The concern is that this article for instance suggests that after a YAG there may be a need to place the lens in the sulcus rather than the capsular bag:
"• Lens exchange post-capsulotomy. ...
and finally place the new lens in the sulcus"
Unfortunately I don't know enough about the issue to know if this is almost always the case, or if it is often possible to put the lens in the bag still, I don't know if anyone else has more info on this (I'm suspecting he may just need to directly contact a surgeon to find out, and that it may require an exam, unless someone else here knows more).
The concern is that the Symfony's page has a warning that:
" The TECNIS® Symfony IOLs should be placed entirely in the capsular bag and should not be placed in the ciliary sulcus."
I don't know however if that might merely indicate that if the capsular bag is an option at all that it should be placed there and not in the sulcus, or if it unfortunately more likely means that it should never be placed in the sulcus even if the bag isn't an option.
I don't know if there are other backup options for him even if the Symfony is preferred, if any multifocals for instance work outside of the bag, or if people have comments on alternative piggy back or laser options for that monofocal eye.
Hi, Sorry to hear you are finding the Monofocal lens so difficult to get along with, I myself have had cataract surgery on both eyes over the past couple of month. I have had the Symfony lens placed in both eyes, my left eye was done 8 weeks ago and I have 20/20 at distance and middle distance and my right eye was done 4 weeks ago and is better than 20/20 at distance and middle distance. However my near distance is not as good as they try to make out in all the info, my left eye is not too bad however my right eye is a lot worse than my left, hopefully as I had this done only 4 weeks ago it will improve.
With all this said I am able to read a newspaper at around 12 to 14 inches (30 to 36 cm), for smaller text I still have to wear my reading glasses and also for PC work as well at the moment. However the best thing is I can now see better than I did when I was 20 and that was 30 years ago.
Hope this helps on how these types of lenses work.
Unfortunately no lens yet is going to give you the same sort of visual range that a natural 19 year old lens will have (even if it gives you perhaps just as good visual acuity). There are always tradeoffs. Hopefully I think the literature and doctors make the tradeoffs clear (even if confusing to decide between). There are bifocals lenses with high adds that will give better near vision (and possibly some trifocals, depending on how you define "near").. at the expense of lower quality intermediate vision than something like the Symfony. There is more of a risk of needing reading glasses for near at times with the Symfony than some of those lenses, with again the tradeoff of better near vision and a lower risk of problems with night vision like bothersome halo&glare.
Did they give you a test for your near vision? It actually sounds fairly good if you can read a newspaper at 12 inches. Everyone's results will be different, the studies show only the averages. However if someone does below average with one lens, its possible they would have down below average with another lens also due to the rest of their visual system not being below average somehow.
The major issue with how good your vision is at different distances is what your refractive error is, i.e. did they leave you hyperopic or myopic, did they give you your prescription, your refraction? That is likely to account for the difference between the two eyes. Of course what matters is the visual quality with both eyes together rather than testing each by itself.
I'm surprised that you need glasses for PC work if your vision is 20/20 at middle distance.
A presentation at a large yearly conference last week compared the Symfony to other options out there and found:
"New Extended Focus IOL Versus Bifocal, Trifocal, and Accommodating IOLs...
Extended focus lens achieves the best results from 46 cms to farthest vision with no disphotopsic phenomenon and with a great subjective satisfaction."
Closer than 46cms there may be some lenses that do better, but with lower quality vision further out. Another paper indicated that a small fraction of those with the Symfony do need reading glasses at times (and unfortunately someone winds up being the unlikely statistic), even if most didn't need them:
"Three-month results1 of 140 patients revealed binocular uncorrected VA of ≥20/25 over more than 1.5 D of defocus. 95 % and more patients reported comfortable visual function w/o glasses for far/intermediate, 76 % w/o glasses at near. 70% of subjects reported using glasses never/rarely, with 38% reporting using it for reading. Micro-monovision outcomes improved uncorrected near vision and reduced spectacle usage. More than 90 % reported no day/night glare and no/mild halos. More than 95% reported acceptable to very easy to perform activities w/o glasses during day/night including watching TV and using iPads/PCs. No device-related adverse event occurred."
