Symfony IOL in my right eye yesterday.

[Jorginho]

Oke, since I have s trong tendendy to be too detailed and longwinded even for my own taste, here we go.

History
1) Retinal tear after vitreous detachment in  sept 2012. Surgery fixed a huge tear
2) After 2 years typical cataract signs appeard, but continued slowly
3) jan 2016: indeed a cataract but very slight. It was uniform which was probably what hindered me with more cataract formation at the peripherial part of the eye
4) April: went to Eyescan in NL (surgeon). Was deadset on Finevision by Fysiol but noted the Symfony. Eyescan had no problem with using this one.
5) Opted for standard procedure since research has shown outcome with FemtoSecondLaser has a worse outcome (not remember  about the significance of this finding).
6) Surgeon suggested to target -0.5 D to get good nearvision. Agreed.
5) Surgery on 2june 2016, so yesterday...

Procedure:
1) Fluid Ibuprofen (well Fluid  NSAID Nevanac) in the eye evening prior to operation
2) Had some Dexamthason drops and drops to widen the pupil. The later worked extremely well so they did not put all in them.
3) Asked me if I was fine with Midazolam. Well....yes but I used it thrice for sleep at 10 and 15 mg dose and did not sleep well, was completely unlike myself the next day (easy going guy going extremely irritable)
4) I have several research chemicals (benzo's) for sleep. Keep it to once every 7 days. No tolerance or addiction use it over a year. So I opted for Pyrazolam 0.5 mg. Since it is superfunctioneal: zero amnesia, zero sedation, zero, hypnotic and great anxiolysys. I never use them, since I am never anxious but with an operation I can be. Used 0.75 mg in the end and felt deadcalm and awake. So i asked the anasteasist to be calm with Midazolam.
5) Only pain I ever felt (only discomfort) was from the syringe when it wqas put in. Scored a 1 on a scale of 10 so that was far from painful. Not the eyedrops nor anything else caused even the slightest amount of discomfort (drops felt soothing).

Operation:
1) she still used some midazolam so I almost fell asleep. Combination with Pyrazolam could be a reason but I answered the questions asked. A strange one: did they use oil with the vitrectomy?? No...Gass.
2) Due to the lack of a vitreous gel he did not want to risk anything and told me he would leave a slight bit of cataract on  the csapsular bag. I told him I knew and understood why and was fine with it.
3) It lasted 10-15 minutes. I stood up, got a plastic protector for my eye and walked to my GF

Aftermath (remember, this is less than 24 hrs ago as I write this):
1) I saw nothing through the eye. Thought the cap was closed, but it wasn't. Eyesight returned after 1,5 hrs and very slowly. Pupil was extremely wide.
2) The Eyesight yesterday evening was clearly the best at long distance. Intermediate and near were very blurry.
3) Night vision was nonexistant
4) Huge and superbright halo's surround every thing with light, also the TV screen was surrounded by a rectangular halo.
5) Next morning Pupil still extremely wide, went to the checkup luckily not 200 km away in Utrecht but 60 km drive.
6) Halo's did not change one bit.
7) Vision at distance not sharp, not sharp at any distance but severly blurred on screen.
8) Everything was excellent btw: eyepressure higher than my usual 14,5. It was 17 which is well within acceptable limits.
9) I  am 47 but my lefteye is 20/10 at long distance and intermediate, nearby it is still 20/20 and I am not presbyopic at all.
10) One thing that is very notable?; my god the colours are super vibrant! Better than my lefteye where white now seems all offwhite. But all colours are extremely brilliant without being unnatural. The most likely thing is that the lefthand side has suffered there  a bit . Only notable now that the right eye has this lens.

In short:
A very easy and painless procedure in my case. Functional Eyesight at all but neardistance after less than 24 hours.  In contrast to my vitrectomy (which was also not paifull but had some discomfort with a stiff feeling in the eye) the eye feels like nothing ever happened at any stage after surgery.
The colours are fantastic.Shaprness of course leaves something to be desired. Halo and glare are seriously disturbing. To be clear: this is just an evalution and not a complaint. I knew this would be likely and it will take time (weeks ot months) to get it better.

Hope this helps others.

[JohnHaganMD]

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[Jorginho]

Almost 3 weeks now. Not much has changed, but the floaters have vanished. They re just no longer there. Eyesight is the same but you get used to it being perfect I guess. Seems ages ago I had a severe fog in that eye due to the cataract.

I now checked my eyes in the exact same way I also do after one week and the vision for reading is again a bit better. Reading in bad light is significantly worse than with my unaffected left eye. Yes we cannot have it all.

