but want to also know how does that range of vision holdup compared to a monofocal IOL. I understand the range of monofocal is not as varied and set at one point compared as the Symfony but which one is sharper at the desired distance? am worried that even a monofocal set for distance might be sharper or clearer than the Symfony IOL. And than using glasses on top of monofocal for other nearer close up and intermediate would be clearer as well? I know Symfony sounds good on paper but everything I hear on the personal annocdotes seem to be a lot of negative issues and people resorts to having them taken out.  I will have to think about this as I know their is no such thing as a perfect lens available. And it is what it is but still need to make a wise and well minded decision. 

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Also would like to know how people with monofocal IOL are doing with viewing intermediate and near range activities. I know you will need glasses to function in the other areas of vision but wondering if doing work on writing/sketching on a notebook and than looking up at a computer monitor will you need 2 different pairs of glasses to function? I would have a difficulty trying to transition from this experience if I had to keep switching glasses. My question for people who have monofocal how many pairs of glasses do you have? 

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There has been an extensive discussion of this topic under my post,  "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens." You may find that useful.

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Yeah I've seen and read through your post regarding those issues with concentric circles at night. Although very helpful information but just wanted to post this as I have very specific questions about the performance of the symfony IOL implanted. 

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Agree with a201 - the thread he is referring to is extensive.  I read through it a few times when trying to decide on lens.

Unfortunately I know from experience that you can't be 100% positive of outcome.  It is much like game 'would you rather... '. I drove myself nuts.   if you can tolerate monovision or easier mini monovision then likely you will only need glasses for up close (monovision) or close and computer distance with mini monovision.  Those you can get as bifocal glasses vs 2 pairs.  This gives you the highest chance of no night time issues.  However there is a small % of people that experience those even with monofocal lenses.

I think I already gave you my input with Symfony lens.  My surgery was almost 5 weeks ago.  2nd eye will soon be operated on.  

The issues I experience are still the same.  I have no trouble with working on a computer or wTching TV, iPhone or iPad.  Slight ghosting (more highlight - hard to explain) with white letters in black background.  Letters are clear to read.  Likely this is due to LED lights.  I don't see double or anything.  The concentric circles are faint so I don't have trouble driving.  More of an issue are bright LED headlights.  But my husband had trouble too with those and he doesn't have any signs of cataracts yet.   I had real trouble with those with cataracts and worse contrast sensitivity.   I am thinking all lenses have a little less contrast in low lighting as my friend with monofocals has trouble too in dimly lit restaurants with menues - especially with grey lettering.  I use my iPhone flashlight to provide better lighting to read menu.

I am not sure what your work entails.  But you may find a little difference in doing your work no matter which lens you choose.  reality is we can't have the vision we had in our twenties but it sure is a LOT better than what my grandmother had after cataract surgery. 

You learn to adapt and live with a new normal.  

I was hiking this week and couldn't get over the colours and beauty of nature.  This Symfony lens in daytime is fantastic.  As I get older I will not be driving as much during the dark.  Locally when there are streetlights there are less issues.  Traffic lights are fine too.  Just see concentric circles when people apply brakes.  Also on dark highways glare from oncoming traffic - lots of glare.  I look to side of road to avoid glare.  Likely monofocals have a lot less of that.  For my decision I spend more time at work and outside on weekends during daytime - no issues there and great to be glasses free.

You'll have to come to a point of deciding which compromise you want to make.  Most people do t have the other complications associated with cataract surgery - surgery 95% successful.  Most of those never post as they are content with text.  I posted here prior to my surgery to get info.  I am happy with my result personally.  Hoping to give back from my e perience to this community .

Good luck.

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If you want there is a blog I read (very informative) from a person in U.K. who opted for this surgery to rid himself of glasses (in his 40's - no cataracts) in early 2016.  He provides a few updates and I had re he'd out to him a couple of times with specific questions which he graciously responded to.  I cannot provide links on this site. If you google kirinblue Technis Symfony IOL lens replacement surgery review - you can find it.

