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experiences with Symfony IOL, or trifocal IOLs?
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experiences with Symfony IOL, or trifocal IOLs?

Has anyone here gotten the new Symfony IOL, or heard from others who have, or know more than the research you can find with google? It was just approved in June for use in Europe, but initial studies on the web seem to indicate it provides better odds of having good intermediate/computer vision, and better than the AT lisa trifocal except at very near distances. It refers to it as having an extended depth of vision rather than   calling it multifocal (perhaps because it doesn't divide itself into 2 or 3 discrete focal points but in essence it must still have a range of focuses to provide "extended depth").

I've seen detailed threads about the FineVision but only brief comments on the AT lisa trifocal.  Any more comments on any of these lenses? I'd  be curious if anyone has more comments on getting a multifocal in only one eye with the problem cataract and wearing a contact lens in the other (which is still correctible to 20/20 with only an early cataract). The hope would be that perhaps before it goes bad a new generation of lenses might come out, like an accommodating lens that is more likely to work well than the ones out there now.

Any suggestions for good doctors to get them from, preferably laser cataract surgery? I'm open to considering doctors in any country since I'm in the US and will need to travel to get the lens, the UK would be easiest since I only speak English, but I'll consider other options. I've heard the Czech Republic may be cheaper but still have   high quality clinics. Its worth a bit of hassle to get a good lens. I'm only 52 so I'll hopefully be using it a few decades, so thanks greatly for any information you can provide.
65 Comments Post a Comment
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Avatar m tn
PS, I should add for anyone who is outside the US and isn't aware of this, the reason I'm going outside the US is because the government here is remarkably slow about approving new lenses. There are options that have been available for a few years in Europe that we don't have. The FDA seems to be either extremely cautious and/or extremely  incompetent.
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Avatar n tn
I would have to go with FDA incompetence.  At some point the safety factor just is not believable. They are so afraid to approve anything, because their might be a news story about something bad happening over one of their approvals.   But the harm being done to the vast majority out ways the little and I mean little good they are doing.  Just common sense says that after a lenses has been approved and used in Europe for years it should be available for use here in the US..  This should be a decision between the patient and the doctor not the FDA.  Thank God the FDA does not have to approve operating systems or all of us in the USA would be still using DOS.  
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Avatar m tn

I think you may be putting the cart before the horse in trying to pre-select an IOL. I was also considering medical tourism (Tijuana Mexico looked like fun) but I finally decided that being close to home and support was my best option and made appointments for cataract evaluations based on recommendations from my primary MD and my Optometrist with ophthalmologists that have experience with all the IOLs, rather than a one-trick pony Dr who only implants one type.   I cancelled the 3rd appointment when the first 2 told me pretty much the same thing.  
Stay away from multifocals.
Best results (for MY eyes) would be with torics and laser assisted surgery.
Given that it will be about a month before your eyes fully heal, I wouldn't want to be more than a phone-call and a quick drive away from the surgeon for that time period....just in case.
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Avatar n tn
From what I have read the Tecnis Symfony is pretty exciting giving you vision at all distance with reduced halos and glare in comparison to other multifocal lenses.  But it is new so you would be a genie pig of sorts.

I will add I taked to another person that had cateract surgery and asked why he did not choose a multifocal IOL and he did not even know about the.  Apparently his Dr. did not do them so tell even tell him about them.  So in cae those Drs. do not do multifocal, you might want to talk to one more Dr. that does a lot of multifocal and get their assessment.
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Avatar m tn
re: "wouldn't want to be more than a phone-call and a quick drive away"

I have a very good eye surgeon here in the US who diagnosed the cataract and has no problems with doing the followups if I get surgery elsewhere. Fortunately it is possible for educated non-doctors to read the online  published literature about the various lenses and make an informed choice, which in my case is to decide that the lenses approved in Europe are a better bet.

re: "Stay away from multifocals"

The research on the multifocals in Europe shows they are much better than the older ones available in the US. Some surgeons in Europe I gather had stopped using multifocals due to problems with the older ones, but consider the newer ones good enough to use now.  Initial results with the Symfony seem to show little incidence of visual side effects, and better odds of good intermediate vision while still having decent near.

re: "rather than a one-trick pony Dr who only implants one type"

Most doctors do a variety of IOLs since one size doesn't fit all,and there are good doctors outside the United States. Oddly it turns out in some cases its also cheaper   to use an internationally prominent doctor (as judged by industry publications&invited panels, etc, not  just their own  website's claims), or an experienced one on faculty at a prestigious medical school, than it is to get this  done in the US using a lower quality lens option.

  Unfortunately it turns out many doctors don't yet offer the Symfony. Its manufacturer  has poor marketing in that they don't list what clinics offer it, and many eye doctors don't list their IOLs on their websites.  I have found clinics that offer it and   I'll evaluate the doctors first.  I don't need the very top doctors, merely a high quality one to do a straightforward surgery.  I hadn't decided which country to go to yet, which is the main reason for checking on multiple clinics (since for instance there are good UK surgeons, but they are more expensive, and at least one was booked up until January).
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maybe you want to schedule an appointment with the MyVisionCare team. they are situated in Canada. if you can't travel, you can still email them for your concerns
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Avatar f tn
I had a Synchrony implanted overseas. I can tell you that I definitely ran into trouble with follow up care. Doctors would look at my eyes and react with kind of like "what IS that?"
It got bad when I needed a YAG done. They were afraid to do it. They said that the design of the IOL made it look like it might be dangerous. One doctor wanted to explant instead of a yag when I developed PCO, another wanted to do a vitrectomy so they could access the back of the lens and manually cut the hole instead of using a yag laser. They told me it was extremely risky and I might end up blind.
So of course I did nothing, the PCO got worse, which caused my prescription to shift. In response a doctor told me the IOL was probably dislocating due to advance fibrosis and could end up just lying around inthe back of my eye.

So I finally had no choice other than to go back to Germany. Walked in with 20/200 vision from PCO being led by my sister while having a panic attack because I expected an explant/vitrectomy/iris sutured IOL/blindness.
       Turns out I just needed a yag. Which was perfectly safe synchrony or not. Which they had completed 20 minutes later and my vision was fine the next day save  for floaters. And I can still accomodate. The US doctors scared the living crap out of me for no reason other than I had the operation overseas. And you know what else? They  never suggested that I should go back overseas. They were going to explant an extremely difficult and dangerous to explant IOL (dual-optics) or vitrectomize me unecessarily, which would have caused me to lose accomodation. Either way I would have lost my near vision. The one doctor brave enough to try a yag was going to give me a 2mm opening. (Germany did 5mm, my vision would have been awful with 2mm)

The doctors in Germany were awesome. The clinic was awesome. Aside from really scary the experience was fine. And my vision is much better off  than what I would have gotten here. (Im 30, bilateral implants and near vision is STILL J1+ or 20/16 with distance correction.) But BE PREPARED TO GO OVERSEAS FOR FOLLOW UP!