What I still find very funny us looking wonwards on my mobile Phone and seeing the lens. I can see the rings carved in it, I can even see some debries at the edges. Probably some remnants of the cataract which was attached on the capsular bag, but unsure.

I have lowered my eye drops a bit. Some days the eye can feel a little dry and this (no surprise) mostly and may be exclusively happens when working behind the computerscreen.

So result in short: good for reading from 35 cm onwards, sight is excellent  at any distance > 50 cm.

[Jorginho]

So where am I know when it comes to my right eye and its Eyesight.

Short version:
- Reading is getting progressively better, not at the expense of the longer distance.
- Floaters are abating.
- Dry eyes in the morning less notable, bought eyedrops with hyaluron acid and these do help during the day.
- Lensflickering with eye movement: present after day 2 but now later and later in the day. Less notable too.

6 days after operation so nothing conclusive. Just doing fine now.

Longer (seriously extended) version:
- Reading glasses of a collegue did help with that eye. The other eye can focus from 15 cm onwards so even if I would not be able to read with the right (operated) eye I would have no troubles. Fun to see reading glasses made everything somehow calmer and better with the right eye. So there is room for improvement but I am happy. I can now read small print (yesterday 1 mm fonts, today about 0.7mm fonts which were the smallest I could find.) from 30-35 cm. I am not expecting anything more.
Important: target was -0.5 D. Since Symfony EDOF lenses are not as good for reading in general as trifoclas are/tend to be, I think it is why he opted for that and I agreed based on the information I gathered.

- Floaters are peculiar. They are moving down (so in reality moving up). SInce I had a vitrectomy 4 yrs ago (which got rid of all the floaters I had due to a PVD) I do not have a vitreous gel in my eye .Whatever is floating in there has got to be lighter than the basic substance (water?). They very much ike vry tiny floaters (got progressivly smaller) and some far less translucent cobwires. These cobwires were clearly visible. But now I only see the tiny translucent dots. The cobwires are all gone. Again; nothing was floating, it was all mvoing down. So either thas was a conveyor in my eye where the real movement was upwards  close to the lens and down close to the retina (so in reality it was a limited amount of floaters that were invisible moving down and became visible moving up) or there was constant production of them.
I do and did not notice flashes or something like a vale at all.

Why is this peculiar: I noted that this surgery does not cause floaters (it has been said). They already were there or something else (PVD) caused them. You can read why this is on the net. But my PVD was completed 4 yrs ago. I had a vitrectomy afte r that and all highly annoying floaters I had then were completely gone. So what caused them to return?

Two other thingsI noted:
1) I feel slightly different. No one notices it, but I experience myself as a somewhat different person feeling different in the same as usual situations. Difficult to explain.
2) Sleepaid I used for a year (once a week only to prevent tolerance) has suddenly stopped working. Do note I do not feel anxious and Always fall asleep like that. I just wake up too early and am tired all day. The sleepaid gve me 7 hours of well rested sleep.

After the third day of feeling different I started to read into the sideeffects of dexamethason. Itmight be the culprit. We'll see if things change once I stop using these eyedrops.

- My eye is slower to respond to changing light conditions. I noted the pupil responds much slower than the onein the untreated eye.
- Dynamic range is smaller: where I can see details in wel lit subjects with the untreated eye I cannot do the same with the treated eye. It is too brght white to see structures in it. So highlights are overblown, but it is a small difference.

[JohnHaganMD]

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[Jorginho]

Hi,

Day 8. So the second check with the opthm. Since the first one was 18 hours after operation with a huge open pupil this one is the first serious one. And  boy am I  happy!
1) Eye looks great, he saw nothing nervy, no cells, zero inflamation.
2) Pressure is 18 (from 17 last week and 15 at baselevel. Left eye is 15 still. Eyedrops probably cause it. No reason for concern.
3) Current measurement is that I am at 0 D. Target was -0.5 D so wait and see!
4) Eyesight is brilliant! Far sight is at 110%. The guy was very pleased said "superior Eyesight" and "superior resolution" several times.
5) Then I mentioned reading was fine as well. He frowned a bit and gave me his own unofficial test whichg were 6 shorts texts. All different from big to small fonts. I could read the smallest text with  a little effort.
He asked: you are reading with  both eyes now.
Me:"No of course not, what use would that be?"
He was amazed, but noted many people were very pleased. He told me about a 70yr old woman who had -10 D and now had 80% vision. She was so glad with that result. I would be too, I had a cataract and a retinal tear before it. So regaining 80% would be great. My current result is of course so fortunate. Still early days.
Next check up 5th august...
He told the Symfony was sold  mostly to people who wanted to replace glasses and not so much for cataract surgeryin their clinic...