He had blurrier eyesight first few days following surgery than I did but it seems his outcome mimics mine.  He is a photographer so he wanted to be able to read camera settings etc.  My eyesight was clear after first day and has been stable since.

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I am worried about the concentric circles too.  Miguel brings aup good point about traffic jam. Would your vision be just 100s of intermingled circles?

I have cataracts distorting vision in one eye at this time.   I am 41. I believe younger people should try and stay away from lens exchange as they are prone to retina detachment. Especially men. 

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Hello - you wrote:   I know you will need glasses to function in the other areas of vision but wondering if doing work on writing/sketching on a notebook and than looking up at a computer monitor will you need 2 different pairs of glasses to function?

I highly doubt it.  I think most who set their monofocals for distance can read the computer screen just fine without any glasses (unless you are 5 inches from the computer screen which is too close anyways).  Also, if you place the notebook at an adequate distance (at least 14" or 16"wink you might not need any reading glasses at all with a monofocal.

Also, technically, you never really "need" two pairs of glasses anyways since you can always get bifocals or multifocals.  Now, obviously the idea of surgery is to get away from glasses as much as possible and not the other way around.  As you may know from a previous response on another thread, I chose monofocal lens.  Actually, it wasn't a choice due to prior history of my eye trauma my doctor refused to do any multifocal.  In hindsight, I'm glad because my vision is fantastic.  I have no halos, no artifacts and none of the things others complain about with multifocal lens.  My vision is beautifully clear in the morning, afternoon, evening, driving in the city or freeway day or night - doesn't matter - no halos.  Someone's car brights could be blasting in my eyes at night....annoying ...yes....halos...no.  The ONLY time I had halos (double vision with lights/leds, etc.) was the first evening after the surgery which I attribute to my eyes still being quite dialated.

My biggest concern after the first eye was done was I did not want to have glasses on "both sides" of the spectrum.  In other words, if it turned out that I was just shy of 20/20 distance in one eye and I chose monovision and the other eye was just shy of near then I would wind up with glasses for both ends of the specturm and a somewhat weak foundation (if that makes sense).  So, monovision was not for me but "mini-monovision" is definitley something i would highly recommend many consider.  there's going to be a 1/2 diopter error factor to begin with and I wanted my eyes to work together with a decent range of vision.  After the first eye was done, I was bothered that my near vision appeared to be pretty much gone  (mid range and distance were great because I chose a distance monofocal).

So, for the second eye, I chose distance but with a biased to near  (so it was set to distance but only 1/2 diopter in for "mini-monovision."  My eyes see BETTER together at ALL ranges now.  Really small print that I cannot read up close with either eye separately, I can read with both.  When sitting at the computer (which is several hours a day) I tend to recline a lot (although that might change since I got my sit/stand platform that I put on my desk).  So, I usually try to be at least 30" from the screen which I have read is better for your eyes anyways and less likely to cause dry eye and eye irritation.  Anyways, the computer screen is "crystal clear."   I almost NEVER wear glasses for any range of vision and never for distance or mid-range.  Once in a while for extended up close work such as writing checks or reading really small print I'll usually throw on reading glasses, but it's not too often and it's no big deal.  In other words, it's correctable - as far as I know, you can't do anything about halos (except avoid driving at night).  If you're getting into computer gaming and seeing things beam across the screen especially in low light settings, I think you are going to have more risk of halos with any multifocal lens.  Some have said (that for some) the brain eventually blocks it out.  Either way, it worked out great for me and perhaps I have a greater range of field than most with a monofocal lens, but I have also learned to reprogram my brain to hold the phone further away than I used to.  When you are nearsighted you tend to look at everything REALLY close so it's a learning process to find the new sweet spot to read small print which is going to be further than it was before the surgery.  I think it took me about two weeks or so.  I could have easily just decided to wear reading glasses more often but it's not big deal to read something around 16" away with no glasses rather than say 5" with glasses.

