Symfony toric lens cataract surgery September 2017

Eye care
1

First off, I would like to thank profusely everyone who has commented about their cataract surgery experience, especially softwaredev.  I've learned a great deal, but I'm still anxious about my two Symfony toric cataract surgeries scheduled for 6 (right) & 13 (left/dominant) September 2017.

I'm 67 and have an active lifestyle: skiing, cycling, hiking, and climbing.  I have stigmatisms, am quite myopic, and have worn glasses for more than 60 years.  Glasses corrected my vision to 20/20, near & far, until last year. I gave up on hard and soft contact lenses about 20 years ago.

The plan is micro-monovision with a goal for 20/20 both eyes throughout the range of vision (as I understand it.)  During the consultation, the surgeon said that he would probably use the ZXT 150 lens, but that he was going to analyze my measurements a bit more before making a decision.

I had asked about "reverse" micro-monovision because I use my right-eye exclusively for an optical scope sometimes, but the surgeon said that "reverse" was problematic and not as predictable as the normal micro-monovision.

I would be grateful to hear from anyone who has experienced or knows about "reverse" micro-monovision.

The surgeon said that I would have better depth perception with this approach than if a monofocal toric lens were placed in my left eye and the Symfony toric lens in my right eye.

Halos, starbursts, and glare are not too important to me as I rarely drive on busy public roads at night.

The surgeon's informational packet has a couple of booklets extolling the wonders of laser cataract surgery, but he told me that there would be no difference in the outcome between laser and blade surgery.  The professional literature seems to be mixed on this question, but my feeling is to go with blade because that's what the surgeon first suggested;  he was #1 in his undergraduate class at Harvard (physics, concentration in optics), graduated from Duke Medical School with highest honors, and has had an extremely successful practice for 20 years.

The surgeon said that he would do the surgeries with laser if I wanted, so I would be interested to know if anyone on "Patient" has had cataract surgery and would recommend it over blade for specific reasons.

The surgeon will not do a LRI with me and he does not believe that I shall require a lasik enhancement post-op for excellent vision.

The surgeon's literature states:

"The ORA laser scan is used as need.  The ORA takes intraoperative wavefront aberrometry readings."

The Symfony literature states:

"1. Automated examinations may not give reliable results.  These may include: auto refractors using infra-red light, wavefront sensors, photo reactors, and the Duochrome test. Manifest refraction with maximum plus technique is recommended."

Is the ORA problematic in view of Abbot's advice about measurement?

About 7% of Symfony patients (per Abbot) have some problem related to the surgery;  I shall try to mitigate any complication by taking the anti-inflammatory drops exactly as directed and generally using common sense:  no heavy lifting, hard exercise, eye-rubbing, fast movement for a fortnight.  The surgeon will administer an anti-biotic shot during the surgeries.

My German Shepherd, Vait, goes everywhere with me;  although he won't be in the operating theatre, the surgeon said that it would be fine if he accompanied me on this trip. (I had been a bit worried about infection.)I would be grateful for any other tips anyone might have for good recovery.

The day after surgery apparently I should be able to drive;  that will entail Denver freeways and then about 150 miles of mountain driving.  Again, it would be helpful to hear from people who have had challenging driving directly after cataract surgery.

I live on a ranch and for about five weeks after the surgeries I plan to deal with paperwork rather than the dirty, dusty work of the ranch in the hope that my eyes will be completely healed when I do return to what makes the ranch actually run.

The cataract in my right eye is getting really bad.  Hence I am inclined to get this done now.

My left eye has a small cataract, but that eye is still correctable to 20/20 with glasses.  The surgeon's advice is to do the left eye as well now, albeit new cataract lenses are in development.  Given his high success rate I'll take his advice. Each iteration may well be better, but the Symfony usually has excellent results and its doubtful that any toric lens will ever be perfect. Sometimes it's better not to let the perfect be the enemy of the good. 

Has Symfony (Abbot) published any data on studies of cataract patients with astigmatism >1 d?