I still need a lasik touch up, guess where I'm going? I was warned that due to my age the PCO could reoccur, if it does, guess where I'm going?
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Avatar m tn
Evidently you've convinced yourself that the Tecnis Symfony is the best choice.  
It seems to be a modified Tecnis Multifocal to provide better intermediate vision which is the Tecnis Multifocal's weakest vision area.   The Acrysof ReSTOR 2.5, and the toric versions of the 2.5 and 3.0 ReSTOR multifocals are currently undergoing US trials. They also seem like excellent IOL options and received CE Mark in Feb 2012.
Hopefully you will provide updates when/if you get the surgery.
Good luck.
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Avatar m tn
Wow, sorry to hear about your troubles with US doctors doing followups. The eye doctor I have here seems to be very reasonable, I appreciate your warning, I will be sure to be prepared to go back for followups if needed. I do live in a decent size metro area,Boulder/Denver, so I'd hope  if my current doc weren't reasonable I could find other nearby docs who are. I had considered the Synchrony lens in the past but consider other options better, I had seen a comment on this site suggesting the lens may have been pulled form the market, but I hadn't followed up to confirm that since I had been reading good results.
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Avatar m tn
Actually I hadn't decided for sure if the Symfony is the best choice, partly since there is little study/data on it yet and it has just come out so there has been less time for more doctors to confirm the initial promising results.  I figured it made sense to book surgery with a doctor who offered that as an option as well as a trifocal so I needn't decide until the last minute in case new information comes out in the meantime. Unfortunately  I am hearing conflicting reports now about whether the FineVision or the AT Lisa is the best trifocal to consider as a backup option, which I seem to be a better fit than the ReSTOR for me.
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Avatar m tn
Just wondering.
What did your "very good eye surgeon here in the US who diagnosed the cataract." recommend for your eyes.
I'm assuming he did a cataract evaluation and measured your eyes for the needed powers and astigmatism corrections, if needed.  
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Avatar m tn
My local  eye surgeon is one who doesn't implant the US approved multifocals due to concerns with them.  Since he is in the US there is no reason for him to have explored the European options in depth. He does implant the Crystalens and seemed realistic about its questionable benefit, though it seems at least a better bet than a pure monofocal for those who don't want a multifocal (and won't leave the US for other accommodating lenses).

I only have 0.25D of corneal astigmatism, so that doesn't impact lens choice,and he did a thorough exam and didn't see any other eye health problems (my optometrist hadn't been sure what accounted for a rapid reduction of  visual acuity, and shift in prescription,  over a few months, so the MD   checked to be sure this was the only issue he saw).
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Avatar m tn
Wow.  The minimal astigmatism does increase your options.  
As long as you are looking at the Pros AND Cons, I'm sure you'll make the best choice for YOUR eyes.  
Good luck and keep updating.
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Avatar f tn
The  Synchrony was indeed pulled from the market. The lens was marketed all these years with the eventual goal of obtaining FDA approval as the first truly accomodating IOL, meaning not just effective for cataracts, but as a means of restoring accomodation. The FDA did not approve it, my understanding is that there was some debate over the definition of "accomodation" although I don't know  the details for sure. I do know that it was not a safety issue.
    Unfortunately, that limited the lens to the european market. And unfortunately, the european market likes tried and true. The germans love their glasses, literally EVERYONE wears them so very few of them are motivated to pay thousands of euros out of pocket for an option beyond a monofocal. Due to its limited niche market and lack of demand, the cost of keeping the IOL in production has been higher than the profit. The only reason they did it was with the eventual goal of US approval, which could instantly have turned it into a cash cow.
     Once that was taken off the table, there was no longer any reason to continue production. I did recently hear from someone that the lens is once again  being offered in the UK, although I know in Germany they told me they could not order it anymore and had to return their stock last april. So, I'm not sure. I'm sure it was pulled. I am not sure if it has been re released since.
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Avatar m tn
re: "that it was not a safety issue"

That is truly unfortunate obviously, if there isn't a safety problem they should leave it up to the patients (consulting with their doctors) to decide. A field of economics called "regulatory capture" theory explains that unfortunately often the regulatory process is controlled by the industry they are supposed to regulate, and existing companies use it to try to keep out competitors. I wonder if that was a factor then, regardless of whatever rationalization they gave for not approving it.

re: "limited the lens to the european market"

There are a number of non-FDA approved lenses that seem to be surviving in the non-US markets, the rest of the world is a large market. Some countries follow the lead of the FDA, but many   countries aren't as behind the times in what they allow. It seems likely there is more to the story we hadn't heard, perhaps the market wasn't accepting it. You had commented on a prior thread about hearing mixed results from some surgeons, it sounded like many showed no accommodation, even if others had good results as you did. I also heard that the lens wasn't as good for fairly myopic people (which was another reason I decided to cross it off the list, before the cataract hit I was a -9 or so  worst eye).

re: "so very few of them are motivated to pay"

Surprisingly if you hunt for cataract surgery trade literature you will see many people commenting on   a growing premium IOL market in Europe (and I thought one of those commenting was German, I can't remember for sure). I think its  partly  driven by RLE, patients who are getting lenses implanted even without a cataract when faced with presbyopia, and partly driven by awareness of better lens options slowly spreading.
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Avatar f tn
The method of accomodation that the synchrony used was only supported by a limited range of lens powers. It came in 16D-28D. I had a friend who tried to get it after me. The closest to plano they would have been able to get him was like a -10. There is no toric version. If  you needed glasses before you had cataracts chances are you aren't a candidate.

In 30% of cases, there was no accomodation. It depends on the size of the capsular bag. The lens comes in different powers, but they're all the same size. Not everyones capsule is the same size. Dr stated it was not possible to tell pre surgery who it would work for and who it wouldnt. 30% end up with a very expensive monofocal, and see below for what else they win.

Because it shifts inside the eye after implantation, refractive outcomes are VERY unpredictable. They only hit target refraction in 7% of cases in a study I read. You're going to need glasses or lasik. In my case, lasik because not only did they miss target by over 1 D with both eyes, but they also landed them 2.5 diopters apart.

The size of the lens means explantation is only considered in SEVERE cases. Its nearly impossible to remove safely. It is guaranteed they will tear the capsule at least partially, and there is a frighteningly large chance they will completely wreck the capsule and you'll need the new IOL sutured to your iris. Its not something they would do for refractive reasons.

Due to its size, a piggyback IOL is also not an option, there is no place to put it.

The surgery is much more difficult to perform than other IOLS. And they need to paralyze your eye temporarily which carries some additional risk.  You always need a backup IOL as an option should the capsule tear in surgery, which is more likely due to the additional manipulation required.

Those are the reasons to stay away. Now for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. (Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field) When I look at a piece of paper, its a blurry mess for a second. Then it shifts into focus. I got what I was after.
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Avatar m tn
"Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field."

I have the Trulign IOLs, the toric version of the Crystalens.   After reading for 10 - 15 minutes or so, when I look up at something distant it is a little blurred for a minute or so, and then gets clear.  Same situation going from distance to close reading.  So, for me, it is a lot more than just depth of field.  It is accommodation.  
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Avatar m tn
When I was first diagnosed with a cataract a couple of years ago I was checking on the Synchrony, and contacting them about  clinical trials in the US. Aside from limited power availability  I recall getting the impression that some aspect of the Synchrony's  accommodation  might not have worked well due in most  myopic eyes due to some physical attributes they tend to possess,  but unfortunately I can't recall what the issue was so I might be wrong. I  just remember the impression there was a reason there weren't lens powers available for myopes other than simply focusing on the most common powers required. If it had higher odds of accommodating than it does, even  for myopes,  but merely weren't in the right power, it might have been worth just getting laser enhancement (or  contact lenses),

re: "for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. "

I can understand the desire to have good vision at all distances. I had hoped I could postpone surgery until  a future   generation  accommodating lens that works well is approved.

