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Cataract Surgery | Feedback/Experience w/Tecnis Symfony
I have found this forum very useful in exploring cataract surgery options and experiences.  I would like to thank those who post and, of course, those who put in the time and effort to keep it up and running.

I am going to post my own experience here in hope that someone might find it useful.

Long post.

In my early 60s, I developed nuclear cataracts in both eyes.  Progression took place over a period of 2-3 years.  By 63, the vision in my RE was no longer correctable.  I have been near-sighted and worn corrective lenses (both contacts and glasses) since I was very young.

The prescription I was wearing at the time I sought cataract surgery was RE -6.75 +1.5 005 | LE -5.50 +1.25 145.  My uncorrected vision was 20/400 in both eyes. (Of course, I had very good CU vision within about 8 inches.)  My corrected vision was 20/25 in my LE, 20/100 in my RE (thus the need for cataract surgery).

The cataracts were rated 1-2+ in my LE, 2-3+ in my RE. 4mm pupil diameter.

I saw two surgeons. Both offered monofocals, but neither recommended them. The only premium lenses offered by the first was a bifocal lenses with no toric options, with LASIK the only option to correct any post-op astigmatism with the premium lens (at no extra charge).  The second surgeon offered Tecnis Symfony lenses, implanted the lenses using the ORA system, and, at an extra charge, offered CATALYST laser surgery (but did not recommend it as offering a value-based advantage).  After much deliberation (including searching this forum), I went with the Tecnis Symfony lens in both eyes. This totaled about $7K (inclusive, both eyes); the first option would probably have been $2-3K less -- and, of course, monofocals much cheaper still.  My lenses were implanted using ORA, no CATALYST.

The astigmatism in my RE was judged to be 0 with the lens removed; 1.25 in my LE. I had a toric symfony implanted in my LE, regular symfony in my RE.

I am left-eye dominant.  I had surgery on my RE first, two weeks later on my LE -- as recommended by the surgeon. RE lens: ZXR00 +11.5, aim -.5; LE lens ZXT150 +11.5 @117, aim plano. The goal was to provide mini-monovision which would enable me not to wear glasses and to see clearly in the intermediate range (computer use), which was very important to me.

There were no complications with either surgery.  I am now four weeks after the surgery on my LE.

Hopefully, that is enough of the technical data for you to compare your eyes with mine.

Here are my more subjective impressions.

Both eyes appear to have come out a little more near-sighted than was aimed for.  I judge my LE at about -.05 (20/30 or better in most conditions), and my RE at about -1.0 (20/40 or better in most conditions).  My RE, however, has retained some astigmatism (-1.25 @180), which interferes with RE acuity.  

I do not need to wear glasses for either distance (driving) or reading. I really haven't worn glasses at all since my first surgery.  I can drive comfortably with either eye (which I found out between the two surgeries), and I have quite good near vision (J1+) with my RE, but my near vision is VERY dependent on lighting.  In strong light, I see very well, in dim light, acuity drops off rapidly -- into the J4 or worse range.  For this reason, I keep a backup pair of reading glasses around the house, but, in general, find it much easier to struggle a bit in dim light than to find and put on the reading glasses. The difference btw my RE and LE is noticeable, leading me to believe the mini-monovision setup was necessary to get rid of glasses entirely; I cannot read comfortably with my LE alone.  Intermediate vision (which is most important to me), is good to very good with both eyes.  The focal range provided by the symfony lens, along with the monovision setup, has been a very satisfying.

However, some issues remain.

The remaining astigmatism in my RE takes away about one and a half lines on the eye chart; it's on the edge, but not quite over the edge, of being unacceptable.  Even using the ORA system, there seems to be some difficulty in measuring and correcting astigmatism.

Nothing is *crystal* clear.  This is disappointing.  Both eyes retain a small ghosting/double-image artifact along the vertical axis.  This was quite pronounced after my first RE surgery, and I almost switched my lens choice for my LE because of it.  I have not read about this particular artifact of the symfony lens widely elsewhere, so I don't know quite how to deal with it.  The surgeon insists there is nothing inherent in the design of the symfony that would cause this to occur, but it is an artifact that I now observe in both eyes -- most noticeable with white letters on a dark/black background.  There is some neural adaptation going on around this (not nearly as bad as it was in the beginning), but it has certainly not gone completely away.

The halos.  The halos are noticeable, but, for whatever reason, do not bother me. This effect seems more distracting in twilight than full darkness.  This has not gotten any different/better over time (as opposed to the ghosting), but it does not cause me to question my choice of lenses as does the ghosting effect.  

And, finally, I find I frequently have eyestrain at the end of the day.  This is probably because I am at the computer for so (too) long each day.  When I am driving or using my eyes at different focal lengths, I have not experienced the same sense of strain.    

Overall, I am very pleased with being glasses independent (first time in my life). I am very pleased with the mini-monovision strategy using the symfony lens.  I wish there were a more effective, first-time-get-it-right treatment for astigmatism, and I wish that I could see things as SHARPLY as I could with my old, six-inch myopia vision of the past.  It would be very nice indeed if you could try on replacement lenses like you can glasses, so that I could see the (potential) difference in clarity between a monofocal and the symfony.  Nevertheless, if I had it to do everything all over again, given all all the same information available, I would make the same choices in lenses and setup that I have made to this point.

Hope this helps someone.
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177275 tn?1511758844
Thank you for the information.  As they say "Different strokes for different folks"   As I have posted about 5 weeks ago my wife who had hyperopic astigmatism and wore glasses all the time had cataract/IOL surgery at our Kansas City Discover Vision Centers clinics.  She chose a tecnis monofocal IOL (ZA9000)  We did not opt for any extra technology such as femosecond laser or ORA or multifocal or toric.  She has done fabulous. Can do much without glasses.  The expense and chance of complications or need for subsequent procedure was minimal.    That would not make every person happy but it really is "mix and match"
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