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my Symfony IOL results after cataract surgery
I'd posted before asking for information about lens options before surgery,  but thought I'd start a new thread now that I've gotten the lens where perhaps others can add their results as well with the Symfony lens. It is a  new type of "extended depth of focus" lens that uses a different design than   multifocal and accommodating lenses.

I had Symfony lenses implanted in both eyes the first week of December.  By 1 week postop my uncorrected vision at distance was between 20/15 and 20/20. At near my vision was already about 20/25 (but fluctuating a bit it had seemed better earlier that day). Given its improvement since then I'd guess its likely 20/20 or so, I can read the small print on my eye drop bottles for instance.  Not everyone achieves this level of near vision with the lens so people shouldn't expect to necessarily get quite as good a result, and should be prepared for the possibility for needing reading glasses at near. I suspect the fact that I'm comparatively young for cataract surgery, 52, might have   something to do with the results.

I had originally only planned on having 1 eye done (since the other was 20/20 correctible still), but when the patch came off the next day I discovered it might be hard to adapt to the difference in vision between the two eyes even with a contact lens in the other eye. I might have quickly adapted if I'd taken the time, but I decided I didn't want to risk it,  so I had the 2nd eye operated on a few hours later.

My intermediate vision hasn't been tested explicitly but I suspect is at least 20/20. That is  based on my subjective sense of it being better than near and because of the design of this lens where visual acuity drops off in a continuous curve from far to near, so intermediate should be around the same as far, definitely better then near. That is one of the differences between this lens and for instance a bifocal IOL where vision may be worse at intermediate than it is at near or far. I spend a large number of hours at a computer and was willing to risk needing reading glasses occasionally for near in order to get better intermediate vision. Most household tasks and social interactions occur at intermediate distance as well.

Unfortunately the lens isn't yet available in the US yet, they are starting a clinical trial here which is randomized with a monofocal lens (there is a 50% chance you would get a monofocal) so I went to Europe for my surgery.  I figured that at my age I hopefully may be using these lenses for a few decades so it was worth a bit of effort to get a better lens. This industry publication suggests it might be  generally available in the US in a couple of years, and that some US surgeons find it interesting:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/us-surgeons-anticipate-new-iols?page=0,1
"the Symfony IOL might be available in the US by late 2016 or early 2017...
Of the IOLs discussed at the ESCRS Congress, Dr. Olson and Dr. Packer concurred that the brand new Tecnis Symfony Extended Range of Vision IOL was the most interesting as it represents a new concept for addressing presbyopia that seems to overcome the limitations of multifocal IOLs....

from what I’ve heard so far from respected and trusted surgeons, patients implanted with this IOL are seeing 20/20 at distance and intermediate with very usable, J2 or J3 near vision and are not experiencing any loss of contrast or perceptible problems with glare, halos or other dysphotopsias. So, it looks like they are having their cake and eating it too.”

I had considered the option of getting a trifocal lens which targets far, intermediate, and near (also unfortunately not yet available in the US), or even a bifocal with a small add so its focused more at intermediate than near.  However the studies so far seem to indicate that the Symfony provides better quality intermediate vision. In addition multifocal lenses reduce contrast sensitivity which is useful for night vision, while reports indicate the Symfony is at least as good as a monofocal lens. The other thing the Symfony does is to correct for "chromatic aberration", an issue which is discussed in this industry publication which quotes one prominent surgeon noting:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "

Although the Symfony uses a high Abbe material (I'm assuming its the same Tecnis material that article lists as having a 55 Abbe), it also has other features to to correct for CA to improve image quality. It seemed like a good bet the image quality for distance would be comparable, and perhaps even better, than a monofocal lens, or an accommodating lens.

Although some results for the Crystalens look like it will similarly do well for intermediate while providing some chance at decent near vision, some showed a lower chance of good near, e.g. some of the studies listed for the March 2014 update in this government review:

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/OphthalmicDevicesPanel/UCM346413.pdf

Part of the concern I had with the Crystalens was that in some patients the lens does well, but in some it doesn't accommodate, which leaves it effectively being  a monofocal lens ( but without things like the correction for chromatic abberation). There is also concern I'd read among some  over whether over decades of aging anything would interfere with the physical movement of the lens, something non-accommodating lenses don't require. There is no perfect lens, so its partly a matter of placing a bet on which might work out well, and I figured that it was better to bet on something that didn't require the accommodation to work (in addition to other concerns regarding problems people have with the Crystalens, though those may be fewer in the newest versions). I hadn't searched to find  the study behind the figure in this presentation, but it notes:
http://www.slideshare.net/alanglazier/accommodating-intra-ocular-lenses

that about half of Crystalens patients require reading correction. That may be in part because as it notes: ' "Pushing” does not equal “Sustaining” '. This issue is that someone with their natural lens still who is presbyopic for instance may be able to theoretically read a particular print size without glasses, but that the muscle effort to focus may be a strain to do  for an extended period of time, and the Crystalens at least partly seems to require the same sort of accommodative effort.  (though  there is speculation it may be benefit from some extended depth of focus, which is what the Symfony is designed to use to begin with). I'll continue this in another post in a few minutes.
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I don't think you'd mentioned how myopic you are, those who are fairly myopic often find it easier to use a contact lens on the unoperated eye after the first surgery rather than glasses, though with low myopia glasses are workable (the issue is the difference in image size between an eye corrected at the IOL plane and the spectacle plane). Another useful think about contacts is that it may take a little while for the vision to stabilize after cataract surgery before they even prescribe new glasses, so if you have a contact lens for your unoperated eye in the meantime that'll help.


I wasn't sure if you might be able to try a multifocal contact in your good eye at least to get a sense of whether the reduced light is an issue for you. Again you can do blended vision/monovision with the Symfony and have an even better bet to be without glasses. In most ways its like a monofocal but with merely a greater range of near vision for each eye. Again, one issue with a contact lens trial of monovision is that at your age you'll have more near vision with each eye than you would with a monofocal IOL, and of course the cataract will interfere a bit. Hopefully they let you try different levels of monovision difference between the two eyes, or gave you a fairly high level to start with to see if you can adapt. Often contact lens deals include some followups and trying other lenses.

Another issue is if you do go monofocal, to decide which one. Some monofocals claim to provide a larger depth of focus than standard monofocals, like the Softec HD, though I haven't researched the issue to be sure. Among the more common ones, I have the impression the Tecnis may have lower risk of halos&glare than the Alcon, and the Alcon is a blue blocking lens (for better or worse). The Crystalens is another option that might give more near vision for each eye, with the risk in a minority of cases  it may just be a more expensive monofocal.

I know the Zeiss AT Lisa trifocal is widely used in Europe, as is the FineVision trifocal,  but I wasn't sure about whether its even approved in Canada, I know at least the AT Lisa is.
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I had also hoped to try a multifocal contact lens as well as the monovision ones I did get. Unfortunately the optometrist said that with my cataract as it is, it would not be possible and refused to give me them. It was enough of a job to get her to give me these contacts as it was. There are few choices for walk-in optometrists here so going elsewhere isn't really an option.
My left eye is -5.5 and my right eye before the cataract was -2. With the cataract, it's -8.25.
The contacts I have are now -5.25 for the left eye and -6.0 for the right. Do you have a suggestion for a different range?
My surgeon had said he would choose -1.5 for my right eye if I go with blended vision monofocals.
I've never actually worn contacts before and they are certainly a struggle to get in and out. As my left eye has no cataract, I don't plan on having surgery on it at this time unless I really feel I need to after the right eye is done. So I suppose I will have to get used to using a contact for my left eye. My own optometrist said glasses will not be possible to wear after surgery on one eye only and that a single contact will be my only option. However if I can use glasses, I would choose them.
As these are my eyes & my vision for the rest of my life, like you I am willing to travel for the best option for myself. I have contacted a clinic in London to see about the trifocal Lisa but with the progress of the cataract I wouldn't be able to wait too long. I don't know if there are waits at clinics there as there are here. It's good to hear about Mexico, as that would be a much easier trip for me than London.
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I recommend the Herzig Eye institute in Toronto.
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oops, that should have ended "I know at least the AT Lisa is available  in Mexico" for any others considering options who are in the US.
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I'm assuming the RX for your right eye of -8.25 is for glasses. Contact lens powers are a bit different since the lens is at a different distance from your eye, so a conversion chart shows a -8.25D glass prescription is about a -7.75D contact lens prescription. So according to those values, the contacts  did give leave that eye around -1.75D myopic (the value at the spectacle plane isn't much different). Refractions aren't exact,  and can fluctuate throughout the day and I don't know if your glasses RX wasn't from this optometrist but your doctor perhaps, so  I'm suspecting     the optometrist gave you -1.5D monovision according to his measurements when you got them. Regardless it may give you some idea of whether you can adapt to a difference between the eyes (though if you struggle it may be due to the cataract). Again the level of near vision you have will be more than with a monofocal IOL since even your distance eye can focus a bit near still at your age.

Before my cataract surgery my cataract eye became so myopic that I couldn't get a multifocal lens in that power off the shelf, so I switched to  a single focus lens in that eye and a multifocal in the good eye.
  
If you were looking at trifocal IOLss, here was the one article I'd found with some details on the new Panoptix which is available in London (some promos refer to it as a quadfocal, but that is a technicality of the internal optics, one focus is redirected to distance apparently so its a trifocal really).

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/novel-trifocal-iol-extends-range-vision

The graphs show a bit better visual acuity than the FineVision, but unfortunately it doesn't show the AT Lisa trifocal or Symfony to compare. To see the images larger,  if you right-click you can open the figures in a new tab, or copy the image URL and open them by themselves.

One of my concerns with the trifocals was that intermediate was better than a bifocal, but that there was a drop in intermediate vision. One of the reasons for switching to the Symfony was an article that seemed to show an even larger drop for a trifocal for intermediate than I'd seen anywhere else, and better near than I'd expected for the Symfony. Here is the newest article by the same doctor with his results:

http://www.opticianonline.net/presbyopia-surgical-management/

I still don't know if the doctors data might be a bit off since I still haven't seen anyplace that shows quite as much of a drop at intermediate for the AT Lisa tri (even though all sources seem to show the Symfony better at intermediate at some distances,  or at different distances comparable  at intermediate). It could be that he measures the visual acuity at more distances than others so the data spotted a drop others miss.