I am curious   as to why you didn't think the trifocals might be a better bet to get useful vision at a variety of distances  given the odds of trouble with the Synchrony. I see a reference in a prior post of yours to reading speed, but it was only regarding some version of the Restor, and lenses differ of course. I'm not sure which paper you were referring to, I see one that notes reduced speed in Restor vs a monofocal , but not quite as much as you indicated. I also  only saw the abstract  (I hadn't searched to see if there is free version of the full text) and can't confirm things like how long postop the reading speed was measured  (e.g. did they give the patients enough time to adapt).  I see other papers that suggest for instance:

http://www.sciencedirect.com/science/article/pii/S0886335012011625
"Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions...

Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL."

I  hadn't seen the full text of that, or  researched this issue in depth. I didn't have the impression reading speed was a reason to avoid the newest multifocals.  If anyone does know of a reason to be concerned about their impact on reading speed  I'd appreciate input since I read a great deal (mostly at computer monitor distance), I may try searching a bit more this weekend.

People's priorities vary obviously, I'm just trying to figure out of there is any drawback I've missed aside from the commonly mentioned ones (like halo risk, etc). Was your concern  a strong a preference for trying to get more natural accommodation since you were hesitant to trust that using a different method to achieve   functional vision at different distances  due to multifocality was going to really feel close enough to natural vision to be worth it?

I'm guessing  I might have had more of a concern over multifocals if I hadn't already tried multifocal contact lenses to deal with presbyopia. (though I do know the optics is different than those of the IOLs). Unfortunately at your age I'm guessing there would have been no easy way to usefully try multifocal contacts since you still had enough accommodation.

I can't wait any longer to get one eye done (difficulty merging images now, I should have had it done already), but I'm hoping they might be available by the time my other eye's vision degrades (though I can't know how long I have before that,  my left eye lost quite a bit of visual acuity within a few months when it first caused trouble. My right eye showed the beginnings of a cataract two years ago  but has stayed 20/20  so far).
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Avatar m tn
PS, in the last paragraph when I said "hoping they might be available" I meant of course the next gen accommodating lenses, I'd moved the paragraph, I need to go and didn't take time to proofread. They should let you edit posts on this site.
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Avatar n tn
I thought his interest was in the Tecnis Symfony not the Synchrony IOL.  If you are willing to cutting edge, what is the latest news on the Light Adjustable Lens.  I called AMO and they said they haves some trials for Symfony in the US but I have not followed up it yet.  Might be something to explore
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Avatar m tn
Coincidentally before I saw your post I had gotten into contact with the person running the trials in the US. The details are still being worked out, but they will be randomized trials with 50% getting this lens and the others a control lens (it didn't sound like they knew what that would be).  I would rather not risk that, and I'd rather not  wait for the trial regardless I decided since this has started interfering with vision.

I will note that i have been cautioned btw by an experienced US surgeon to be sure if I use a non-US doctor to be careful of the fact that in even in good  European clinics their standards may not be as high as US doctors in terms of things like complication rates and hitting the refractive target.

As with anything however, prices vary for many reasons between countries and there are good surgeons who are lower cost, but it is best to be cautious of course to ensure you are getting high quality treatment.
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Avatar n tn
One of the problems is the dollar is so weak that the price in Europe for the lens is expensive.  Has Canada approved this yet?  Let me know what you decide and your experience.  One other thing is I am confused about how this lens actually works.  I under multifocal that create 2 or more focal points but how this lens is able to provide distance to close vision is not clear to me. I keep putting off the surgery as long as I can hoping for better options.  I hate how you hear news stories such as below and then you never hear any follow up.  
http://www.scotsman.com/news/health/scots-scientists-develop-laser-cure-for-cataracts-1-3242146

I doubt I would do a trial where I might be given some unknown control lens.  That is ridiculous, unless it is the Tecnis multifocal.    
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Avatar m tn
Even living in the UK I considered going to Czech Republic, to the Gemini Clinic in Zlin, where they use the Femtosecond laser for the incisions and Astigmatism correction. This was for CLE, with no cataracts or other anomalies.

I eventually found a very local, and very experienced surgeon who used the Finevision, although not with the Femtosecond. I looked at the Symphony accommodating but the few reports available suggested limited accommodation with varying degrees of success.

With the Finevision having had a two year history, no negative reports and a very high probability of a spectacle free outcome I chose this as my preferred option, assuming the surgeon thought it a suitable lens for me.

I am spec free as hoped, with very little effects in some very minor situations, as per my diary on this forum. The holy grail of full accommodation is, I believe, some way away, and I wanted rid of specs.

Best wishes in your research before making this enormous decision.

Phil
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Avatar m tn
re: "I looked at the Symphony accommodating but the few reports available suggested limited accommodation with varying degrees of success. "

I'm guessing you meant the Synchrony lens, the Symfony isn't an accommodating lens and was only CE marked in June.  It does seem to provide some of the advantages an accommodating lens has   like lower risk of haloes & glare than multifocals. It seems to provide better near vision than the accommodating lenses that are approved anywhere at the moment, though unfortunately perhaps not as good as trifocals for near (though often good enough it appears, and unfortunately no lens is perfect at the moment).

It sounds like surgeons are divided over whether the FInevision or the AT Lisa tri is the best trifocal option, though it seems like those with experience with both give the AT Lisa tri a slight edge overall, that it may vary with the patient which is best.
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Avatar m tn
re: "trial where I might be given some unknown control lens"

I should clarify that I simply don't know at the moment  what the alternate lens will be, I had the impression they didn't know yet. I imagine they must tell that to the patient upfront, and it seems like there are decent odds it might be the Tecnis multifocal since it is from the same company and available in the US.

Unfortunately the fact that a clinical trial is being done doesn't mean the lens will be approved anytime soon even if it is safe given the red tape and politics that goes into FDA approvals.

re: "Has Canada approved this yet? "

Not as far as I can tell, It seems like some countries follow the US lead, others the EU. I don't think its in Mexico either, where I know they do have the Light Adjustable Lens you'd mentioned in a prior post. I know they are working on multifocal variations of the LAL technique, but as far as I know those are still in the trial stage. I'm an early adopter, but not quite that early. I'd prefer to avoid early stage clinical trials done before any approvals have been granted anywhere.

Even if I don't participate in a trial,  I do like the idea   of considering a doctor who has participated in early clinical trials for other lenses.   I figure the lens companies only pick doctors whose surgical skills they approve of and that they are more likely to have the resources to be a better judge of that than a patient will be. I may be wrong, but it seems like  they logically would want the lens results to be based on the best possible surgical outcomes rather than a lens looking bad because the surgeons testing it didn't do a good job.

re: ".  I hate how you hear news stories such as below and then you never hear any follow up. "

Yup, though  often stories like that one involve early research which may not turn out to lead to anything viable, or it may take longer than expected (like the better accommodating lenses which have been on the horizon the last couple of years).

re: how the Symfony works, it is unfortunate there is limited information about it, but I can't wait too long for more.  I don't know if you'd seen the other page on this site where I posted some clips from articles for more info:

http://www.medhelp.org/posts/Eye-Care/Are-my-eyes-getting-worse-because-of-Cataracts/show/2368182

I admit I would prefer to see more analysis of how it works, for instance what it means for how much light is available for each different focal range the way they have analyzed trifocals to show say 20% for intermediate or whatever (usually varying by pupil size&light conditions).