In sum, I would really appreciate any advice for the procedure and recovery which anyone may have.

Thanks very much for your consideration!

2

Hello - I can't comment too much on the symfony since I have a pair of mono focal lens.  But, here's some advice for you.  First, you said you were going to drive a day after surgery.  Be very careful because you said you were near sighted so you might have problems with your depth perception since one eye won't be done yet.  Many offices will heat up your glasses to remove the lens from the eye that was done so that you can still wear your glasses for the other eye.  If they don't do that, sometimes you can "pop out" the lens after using a hot hair dryer on the frames for a few seconds.  Frankly, that still didn't work so well for me because my eyes were still just so out of whack.  One eye was now seeing almost "perfect" while the other still had a cataract.

Another thing that was nice was I got a free pair of dark sunglasses which helped a lot because my eyes were sensitive to daylight for around 3 weeks.  I don't know if all offices provide some kind of dark out glasses but if not you might want to consider bringing a pair of dark glasses for after surgery when you are about to be driven home or go outside.

Good luck with your surgery.

 

3

Hi - I had Symfony lenses implanted in both eyes (July and August last week).  I will let others weigh in on laser vs regular surgery technique (I had latter).  I also live in Canada so not as familiar with USA .  

I have not had to have any tweaking since either surgery and daytime vision has so far been great.  I can see from 14 inches and beyond (did not have mini monovision done).  I have not needed glasses since surgery.  I am young at 53 for this surgery and still work in an office full time with no difficulties with paperwork or computer.  Can read newspapers books phone book even with no issues - same with my iPhone without changing its original font.

I do have glare halo and concentric circles at night.  Most of the problematic ones are from oncoming car headlights.  Streetlights etc don't have problems with any overhead lighting.  Neither do I have issues with inside lighting.  From what my surgeon told me this is what one should expect with Symfony lenses (I was aware of night issues prior to surgery).  I came on forums to gain some info not because I had a complaint or issue with my vision.  The most difficult aspect is driving at night on dark unlighted roads.  Glare from oncoming cars is bothersome.  Not sure I'd want to do a long drive.  City driving I am ok with due to overhead streetlights.

Re your comment about driving day after surgery.  Personally my surgeon told me I needed a driver day of surgery and day after surgery for post op visit.  I doubt you'd want to drive day after surgery.  I had clear vision within 24 hours of surgery but was told it could take a few days to get clear vision due to swelling and eyes being dialated for surgery.   

Yes to avoid complications be vigilant about drops regiment- wear eyeshield at least 1 week for naps and overnight sleep.  I wore it for 2 weeks to make sure.  I also took a week off work both times.  

Good luck with your surgery.  

4

Interesting - eye shield for me was only the night of the surgery and not an entire week.  I don't know if that's due to fact I had ORA (maybe the cut is smaller - I don't know).  I've read ORA is supposed to give a better result.  I have two Alcon mono focals and have no halos and no problems with glare at all.  I had mini mono vision performed and rarely ever need to use glasses. Once in a while I use them or a "credit card magnifier" to read really small print.

 

5

Many thanks, Michael.

I really appreciate the tips!

Cheers,

Ed

6

Thank you so much, Sue An!

Your reply as well as your many other excellent posts have been really helpful!

I am most grateful!

Cheers,

Ed

7

You're very welcome.  All the best for your upcoming surgery.  Let us know how you make out.

8

Myself I wouldn't want to get the second eye done only a week after the first eye.  I would want at least a month for the first eye to heal since you would be dependent on that eye a lot while the second eye is healing.

I don't know if driving such a long distance the day after surgery is recommended, the eye surgeons I have gotten consultations with recommend being driven for the surgery and the day after checkup.

I have more significant astigmatism myself, almost 3D, so I am planning a Tecnics monofocal toric for my right eye with the higher astigmatism and for distance since its my dominant eye and has the worse cataract. My left eye has only an early stage cataract that doesn't affect my vision yet so it could wait a few years probably and use a contact until then.  I may consider a Toric Symfony IOL for the left eye if I don't get enough focus range from the monofocal in the right eye. 

