Wait for Symfony IOL in US or go to Canada?

[athanasius]

Hi, I am a 45 year old male with an injury related cataract in my right eye. After exams with local ophthalmologists here in western Pennsylvania and much reading online (specifically this forum) I have concluded that I would like to have the Symfony IOL implanted in my eye. I had recently sent a letter along with my latest exam results to the Herzig Eye Institute in Toronto. I followed up my letter with a phone call last Monday to verify that my letter had arrived. The receptionist told me that oddly enough she had just gotten word that morning that the FDA had approved the Symfony IOL that past Friday.

So here is my dilemma now, do I wait until the Symfony IOL becomes available or do I still travel to Toronto. My right eye has gotten extremely bad (cannot even read billboard text, and the white in the pupil is clearly visible) so I am hesitant to wait. Is there an advantage to using a surgeon (i.e. Dr. Herzig) that has had experience with the Symfony IOL vs a local surgeon that doesn't? I don't want to be the "first" patient with a local surgeon that installs the Symfony IOL.  I don't mind traveling or the out-of-pocket expense, however at the same time I'd prefer to not travel up to Toronto multiple times if an issue arises.  

Thanks!

[deebeedo]

I'd like to chime in on a couple of issues . I am 67, female, with a couple of nice ripe cataracts that need removing.

I live part-time in Colorado and part-time in Toronto (actually just a block from Sheldon Herzig's office). I have been trying to decide where to have my surgery, which lenses, and when to have it done. I have a good idea of who the most experienced surgeons are in Toronto, not so much in Colorado. (suggestions SD?) Naturally, when the Symfony was approved in the US a couple weeks ago, I had just decided to have it done in Canada! The Symfony has been in use there for a year, but I don't think I'd go to Herzig because I want immediately sequential bilateral surgery (one eye right after the other) and Herzig doesn't do that. But several other excellent surgeons in Toronto prefer to do it that way, in spite of the fact that provincial insurance will only pay for surgery on the first eye done in one day.

The only doctors I know of who do that in Colorado are at Kaiser Permanente HMO; Kaiser charges a flat fee of $600 for the surgery and all associated care - whether for one eye or two, charging extra only for the additional cost of a premium lens.

But I'm not a Kaiser member. I do have a Medicare plan with a private insurer, but I have been completely frustrated in my attempts to find out how much it would require me to pay, not even the copay for the basic monofocal package. I have an employee plan through my husband's Toronto employer, but the insurer won't tell me what it's willing to pay until I select the surgeon and the surgeon submits a detailed treatment plan proposal. Which the surgeon won't do until I have a consultation and go through numerous tests for which I'll have to pay up front unless I decide right off the bat that I only want the basic non-laser-assisted monofocal package - and wait 8-10 months to have it done in a hospital.. Oh no! Another catch-22 - I can't get it done in a hospital without an Ontario health card.

And the Herzig Eye Institute is really expensive. Much like US Medicare, Ontario provincial health insurance pays for the surgery and a basic monofocal lens at really low rates of compensation. For any other lens, the patient has to pay the cost of the upgrade, as well as extra charges for additional consultation, instruments and measurements and followup visits.  It sounds to me as if Herzig might run as high as $5,000 per eye over the basic surgery-plus-monofocal. package.

[JohnHaganMD]

It should not be that difficult to determine any Medicare plan as the rates are standardized. Even if you didn't have insurance you could probably negotiate with the US surgeon to pay cash for the medicare price which would be like $600-800. And yes once people start paying a la carte for premium lens, ORA technology, femtosecond laser you can end up paying out of pocket over $5K/eye  That's why there is so much pressure in many clinics to "opt-up" to these "extras" that most people don't need.

[SoftwareDeveloper]

I do recall seeing Colorado doctors at Kaiser writing about immediately sequential bilateral surgery, but I haven't heard of any others that do it offhand. Where in Colorado are you located? (there is a prominent  surgeon I was going to email soon who I can ask while I'm at it, he is based in  Boulder but not currently practicing so I was going to ask if he had any recommendations for others now that he has been here 19  months or so).

[JohnHaganMD]

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[SoftwareDeveloper]

The Symfony's optics are different from other Tecnis lenses, but its overall physical size and shape and method of implantation are the same as the widely used Tecnis monofocals and  multifocals. The surgery is exactly the same procedure so I don't see any problem with being the first patient a surgeon implants with the Symfony.  If you do get the surgery in Toronto, you should be able to get followups here with no problem, merely check with surgeons in advance to be sure they are ok with it. I did that before I traveled for surgery to be prepared for the 1 week followup after I got back, and most seemed ok with it (one seemed reticent to approve of medical tourism).

I think I'd read  a surgeon had said  the Symfony is more tolerant of decentration than multifocals (though I don't have a link to confirm so don't depend on this, you might search or try contacting doctors who have studied   the Symfony), and another suggested that the extended depth of focus might potentially make it more tolerant than a monofocal. The potential for damaged zonules leading to the IOL  moving around more when the eye moves  (vs. moving out of position once and staying decentered), pseudophakodonesis, I'm less sure of   (since I speculated at first I might have had the issue so I asked surgeons for opinions on it) and I had surgeons speculate a diffractive lens might make the issue worse, while another speculated that again the extended focus might make it better.  Surgeons should be able to check for signs of damaged zonules beforehand, like phacodonesis (the natural lens jiggling more than it should) , and e.g. look at your eye without using a cycloplegic dilating agent (I'd read that cycloplegics   tighten zonules and can reduce lens movement and lead phacodonesis to not be seen that is visible without cycloplegic).

[JohnHaganMD]

That is pretty much both sides of the issue.

[JohnHaganMD]

There are several extended discussions that you can easily find by looking at the topic heading that deal with the Symfony IOL and estimates of its availability. I want to raise an additional matter besides the additional cost, additional complications and reduce optics of Symfony and other 'premium" IOLs. You indicate you had trauma to your eye. Often if the trauma is severe enough to create a cataract it can also damage the zonules of the lens that hold it in place. Thus the chance of an IOL dislocating after surgery is higher in your eye than an un-traumatized eye. Decentration (e.g. 'sunset snydrome' or 'sunrise syndrome' or lateral displacement) will cause a lot more problem with a premium IOL than a standard monofocal IOL.