It seems like the description must mean that rather than splitting the light up into distinct focal points X, Y, and Z, that the light is distributed over a more continuous range of focal points from X through Z. Even with a standard monofocal or multifocals the visual system has some "depth of focus" which leads to light coming in at a range of focuses around those concentrated distinct focal points,  so that you can see better at distances in between X,Y, and Z.

It would seem logically that  the Symfony's  approach  would seem to  give less light at each discrete  focal point within that continues range (rather than as in a multifocal more of it concentrated at  discrete X,Y, and Z points), so I'm assuming the visual system must   use light from within a short interval of nearby focal points, e.g. from the range of focuses between P1 and P2, rather than merely only using the light at precisely P1 or P2. Obviously an accommodating lens that accommodated well would be a better option, but despite some patients having luck with say the Synchrony, the current accommodating lenses don't seem a good enough bet to me.


re: "price in Europe for the lens is expensive"

Actually it appears that I can get the lens (for 1 eye), including travel cheaper than the cheapest cataract surgery with a monofocal here in the US.  (even including laser cataract surgery if I decide to go for that). In some other European countries  even with travel  its comparable to the cost of surgery with a premium lens in the US (at least if you have a high deductible).  It is a different tradeoff I know for those with a low deductible just covering the lens cost. However they might wish to factor in the higher odds of needing to pay for correction the rest of their lives if they don't get a premium lens, or the higher risk of needing to explant a US-approved multifocal due to concerns over visual artifacts (which are lower in the newer lenses available elsewhere).

As a US surgeon noted of course, even though this is a very safe surgery, you do wish to be sure you use a good surgeon with low complication rates, and who is likely to hit the refraction target well enough for a premium lens to live up to its potential. Those who aren't willing to do research and take some risk should stick to the US approved lenses.
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Avatar m tn
Actually I should have said I can get it cheaper than the cheapest surgery near where I live in the US (and cheaper than the US average). Within the US prices vary of course. This site gives costs for various areas in the US:

http://www.newchoicehealth.com/cataract-cost
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Avatar m tn
"Because pricing varies by procedure type, insurance type, and numerous other factors the information shown on this site is not exact pricing."
I don't know of any US health insurance that will cover elective surgery outside of the USA.
Unless, of course, you don't have any kind of health insurance.  
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Avatar m tn
Some companies provide their own insurance, and some insurers are grasping they can save money with procedures done overseas.

http://www.businessinsider.com/medical-tourism-as-an-alternative-to-obamacare-2013-10

"HSM, a manufacturer in North Carolina, is one of the many companies that encourage employees to undergo costly medical services across U.S. borders. The company reported that this medical alternative has saved it nearly $10 million in the last five years."

For many the insurance issue is academic:

http://www.healthpocket.com/individual-health-insurance/bronze-health-plans#.VGga3p94p0I
"HealthPocket found individual Bronze plan medical deductibles were $5,081 on average in the individual and family market."

Surgery can be done in a few European countries for less than that including travel. The average cost for cataract surgery in the US for 1 eye according to that site above is $4700 (the lowest cost around me is $4200), and since most don't get premium lenses I'd imagine the cost is quite a bit above that for them. Even above a deductible there are co-pays for some insurance plans up to a maximum out-of-pocket, so the cost of a premium lens in the US for many would be above that average.

Many folks have high deductibles since we rarely use healthcare and it is cheaper to have lower deductibles and pay out of pocket. Yup, it may have made sense to game the system and get a lower deductible in a   year when we expect to have more.. if we knew what year we were going to have the expense in (rather than not being able to wait as long as expected), except as you note most won't cover getting a better lens overseas to begin with (and even in the US co-pays can add up and the premium lenses aren't covered).
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oops, they really should let you edit posts.  Of course I didn't mean "cheaper to have lower deductibles", I  meant it is cheaper to have a high deductible policy and pay out of pocket. The only way insurance companies make money is by the fact that the average person pays in more money than is paid out for expenses. It is like gambling, on average the house will win, so you lose money on average gambling and paying for insurance. So the less you gamble the better.

The reason for taking the bet is since there is a chance of a major medical problem and so its best to hedge against it to get  high payouts covered. Its  most cost effective for many people who are healthy  to have a healthcare savings account and a higher deductible than it is to pay for more costly lower deductible policies. However that then leads to more pressure to show around for prices, which some people don't want to bother with so they keep a low deductible (or simply haven't thought through the odds of whats most cost effective). The issue is different for those who expect higher medical expenses, and various changes in the insurance world and rates also may be changing what makes sense for people.
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SoftwareDeveloper

I for one would appreciate it if you keep us informed on what you decide and your experience.  I will have to decide soon on what to do and look forward to hearing about your experience.
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SoftwareDeveloper

You mentioned DR. Auffarth in another thread.  I found this link, which you probably have seen but thought it was interesting.

http://eyetube.net/series/daily-coverage-london-september-2014/extended-range-of-vision-1-piece-iol/

You have to register to see the entire interview.

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Also here is an article comparing the Symfony IOL with the AT Lisa Tri

http://bmctoday.net/crstodayeurope/2014/10/article.asp?f=early-results-with-the-symfony-iol

Might be worth calling this surgeon who has experience with both.

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This article and Show interview might be a bit over optimistic but worth a look

http://www.dailymail.co.uk/news/article-2664631/Is-end-sight-reading-glasses-Eye-implant-claims-patients-pin-sharp-focus-youre-looking-just-inches-away-horizon.html

https://www.youtube.com/watch?v=v-hebUlxwb8

Definitely worth giving Dr. Qureshi being he has experience with this and other lenses
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re: "Might be worth calling this surgeon who has experience with both. "

Actually I had contacted him first, , and after an initial reply he didn't respond to a followup query. He'd suggested that neuroadaptation is much faster in the AT Lisa tri, and so I hoped to get him to quantity that a little bit but never heard back. That article also gives a defocus curve for the AT Lisa tri which doesn't match any of the ones I'd seen in other articles with far larger numbers of patients. I'm not sure if its an artifact of the curve fitting software he used along with a random statistical fluctuation due to the low number of patients, or what explains it. The fact that he both didn't get back to me with even a quick reply made me consider going elsewhere, as did  the fact that he didn't address this odd discrepancy in the article.

I'd contacted other doctors who used both lenses who suggested that the Symfony was a better bet.

I decided to get the Symfony, and things appear promising. I just had the surgery a couple of days ago so still recovering/adapting so I wanted to hold off on comments (especially since I'm also not fully awake after major jetlag doing a weeklong trip to Europe for the surgery, with 8 hour time difference and long travel time with little sleep). I'll give an update in a few days after a postop with my usual eye doc where I'll try to get more detailed results.

I hope I adapt well since I actually got both eyes done, even though I'd hoped to wait on the other and get to decide later. One eye  barely had a cataract and was still correctible to 20/20, but after I had the first eye done and had the bandage off the next day,  it appeared hard to get the vision in the 2 eyes to merge even though each eye seemed to have good vision by itself . The other eye was using a contact lens, -6D. I'd read of others just doing one eye and wearing a contact lens on the unoperated eye. So its possible  I may have adapted to it quickly, it may simply have been the issue of adapting to the new lens. However I didn't have much time to wait to see if that would  happen if I were going to get the 2nd eye done on this trip. I figured  perhaps I'm myopic enough that its harder to adapt to, and   I didn't want to risk getting home and having trouble, so I went ahead and got the 2nd eye done a few hours after the bandage came off the first eye.