One last thing, I did a "test contact lens" before doing my second surgery to test monovision at different ranges (this is when I was considering monovision).  I'm glad I did NOT choose either lens.  One lens was around 20/100 and the other test lens was around 20/70.  I'm glad I did not choose them because they were misleading.  The reason is simple, the cataract was making my vision WORSE at all distances.  So, even though my doctor set the second eye 1/2 diopter in for mini-monovision, I was still able to see at 20/20 distance and my near vision is far better than it was with the test contacts.

If your doctor targets 20/20 for the first eye you do and they overshoot it a little (so you wind up a little far-sighted) then more near vision will be compromised.  One solution is to target the second eye 1/2 diopter in for a wider range of vision.  If the opposite happens and the doctor undershoots the 20/20 then your near might be a little better and they can target the second eye more for distance.  Ideally, I've read the dominant eye should be targeted for distance but in mini-monovision it probably doesn't matter quite as much if it doesn't work out that way.  Of course, the other or additional solution is to do a laser tweek post cataract surgery if needed to set your eyes exactly the way you want.  I haven't needed to do any laser tweeks.  I can definitely say is that I'm happy and it has worked out great for me.

The best advice I can offer is to be sure your doctor has a LOT of experience doing both cataract surgery and working with the laser.  I had ORA done during surgery to improve the final outcome which I think many doctors do these days.

Good luck to you

 

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If you only have cataract in one eye and given your age, perhaps a monofocal lens set for distance would be your better option.  Your other unoperated eye will compensate for near vision and do the reading.  By the time you need the other eye done there likely will be better lens options.  And if not since you will already used to monovision you could get a premium lens.

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Thanks Michael.  Glad you've had good results.  Yes an experienced surgeon is key.  Using similar set up Miguel you could also mix and match - monofocal for distance in one eye and Symfony set for slightly nearer.  This way you could get closer vision to read fine print and possibly have less night vision issues.

11

Good point about if the cataract is only in one eye, then I agree that a monofocal lens for distance is definitely something to consider.  With that said, they will not be used to "monovision."  Since, at mid-range and distance both eyes will still be working together and perhaps the "monovision" might only be up close if they get the monofocal set for distance.

 

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I had considered mixing and matching but my doctor advised against it and also said that the multifocals work best when in both eyes.  Also, I think some have still reported annoying halos even with a multifocal in only one eye.  But, there might be other options available when Miguel needs to do the other eye in the future.

 

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Agree. I wonder why some surgeons are ok with mix and match but others aren't. My own surgeon too doesn't advise mix and match.  He thinks MF lenses are best when used in each eye. 

I do not live in a major city so it's difficult to get a consult elsewhere.   I do have a good surgeon here.  The results I got with the one eye are exactly what he sId to expect.  The night time issues I decided to live with.  And since I don't live in a major city - no significant traffic in the city to contend with - lol.  Most we have are double lanes.

I get my husband to do the night driving. Hoping he will have other options when his time comes for cataract surgery.

I was st a gathering of friends tonight.  By chance chatted with a person considering clear lens exchange.  I hope I was able to talk them out of it.  Really cannot see why anyone would go for this surgery when they don't have cataracts.

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I do have cataract in both eyes. But the one in the right is at the periphery so no interfering with the vision. 

I would not do mix and match as I am bothered by my current state where when something is blocked for my good eye, it is blurry and then becomes clear when it comes in line of sight for the good eye. 

The near vision in the cataract eye is OK. So basically I am monovisio right now and do not like it. 

Sue.An, will the entire vision be with concentric circles if there are many lights?

15

It seems that part of the reasons for the confusion about whether the different types of lenses can be combined or not is because many surgeons lump multifocal lenses (which have 2 or 3 very small ranges of focus) with the Symfony lenses (which are extended-focus lenses with a large region of focus).

One should combine different types of lenses if there is a good rationale for using those. With the true multifocal lenses, there is not much advantage in combining different types of lenses (except possibly saving some money by having one monofocal lens). On the other hand, combining monofocal lenses with either Symfony lens (the combination which I have) or with Cystallens (which my wife has and was a good option before Symfony) made sense to us and to our surgeons completely right from the start. We have had no visual issues due to and thus no regrets about combining the 2 types of .lenses.