However other comparisons   tend to show the AT Lisa doing better than the Symfony at 40cm, even if at the person's "best near" (which can be  further out)  the Symfony might be comparable/better, for instance this  study which doesn't give a whole defocus curve but just 3 points and at near shows the AT Lisa is better at 40cm:

http://www.escrs.org/athens2016/Programme/posters-details.asp?id=25354

This one has the Symfony vs. the Panoptix and Finevision, and gives a slightly better value for the Symfony at near than the study above:

https://ascrs.confex.com/ascrs/16am/meetingapp.cgi/Paper/22784

A major factor for me was the reduced risk of night vision issues with the Symfony (less a factor for you I know), a recent study on complications shows a low % of issues:
https://ascrs.confex.com/ascrs/16am/meetingapp.cgi/Paper/24808

One way they sometimes compare lenses is to show a simulated image at different distances of an air force target figure, made by putting the lens on an optical bench, i.e. testing it outside the eye. Unfortunately that isn't exactly what people will see, since its a monocular image and people's neural processing  with 2 eyes can lead to improvements over what they show. I haven't seen examples of a near target image for the Symfony vs. the trifocals, but I ran into an article that compares a similar lens to the trifocals and shows USAF target images.

This other  new lens, the Mini Well,   doesn't seem to be used much at all now, its not as widely used or tested as the Symfony  (and I doubt its available outside Europe now), but is also an extended depth of focus lens, though it uses different optical techniques (they sometimes refer to it as a   "progressive"  lens).  The results i've seen suggest the 2 lenses are fairly comparable in performance, I haven't seen enough data to be sure about the Mini Well, it might have a slight edge but it isn't clear since its close, and I haven't seen enough data on things like risk of visual artifacts. It is something to keep an eye on to see if it proves itself in the future. Currently,   without more signs of a definite difference I'm unsure personally  its worth seeking out yet in part since one thing that made the Symfony seem slighlty lower risk even though it was new when I got it was   that although the optics are different than other Tecnis lenses, the material and physical shape of the lens (the haptics that hold it into place) are the same as their other lenses that have been widely used in many eyes, unlike the Mini Well.

This article has figures 3 and 4 that show simulated distance, intermediate, and near images for trifocals and the Mini Well:

http://www.jcrsjournal.org/article/S0886-3350(15)01263-8/fulltext

Another article compares the Symfony to the Mini Well using an optical bench and shows optical bench USAF target images for both, but unfortunately the near one is missing for the Symfony:

http://link.springer.com/article/10.1007/s00417-015-3240-7/fulltext.html

The results from that study are again optical bench tests outside the eye, and as other commentary has pointed out, some of the technical specs that look a bit better seem to not translate into a difference when placed in to the visual system. They do suggest as I said the lens is worth keeping an eye on though since its possible it will prove to have a slight edge.
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Thanks again for such a detailed post.  One of the studies you linked, https://ascrs.confex.com/ascrs/16am/meetingapp.cgi/Paper/22784, shows better results for trifocals than the Symfony, with no difference in contrast sensitivity.  Yet other studies have shown better contrast sensitivity with the Symfony.
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hey, remember me?
I'm going to give my eyes to Dr. Stein in 21 jun! I'm excited. Actually, I want to do as he said: single focus far vision standard monofocal IOL + thin pair of glasses off the shelf for my reading. He does my write eye first to see how it heals. (R= 8+ L= 8.25+ with lazy eye and little bit of astigmatism and off curse which is not able to handle multifocals. removed cataracts at age of 6 months old and  now am 24 and in all those years, just been using f...ing glasses from morning to night)
well I am really afraid if it's going to be sth worse than my current vision after the operation.
Also they told me that they're gonna use a "standard' monofocal IOL but I've heard the even in monofocals, there are "premium" IOLs ,too. I don't know. I trust Dr. Stein. He is a pro and I am sure he has opted the best possible choice for my eyes.
I don't have a smallest idea of how my intermediate and close vision will be. will I need glasses to read my texts in my iphone? or see myself in the mirror.
I made this decision coz 3 other Drs gave me roughly the same choice.
What is your opinion my friend?  
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I'm guessing he will be giving you some degree of monovision, one eye focused nearer in, to get better intermediate&near vision. How much monovision, where that near eye is focused, will impact how much intermediate and/or near vision you get. Unfortunately people's natural depth of focus varies drastically. A very tiny minority of lucky people can read a bit with a monofocal set for distance, but for most people I'd heard that vision getting blurry from 6 feet in is a good guess for a monofocal set for distance, which is why it matters how near the close eye is set.

You could ask him which monofocal he intends to use and post (perhaps on a different  page/thread about whatever the lens is, since those who have monofocals might not notice it on a page about the Symfony). There are some that claim a bit more depth of focus than standard monofocals (though not as much as the Symfony, which I consider a better option than monofocals for most people if they have access to it in their country), and some use materials that have less chromatic aberration (like the Tecnis).  
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I'm guessing he will be giving you some degree of monovision, one eye focused nearer in, to get better intermediate&near vision. How much monovision, where that near eye is focused, will impact how much intermediate and/or near vision you get. Unfortunately people's natural depth of focus varies drastically. A very tiny minority of lucky people can read a bit with a monofocal set for distance, but for most people I'd heard that vision getting blurry from 6 feet in is a good guess for a monofocal set for distance, which is why it matters how near the close eye is set.

You could ask him which monofocal he intends to use and post (perhaps on a different  page/thread about whatever the lens is, since those who have monofocals might not notice it on a page about the Symfony). There are some that claim a bit more depth of focus than standard monofocals (though not as much as the Symfony, which I consider a better option than monofocals for most people if they have access to it in their country), and some use materials that have less chromatic aberration (like the Tecnis).  
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sorry for the double post, the site seems to be glitching.
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sorry for the double post, the site seems to be glitching.
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The Staar NanoFlex is a standard monofocus IOL that has shown some ability to accommodate (perhaps due to its flexibility).  If used with some amount of monovisan, it offers some people great vision at almost all distances.  But according to my ophthalmologist, it's harder to hit the exact target acuity.
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hi! I m 26 years old with a posterior subcapsular cataract from years corticosteroid use(I have Crohn disease) and the past year it just got worse and it is difficult even to drive in the sunlight so I ve decided to do the surgery. I ve visited 6-7 doctors all with a different opinion but all told me it is in my hands to choose! Firstly i thought to go for trulign(the toric version of Crystalens because i have astigmatism) which imitates the adaptive capacity of natural lense of the eye but I ve read those lenses have a lot of risks aftere surgery and then I ve seen the Symfony which I believe it is the most appropriate solution for me! I ve found and a doctor to know how to operate with them but he told their new and to lower my expectations and what I am waiting from them!!(even though he put them in a few patients i guess he doesn t believe much in them and he told if they were so good everyone would put them )
So I would like to ask what is like to lose the adaptive capacity of the natural lense with a Symfony iol?? (to those who already put them) how is it to have an enlongated focus?? is it worthy it (not only costly but as an experience!!) or would you suggest to go for an monofocal aspheric iol ?? (the doctor told me not to risk it and have an aspheric monofocal and have an excellent vision far and put glasses for near but it is my choice)
PS : I have an active life I am a martial arts instructor and I dont want to lose that part of my life!!(that is why I want my intermediate and far vision to be best!!)
http://imgur.com/Hs3yXeu  
here is my prescription for glasses (if that helps)
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I've seen comments from many doctors that consider the Symfony their preferred lens now in countries where it is available, and some US doctors that say that if they had to have surgery now they'd go outside the US to get the Symfony. Studies put the distance vision with the Symfony as comparable to a good monofocal, so unless there are other eye issues I'm not sure why someone would recommend against it. Some doctors are just extremely conservative. Most people with premium lenses are happy with the results, a tiny minority with multifocals or the Crystalens/Trulign do have issues (but the Symfony seems to have a very low risk of problems, not  much more of a risk than a monofocal overall).  Some doctors  would rather not risk any complaints, and figure even if many patients might not be as happy with a monofocal as they might have been with a premium lens, at least they are less likely to be unhappy enough to complain.

However I figure a young patient is going to live with the lens for a few more decades than the typical cataract patient. Before the Symfony came out, I was willing to risk a trifocal since I figured I figured it was worth a minuscule chance I'd need a lens exchange to have a  result I'd be happier with for decades.

However which lens is best  depends on the needs of each patient since unfortunately no lens yet is perfect. Some surgeons still prefer a trifocal lens that provides better near than the Symfony (at the expense of slightly lower quality, but still good, at intermediate). Most (if not all) countries where the Symfony is available have also approved the trifocals.

The Trulign seems to have a higher risk of complications and a risk that it won't accommodate, and a higher percentage of people that need reading glasses than the Symfony. Someone I know with the non-toric Crystalens seems to have poorer low light reading vision than I do with the Symfony, but I don't know how much of that might be individual variation (though he is about the same age I am).

The major reason for going for a monofocal would be if you were concerned about potential night vision issues like halos (though the risk of that  seems to be fairly comparable with the Symfony as a good monofocal).

At your age I would suspect that losing near vision would be   more of a shock than with someone older who already has presbyopia and has lost some of their near vision. Monovision with a monofocal can reduce that, but then for some distances you are mostly using 1 eye which can reduce stereopsis (binocular 3D perception). Most people adapt to that and don't notice it. When I wore contact lenses in monovision (for early presbyopia), I didn't notice it ,but when I switched to multifocal contacts I noticed the close up world seemd a bit more 3D. If you had full monovision with monofocals, then that might be enough to reduce stereopsis for intermediate vision, which might be a bit of a concern for someone fairly active. (e.g. -1.75D of monovision leaves one eye focused at about 57 cm, about 22 inches, which is closer in than intermediate, though you do have good vision a little bit further out than the exact focus of the lens). I've gotten back into trail running & hiking lately and I appreciate the fact that the rocky (or icy in winter) trail ahead of me is crystal clear full 3D, though it could be with monovision it wouldn't be a big deal (I wasn't as active outdoors when I had monovision contacts,  I was swimming for exercise instead of running, and never thought to pay attention to the issue of stereopsis at the time).
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My friend, if I were in you, I'd probably forgotten anything related to martial arts AFTER any eye implantation. I don't want to disappoint you bu I knew a guy who was a diver/swimmer. His doctor prohibited him from diving and swimming as a sport after the operation. off course if you an instructor who does not perform the actions, it does not matter, I guess. There is always the risk of lens displacement. That becomes crucially important if you go for Symfony, which is a multifocal.
And about the lens, if your doc has said that your eyes CAN handle Symfony, then certainly go for it and don't think about other types of lenses. BUT, you have to find a very professional doc to do it, because it is new and needs a lot of care for operating it and determining the right power.
Unfortunately, in my case, because of my Nystagmus and Amblyopia and a weak capsular bag, Symfony is not an option. If it was, I would choose it %100.
good luck
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After eye surgery there may be some risk of lens dislocation for a while with a high impact activity, I don't know how long they'd suggest holding off of martial arts,  but as far as I have read, eventually there aren't any restrictions on activities.