[JohnHaganMD]

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[Jorginho]

Yes, it is may be a good thing to realise that when we get less than perfect result but do regain perfectly usefull Eyesight!

So we are on  day 3. Has it been 3 days seriously? Yes.Why do I say this? Because things change still and fast and to my advantage (fingers crossed it will continue this way).

So nearsighted vision has improved but not at the expense of my far and intermediate vision.A little glare with some bright lights at night but hardly different than my left eye.

But the difference with yesterday, particularly during this afternoon  is that reading from the computerscreen has become much  better. it was impossible on Friday (1 day post op), it was very difficult yesterday (2nd day after op) and it is actually fine now. I am sitting behind my laptop and the measured distance is 46 cm (measured).

When I look at the white screen  I do see rally LOADS of very tiny  floaters. The first days it there were also the somewhat larger floaters and it was like an endeless snowshower only to be seen looking at bright even coloured background (like white computerscreens). Nothing else noted. And they are not floating, they are falling down at a steady pace. But this i can see has clearly subsided to about 25% of what it was yesterday.

So the current result after three days:
1) distant vision: fanstastic (10 meter to infinity)
2) Intermediate vision: fantastic (1m-10 meter)
3) near vision:( 45 cm- 1m: good to fantastic fruther away being better)
4) 30-45 cm: small printer readable but blurry

The finest print like you'll find on bottles of contactlenses (since most will be familiar with these over here) is not readable though. It is too small.

Finally?: I left the contact lens out of my good left eye, since I can  read with it to about 10 cm distance (finest print). it is -2  or so. So without it at the computer screen at 45 cm (as luck would have it) becomes to blurry. And my right eye takes over!

Finally eyseterday morning I noted some dryish and a little irritated eye. I noted the same thing walking through the Woods (for hours). Sweat might have  been the cause. Today when I woke up I did not have a dry feeling.

I keep on using Nenavac NSAID drops once a day and Demethasone eyedrops thrice a fay for the coming few weeks

[JohnHaganMD]

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[Jorginho]

Second day.

Halo's seem to have been  een  artefact of a very wide pupil. Yesterday evening may be 8 hours after my opening post the pupil rapidly had declined in  size and was virtually normal. No halo's were seen, some glare remained which I for now will attribute for the surgeon leaving some of the cataract on the capsular bag.

Eyesight improved very rapid over the day. In  the evening it was as good as I ever had, better than I remembered, Everything from 60 cm onwards looks supersharp now and with a clarity, vibrance and from long ago. In my case it is kind a nice my left eye has no cataract and no tear so I can compare. Everyhing in that eye is normal. It is like the rigth eye is sort of like an LCD and the left eye is more like a plasma screen. If that means something to anyone, when I bought a flatpanel TV I first went with a Samsung LCD and the contrast and brightness were so strong regardless of the setting my brain could not deal with it.. After three days it went and my Panasonic plasma came. And what a relief. It is more organic and milder.
So my right eye is all a bit softer in vibrance and contrast and the right eye is a bit like the Samsung LCD. Not that much, it is just right.

The eyes are also cooperating in a great way. Yesterday the letters ion the TV,  before the improvement, were blurry with  my right eye. So what happened? I saw the letters being bright white (not off white) so that was clearly my right eye. But the sharpness was from myu left eye. So the braincombined the best of both worlds 9at least how my brain perceives that): everything was sharp while with my right eye at that point it wasn't and the colours and vibrancy of the right eye.

This morning  I had a long sleep and my right eye felt a but dry. A few times blinking resolved that.

So far so good. No?; I am thrilled. Also I am so glad that the bright shimmering in the rigth corner of my right  eye has completely vanished. that was probably the most disturbing part of my cataract.

In the end: how lucky are we? There have been 30000 generations or so of modern man. And only the last 3 have had the option to get their cataract treated in  any way sensible way our current options are really  so good. I am  not asking  for perfect sight  at all, Nice if I get it, but  I am so glad in  hindsight I  was born  comparatively recently!

[JohnHaganMD]

Yes even in my professional lifetime in cataract surgery and ophthalmology dating back almost 40 years the changes are remarkable.  Cataract removal and insertion of an IOL has become the most common, the most successful, the lowest complication and the most economical major operation done on people world-wide.

[JohnHaganMD]

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