After the bandage came off the 2nd eye, I didn't feel any trouble merging the two eyes.  I will note that  the day the bandage came off the 2nd eye, when I tried a few hours later I was able to read gmail on my phone (with concentration), without changing font sizes,  though the vision still seemed to fluctuate a bit still recovering from surgery. I figure that is a good sign that with adaptation I'll be able to read it without struggle. (perhaps even merely after I've recovered from surgery, and caught up on sleep, within a few days).
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Thanks for the update,  Please let me know which center you went to and the Dr. you used and your experience as time passes.  I did finally call the Clinic doing the trial closes to me.  Like you said 50% chance you get the Symfony lens, but the other lens is a mono-focal, not a multifocal, so not crazy about the idea.  Plus they require a lot of follow up so a lot of traveling back and forth.  Also still waiting to hear back from them on what the cost would be.  You still have to pay for surgery, surgery center and other things.

BTW, I want to thank you for being brave enough to try out this rather new lens that seems so promising.
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re: "that seems so promising."

I'm still waiting to post more until after Friday postop with US eye doc when I've had some recovery time. However I was pleasantly surprised to discover that I can already read the small print on medicine bottles (like the eye drops I'm using) if I concentrate a bit, and I can use my smartphone. The vision is fluctuating a bit so I suspect I'm still recovering from the surgery, but since it can take a few months to fully adapt to the lenses I'm hopeful that I'll have useful enough near vision even without reading glasses usually.
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Could you provide info about how to contact clinics in the Symfony trial?
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I contacted AMO directly and they provided to me the clinics conducting the trials in my state.  My understanding is they where selecting people in Dec. and performing the operations in January so I think the trials are closed, but you can contact them and check.  I was not interested in the trials as they would not tell you if you were in the control group or not and the other lens was a mono-focal lens.  I will give you another option that I am now considering.  I contacted the person heading the Symfony trials and he recommended to me the newly approved Tecnis low-add lens.  He had also done the trials with that lens and he was very impressed with the results.  I am still researching it but I feel there is risk (imagined or real) with having an operation of this nature done overseas, so I am now leaning toward the Tecnis Multifocal low-add lens.  From all my research it is a superior lens over Restor's Multifocal.   Anyway another option for you to consider.  I would recommend finding the clinics in your area who did trials for both the Tecnis Symfony and the Tecnis low-add lens and talk directly with that Ophthalmologist and get his assessment.  The person I talked to called me on the phone and went into great detail about the 2 lenses.  I also heard the Symfony is on the fast track for FDA approval.  Of course the FDA idea of fast is usually slow to everyone else.
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I had the Vision ICL implanted in both eyes a few years ago overseas, because I wanted the toric version, which is still only available outside the U.S.  This is a phakic IOL, so it is inserted into the posterior chamber and does not affect the natural lens.  I spent a few months researching the lens (along with other treatments for high myopia with astigmatism) and various surgeons.  I selected one who has extensive experience with the Vision ICL and routinely presents at conferences and publishes papers.

The surgeon and all the staff spoke perfect English and the surgical facility seemed top-notch.  Each O.R. has positive air pressure, all staff switch to O.R. shoes before entering.  The surgeon rewashed and changed gloves, smock, mask, etc. between eyes.

I am now developing a cataract in one eye and am considering the Symfony for when my vision deteriorates to where I need surgery.  I would no concern with again going overseas if best lens for me is not approved in the U.S.
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What clinic did you visit for your Vision ICL surgery?
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Can you give us an update on your vision and experience with this lens?
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I'll post a summary, but I'll note I  started a new thread to focus on my experiences with the lens:

http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258

which is likely too long for many to wade through by now, partly with details of some visual glitches that seem to be due to back luck with my eye anatomy after surgery (like iridodonesis and/or phacodonesis) and nothing to do with the Symfony lens, which I think was a good choice. I have excellent visual acuity, i was almost 20/15 for distance by 1 week postop, and am probably there by now I'd guess, and 20/25 for near (at the distance I hold the reading card). I'd guess I'm between 20/15 and 20/20 for intermediate like computer distance, and I can read my phone's email and browser (though for multi-column newspaper pages where they use a small font  sometimes I need to double-tap a column to read it more easily).

I am one of the rare people that see halos with the lens, but they've never been problematic since they aren't very bright so I see through/past them and since my night vision overall is better than I remember it being in the past (I always felt my night vision wasn't as good as others seemed to be). I don't have a problem with glare at night, I think I had more trouble back before i had cataracts.   I think for very near a trifocal might have been better, but that this was a better tradeoff in my case to make to get likely better intermediate than I would have had with a trifocal.

The only option I'm wondering if I should have looked into more is the idea of a Crystalens in combination with the Raindrop corneal inlay which provides more depth of focus, but I hadn't seen any studies on that (only studies of a monofocal IOL with the Raindrop). The Crystalens by itself  which risks not accommodating, and by itself is more likely to leave a need for reading glasses than the Symfony so I didn't consider it as good a choice. However the results I'd seen for the Raindrop corneal inlay placed over   a monofocal IOL seem comparable to what the Symfony provides. So I have to wonder if the Crystalens did accommodate if that would give even better near vision with the Raindrop, and if the Crystalens didn't work if the Raindrop would then provide usable near vision. I'm not sure if  the Symfony and Raindrop would work in combination to extend depth of focus even further, or if there is a limit to how well that would work, I hadn't explored the idea since the Symfony is good enough for the moment.

There are other risks with the Crystalens (like z-syndrome, which might not be much of an issue with recent lenses so I hadn't looked further into it) so it is something to be cautious of before considering that approach. I also don't know how contrast sensitivity would compare with that approach, but it sounds like the Raindrop may not reduce contrast sensitivity much (unlike the Kamra inlay where that sounds like perhaps more of an issue).  The Symfony is simpler obviously than that approach since it doesn't require 2 lenses and the added expense and risk.
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I am a 37-year old female, high myope with the Symphony IOL in my right eye as of October, 2015. No near and no intermediate vision after the surgery. Distance vision is near perfect with limited peripheral vision. My cataract was pretty advanced in that eye, so this outcome is still better than it would have been with the cataract, but I expected much better results, at least for intermediate vision.
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I am a retired 69 year old GP in Scotland and am 2 weeks after having Restor IOLs . I had been reading SoftwareDevelopers posts with great interest , and asked my Ophthalmologist for Symfony - his advice was to go for Restor 2.5 in the dominant and 3.0 in the other eye. I had confidence in his assessment of my needs ( good vision when sailing , running and hill walking in Scottish weather  - and reading  )  so went with his suggestion.
I have had excellent results for my needs - 20/20 or slightly better distance , smallest font size on Kindle perfect , laptop easy to see. Night driving - 3 hours on a particularly wet night was fine , and much better than using multifocal contacts. Less haloes than with contacts . Yes , at a temporary red traffic light I did have a particularly beautiful  spider web of concentric fine rings , but if I diverted my attention the web disappeared -  part of my neuroadaptation ?  I am posting this because I feel there are good results out there which should be reported.
Very grateful to SoftwareDeveloper for his input.
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Glad to hear you have good results. You might consider posting that  on a separate page with its own topic so people realize its about the Restor lenses, which many people complain about so it is a good example to remind people that the vast majority are happy with their results.  Those who go for non-monofocals do need to be aware of the risks of course since someone winds up being the "statistic" since no lens is perfect.