I know that people swim and scuba dive after they've recovered from surgery (there are posts on the net from people who have) , I made sure to confirm that  before my surgery since I do both (even though I haven't yet since my surgery). I don't know if you are talking about high diving rather than scuba/snorkeling, but I'd imagine it also would be a temporary restriction.

re: "because it is new and needs a lot of care for operating it and determining the right power. "

Actually the Symfony is physically the same overall size and shape as the other Tecnis lenses (monofocal and multifocal)  that have been widely used for a while so any doctor familiar with them will have no trouble with the Symfony (and IOLs in general tend to have similar implantation techniques, even if the details do vary between manufacturers, its usually not much of an issue for a competent surgeon). The issue of determining lens power is also the same for the Symfony as other lenses, there is just a constant or two they plug into the equations that varies depending on the lens.
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After eye surgery there may be some risk of lens dislocation for a while with a high impact activity, I don't know how long they'd suggest holding off of martial arts,  but as far as I have read, eventually there aren't any restrictions on activities.

I know that people swim and scuba dive after they've recovered from surgery (there are posts on the net from people who have) , I made sure to confirm that  before my surgery since I do both (even though I haven't yet since my surgery). I don't know if you are talking about high diving rather than scuba/snorkeling, but I'd imagine it also would be a temporary restriction.

re: "because it is new and needs a lot of care for operating it and determining the right power. "

Actually the Symfony is physically the same overall size and shape as the other Tecnis lenses (monofocal and multifocal)  that have been widely used for a while so any doctor familiar with them will have no trouble with the Symfony (and IOLs in general tend to have similar implantation techniques, even if the details do vary between manufacturers, its usually not much of an issue for a competent surgeon). The issue of determining lens power is also the same for the Symfony as other lenses, there is just a constant or two they plug into the equations that varies depending on the lens.
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sorry again for another double post, the comment button didn't seem to be working so I clicked it again, but I guess the site was just slow. (though its a bug in the software for that to lead to a double post, there is no need for it).
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sorry again for another double post, the comment button didn't seem to be working so I clicked it again, but I guess the site was just slow. (though its a bug in the software for that to lead to a double post, there is no need for it).
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I had the black edge effect but now after 4 months that has largely gone.  I only notice it if I am very tired at the end of a long day, probably only seen it twice in the last month.
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Feedback after 4 months:
My two lens have now settled down.  My Toric right lens still focuses at about 7" to 1 yard, beyond that it gets blurry but my left eye is good at all distances. Unfortunately my brain has not swapped from right eye dominant to left so when driving I am fine until it rains, then I can only only focus on the windscreen.  I have to shut my right eye to regain distance focus.
I trialed a contact lens on my right eye last week. Both my surgeon and the optometrist suggested I would hate it as I would lose reading distance focus, but in a surprise to everyone it was fantastic.  Totally clear vision at all distances, in fact REALLY clear.  So now I am booked in next Monday for Lasic to permanently do what the contact provided. I am super thrilled with my Symfony IOLs.
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Man, I like the way you answer. It is clear you've done the research! So, thank you very much for sharing your experiences with us.
But, what you just said, made me more confused. (excuse me for my poor English)
What do you mean by mono vision? My doc, Mr. Stein, said both eyes set for distance with a mono focal IOL. I went to 3 other docs who told me the best option for me is the same thing Dr. Stein recommended. But, now you're saying that: "At your age I would suspect that losing near vision would be   more of a shock..." I'm really afraid my friend. Even right now with glasses, I use a big magnifier to read, but have no trouble seeing people in close. I don't see for example the wrinkles on the face of my dad in for instance 50cm but in 30 or 20cm I see them. So now that you've had both mono focal and multi focal, you're telling me that this would be a concern. don't you?
But, something that all the docs were completely sure of was the fact that Symfony is not good for me. One of their residents, who was a doc, too, told me maybe it's because of the nature of Symfony which finding the right axis is difficult.
You know what, I don't have anything to lose, man. And I am a risk taker; so thinking of my doc's being conservative makes me angry. It makes me rally angry if after the surgery, I find out that I've put all my eggs in one basket that was torn from the beginning and everything is worse that before.
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Monovision is setting 1 eye for distance and 1 eye for nearer in. Its commonly done for people who get monofocals to give them better near or intermediate (depending on how far in the near eye is set). Often doctors have people try monovision using contact lenses first (even if they don't usually wear contacts, its just a temporary test). Almost everyone adapts to a small level of monovision (like they'd use with the Symfony) so doctors consider that a safe bet, the issue is to see if someone is comfortable with a large amount if they prefer more near vision.

I'm surprised any doctor these would be talking about having both eyes set for distance with a monofocal, I would suggest trying to find out why they are suggesting that rather than monovision. One thing that crosses my mind is that perhaps you don't have an intact capsular bag to put an IOL like the Symfony into. Most premium IOLs need to go into the capsular bag where the natural lens was removed from. Lenses placed outside the bag are usually monofocals, though I think there are some multifocal options (though fewer than there are for placement inside the bag).

Other than that, if there were an intact capsular bag  there may be some other eye issues that lead them to prefer not to use a multifocal. Since the Symfony is fairly new (especially in Canada where it hasn't been out as long as in Europe) some doctors may be more cautious about it and avoid suggesting it if they wouldn't suggest a multifocal. Other surgeons I've read that have more experience with it seem more willing to implant it even when a multifocal wouldn't be a good idea.
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My friend,
Dr. Stein didn't explain anything to me. He actually saw me for 2 mins. Instead his assistant, Cathy, explained to me what Dr. Stein had suggested. But, on the other hand, wherever I went and to whomever I talked, I was told that Dr. Stein is a pro in his job, so this made me more confident and comfortable, that he is going to do the best possible choice for me. Now, I have to weigh these 2 things to see which one has more benefits for me:
1-I've been living with glasses since 24 yrs ago. The bad: I hate them, I still need to use a magnifier to read, they get dirty and I have to clean them everyday, they limit my visual zone or field. The good: I'm doing OK with them, I've got used to them for 24 yrs! I don't have trouble seeing near (not reading or working with PC.
2-Monofocal IOL set for distance for both eyes. The bad: poor near/intermediate vision, possibility of infection thus evacuating my eyes, needing reading glasses, displacement, I'm not used to it. The good: good far vision, more visual field or zone, not wearing glasses (at least for daily activities), being able to drive, maybe getting better from 20/60 to 20/50 or 20/40.
Am I right? This is a decision for life, man. Cathy said if anything goes wrong, they're not gonna take the lens out and it'll stay there for good. But she insisted that my vision wouldn't become worse than now, if it's not gonna be better and that the probability of destroying the operation with Dr. Stein is low, because he's done 200,000 operations till now.
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I did check them out and Dr. Raymond Stein was rated highly at https://www.ratemds.com/doctor-ratings/143169/Dr-Raymond-Stein-Toronto-ON.html
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The last thing I wanna mention is that my problem is rather more mental than physical. If I was your age, that would be different. My father was a driver of any type of vehicle you could imagine for all of his life. He tells me that right now I see more than he does and the reason he drives perfectly is because he is a pro driver and if given the right condition, he even can drive blindfolded. He says the reason of my stress is because I, haven't driven yet, not necessarily due to my vision.
Something I don't understand is that the other 3 docs said that the option of contacts is a very good option for me. I hate contacts. If I am to choose, glasses are better than contacts.
I really wish I could put Symfony, then I'd be probably out of this philosophical to be or not to be dilemma.
So my friend, please tell me everything you think is necessary for me to know so that my judgment be based on reality and truth, rather than propaganda and illusion.
Thank you very much
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thank you all for your immediate answers!! the doctor told me I will be fine continuing martial arts even in playing mathces but only after full healing(which didn t tell me how long this will take)..also I ve put a contact lens to stimulate a monovision but it wasn t for me it is causing kind of a headache and dizziness..and yes it seems very akward to have glasses for near but I think it is a habit after a while so I am leaning on the Symfony and if necessary reading glasses(we can t have it all after all) if the Symfony doesn t work for all distances...I was thinking if it s best to leave a 0,5D myopia so to have a middle ground solution and to don t need to wear reading glasses..also I would like to ask how is the night driving did any of you had any problems?? (now with the catarract I only have issues with lights which cause a huge glare due to posterior subcapsular cataract which is in the center of my natural lenses)..also the contrast comparing to natural lens(aka before surgery) how would you describe it??
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and also what scares me the most is the accommodating loss of the natural lenses and what would be like to have a any type of iol and that no one can show me how will I be able to see with any kind of iol to choose,now it s a blind choice that I have to take (every cataracts patient to be honest not just me ) that s what troubles me about the whole matter
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I had symphony lenses fitted in both eyes On July 15 last year I now have great vision at all distances

I was very concerned   about dislodging my lenses for several months after But the apprehension eventually wares off I took it easy for two months No heavy lifting or sport
Now I'm back to normal without any restrictions and glasses free
Tho I still wake in the morning and reach for my specs
Old habits die hard
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thank you for your response Garrry that's very hopeful!!! I am leaning towards Symfony too as I said previously..do you have any issues during night driving??..and after surgery there was a transitional period to get use to the iol or were you able to see "naturally" without any diffuculty or any discomfort??...
I m sorry about all these questions but they 've told me that noone in Greece had those lenses and they made me believe I m taking a huge risk putting those lenses but I don t see it in comparison to a toric monofocal and there isn t any other condition deside astigmatism which will be fixed with the toric version of Symfony!
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Yes that's wright. My capsular bag, as I said, is not intact and even if he had offered me mono vision, I wouldn't have chosen it. But, the problem is Amblyopia and Astigmatism + intact capsular bag.
My friend, you just pointed your finger exactly on what was my main concern. What if my doctor is over conservative and afraid of Syfony because its new? but I've seen posts like this :http://eyedoc2020.blogspot.ca/2014/12/amblyopia-and-intraocular-lens-implant.html
that discouraged me of Symfony. My condition is very complicated. They told me they haven't encountered a patient with my situation. (being Aphakia for 24 yrs after cataract removal)
I have to say one of the docs insisted on contacts but I didn't accept coz for me, it's enough. In addition, glasses are far less harmful than contacts.
The other thing is that I don't have the opportunity to go to Europe especially London to get their opinions. I really can't wait more for the technology to advance more.  
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First of all don t lose hope or faith poorya0014 having a Crohn diseace taught me that patience and hope are beyond gold..also I believe doctors don t want complaints and they choose the conservative option so as to have success (one doctor of mine told me that if I choose them, it was an institute,I will make friends!!! which was completely irrelevant beacause I asked him if he had operated with the Symfony lenses again!!) ..If I were you I d keep searching for more doctors near my area but if everyone was telling me the same thing I d chose their option..I m near your age and it ***** to not be able to see clear!!!!I drive 8 years and now I dont trust myself to put anyone in the car because I cant see and thats why I decided to do the surgery finally(doctors said to wait as long as possible but its dangerous to wait any longer) ..I m hoping the best for you and a solution to be found as soon as possible!!!
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I missed the part about the capsular bag not being intact, I hadn't checked back for earlier posts to see if that had been mentioned. That tends to rule out the Symfony since its a 1 piece lens. They tend to only put 3 piece lenses outside the capsular bag. There are multifocal options available for outside the bag that are just less common.
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You're very lucky my friend. Enjoy your glasses-free life! I wish I were in you. I even don't want 20/20 vision. I just want these glasses to be gone.
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Thank you man for your hope giving! I'm sorry to hear bout your disease. I completely understand and feel you.
Yes, all 4 doctors I've seen, have told me the best option for me is mono focal set for distance, unfortunately. Though I guess you're wright about doctors being conservative. One of the residents, who also was a doctor himself, told me that her mother had been operated with Symfony and the reason doctors say its not a good option for me is maybe because this type of lens requires risk taking which most of them don't want, as you said, a complaining patient. But, even he emphasized that it would be, at the same time, dangerous, too. Because if it's not gonna be alright, it'll make my vision even worse. But what I thought was that even if this worse case scenario happens, I can extract the lens. However, in my case it'll be very difficult to extract the lens because my capsular impact is not intact.
How old are you? What is your eye numbers? Hopefully in your case it was not a congenital cataract and you're eye is intact. So I'm really happy that you can get Symfony and wish you best luck with that. But, make sure to visit here and say your results.  
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I m 26 years old and my cataract was caused by 6 years periodic corticosteroid use.That's what all 8 doctors said to me also due to my young age as they claimed!But I ve found a doctor who had experience with Crystalens and Symfony(technis company in general) and it s the same cost to go to London or anywhere abroad(he told me 4500 euros for one eye with six months supervision which covers possible YAG laser as they told me it is going to be necessary while others told me 1900 for the surgery only which is huge difference!!!so beyond healthy risk its a huge cost for my family budget too but its my vision so I hope Symfony will be the best choice and I m not a gambler so I hope I dont regret my choice!!..I m thinking in the next month I m going to do it for my left eye firstly and we ll see after that(hopefully!)
I also have a minor astigmatism thats why I m going for toric version of Symfony
thats my perscription:
http://imgur.com/Hs3yXeu
If I do it I ll be back with my experience and results!!
Also if I were you I d visit some more doctors,you dont have anything to lose!!!
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Only a tiny minority of people need a YAG treatment with modern lenses. I don't know if you meant the 1900 is for surgery with the Symfony, or just with a monofocal.