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The night visual issues I think are different in degrees of 'bothersome'.   First few weeks I did not even notice the circles.  Streetlights are a bit fuzzy but not bothersome.  Car headlights with the newest LED ones more troublesome.   And I have driven at night in our city.  Also walk an hour each evening.  Nothing I find really bothersome.  First time I noticed the concentric circles was driving home from an away soccer game (2 hours from home).  First time driving on a dark highway with no overhead streetlights. Trucks and car break lights had them.  They are big but the lines are quite translucent - like spider web.  they are less bothersome than glare from

headlights.  I only have one eye done so trying to find out if it will be less noticeable with both eyes done.  2nd surgery soon so will find out.

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Thanks for the reply Sue.An.

So not every light source at night is a spiderweb correct?  Would driving in city with street lights be a problem?

I can give up night highway (freeway) driving as it is not safe anyway but giving up city night driving is something to worry for me. 

Also, my mother had monofocal for distance and did not need reading glasses. 

18

The important thing is that you should be aware of the possibility of seeing multiple circles around lights at night. One can see multiple circles around more than one light just like one can be bothered by glare from more than 1 light at the same time.

These visual effects are bothersome and I do wish that I did not have to put up with them. However, I have learned to live with them and don't let that stop me from driving at night.

19

Correct I do not see the circles from every light source.  But there are those on this site that see them more.  Some see them inside which I haven't .  Inside lights are fine for me.  Like 201a mentioned you should be aware of that possibility.  I was really concerned about them prior to surgery but quite relieved it wasn't as bad as I was expecting.  They obviously are due to lens design but I am convinced it is individual too - in part surgeon's skill - how far off the correct power needed in lens and size of your pupil.  Could also do with how brain adjusts.  Read many articles about patient selection.  Some surgeons use a questionnaire to assess patient personality and vision needs/assessment.  

For city driving I do just fine.  The most trouble I have are from headlights from those vehicles with LED lights.  But I look to side of road to avoid glare.  Other lights do not bother me when driving.  The concentric circles seem to come more from red taillights for me - circles are red.  As 201a said wish they weren't there but I can drive and see through them ok.

When there is good overhead lighting from streetlights driving is easier.  I was concerned prior to surgery about watching soccer games at night due to floodlights.  Questioned a few people about that.  But that too is a non issue.  Can see the games just fine.  Better even.  I was so frustrated with cataracts / couldn't see numbers on jerseys before.  Now I can.

I know there must be at least a bit of mini monovision going on for those with monofocals to get vision at multiple distances.  I am not discounting that and it is a viable option for you to consider.  You do sacrifice a bit of depth perception to achieve that and maybe a non issue while young.  I also know there are people that end of unhappy with those lenses too - every lens can possibly  end up unsatisfactory for individuals.

Statistics are good you'll be happy whatever your choice.  

20

For anyone considering a Symfony lens vs. an aspheric monofocal lens, this is from the Abbott official brochure for the Symfony lens:

"The TECNIS Symfony® IOL may cause a reduction in contrast sensitivity under certain conditions, compared to an aspheric monofocal IOL. The physician should carefully weigh the potential risks and benefits for each patient, and should fully inform the patient of the potential for reduced contrast sensitivity before implanting the lens in patients. Special consideration of potential visual problems should be made before implanting the lens in patients with macular disease, amblyopia, corneal irregularities, or other ocular disease which may cause present or future reduction in acuity or contrast sensitivity. Because the TECNIS Symfony® IOL may cause a reduction in contrast sensitivity compared to a monofocal IOL, patients implanted with the lens should be informed to exercise special caution when driving at night or in poor visibility conditions. Some visual effects associated with the TECNIS Symfony® IOL may be expected due to the lens design that delivers elongation of focus. These may include a perception of halos, glare, or starbursts around lights under nighttime conditions. The experience of these phenomena will be bothersome or very bothersome in some people, particularly in low-illumination conditions. On rare occasions, these visual effects may be significant enough that the patient may request removal of the IOL."

https: // www. vision. abbott/ us/ iols/ extended-depth-of-focus/ tecnis-symfony . html