A low add bifocal likely gives reasonably comparable results to the Symfony. You might have slightly better near but not quite as good intermediate (at least further out intermediate). The major difference is   I'd suspect your contrast sensitivity, low light vision, might be reduced compared to the Symfony due to the light splitting to multiple focal points. I  definitely have better low light vision with the Symfony than I had with multifocal contacts pre-cataract, though I was happy with the contacts despite that.

Your running&hill walking comment brings up one of the potential benefits of presbyopia-correcting lenses compared to monofocals. Full monovision using a monofocal with the near eye set to for instance -1.75 leaves its best focus at 27 inches, which means that further out intermediate distance, seeing the ground ahead of you when walking, may be relying mostly on one eye with less 3D vision. I don't know how much of a difference that makes, but I've been out walking trails more  (and soon running them) and appreciate seeing rocks/snow/ice in full 3D clarity with both eyes. I'd be curious how much the odds of a fall are reduced.  Actually I'm guessing that is within the range the Symfony may do better then the low add Restor&Tecnis bifocals.
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just wondering -- i have cataract in rt eye caused by a vitrectomy from another issue so am "looking forward" to surgery to replace lens. trying to wait till symfony is approved in the US (sounds like 2017 or earlier now)  
question
do they come in different "flavors" or strengths? i.e. can it be set for more close/intermediate rather than intermediate/far? i have worn distance glasses since grad school and have no issue with continuing-- but i need far more close and intermediate clear vision for work and hobbies.
how do they set the extended depth of focus?
i really hope they get approved in the US soon. and then to find someone versed enough to to the surgery.

i was hoping for the "liquid vision" lens to be out sooner for better but this seems the best current solution and as it's the non dominant eye less strict?
in L.A. area
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The lenses come in different powers, just like glasses or contacts. You'll see discussion on this site and elsewhere of people getting monofocals where there best focal point is set for intermediate or near instead of for distance. The same can be done for the Symfony. The difference is that if you had the Symfony and a monofocal both set to the same best focal point (whether intermediate or distance), that the Symfony will give you a wider range of clear vision, you will be able to see well  closer in with the Symfony  than a  monofocal by a diopter or so  (unfortunately that isn't a fixed distance in inches or centimeters, the distance  a diopter translates to is different depending on where the focal point starts).

re: "then to find someone versed enough to to the surgery"

Any competent surgeon will be able to do the surgery with the Symfony since the procedure to implant it is the same as other IOLs. The lens material and the overall lens shape and size is the same as the widely used Tecnis monofocal and multifocals currently available in the US. The only difference is the optics of the lens, which doesn't matter to the surgeon implanting the lens. The only issue that might be new to them is helping you decide where to put the best focal point because of the fact that it does have a wider range of good vision than a monofocal, but that is a simple matter they can understand from looking at the defocus charts and data.

re: " "liquid vision" lens to be out sooner for better"

The next generation accommodating lenses are a ways away from approval in the US. The only one I'd heard trying for approval anywhere is the Lumina which is reportedly trying for approval in Europe, trying to get  a CE Mark (their equivalent of FDA approval). I haven't seen any estimate as to when that might happen, and after it does it'd likely be quite a while before its approved in the US. More importantly, I'd suggest caution before considering using a next generation accommodating lens until they've been widely used in human eyes. Their functioning relies on the eye's accommodation mechanism, which means that the only way to test them well is with humans.  They need to be sure not only that the lenses move properly, but that all the movement doesn't lead to problems over time (e.g. the lens moving out of position, some bad interaction over time physically wearing out part of the eye through its movements, or whatever other complications might arise when there are moving parts at work). The new accommodating lenses are also often different sizes, shapes  and materials compared to existing lenses, so any issues that might arise from that need to be tested.


Static lenses that don't need to move or change shape (like the Symfony, monofocals, and multifocals) only differ in their optics, which can be well tested on optical benches outside of the eye. The major issue they need to test for in human eyes are subjective factors like halo&glare, which can be done well with fairly small clinical trials.  


The Synchrony lens was an accommodating lens that showed promise, but seems to be off the market (or at least not used by anyone) due to a sizeable minority having problems (one of the posters on this site, AnomalyChick, got the Synchrony lens in Europe).  I tend to be an early adopter of technology, but someone who tries to take educated risks and I'd personally be cautious to ensure a new accommodating lens was used a fair amount before I risked it, but everyone's risk tolerance is different. The issue would be to figure out what the potential risks are, e.g. if you did need a lens exchange from an accommodating lens due to problems,  would there be a greater risk that the capsule might be damaged, which would limit the sort of replacement lens you could get (since most premium lenses are for placement in the capsule).

I'd originally hoped I might wait for an accommodating lens, but I later realized that I'd have been more cautious about it than a new static lens like a new extended depth of focus design or a  trifocal.
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thanks for the input. as i work as a hair stylist/barber my need for best vision is in the "foot to ten feet" range-- or close enough for a good men's hair cut and out to the mirror and back.... i have worn didstance glasses since 9, so that's not an issue, i'd be fine still wearing them. it's that quesiton of does it go from clear to blurry fast or is there that 'range' where like normally, it just gets blurry from the distance? if the makes sense. the monofocals sound like it's "focus at one foot and anything 13 inches and out or in is blurred" or "get good distance, but trying to see the dashboard while driving is like looking trough wax paper.... that depth of focus and binocular vision loss...
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re: "it's that question of does it go from clear to blurry fast"

That is the difference between a monofocal and the Symfony, the monofocal gets blurry much faster than the Symfony, the range of good vision is smaller. The range outwards from the best focus is about the same in both cases (e.g. if the best focus is set at 10 feet, the vision further out would be about the same with a Symfony and a monofocal, and it still might actually be 20/20 for far distance).  Unfortunately the studies only give average values, some people have better or worse results, but the studies give some clue what might work.

It is difficult to know what the various numbers like 20/40 translate to in terms of visual quality, but this site I found lists the print sizes you can see for various levels of vision at near, which suggests e.g. 20/40 isn't bad:

http://www.teachingvisuallyimpaired.com/print-comparisons.html

For instance if you had an eye set to focus at  far distance with a monofocal, then according to info on the Tecnis website:

http://www.tecnisiol.com/eu/tecnis-symfony-iol.htm

with their monofocal your vision would have dropped to almost 20/40 by around -1.5D = 66 cm = about 26 inches, whereas with the Symfony it wouldn't drop that far down until about -2.5D = 40 cm = about 15.7 inches. With a slight bit of monovision, you might be able to have one eye set just a little bit closer in and be able to hit your "one foot" mark with the Symfony while still having great distance vision.  

10 feet is about 305 centimeters. The formula for determining the diopters  required for a particular focal point is -(100 / distance_in_centimeters) so that would be focused at -0.33D.  So one eye could be focused there (giving you perhaps 20/20 still at far distance) or at perhaps -0.5D or -0.75D (since you get good vision a little further our).