If  I recall correctly, at least a year or so ago you could   get the Symfony from reputable surgeons elsewhere in western Europe for perhaps 2500-3500 euros, though that only covered the initial postop the day after surgery,  not the 6 month followup that you refer to.. and well under 2000 euros in the Czech Republic (depending on whether you have laser surgery), and somewhere in between in Croatia.
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1900 was for a simple monofocal toric lens from 8 doctors I ve search in my country only one who studied in USA(Michigan if I remember correctly) told he can order and operate with the Symfony or the Crystalens..4500 is total cost for one eye and 6 months cover even if I need YAG in this period (he told me its possible because I m young and my eyes generate faster cells thats his explanation,I dont know more)..in that cost 2500 it s the payment of the doctor 1100 its the cost of the lens and the rest its the anaesthesiologist and they use disposable tools as they explain to me for hygiene and to minimize the risk of infection after(also I dont know if everyone uses disposable tools during surgery and he told me to impress me)
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I m sorry I didnt explain it better previously
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The cost ranges I gave were total costs for preop, surgery, and day 1 postop from prominent surgeons (one of the posters on this site got his in Austria from one of the top surgeons in Europe who had quoted me something in that range), but then you'd add travel expenses and hassle. A quick check shows one site listing 1300 euros and another 1670 euros for a premium lens in the Czech Republic. I had a special introductory  major discount   that others won't get and hadn't checked current pricing. The odds are there won't be much followup in the 6 months postop other than them just looking to see that things are ok, which likely shouldn't cost much, even a YAG most often would happen after that time in the unlikely event you need one.  The risk of PCO may be higher with younger eyes, but as far as I recall most people still don't need a YAG with modern lenses (older lenses led to more people needing them).
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oops, I should add that I meant they were total costs *including* the Symfony or other premium lens, per eye.
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thanks for the information SoftwareDeveloper..I know its very expensive the exact doctor but he has the best technology equipment and experience in Greece so I think I trust him even the 4500 per eye!
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I am going ahead with the Tecnis Symfony lenses and the cost is $3,750 Canadian per eye all inclusive in Toronto Ontario and any adjustments or additional Lasik corrective requirements are included for 3 years thereafter.
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Hi my problem also was astigmatism in both eyes
So poor vision both near and far since I was a child
As I have previously stated I had both eyes fitted with symphony lenses on the same day
The results were instant
The halos and night driving were a big concern prior to my operation
My surgeon was very confident that it would be highly unlikely that I would experience halos
Nine months on I can honestly say that there has been no halos
Night driving is very easy now Though it has taken a while to get used to everything being so much closer
I must confess that I wear lightly tinted sunglasses for driving on bright days
and my eyes are more sensitive to bright sunlight
A very small price to pay
     Regards  Gary
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That s why I am going to be operated! I can t drive with sunlight any more it s impossible to see,it s a huge glare and I try with my peripheral vision to see because cataract clouded my central/direct vision)..It s difficult to cross even road in the morning!so besides falls they say its very dangerous for other reasons also!..Garrry thank you so much for your informations! one last question though what would you say was the difference opponent to the natural lens??beyond that you can see clear with the Symfony did you need any adjustment period where there multiple images or by the next day it felt all normal to the brain??(thats what worry me the most if I dont like the sensation)..PS: sorry for all the questions but I ve search this on my one and I am a bit nervous for the outcome because most of the doctors suggest the monofocal option and not for any other issue/condition with my eyes but because everyone or most part of the people(as they told me) in Greece just put monofocal and the doctors dont want complaints which sound ridiculous to me if indeed they have a lot of other options!!!the symfony for example noone told me as an option I told them and they agreed! If I havent told them noone would have told me about them!!!
the sunglasses are the least problem I think and I m very happy for your good outcome!!
Kind regards,
Koncard
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At least in the US the average cataract patient is in their mid 70s, so their needs are different than younger patients who will live with the result for decades and are more likely to be more active. They also likely don't want to spend the money for a lens they won't use as long, whereas someone young is making an investment in good vision for a few decades. In my case I figured that even if there were a small risk of a problem that needed  a lens exchange, that it was worth having the bet to have better vision for decades if it worked well  since most people have great results.

In my case for a day or two my near vision went in and out (with distance vision being great from the start), but after that it was fine and I never saw "multiple images" (not something I've seen anyway ever comment on, nor mention in articles).  My near vision did improve a bit, but not much, over time.  
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that s what I was thinking and I am searching a better option than monofocal or monovision! the multiple images where an example there could be some other inconvenience the contrast the focus I dont know and because I dont know the feeling/sensation of an enlongated focused lens opponent to natural accommodating lens of the eye..which is causing some worries (or cold feet to proceed to surgery)
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There is no different feeling/sensation, you just see everything in focus all at once without thinking about it, just as even eyes that still accommodate with a natural lens do, you just can't see as near as a young person with a natural lens. There is no different sensation to me than wearing regular contacts or glasses provided before, except that my distance vision is shaper than I can remember it ever being and I don't need to wear anything to get that. Unfortunately the loss of very near vision will be a new experience for anyone who wasn't yet presbyopic, but its less of a shock than it would be if you went with a monofocal. A trifocal may give better very near vision so in that sense it may be less of a shock to someone who hasn't had presbyopia, but I think the better intermediate of the Symfony and lower risk of halos make it a better bet still.
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as I said I have posterior subcapsular cataract so and now my very near isn t at its best because at the center of my vision its very cloudy so I guess it wont be much of a difference..thank you very much for your immediate answers though!!!In the end I think Symfony is the most risk-free option for me..thank you all very much!
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Sorry for my late reply I don't visit the forum very often
Answer to your question was that there was no adjustment period
other than colours being much richer and everything seemed much closer
As I have already stated I had both eyes done on the same day
I expected to be help into my car and then home to bed
I had Perspex covers over each eye but was able to see fine
obviously blurry due  to the the drops and anaesthetic drops
I removed the covers that evening and watched TV  although there was a halo around every light due to the drops I woke up about 430am I removed the covers from my eyes and everything was crystal clear
So sunglasses on and out to the seaside for the day
I was told not to drive till after my two week check-up But in reality I would have been ok to drive after a few days
But waited for my surgeon to tell me that all was well
Good luck with your choices Gary      






        


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I hope this isn't off topic but am wondering if anyone knows if and when USA will have symfony available  and why is it not available /approved  now?
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They have submitted data to the FDA for approval, but how long it will take isn't predictable, especially since it is a new class of  "extended depth of focus" lens that they had to decide on standards for. I've seen guesses that its likely within a year. It could surprise us and be soon instead.. or take longer. There are trifocals that have been out for a few years longer that aren't approved here, and last I heard they hadn't even tried for approval due to the high cost and long timeline  involved in that process. Unfortunately the FDA is infamous for being slow and conservative about approving new treatments and leaving us a few years behind the rest of the world which often gets to use American technology well before we do. Unfortunately bureaucrats tend to be scolded more if there is ever a problem with something they approve than for being too cautious, so they err on the side of caution. In addition politically they get pressure from those with existing products to be slow to approve competitive products. The Symfony is made by a company that already has lenses on the market in the US so perhaps that leads the company to have more political clout to get it approved. For whatever reason the approval agencies elsewhere in the world aren't quite as bad.
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Well, Cathy, Dr Stein's assistant, told me that his wherever I go, there is only 1 choice of IOL for me based on my eyes specifications and that should be put in posterior chamber. But, just today I noticed something: I think because I have a sever Nystagmus in my left eye (if right is closed I can not concentrate the left to read the Snellen chart and I have to stop my left with 2 fingers from movements to see the chart) and because of this most of the doctors in here, determined my left to be 20/200 but my optometrist, who is a very patient doctor, put time and determined my left to be 20/60!! How is it possible man? I guessed if this is why they think I have Amblyopia (one eye hasn't developed the brain connections correctly like the other eye) and thus Multifocals are not suitable for me, then I have to cancel the whole thing, man. This ain't right. They don't even want to talk to you more than 2 minutes. Man, I know you have got your own troubles but, my English *****! So would you please give me any info about multifocals for my case? for example the name, company brand, or a website I can read more? remember. they said only posterior chamber.  
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You might want to start a new thread/page asking about multifocals for your case (since people who had your situation aren't likely reading a page about the Symfony, and I think the US doctor here may not always follow threads about the non-US lenses as closely). I don't know of options offhand, I may check at some point, but you could check this site that has a database of lenses:

https://www.mylifestylelens.com/

Or do a search on the net. Lenses meant to go outside the bag are 3 piece lenses, whereas most premium lenses are 1 piece lenses that are meant for placement inside an intact capsular bag. I recall seeing mention in the past of 3 piece multifocals, but I don't know what is currently available.
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Re: "...Unfortunately the loss of very near vision will be a new experience for anyone who wasn't yet presbyopic, but its less of a shock than it would be if you went with a monofocal..."
Can you just tell me how this shock is? I remember once one optometrist prescribed me a pair of reading glasses, by which I could not see what was beyond 30 cm . But, I had a very nice reading experience. Do you think my near vision will be like that after mono focal IOL? I mean, for instance, tell me when you look at mirror, what do you see with a monofocal? Is it in a way that you DON'T see anything, see BUT WITH DIFFICULTY or YOU CAN SEE but the image is not clear and you have to get closer or wear your thin pair of glasses?
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Since that is a question about a monofocal you might try starting a new page/thread (along with your other monofocal questions) if you want to get comments from people with monofocals (if any are reading the site). I was an presbyopic for a number of years before my cataract so I was used to the idea,  but still didn't like it and fought it off using contacts in monovision and the multifocal contacts.   I was young enough that I hadn't lost all my near vision, and the thought of losing it all with a monofocal (or being forced into monovision with monofocals) was part of why I went for a premium lens. People with presbyopia gradually see their near vision decline over many years so they don't go through the shock of having it suddenly disappear. My near vision with the Symfony is better than it was before the cataract.  How much near vision you get  with a monofocal will vary greatly between people due to variations in their eye's natural depth of focus. A very tiny minority can actually read a bit with a monofocal set for distance, but for most people I'd heard the general expectation was that closer than 6 feet starts to get blurry with a monofocal set for distance, but perhaps others can give a better sense of it.  That is why monovision is useful with monofocals, and   the issue is how much monovision you'd go for, how much nearer one eye would be set than the other.
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Update.....I had my left eye done on 03/11/2016.  After one month and a half of that surgery and many visits to see my doctor I've gotten pretty much used to my new sight.  Halos at night are still there but with less intensity so they don't bother me that much while driving.  My sight is 20/15 but my near sight is not as expected.  When I read a book, read something on my cellphone or work on my computer I see a "grey shadow" behind and slightly up each letter/word.  This condition makes my sight tired after a while.  Does anyone have the same problem?
I just went and bought a $30 pair of 1.5 strength over the counter reading glasses and this effect pretty much disappears at a reading distance of about 18 inches.  Trying to read any closer than that would make the "phantom letters" appear.  Any comments?
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Have you tried using one eye at a time to see if this happens with only one eye? One question is whether its something having to do with the vision in just one of your eyes by itself, or if its something to do with your brain combining the two images in a flawed way for some reason leading to a slightly doubled image perceived as a shadow. Has your doctor any comments on the issue?   I'm guessing this doesn't relate to which IOL you have (I seem to recall posts with vaguely similar problems   with people with no IOL or different ones, but I'm not positive), but some other aspect of your eyes, an issue combining vision from the 2 eyes, perhaps  residual astigmatism or corneal aberrations that when the image isn't in sharp enough focus cause you to perceive the glitch as a shadow, but when in sharper focus your brain tunes it out.  
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oh really? and you're having this problem with Symfony? or is it a monofocal iol? I'm going to put a mono focal iol set for distance vision in my eyes so it would be a great help if you could tell us more bout your experiences. How much blurry your vision is?
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it seems no 1 likes to answer my questions in my topic
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Man, is there any doctors around in this forum? Coz no 1 visited my topic. I am in a hurry coz i have to decide to proceed to iol master test or not.
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You might post that comment on the page you started, perhaps the doctor who posts on this site may notice (there is only 1 that often posts, there was another that used to occasionally post but I haven't seen something from him in months). I think the US doctor that sometimes posts on this site may pay less attention to this page since its about a lens not available in the US so its mostly those of us who have gotten them (or consider getting them) that are posting.
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Thank you Garrry very much for your answer it gives me courage because I m about to proceed to surgery with the Symfony in may or june..we'll see(hopefully!!!)
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Just a short question.
Have you read about the effects of temperature on IOLs specially from Abbot? coz recently I read bout a woman when she was getting her hair done at a saloon with a special hair drier that the whole head goes into it, her contacts started to melt and caused her eye problems. It just reminded me of how important the environmental effects on lenses could be; especially for me who am living in Canada where the weather is sometimes -10 c or lower. Apart from that, I thought what happens if I go to a sauna with my IOL for instance?
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An IOL is inside your eye just like a natural lens so its shielded from outside temperatures. It is likely more durable when exposed to temperature variations than the rest of your eye outside the lens, or the natural lens you have now.  This winter I was out exercising when the temperature was perhaps 10 degrees F (= -12.2 degrees C), that isn't a problem (nor would exercising in even colder weather be an issue, we just didn't have any colder mornings this year on my workout days). I haven't been in a sauna, not something I'm that into, but I've never heard of it being an issue in anything that I'd read. Again the IOL is going to be more durable than the eye tissue surrounding it, and I doubt they'd have a sauna hot enough to to do damage to people's eyes (or that you'd remain in one if it were that hot).

I'm surprised that someone could have their contact lenses melt from a hair drier, I would suspect if the temperature at her eyes were that high it'd be enough to be damaging the eye whether or not the person was wearing contacts, but admittedly I hadn't researched the issue.
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Tnx man. At least in this regard, you made me confident.
Yes, the contacts had been like glued to her eyes. They were not melted but I don't know how to say it.
And I guess what you said about both eyes being done with far IOL and afterwards, both are done with raindrop inlay, could be a good option for me. I have to ask if Dr. Stien confirms and agrees upon this. no matter if I lose 1 or 2 lines in Snellen chart for my far vision, as long as I can drive and read without glasses, it worth it.
I've read stories of people explaining Symfony or any multi focal to have a monofocal.
But, again, I'm totally confused.
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The Raindrop inlay is not indicated for use in people who have had cataract surgery.  There may be surgeons who will do it, though.
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I have Symfony IOL's in both eyes.  The problem appears when using either eye independently or with both eyes at the same time.  My doctor says that he has not heard of this "shadowing" from other patients and that he will do some research with other doctors on the issue.  I think I've waited long enough for both eyes (and the brain) to get used to the lenses so I'll go to see my doctor this week and see if there is something to be done.
I'll keep on sending feedback since I think this site is very important for other people to be informed.  Thanks Software Developer.
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I have that same "shadowing" and I've not yet had cataract surgery.  I suspect it might be residual astigmatism, but that's just a guess.  I was highly myopic but had ICL implants a few years ago.
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I had Symfony IOL's implanted on both eyes.  My far and medium distance sight is very good.  Watching TV is a delight as I can almost see the pixels on the screen (very sharp sight and colors).
My problem is with near vision.  Words on a label, a book, my cellphone, my computer screen have what I call "a shadow".  I basically see double.  Now, for some unknown reason when I use my 1.5 over the counter reading glasses the shadow simply disappears and I don't see double anymore.  It is weird since I know those glasses should not correct any astigmatism.  Reading glasses are basically "loupes".  I got the Symfony IOL's because they are supposed to be the latest technology (extended depth) and I wanted to get rid "completely" of glasses (a bit disappointed).
Probably monofocal IOL's are simpler in the way they work and so results are better in terms of consistency (good results I mean).
Good luck with your operation.
Regards
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re: "reading glasses the shadow simply disappears....those glasses should not correct any astigmatism"

Even if the glasses don't correct for astigmatism  they do change the overall focal point and make the  image clearer . Even if there is still distortion due to astigmatism, the added clarity may make it easier for the brain to tune it out. Monofocals wouldn't be any different in terms of astigmatism, they would merely require you to wear reading correction even more of the time.   If you have astigmatism, they can correct it via incisions now, some  doctors do it even with the patient sitting at their exam slit lamp since it isn't as big a deal to do a surface level incision as it is to do something like   cataract surgery where they need to work inside the eye, or even lasik where they need to deal with a flap.

All the studies and comments from doctors involved with them suggest consistent good results with the Symfony and a risk of visual artifacts similar to a monofocal. There are a small % of people with glitches even with monofocals I recently watched this video

http://eyetube.net/series/daily-coverage-caribbean-eye-2016/onoga/

talking in part about the Symfony where it mentions a point I've seen other surgeons make: that diffractive optics are used in high quality camera lenses and other places where optical quality is important. Diffractive optics may not be "simple" to lay people, but they can provide consistently good results:
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Roberto, what is your current manifest refraction?
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Had my surgery yesterday 15.00 h. One eye had a retinal tear in sept 2012. Slowly developped a cataract. Wanted to wait as long as possible to get the latest greatest.
Was set on the FineVision in 2015 but found about the Symfony in the fall. Seemed to be the best option.

I live in NL so we have a lot of choices here. made an oppointment in January. The  cataract was not bad and the optometrist doubted if needed one but believe me: It was very foggy in my eye.....So the surgeon checked my eyes in april 2016 and yesterday was the day.

I never felt any  pain, I used my own benzo to calm me down (pyrazolam, a research  chemical that is purely  anxiolytic, I become a very  irritable person with midazolam which they still used but in a minute amount).

Operation went fine, just the surgeon didn't want to push the polishing since there was no vitreous gel in my eye The operation  was absolutely painless in  fact I never felt any discomfort.

Results:
1-2 hours: no Eyesight)
2-8 hours hazy Eyesight. Extremely bright halo's and extremely wide pupil.
9-16 hours (slept)
Woke up had to let my eyes checked: lens was centered well, eyepressure was alright, Pupil was still hure though.

During the day Eyesight got better and better. Pupil started to shrink a lot and no more halo's even not around bright lamps and lights.

End of the next day: vision at distance is extremely sharp. I have had -4,5 in that eye since age 12. It is now as sharp as it was with a lens on it.but colours are so beautiful and better than in  my left eye.

Intermediate vsion (say1 metre to 4 metres) pin sharp!
Near vision: 60 cm-1 metre is good closer than that is also getting better. I can read at about 40 cm or so but it is quite blurry.

The lens is set to -0.5 D but it is wait and see if that target was reached.

For the first day I'd say the results are really well. If near vision enhances a bit I am already perfectly satisfied. But I think PCO will come since not all cataract could be removed....

In  short;
Very happy since there are no halo's or glare (there is some glare btw), sharpness of vision and colours are great from 80 cm onwards.

Again?; early days, will keep you posted!
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3rd day after surgery:

Everything is fine. Had a dry eye waking up yesterday and walking through the Woods with sweet made my eye a bit irritated. Today I woke up with no strange feeling.
Difference with yesterday (see above) is that the continuous snowshower of floaters has abated a lot. I  would call these sinker, they  are not floating they seem to be falling  down all the time with  some larger fragments. The larger fragments have  gone, now only  very tiny ones reamin. And they  are much less in number.
The very smallest pri
Nearsight has become quite a bit better now. Might be because I do not wear a contact in  my  (good) left eye. It is about -2 (-2.25 actually) and at 45-50 cm the print on the screen becomes blurry. Great! My rigth eye has to take over and it does and I can  see now almost perfectly from 45 cm onwards.