9

michael, did you have femtolaser assisted surgery? That could produce a smaller incision for faster healing.

ORA isn't involved in the incision, thats equipment that monitors the refraction in real time to get the power and cylinder as accurate as possible.

10

Very good point about waiting especially since he's considering mini mono vision.  I waited three weeks and had mini mono vision and had my second eye 1/2 diopter in from distance.

11

I'm not sure but I do know that for me I had only a local (I chose to not have any IV sedation) and I had no pain at all after both surgeries.

 

12

Most of the people in waiting area had no sedation.  I had an Ativan.   They freeze your eye so no pain involved.  Sedation or pill helps with anxiety only.

13

I had no pain at all 2nd eye from about day 2.  1st eye was was sore for several

Weeks especially eyelid.  Could not even touch it.  Had a slight bruise under eye 3 weeks post op.  So far it had been a week with 2nd eye and I don't even feel the sensation like something is in there like an eyelash (1st eye still feels that way).  Maybe dry eye not sure affects things.

14

I meant I had no sedation during the procedure.  Also, the local they used during the procedure was an eye numbing drops and gel.

15

But everyone's different.  For me they required an IV but I was able to opt out of any sedation but it was hooked up as a precaution in the event that I wanted something.  But I didn't need anything.  The drops and gel worked out just fine.

16

Same here.  Numbing drops worked.  Ativan only kicked in after surgery.  Nurse told me to take it and then patient in front of me was giving her hard time about dialation drops so she told me I would be next.  20 min not enough time for Ativan to kick in.  Gave me a good sleep though afterwards.  Went home and slept text of the day.

17

Hi Sue An:

Did you have any problems stay still?

I was planning on listening to Gregorian chants through one ear bud of my I_pod.  Do you think that's a good idea?

Thanks,

Ed

18

Thank you, Night-Hawk:

Based upon what several people have said, I'll get a ride to the surgeon's office on the 7th & 14th for the post-op exam;  then I'll make a determination if I'm fit to drive.

If I'm not, I'll stay in Denver until I am.

Is depth perception a concern for you with the monodical in your right eye and perhaps a Toric IOL in your left eye?

Many thanks!

Ed

19

I thought I would have problems keeping - thought I would flinch or panic once natural lens removed and all going dark but the odd thing is nothing goes dark.  You are draped in sheets head to toe.  There was a pipe under sheet with me pumping in oxygen to help me breathe.  The sheet over my head had a window (plastic) that had a sticky part that nurse pull back so eye to be operated on is exposed.  I think drops poured over eye at this point or some sort of gel.  They also monitor your pulse putting one of those clips on your finger. Then a big machine rolls over your face and you stare at lights.  They were red (pinkish) with 3 circles (red mixed with white) and that view didn't change for entire procedure.  Surgeon talked to me and told me each step he was doing.  I could actually see the lens unfolding in my eye - knew it was a Symfony as I could see it's rings.  I asked my doc if that is whatbibwad seeing and he confirmed it was.  While surgery was 8 min tops. In the room was surgeon 1 nurse and anesthetist.  

I am not sure I would have been allowed earbuds to listen to music.  There were times he just kept saying to stare at those 3 circles.  I think he was seeing how my pupil focuses so as to centre the lens - not 100% - just my guess.

At post op first eye I asked if I could do without the Ativan as it made me sick 1st time.  Vomited later on when I got home.  But doc said I was pretty nervous so he'd prefer I took it for 2nd op.  have to say I was just as nervous 2nd time even though I knew the drill.  Guess something about the eyes freaks me out.  But it doesn't hurt- you just feel pressure.  

20

Have you tried monovision with contact lenses?   I think I have read most people tolerate the mini mono vision well but for full monovision it is better if you try it out with contact lenses to know if your brain adjusts to that.

If you can - stay overnight in Denver after the surgery and go for post op next morning.