What are the pros and cons of using the Symfony IOL versus the Crystalens IOL?

[takilmajoya]

I had Lasik surgery several years ago. I now need to have cataract surgery. I have read wonderful things about the Symfony lens, used extensively in other countries and recently introduced to the US. My eye specialist says that Crystalens is a better option for someone who has had Lasik surgery. He said that there has not been enough studies done using Symfony with post-Lasik patients for him to feel comfortable recommending them to me. What do you think are the pros and cons of each, and which do you recommend?

[SoftwareDeveloper]

Although this post is a few weeks old, I thought I'd add to it for future reference for anyone else since I just saw relevant comments on an ophthalmology news site. I hadn't sought out good statistics for the Crystalens near performance, but this article mentions typical performance for the Trulign (the toric version of the Cyrstalens, and the results should be comparable)  vs. the Symfony:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/approval-new-class-implants-tops-cataract-surgery-news
' Mark Packer, MD, offered similar thoughts. “The Symfony IOLs are associated with less halos and glare than the progenitor platform, the Tecnis Multifocal IOL (Abbott), and they can provide 20/20 UCVA at distance and J1 at 16 to 18 inches, which is pretty strong in terms of presbyopia correction,” he said.
  ... "... J5 is the average UCVA at near with the Trulign, which means near vision is worse than that in half of people who are implanted with the lens,” Dr. Packer said.

“In addition, tilting, or the so-called Z-syndrome, remains a nagging concern with this lens, and many surgeons are performing anterior capsulotomy early to avoid that problem,” Dr. Packer said."

I tend to see comments from surgeons suggesting around half of those with the Crystalens need readers, but I hadn't run into a good study (though I hadn't looked much),  with various studies showing most people don't need readers with the Symfony (the manufacturer's site claims 87%, offhand I recall other studies seeming to fall  in the  80-90% range). I think some FDA data for the Crystalens seemed more promising than what I've seen generally reported in actual use.

[takilmajoya]

Dr. Hagan, I have read the discussions in the forum. I'm specifically interested in knowing about the Symfony vs. Crystalens for post-lasik patients. I know that they are both great lens for patients who have not had lasik correction, but I have not seen discussion regarding the adverse effects of Symfony in the post-lasik population. I want the Symfony, my doctor doesn't think that there's enough research regarding post-lasik use. Can I assume from your answer that you think that both of these lens are equally effective in post-lasik patients, with a similar adverse effect profile?

[JohnHaganMD]

just answered your other post of the same question

[SoftwareDeveloper]

Its unclear there is enough data to know the answer to which lens is best at the moment, even though the default answer I assume would be that by default the Crystalens would seem safer on the surface since it doesn't use diffractive optics. but that doesn't indicate the level of risk, whether its anything to be concerned about or merely a theoretical problem. Comments I've seen from other surgeons suggest they think the Symfony is a safer bet than regular multifocals for post-lasik use, but some are still concerned about whether diffractive optics and an irregular surface from lasik might not mix well so some conservative ones might be more likely to err on the side of caution.

I think it partly depends on the patient, some surgeons will use even regular multifocal IOLs (which is more of a risk than the Symfony)  in some patients but not in others depending on what scans show in terms of how regular their cornea is post-lasik.  One clue regarding how conservative the surgeon you are dealing with is would be whether they'd ever  consider a regular multifocal for a post-lasik patient. If they would, it might be of use to see if they'd consider it as an option for you (even if they'd prefer other options), in which case the Symfony is likely a safer bet than the multifocal.

Part of the issue I think is how much risk you are comfortable with, whether you'd risk needing a lens exchange.

[JohnHaganMD]

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[KayakerNC]

At this time, I would consider the much larger number of experienced surgeons who have used the Crystalens on more than just a few patients (ie 100+) to be the biggest advantage.  I have the Trulign (toric Crystalens) and am quite happy.

[JohnHaganMD]

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[JohnHaganMD]

Both IOLs have been discussed at length many times in these forums. You can use the search feature to retrieve and read these. they are both excellent IOLs when used by experienced surgeons. It's like the endless debate "Which is better Ford or Chevy?" or "Honda or Toyota?" All good cars. Our clinic uses both those IOLS with good success.