Intermediate and long range sight is fantastic!

The finest print like on contactlens fluidbottles is not readable. Almost readable at 90 cm distance (armslength). May  be it will get better too. Who knows.

If it stays this way I am 100% satisfied. Finger crossed!
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Glad you are having  good results. You might just direct people over to your page/thread on this rather than posting on both, this one is a bit long as it is.

People seem to vary in terms of how long it takes for their near vision to come in with the Symfony (or multifocals).  I had good near vision within a couple of days, but that might not be typical. Unfortunately I haven't seen any studies on the issue.  Before surgery I was considering a trifocal, and a surgeon who had compared the Symfony with the AT Lisa Trifocal told me in email that neuroadaptation on average took longer with the Symfony to get the best results. Unfortunately he didn't followup with a request to be more specific on that issue, and since I didn't choose to get my surgery there afterall  I didn't try emailing again. (the lack of response was a mark against using him, but I wound up choosing to go to  a  lower cost country or I might have given him another chance)
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Well I have no trouble posting in two threads, One where I can be detailed and another (this one) to be shorter.

Not following up on an email for me is a strike against too btw. I think exactly the same. Which country did you go to btw?

I also considered trifocals. FineVision to be exact but changed my opinion.
I wasn't happy about the remarks on halo's. Also since Symfony is a pretty regular lens in design I figured surgery would be quite easy.

A may be strange reason of minor importance is the fact that I noted some surgeons affiliated with FineVision were being negative in various papers and on a congress on other lenses especially Symfony. I don't like that a whole lot....Minor importance but noted.....

How long has it been since you had your eyes done? When was the final result reached? Thx for your answers and the excellent information you already provided!
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re: "pretty regular lens in design"

Yup, I figured that lowered the risk of going with the Symfony even though it was fairly new when I got it. Its the same overall shape&material as the widely used Tecnis monofocals (and multifocals) so it was only the optics that was new, and much of that can be tested on an optical bench outside of the eye, and with some initial clinical studies showing good results to match.

The trifocals are also good choices still depending on whether people prefer good very near vision at the expense of slightly less intermediate (and a risk of halos). The reports I'd seen suggest the AT Lisa Tri and the FIneVision are fairly comparable, with some surgeons giving a slight edge to one or the other (on balance more with the AT Lisa Tri I think). I don't know how the  new Alcon Panoptic and the Rev-IOL tri-ed (forget exact spelling offhand) compare. It is true that there was at least one surgeon who is a co-inventor of the FineVision so there may be some bias.

As I posted earlier in the thread, I went to a top surgeon in the Czech Republic (a common medical tourism destination for the UK I discovered) rather than going to the UK  and paying more.


As I posted at the start of this thread, my eyes were done in early Dec. 2014, so about a year and a half. By my 1 week postop I was already at almost 20/15 distance and 20/25 at best near. Subjectively it seems there may have been a very slight improvement over the next weeks, but  since then for distance they just confirmed they were at least 20/20 and didn't get an exact acuity for distance.  I should sometime to see if I got past 20/15.  My near acuity hasn't budged from 20/25, though I hadn't checked it for a while (I should just get a near chart).
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Hi.

Thx for your reply and information. I saw infomercial on the panoptix last tuesday and it seemed interesting but also more like another trifocal. I wonder if perfecting  this approach will deliver vastly  better optics but like you say most trifocals are giving people great options and in general are a huge advance over mono or bifocals.

I find this subject in itself quite interesting and will look into the Panoptix and Rev IOL.

This day my near sight got better during rhe day but my work is behind a screen all day so may be it ajusts to it. When I came home and started to wrok again my nearsight was probably equal to yesterday. So I think in the end nothing has changed significantly.

I noted my eye feels dry when I wake up and it stays that way during the day. Got me some eyedrops and they alleviate it. Also note flickering when moving my eye which seems to be pretty normal and will take months to abate.

Still delighted with the results and happy.
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Hi Roberto,  had the same issue and it was astigmatism. My right eye was not focusing colors correctly so I saw grey shadows, particularly on computer screens with black text on a white background.  Lasic on my eye fixed the problem.
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Now that Symfony has been approved by the FDA for use in the USA, does anyone know when it will be available, and/or what US cataract surgeons have experience using it?
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Where did you have your surgery done?  In the US, or in another country?  I assume that you and your surgeon must be in the same, or a nearby, country (since you have been able to continue to interact with him to get explanations - and perhaps further examinations).  But maybe you travelled to get this done; it would be informative to hear whether you think travelling some distance has turned out to be a problem.

Was he a guy (or woman) who already had done a lot of Symfony implantations, or was this an early experience for him too?  I'm asking this in order to get some feeling for how important it is for a surgeon to have previous Symfony experience.  I know that Abbott (Technis) claims that the Symfony is precisely the same form factor as its existing and long-used monofocal lenses, but I wonder whether there might be some other kinds of differences beween the two types nevertheless.

Do you have any reasons to suspect that your horrible experience is due to (a) the Symfony IOL itself, or (b) shortcomings of the surgeon, or (c) something about the structure and condition of your own eyes that couldn't have been detected by anyone in advance, and might have happened with any surgeon and any lens?

Any first-hand information that you can supply would be very interesting and useful.
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I'm not sure if this is directed at me, but I'm in the US but had my surgery done in Europe since the Symfony wasn't available here, and only had the day 1 postop done over there.  Traveling wasn't a problem. I was the first patient to get the Symfony with the surgeon I used, but I wasn't concerned because he had done 40,000+ surgeries and the Symfony is the same physical shape&size and implantation method as other Tecnis lenses (their monofocal&multifocal).

I'm not sure who had the "horrible experience" you are referring to. If you are referring to me and the flickering side effect (which isn't "horrible" anymore), as I mentioned as far as I can tell it has nothing to do with the lens choice but is due to my iris jiggling  (iridodonesis) when the eye moves, a very rare side effect (not something they have statistics on, I get the impression that it may be only one out of tens of thousands of cases, or at least several thousands) that isn't something they couldn't  guess at in advance, especially  since only a subset of those who do have iridodonesis have a visual artifact.  The artificial lens is smaller than the natural lens and so in some people the loss of support for the iris after cataract surgery  can lead to movement of the iris.
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No, no, SoftwareDeveloper, it wasn't you - I was responding to "789Chris", whose post appeared at the very bottom of the list when I responded to it.  Now it appears much farther up.  In any event, he had said:

"789Chris
I had both eyes done with Symphony IOL 1 month ago and still have significantly blurry vision (20/50 in one eye and 20/70 in the other). I also see extremely intense starbursts and halos so much so that i think i will never be able to drive at night. Extremely disappointing and surgeon does want to give me any explanation.
Jul 29
Report "

I haven't found any further posts from him, so either there is some interesting story that we will never know, or else he is some kind of troll.  It is certainly the most negative story involving the Symfony that I have seen yet.




















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Sorry for the confusion, I didn't see the 789Chris post. I didn't think your post  was directed at me, but since I started this thread/page    I responded just in case as the default person replies are addressed to.

Unfortunately even with a monofocal some people can get problematic halos, there is no lens yet that doesn't give them to some people. Even those with a natural lens still can have halo issues. Also, most studies of halos are done at 3 months or 6 months or so postop because many more people have halos temporarily in the first few weeks/months postop, and the poster was only at 1 month postop. Even at one month, someone's eyes could still be healing.  In this case its also possible he might have residual astigmatism or PCO or some other eye condition unrelated to the surgery.  Unfortunately most people who have good results won't post afterwards, so its only those with issues that tend to post.

That post is recent so I doubt there would be any updates, if none are posted you could always try sending the poster a private message. In case you hadn't used them before, I'll note that Medhelp alerts the user that they have a private message via the email they registered so they are more likely to respond than to a public reply they may not notice.
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I finally took the decision to take the surgery 26/07/2016 and I am more than glad that I did!!! I am having the toric Symfony for both eyes but the left is set to -0,5D to enhance the near vision(which it did! 50cm and far my vision is pin sharp!)
1st day I saw 2 halos around every source of light but crystal clear vision!
2nd day the 2 halos disappear k everything is pin sharp!the colour is amazingly clear and bright even before catarract when I was child my vision wasn t that good!
3rd day my vision is getting better and better ( I am having dry eye at times but they said its common issue for the 1st week)
I am more than happy for the Sumfony lens though and I recommend those iols for every patient who has catarract at younger age(I am 27 years old) and the vision is more than great even though it is a bit strange to get used to it but its too soon!the doctor said to wait one month to see how near will I be able to see to prescribe glasses for near even though now I can read but with my hand almost stretched!(as I said my eyes focuses at 50cm and far).for example I can t see when I am eating its blurry or to cut my nails!( it s funny I know but its impractical for those tasks..so I am going to need I little help with glasses for very near tasks but I can read even the little letters at the bottle of the drops with my arm almost stretched!)
Also my distant and intermediate vision is greater than ever!!!!
I drove at noon today there were a little issue with the headlights of the opposite cars or the lights of the road(tiny halos around every light) but not an issue at driving as it was with catarract..I expect to get better it s only 3 days from surgery!Again very glad with the toric Symfony! I don t know how s the feeling with other iols but I would do again the same choice!I was very hesitant to go on with the surgery but I am glad I did at last!so whoever has second thoughts I am telling you go for it you won t regret it , if it s ok with your doctor of course(here in Greece every doctor told me to go with monovision and monofocals even though I was appropriate candidate for the Symfony and I am glad for my choice after all!!!)
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Very glad you are having such wonderful results.  Did you go to another country or use a doctor in Greece who advised monofocals?
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Very glad you are so happy with your results.  Did you go to a surgeon in another country or use one in Greece who recommended monofocus?
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I had Symfony lens implanted in my left eye 24 hours ago. As instructed, I kept protective padding over eye until this morning so did not see the result until approx six hours ago. At first vision was misty, like steamed up spectacles, but this has now almost completely cleared. As only one eye has been done so far I have to cover the other eye to assess the Symfony - it's amazing! It's a bright sunny day and I can see clearly to distant trees yet also easily read my iPhone screen. I'm reading a paperback novel set in 10 point with ease. Using both eyes is better still, the right eye needed only a -1 corrective lens so the combination is perfect. I do have a cataract in the right eye but it does not yet impede my vision. Re the brighter colours reported by other posters, pink is suddenly much brighter. My Built laptop bag appears almost day-glo with my new eye, though quite subtle deeper pink with the other eye. I can see I will have to reassess my wardrobe and weed out the scarily bright clothes (smile). I am posting this on here because I had never heard of Symfony lens until my consultant recommended it to me after I expressed an interest in multifocals. Then, of course, I googled and found your posts.
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Update 48 hours after Symfony lens implant. Delighted beyond belief. No haloes, no starbursts so far. Especially impressed with evening and night vision, which is where I had had particular difficulty. I am 69 btw and I hated the elderly hesitancy I had noticed over the past two or three years when walking outside during the evening and also going up and down flights of stairs. All gone - I feel 20 or even 30 years younger - pre-presbyopic and pre-cataract impaired.