1 foot is about 30.5 centimeters, so that would a focal point of   -3.3D. If you had 1 eye set at -1D with the Symfony, that would give you better than 20/40 vision at 1 foot,  -1.5D with the Symfony  would give you better than 20/30 still at 1 foot, or if you had it set at -2D that would give you 20/20 vision still at 1 foot.  The level of difference between the two eyes would impact how much loss of stereopsis (3D binocular vision) you had. The level of monovision required   would be less than with a regular monofocal.  Unfortunately again those are average study results, so to play it safe you might wish to have one  eye set a bit further in than you need.
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I may be getting a symphony IOL for my right eye here in Pune, India. This lens seems to be common place in India. It is going to cost Rs. 60,000. ( slightly less than 1000 $ US).
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PCO is not a big deal to tackle, it is to be dealt with YAG laser. Only thing is to avoid formation of pits on lens surface. That is avoidable and in my practice i never had optic pits due to YAG laser posterior capsulotomy.Size of Opening has to be 2-5 MM depending on pupil size but patient with small opening can benefit with Pin Hole effect.IOL do not fall back into the vitreous cavity if Yag Laser capsulotomy is done.
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Now that the Symfony IOL has been approved by the FDA for use in the USA, does anyone know when it will be actually available, and/or what US cataract surgeons have experience using it?
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Since you appear to have the most extensive information and experience with the Symfony IOL, perhaps you can tell me:

1.  Is it "axis-independent"?   I don't know the correct terminology for this, but what I mean is, if the lens rotates slightly, or is placed originally so that the north-south position is not exactly north-south, will vision be degraded?  (Or is there even such a thing as a correct north-south orientation?) I am speaking of a non-toric version of the lens.

2.  What optical characteristics are given up in exchange for the broader depth of field?  For instance, does reducing the chromatic aberration affect contrast sensitivity?  Or any other things? I understand, from the literature, that simply correcting chromatic aberration alone would result in better than 20/20 distance vision, and that the manufacturer has therefore also "dialed back" the vision sharpness down to 20/20 in order to widen he depth of field into the intermediate range.  But it seems "too good to be true" that there are only advantages with this lens and absolutely no offsetting disadvantages.
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I haven't seen definitive information about when it'd be available, presumably they didn't know exactly when the FDA approval would come through so they need a little time to get distribution in place.

The Symfony is physically the same shape&size as other Tecnis lenses, their monofocal and multifocal, it merely has different optics, so the surgery would be the same so I wouldn't worry too much about the level of experience a surgeon has with this particular lens.  There were US surgeons involved in the clinical trials, but I haven't seen a list of them, and others  who seem to pay more attention to upcoming technology. If you mention where you are located, perhaps someone might know of a surgeon.
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The regular non-toric Symfony isn't axis dependent, rotating it would make no difference. Most non-toric  lenses don't vary when rotated. (though  I think there are some bifocals outside the US that do vary).

Toric lenses that correct for astigmatism  are all axis-dependent, they need to be oriented right in order to correct the astigmatism.

Other IOLs don't correct for chromatic aberration (even if they might try to reduce it by using a high abbe number material). So for the most part the intent with the Symfony is that the benefit gained by correcting chromatic aberration is what is offset by providing the extended depth of focus.

Studies report its contrast sensitivity is comparable to a monofocal, though in theory its possible that the studies aren't accurate enough and that there is some slight reduction. Standard multifocals lose some light, and reduce low light vision through the light being split to the different focal points. I suspect its possible that the Symfony might have some reduction of light compared to a monofocal due to the elongating of focus, but I hadn't seen any data on it nor any data on whether there is any light lost the way there is with a multifocal. It may be that the chromatic aberration correction counterbalances the lost light in terms of keeping contrast sensitivity similar.

I've seen a comment in an interview  video by one doctor (Dr. Mark Packer on Eye World Video Reporter) who has been examining luminance for various IOLs, but no published results on it yet or other info that I've seen from it. He has been studying  how bright things seem at night through various IOLs, but he only mentioned  examining it qualitatively (in a somewhat questionable fashion taking pictures through a model cornea & IOL, which calls into question the light sensitivity of the camera).  He suggests there is some reduction in luminance with the Symfony, as there is with a multifocal, compared to a monofocal, but I hadn't seen details. It   may be compensated for by neuroadaptation.

I know my vision in dim light with the Symfony is better than it was with multifocal contacts beforehand, partly based on trying to read in a dimly lit restaurant I have a weekly meeting at and my general sense of how light things are.  I know someone who got the Crystalens who is about the same age, and we compared near vision in a well lit auditorium after a lecture. He held a file folder above a near vision chart to cast a shadow, and that was enough to drop his visual acuity some lines, but it didn't impact mine at all. That may be personal variation of course, but it was a surprising data point.


Personally to me it seems like my night vision improved overall after I had the Symfony, things seem bright enough to me, but  my memory may be flawed since I wore multifocal contacts before surgery (at least in the non-cataract eye)  and it had been a few years since I had worn single vision contacts in both eyes.  
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Thanks for the quick response.  I'm in Tampa, FL, if that is any help to anyone.  There are 2 or 3 "go-to" cataract surgeons in this area, who all do exceptionally high volumes of IOL replacements, so lack of experience with the currently existing lenses would not be an issue.  However, the mass-production type of setup of their operations (and possible consequent lack of individualized attention) worries me a bit.  As well, they may be slow to add a new lens to their existing familiar arsenal.  

Also, I don't know their feelings about a square-edged one-piece acrylic lens (i.e, as you point out, any Tecnis lens)  - although that would be the same question with any surgeon - either in general, or in my particular case. I do have some glaucoma and pseudoexfoliation (which is apparently a marker for weak zonules)  in one eye, and I'm not sure how that affects the choice of IOL design for a potentially weakened capsular and supporting structure.

For that reason, I rejected the idea of the Crystalens (or any lens with moving parts) pretty quickly when I started thinking about this last year, and the multifocal solution seemed kludgy, especially since the intermediate range was the most compromised with those lenses, and they were apparently subject to halos and other artifacts.  And I know I wouldn't be able to get used to a monovision arrangement with conventional monofocal IOLs (and would probably have trouble with the two focal points in a multifocal for the same reason).  I don't mind using reading glasses for close vision,so the allure of improved mid-range vision with the Symfony  (as well as its simple unitary structure) has kept me waiting while my cataract has grown progressively denser.  

I was just about to settle for conventional monofocal lenses when the FDA approval for the Symfony finally was announced, so now I'm not sure how much longer I will have to wait, or want to wait.  I'd like to feel comfortable that other unforeseen drawbacks of the Symfony will not begin to emerge over time.  It is encouraging that there don't seem to have been many complaints reported on the internet during the recent 2 years of usage experience in other countries.  Of course, I haven't tried to find (and couldn't read anyhow) foreign language websites.  But your own experience seems to indicate a happy outcome with the Symfony.

I didn't feel as adventurous as you in terms of travel to Europe, especially if some problem cropped up due to my glaucoma/pseudoexfoliation that required repeat visits, plane trips, hotels, etc., especially with no one in this country really equipped to deal with the Symfony legitimately.  So I nixed the European (or even, apparently, Mexican or Canadian) idea.  However,  now, of course, the picture is all changed and this will all be able to be done domestically, even locally.  The real questions now are where and when.  And if the Symfony is appropriate for my eyes.

Anyhow, I don't know why I have taxed you with so much detail about what are probably just some personal choices for me, but I figure that you might have some further words of wisdom.  Thanks for reading all this rambling on, and please answer if you have any further thoughts.  
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P.S. - I understand - at least in theory - the tradeoff between chromatic correction and depth of field.  But I figured that the use of diffraction to achieve the better chromatic confluence (and increased sharpness) might give rise to some other kind of tradeoffs.  Contrast sensitivity was only an example, not my sole concern.

Do you know how the camera lens manufacturers correct for chromatic aberration?  They have been doing it for a long time and I don't recall any photographers complaining about disadvantages.  Do they use a diffractive technique?  As you point out, a high abbe value is really a property of the material and not independently controllable.  Anyhow, maybe you know about these things, and can shed some light by analogy with photography.
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PPS - Forget the preceding comment/question.  I just realized that camera lenses probably do all of their correcting by using multiple elements, while IOLs are still all (I think) single-element lenses.  Sorry.  Also, thanks for answering my question by pointing out that the slight loss of luminance in multifocals may, besides being due to the splitting of the light into two portions, be also due in part to the diffraction itself, or the widening of the depth of field (which may, for all I know, be the same thing).

Anyhow, I promise not to write any more PSs or PPSs or PPPSs, etc.  Thanks for being such a great sport and attending to everyone's concerns on this blog site.
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The psuedoexfoliation issue is one that I haven't checked on in detail.   I seem to recall statements that it may be a better bet than a multifocal, but it isn't clear whether its as safe a bet as a monofocal, though there is some speculation it could be safer due to the extended depth of focus which might make it more tolerant to any displacement. I don't know if anyone has studied the issue, but obviously it is one to be cautious about.


re: "during the recent 2 years of usage experience in other countries.  Of course, I haven't tried to find (and couldn't read anyhow) foreign language websites. "

I get the impression that most ophthalmology research is published in English so searches should turn it up, or e.g. the abstracts at sites like the ESCRS conference site. Most articles in other languages should   also use the name of the lens using English characters, Tecnis Symfony, and so google searches turn up foreign language references and any that look useful can be translated with Google translate (which a link is usually provided to). I guess in part since I was an early adopter I've been watching to see if any "unforseen drawbacks" appear in the studies (to see out of curiosity if I did make the right bet)  and I haven't seen any yet. There is a video interview with I think Jason Jones, and perhaps an article, talking about his meta-analysis of the study data out there on the lens that seemed to confirm the low risk of halo&glare comparable to studies on monofocals. The basic drawback is not having as much near vision as multifocals. There is an occasional fluke publication like one abstract complaining about the level of near vision with the Symfony more than usual while neglecting to notice that the reported data showed their  patients wound up hyperopic on average so they were bound to have lower quality near regardless of the lens compared to other studies.



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Camera lens manufacturers sometimes correct using the shape of the lens, but they can use diffractive optics like the Symfony does. Diffractive optics is used in some high end optical systems (camera and telescopic). I don't know your level of background knowledge of the topic, but if you search for something like: camera chromatic aberration diffractive optics, you should see some hits.

High abbe value merely reduces chromatic aberration, which is different from correcting for it as the Symfony does.
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A single piece lens can have multiple layers. The exact physical design and functioning of the Symfony isn't clearly spelled out in any articles for public consumption beyond high level descriptions that it uses diffractive optics to extend depth of focus and to correct chromatic aberration. Someone found what might be the patent behind the Symfony which is too technical for most people, I've not taken  the time to delve into all the technical details myself (nor even confirmed this is the Symfony),  US Patent number 8,747,466 B2 dated June 10,2014.
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Again, many thanks. I think that the people complaining about poor near vision with the Symfony must not realize that, although it uses diffraction, it is not a multifocal and can't create a dedicated second focal point to target near vision.  Since I don't mind using reading glasses for close work, this is not a great drawback for me - the improved mid-range vision is what I find compelling.  

I hadn't thought about the possible benefit you mention that the Symfony's extended depth of field could help to keep things in focus even if the lens tilts or moves forward or back after implantation.  Thanks for that observation.

The study you found that complained the most about lack of near vision improvement, where the author didn't notice that the subjects all wound up hyperopic, makes me wonder whether these people may have been correctly measured for monofocal IOLs, but in fact some allowance, or constant, or adjustment needs to be made to conventional measurement results when using the Symfony (and they didn't do it and used a too-powerful lens).  This kind of possibility (along with my pseudoexfoliation/zonule issue)  is why I would prefer to find a surgeon who has had a lot of actual experience with the Symfony.  And, as well, a surgeon who takes time to really consider my eye's requirements, rather than a cataract-factory-type guy who has done 20,000 cataract procedures and has thereby achieved a dazzling level of surgical technique, but, who, in the interest of office efficiency and keeping things moving, simply slaps in monofocal IOLs whenever the alternative would require slowing down the assembly line.  

I once listened to a podcast of a lecture given at a professional conference by one of these guys on the subject of  "how to run a high volume cataract practice."  He describes how he has three or four operating rooms running simultaneously, with nurses and assistants in each one finishing up the last patient and preparing the next one, allowing the surgeon to simply walk in and find an already prepared patient sitting in a chair, so that he can immediately do the procedure and move on to the next room where another patient is already set up and waiting.  The guy said that he really likes the feeling of getting into the "rhythm" of moving from room to room without breaking his pace.  I find this somewhat worrying, but maybe I am being too cynical. And I do place a lot of value on extensive experience, especially when it involves a manual skill. I know personally how much difference years of piano practice makes in performance technique, and I've been told that the same kind of practice is necessary for a professional athlete to get really good, so it seems obvious to me that the same principle applies to cataract procedures.

As far as the camera lens comparison is concerned, I didn't realize that IOLs were multi-element too.  I thought that they were one solid piece of plastic.  Thanks for cluing me in.  As usual, there is a lot more to this than I had assumed.  My level of photographic knowledge is pretty rudimentary, and I'm not sure I want to learn about lens designing anyhow; I mean, enough is enough.  But I did fish out the patent you referenced, and it looks like it may well be the operative Symfony patent (although there may be other supporting patents too).  It was applied for in 2008 by two Dutch inventors and finally granted in 2014 (six years!) and simultaneously assigned to the Dutch Abbott subsidiary.  It claims to describe an IOL with a diffractive element having extended depth of focus.  Sounds right.  But it is 39 dense pages and looks like pretty tough sledding.  The timing (2014) seems a little curious.  But maybe they were testing it and applying for approval while waiting for the grant to come through.  I think that, in the case of a patent, you have priority as soon as you file and thereby disclose your invention publicly.  They certainly didn't wait until 2014 to begin putting the wheels in motion.  I'll see if I can understand any of the patent description, although I don't know how much practical benefit it would be, even if I could.

Anyhow, it is nice to find someone who is as obsessive as I am about these things.  And thanks again for taking the time to tell me - and everyone on this blog - what you have learned.
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re: "but in fact some allowance, or constant, or adjustment needs to be made to conventional measurement results when using the Symfony "

There are constants that are associated with each lens that are plugged into formulas. I suspect in this case the doctors merely chose for some reason to err on the side of being hyperopic to ensure good distance vision (since the extended depth of focus means that you get good distance vision even if you wind up a bit hyperopic).  I had heard that with high add bifocals, or even trifocals, some surgeons tended to prefer to err on the side of being hyperopic since it didn't matter if the near point was pushed out a bit, to again ensure good distance vision.

I have read of studies that indicate experience does have an impact with cataract surgery, which makes sense. Surgeons with tens of thousands of surgeries are especially likely to have encountered the various potential rare  complications that might arise and have dealt with them before. I think high volume in general us is useful, but I don't think experience with this particular lens (vs. other Tecnis lenses) is important.


re: "it looks like it may well be the operative Symfony patent "

Yup, though it isn't definite even though its from the right company. It could be that its an earlier version of the approach, or that its a different approach to extended depth of focus that the same company has explored. (though the similarities suggest its most likely either the Symfony or an earlier version of its approach).

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