During the evening I was able to read the paper, use the iPad and iPhone with ease, all while watching television - everything in focus just like it used to be. In fact, better than it used to be because I'm not wearing contact lenses - just so happy.

PS Thank you SoftwareDeveloper - your postings and experience on here gave me the confidence to go with my surgeon's recommendation for the result I wanted.
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Excellent outcome, we're all very happy for you!  If you don't mind, could you share what your Rx was before, and what your manifest refraction is now?
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Hi John C Hagan 111 MD and SoftwareDesigner, thank you for your excellent posts on the Tecnis Symfony IOLs. I have an astigmatism of about 1.25D on my left eye and both eyes are about -5.0 so I am quite myopic and have to wear glasses all the time. I am a musician and needed to find a way to read music charts sometimes 5 pages wide and about an arms length and 4 inches away. I found a solution about two years ago with Essilor 360 degree lenses. They worked great however I realized then that I would need 3 pairs of glasses at any given time. Now my left eye with the astigmitism is getting blurry and I was considering getting IOLs. I have no cataracts and have never had any issues with my eyes. I am 64 years of age and would like to correct my astigmatism and myopia for good if possible. I am looking for a practical solution however unsure if I should go this route. The Essilor 360 seems to provide that extended focal depth and 3D effect some have experienced with the Tecnis Symfony IOLs, with my left eye now getting blurry in that 3-8 foot range and my right dominant eye seems to see much farther than expected I just can't find anything out there that suggests it would be a good way to go if you have no cataracts. Thank you for your assistance!
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Sorry this post is a bit late. The procedure you are referring to, of replacing your natural lens even though you don't have cataracts  is called refractive lens exchange (RLE) or clear lens exchange (CLE), if you wish to search for those. The procedure tends to be more common outside the US where they've had a wider selection of premium IOLs available to make it useful, due to the FDA being slow in its approvals.

Are you able to wear contact lenses, even for a short time? Contacts have improved over the years, so if you hadn't tried them in the last decade or so you might give them another shot. You could try a multifocal contact lens to see if that works out well for you before considering an IOL, or contact lenses in monovision. Both of those would be useful tests also, for instance to see if you can adapt to a tiny bit of monovision. (with the Symfony, a bit of micro-monovision, not enough to have much impact on distance vision or stereopsis, can be useful). A multifocal contact would also allow you to try to pin down where best to focus your eyes, since it sounds like you might wish them to be focused at intermediate distance rather than at far distance, to be able to give you enough range to see things up fairly close. (though 4 inches is going to be a bit of a struggle to get to with any contact or IOL lens).

It sounds like the astigmatism might be complicating issues (and does impact whether to use a toric contact lens or not, which can be harder to fit)  You might consider getting the astigmatism corrected via an incision, even without lens replacement surgery, if that might help. Larger amounts of astigmatism tend to be corrected via a toric IOL if you have lens replacement surgery, but  small amounts are usually corrected surgically using an incision (either via blade or laser), often a limbal relaxing incision (LRI).  The amount you mention is on the borderline where some doctors might suggest a toric, and others an incision. Some surgeons will actually do an LRI at the slit lamp in their office since its a minor procedure since it doesn't involve actually putting anything in the eye, merely a surface incision, or they can do it using laser. So if the astigmatism is an issue you could ask about perhaps getting that corrected. If you are definitely going to have lens replacement, its best to wait on that since they can plan the incisions for the surgery itself to counteract part of the astigmatism, in addition to whatever incision they add to correct the rest.


Although the surgery is extremely safe, no surgery is 100% safe and someone winds up being the "statistic", so its something to consider but   to be cautious about. Eventually everyone who lives long enough needs cataract surgery, but the longer you wait, the safer it gets and the better IOLs they will have.Its like the issue of buying a new computer or smartphone or TV, the longer you wait the better options you'll have.. but in the meantime you live with a less optimal solution.
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Also, as I note in a reply below, another option to look into is to get laser correction for the myopia and astigmatism,  then use a corneal inlay to deal with presbyopia.
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Hi SoftwareDev, KKinCa, and all posters. I have some updates as I have gone in for my preoperative meeting here in Toronto with a very experienced Cataract Surgeon with over 150,000 eyes in the last 20 years and with all the latest technologies including the Catalys, Femtolaser, Lasik, PRK, ICL and IOL.

I have to update my condition somewhat as I was diagnosed with an onset of Cataract in my Left eye that is causing my blurring. My dominant Left  Eye has diminished over the last 2 years to -6.25 from -5.5, no astigmatism. My Right non-dominant eye is steady at -4.5 and +0.50 Cylinder and 145 Axis. They have determined I would be a good candidate for the Tecnis Symfony Extended Range of Vision (non-Toric).

They have been using Symfony IOLs since they came out and nthe new EROV since Health Canada approved in 2015. After my tests the technician and consultant said you are going to love not needing glasses. I hope they are right ;-) I will be going in to surgery next Monday 07-Nov-16 for the right non-dominant eye and returning the next day for the Left and again the following day for post-op.

The slight astigmatism as SoftwareDev explained can be done at original lens removal. The slit as I understand can be placed to offset the astigmatism, remove the lens and then insert the new lens.

I also understand that the opening is so small that they let it heal without sutures.

Just a correction on my statement re reading music and my distance for the Essilor 360 was set at my arms length plus 4 inches or 1 metre, or 40". I will be happy to wear readers if necessary and hope to achieve optimum sight for intermediate sight including computer and reading music, both at 40" or so.

Thank you all for sharing your posts and experiences and I will be back to share mine.
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RE: HenryEyesOnEarth

If you want an implantable lens and don't have cataracts  there are lens made specifically for that purpose and they have the advantage of being removable (cataract lens are not considered "removable"). The Visian ICL is for myops, so you might consider researching that instead of cataract-specific lenses.  ICL lenses go in behind the iris, not in the capsule bag like IOLs.

Astigmatism and myopia are easily, promptly corrected with lasik.  You go in to surgery blind and walk out with vision equivalent to the best contact lenses you've ever worn.  It's amazing,fast and almost painless.  Not sure why you struggled with glasses if only myopia and astigmatism affected your eyes.

At 64 you are now also affected by presbyopia which lasik does not correct (in the US).  I did lasik 15 years ago and I was a -8 with 1.5 astigmatism.  Post-lasik my eyes remained stable at 20/20 until the cataracts appeared.
If you are developing "blurry" vision in one eye and are certain you do not have cataracts- ask your dr about presbyopia.  That's "old eyes".  Sometime after 40 our eyes develop it- it's just part of ageing. It's why you can buy "readers" in drugstores--everyone gets it eventually

Now that Symfany is approved in the US, I am scheduled for cataract surgery in ten days.  Since the Symfany lenses are not yet stocked in the large hospitals/surgical centers in Los Angeles, the drug rep has to bring them to my surgeon. My dr has implanted many of Abbott labs other lenses, so I am comfortable being his first Symfony patient. I will update post-surgery.
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re: "at 64"

At 64 years old, he has to be already familiar with presbyopia given the level of impact it would have had. I'll add that  in the US there are now corneal inlays, the Raindrop and the Kamra, which are approved to deal with presbyopia. They are removable lenses inserted just below the surface of the eye. They don't correct for myopia or astigmatism though, which would need to be handled via laser correction. Surgeons differ regarding whether they think surgical correction via those or an IOL is a better option, both are things for someone that age to consider with different levels of risk and benefit.

re: "has implanted many of Abbot labs other lenses, so I am comfortable being his first Symfony patient"

Yup, it seems a safe bet to use a surgeon that has used other Tecnis lenses. The Symfony is implanted the same as the other Tecnis lenses, it is the same overall size&shape and merely has different optics.
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Yes Presbyopia set in at around age 40, I was so frustrated chasing around to find the right focal point like a brick in the wall, tilting my head and getting neck pain, eye strain and feeling stuck trying to read music. I would need 3 pairs and thank god my wife is far sighted and drives.
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RE: HenryEyesOnEarth

If you want an implantable lens and don't have cataracts  there are lens made specifically for that purpose and they have the advantage of being removable (cataract lens are not considered "removable"). The Visian ICL is for myops, so you might consider researching that instead of cataract-specific lenses.  ICL lenses go in behind the iris, not in the capsule bag like IOLs.

Astigmatism and myopia are easily, promptly corrected with lasik.  You go in to surgery blind and walk out with vision equivalent to the best contact lenses you've ever worn.  It's amazing,fast and almost painless.  Not sure why you struggled with glasses if only myopia and astigmatism affected your eyes.

At 64 you are now also affected by presbyopia which lasik does not correct (in the US).  I did lasik 15 years ago and I was a -8 with 1.5 astigmatism.  Post-lasik my eyes remained stable at 20/20 until the cataracts appeared.
If you are developing "blurry" vision in one eye and are certain you do not have cataracts- ask your dr about presbyopia.  That's "old eyes".  Sometime after 40 our eyes develop it- it's just part of ageing. It's why you can buy "readers" in drugstores--everyone gets it eventually

Now that Symfany is approved in the US, I am scheduled for cataract surgery in ten days.  Since the Symfany lenses are not yet stocked in the large hospitals/surgical centers in Los Angeles, the drug rep has to bring them to my surgeon. My dr has implanted many of Abbott labs other lenses, so I am comfortable being his first Symfony patient. I will update post-surgery.
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I have the ICLs and have been happy with them.  I had much worse myopia (-10/-11) and astigmatism, and those lenses allowed me to live a normal life.  However, the risk of cataract is increased with them, especially in older people, so that's something to think about (although many people develop cataracts anyway in their 60s and 70s).
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That is why the Symfony is a good choice for me with the onset of a Cataract. SoftwareDev mentioned however a chance of Posterior capsule opacification (PCO) and that can be dealt with easily after surgery with Femtosecond Laser.
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who is your L.A. doctor?
i am looking for a second opinion. i need an IOL and thought the symfony sounds my best option but my current dr says absolutely not, he wants to put in crystal lens. i hear crystall can have embedding issues so it stops accommodating in a percentage of people. when i asked why he simply stopped me cold and said no... i want a  better explanation than "no".
i am in LA so am looking in this area...
thanks
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I would be curious what the reasoning is. Some doctors are experts in medicine, but aren't as familiar with optics and seem to confuse the Symfony with a multifocal, and some doctors had bad experiences with the old multifocals (and aren't even aware the newer multifocals have also improved quite a lot compared to old versions).  Doctors are also human, and some can find an approach that works well  enough for them like a particular lens, and be hesitant to risk trying something new.

The studies I've seen show a higher percentage of Symfony patients are free of glasses than Crystalens patients so it has a larger range of vision. That also means if you get the lens targeted for intermediate distance, it would also give more near vision. A small minority of the Crystalens patients reportedly don't get more vision from it than they would a monofocal, and there may be some higher risk of other complications, which is one of the reasons I didn't go for it.

In terms of an LA doctor, I don't know of any offhand, but you might start a new thread asking about good LA surgeons (since some people may not care about the Symfony and not read this long thread). Also many cities have either newspapers or magazines that publish a "best doctors" list every year that is based on asking doctors who they would go to if they needed treatment (figuring they are have connections to hear who is good and are better able to evaluate another doctor  then a typical patient).

You might try searching the net for Symfony and LA (or Los Angeles) for any doctors already promoting that they are using the lens or looking forward to it, or who were involved in the clinical trials . You may even see  hits show up in the trade literature if a doctor is prominent. Unfortunately LA is such a big metro area that often they might use the name of the particular   area nearby city they are in rather than LA.
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You may find someone on www.ratemds.com in LA. I think it is a world wide site. Good Luck!
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Still looking for an LA doctor? My excellent SF doctor who originally rec. the Symfony is now @ Doheny Ctr in Fountain Valley: Benjamin Bert.
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I had the symfony fitted a couple of months ago in one eye and am potentially having it removed.  I'm going to try the Tetraflex instead.

The halos at night around headlights are quite severe for me with the symfony, I'm managing because my other eye still has the natural lens in, also I've had a separate eye test that showed a definite reduction in contrast sensitivity compared to the vision in my left eye; faint letters on the chart weren't visible at all with the synfony, it's a though it was a blank chart but could be seen with the natural lens.  Looking at objects around the house, there just seems less detail compared to the eye with the natural lens.  When looking at a person's face, lines seem to be smoothed out.  

For some reason I ended up with a slight astigmatism after the surgery, which I believe is a risk for cataract surgery but even with wearing glasses to correct it the halos are there.  With the astigmatism the accommodation doesn't really work, instead letters have ghosts that interfere and make the text unreadable but it does accommodate at least for text on a phone with the astigmatism corrected but not really enough for small print.  

If there are ceiling lights above me switched on, there's kind of haze in my vision.  

Even the TV has glare around it.

I suppose if I'd had both eyes done, I wouldn't notice the reduced quality in vision compared to the natural lens.  

The reason I'm going for the accommodating lens instead; it's essentially a clear mono lens that can move, so hopefully won't have as bad halos or reduced contrast.

I may be a one-off but I'm pretty disappointed and just hope it can be removed safetly enough to have an accommodating lens put in.
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re: "accommodating lens instead; it's essentially a clear mono lens that can move, so hopefully won't have as bad halos or reduced contrast"

I would be careful before leaping to that conclusion.  The FDA data for the Crystalens, which also matches that description, indicates a higher incidence of problematic halos with the Crystalens than with the Symfony. Some people get halos even with strictly monofocal lenses. The  studies seem to show the incidence of problematic halos with the Symfony is in the general range of monofocals, higher than the best monofocal but lower than some other monofocals.

I haven't examined data for the Tetraflex since its not approved in the US and my initial reading didn't suggest it was an improvement over the Crystalens available here.  Its possible it does have a lower incidence of problem halos, but I hadn't looked into it.

Most studies on halos are done after 3 or 6 months because more people even with monofocal see them initially  before most fade after the first few months.

I know someone in town who had the Crystalens implanted, and he has complaints about his low light reading vision. We met in a well lighted auditorium after a lecture and he did an experiment with a near reading chart. He held a file folder over it to merely cast a shadow, and that was enough to cause his near vision to be reduced with the Crystalens noticeably.. but it didn't make a difference for me with the Symfony. We are about the same age (lighting needs do increase with age), but its possible it may be individual variation. In general however there may be some reduction in low light vision with an IOL.

It sounds like much your problem is due to the astigmatism, which can interfere with visual quality with any lens.. and I've seen some surgeons suggest the impact is less with the Symfony than with a monofocal.

I would suggest researching data on the Tetraflex before leaping to conclusions regarding how much it will improve things. It may be that if you do see halos with the Tetraflex that they would be less problematic for you than the sort you get with the Symfony.. but perhaps not.  I don't recall how much near the Tetraflex has, its been at least 2 or more years since I looked into it.

I don't find any issue with the level of detail I see with the Symfony, but I got both eyes implanted a day apart so I didn't have  time to compare, though in the hour I had to do while I decided whether to have the 2nd surgery and I walked around testing vision I didn't see anything that was a problem (merely a sense off imbalance between the two, if anything the Symfony eye seemed crisper). It seems better than I can recall having with contacts before I had a problem cataract.
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Hi Triggered, I have the similar issue with my operated right eye.  I am seeing less details and haze, but it's better before the operation.  My doctor put on a -1.00 contact lens then i can see 20/30 vs. 20/60.  he also thinks it could be secondary cataract.  I am not sure now, but would be curious to hear your replacement operation.
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I'm having surgery in a few weeks and haven't decided if I'm going with symphony or not. My concern is will I still need readers for up to 12 inch distance or not. I currently need them for example using my iPhone or reading small print within 12 inches. I have cataracts and astigmatism.
I wear glasses or contacts.
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Unfortunately no one can tell you exactly how good your results will be since each person's natural depth of focus varies. The same lens in two different people will yield different results. All studies can show are average  results (or sometimes the range found in the study), and patients online merely report their anecdotal results. Most patients report being free of glasses, and given the high % of people with smartphones that suggests most can deal with them.  With a monofocal set for distance the odds are high you wouldn't be able to do much with a smartphone other than perhaps dial using a large font (though even that I hadn't checked on to be sure how likely it is). Monovision, setting one eye nearer,  can help with a monofocal, but that helps even more with the Symfony and you can do a smaller degree of monovision and expect good results.

I don't know how large the screen is on your phone, what the font size is. In my case I've had no trouble using my smartphones without bothering to change fonts and just holding them at a natural distance without needing to even think about where I hold it (with one exception mentioned below). First it was with a 4.7" screen on an HTC One M7, now with a 5.1" screen on a Samsung Galaxy S7. Note: I upgraded phones for other reasons, I didn't factor in the screen size, I had no problem using the smaller screen on the old phone. With newspaper sites with multiple columns I do find it easier to read when I double-tap the screen to expand to one column (though I can read multicolumn headline size text and if I try I  usually make  out the multicolumn small font without going single column, I just  need to concentrate to do so and sometimes  find the right position to hold the phone to read the smaller font).

If you opt for micro-monovision that will increase the odds of having good enough near vision to read your phone. Holding the phone farther out might be of help if it turns out that 12 inches is a problem, or worst case trying larger fonts.
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Just had a symfony implanted.  So far it's interesting.  Vision is better.  In day two have a shimmering or flickering effect.  Do have halos and glare and a some floaters from the surgery.  My hope is they go away.  I'm still healing, but would like to know where my vision will end up.  I'd say I need 1.5 readers for up close, which is just not that bad.   Too early to tell on final outcome, bit I'm optimistic
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Just had a symfony implanted.  So far it's interesting.  Vision is better.  In day two have a shimmering or flickering effect.  Do have halos and glare and a some floaters from the surgery.  My hope is they go away.  I'm still healing, but would like to know where my vision will end up.  I'd say I need 1.5 readers for up close, which is just not that bad.   Too early to tell on final outcome, bit I'm optimistic
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Thank you for your detailed notes. Wish I had found this site before I had my surgery. Anyway, I'm 2 weeks post-op on left eye and 1 wk post-op for the right.
At my day-after checkups, distance in each eye was measured 20-20 with 1 incorrect letter bottom line. So, I'm very happy with that!
Reading was about 20-25 and 20-30ish on day 2, but I suspect it's a bit less now, especially with halo and glare on my phone. Should I expect continued improvement with my reading acuity?
Also, tonight I drove in the dark for the first time with my "new eyes."  Quite a bit of halo, starburst and spider web things around lights. On day 2, my eyes were blurry but didn't have this much halo. Should I be concerned?

I have another checkup tomorrow and will ask. Hope I will continue to improve for another month or so, as I've heard it really can take that long.
Thanks for any feedback, it's appreciated.
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You are very early on so there is a very good chance of improvement. Most studies of IOLs don't even bother recording the incidence of night vision artifacts like halos until 3 or 6 months to let people get past the initial healing  and neuroadaptation period where more people see them. Since you started a new page repeating the comment, I'd suggest making any followups there where I'll repost this.
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I have a right eye cataract that has for the past year progressed so that it can't be corrected better than about 20/40 for distance.  I also have early stage glaucoma that has been controlled for the past 3+ years and stable with eye drops. Doctor can detect an early stage cataract in the left eye, but it has no noticeable effects on vision in that eye yet, probably will take several years to do so, and it can correct to 20/15 or better easily.  I have -2.75D cylinder astimagtism in the right eye and -2.00D cylinder in the left.  

I was considering the Trulign toric IOL for the right eye, though it might require an additional small 0.50D cylinder LRI or equivalent in addition to the IOL to eliminate all of the -2.75D cylinder in that eye.  But I found a highly rated medical clinic in my area (San Diego, CA) with eye surgeons that use the most state of the art laser equipment and the latest IOLs including Trulign and the new Symfony.  So I'm wondering if the Symfony Toric IOL would be even better than Trulign for my right eye cataract surgery? The Symfony appears to have a higher cylinder model available that might be enough by itself (with no LRI) for the -2.75D cylinder  in my right eye.  And if that worked out, later in the future I could get it for my left eye as well which only has -2.00D cylinder.

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My current eye doctor is a glaucoma specialist and eye surgeon. She does cataract eye surgeries but only with a limited set of IOLs, like the distance only Alcon Torics, but not the newer ones I'm interested in.

She has told me that due to glaucoma possibly reducing contrast sensitivity some, she would rule out the multifocal IOLs since they signficantly reduce contrast sensitivity further.

I'm hoping that the Symfony and the Trulign IOLs don't have that issue, and so I could still be a good candidate for those ones however.  I'm age 62.
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This conversation has a lot of posts and a quick review seems more unhappy or bothered by vision or glare than happy.  Few cheerleaders like Software developer.  Think hard before you run off to some clinic to get an "up-sell" lens. Also talk to your glaucoma specialist. Some physicians that do cataract surgery will not follow patients that leave their practice to go to a hyper-advertising, cataract/IOL 'factory" where they operate then dump the patient on local surgeons to follow them.
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