I have had several surgeries including cataract, YAG, lens exchange, and PPV. It is true that a previous YAG complicates exchange. It is also true that, if a replacement lens needs to be put in the sulcus, the options are restricted.
Your situation is complex. You have had a lot of surgery over a short period of time, and a PPV is very invasive. If you are going to have more surgery, you need a rock star surgeon. I recommend scheduling a consultation at Bascom Palmer Eye Institute in Miami. Be sure to clearly explain your eye history (especially the reason for PPV) when scheduling the appointment so they can match you with the most qualified doctor for your situation. Best wishes.
Hi, True about the computer work, think it is more to do with the screen resolution it may be possibly a bit to high thus making the text too small. However I am led to believe that your eyes will keep improving as they heal and your brain will get use to a new way of focusing, and this can continue for upto 6 months give or take. So hopefully they will improve, and even if they don't improve to the extent that I don't need reading glasses it isn't really a big deal.
Also your comment about the night vision I do get halos and glare at the moment at night and also some visual disturbance during the day in certain light and angle conditions, but once again I was led to believe that this should improve over time but not necessarily go all together.
People sometimes need an adjustment period even for new glasses, especially progressive glasses. With IOLs your vision does improve over time through neuroadaptation, your brain adjusting to the lens. In October I had contacted the author of the first article I saw on the Symfony, a Dr. Hamid in the UK who had compared it with a trifocal, the AT Lisa Tri. When comparing the lenses he did mention in email one benifit of the trifocal was that: "2. Neuroadaptation is far quicker than in the Symfony" however he didn't respond to a followup question asking him to be more specific, so I suspect it was a qualitative impression he hadn't collected data on.
In my case visual acuity at computer distance and near has been fine all along. Subjectively my near acuity has improved (5 months postop now) but I hadn't tested it since 2 months postop (when it was 20/25, as it had been at 1 week postop).
Some people see halos&glare even with their natural lens, e.g. this eyeglass site is pitching reduced halos with their glasses and shows a simulated images:
I heard from one surgeon who pointed out that the statistics on halo&glare tend to be collected some months after surgery (or at least a month), since with all lenses glitches are more common initially, and with some they disappear in the first few days or weeks, and then with others they subside over a few months. However even later on, some people see halos&glare with even a monofocal (just as some even with their natural lens with no cataract have such issues). Its true that some people don't see
In my case I had no problems with glare, I had much better night vision from the start than I can recall having when I was younger (but it is hard to be sure if memory is accurate, I just never felt I had good night vision). I do see halos, but they've never been problematic since I can see through/past them so I don't even think about them.
This book on IOLs has a good description with images of the issue in a chapter by Dr. Chang, its worth looking at since it also includes an artists depiction of the halos they saw and their decline over time. Just an excerpt:
"Halos are not necessarily abnormal aspects of human vision. They occur naturally in manu people. They can be from refractive effects or diffractive effects (Figure 1). It is common to implant a multifocal IOL in a hyperopic patient who is having refractive lens surgery or presbyopic lens exchange and have that patient comment that the halos with the multifocal IOL are less than with the original natural lens. This almost never happens with a myopic patient. Therein lays an important lesson about the difference between myopic and hyperopic visual systems. Hyperopes commonly have halos as part of their visual experience prior to IOL implantation and are much more forgiving of them after implantation of a multifocal IOL. Myopes rarely have halos as part of their visual experience and are less tolerant of them after implantation of a multifocal IOL.
Because halos are normal after any type of IOL implantation, the important question to ask is not, "Do you have halos?" but rather, "Are the halos bothersome?" Every IOL ever studied has some incidence of halos reported after implantation. Researchers have been known to brag about the IOL they use having a less than 5% incidence of halos. "
Dr. Chang writes about multifocal halos on his website also:
"Depending upon the size of your pupils you may see halos, which appear as a glow around lights at night. These halos are different from, and much less problematic than those caused by cataracts. They relate to viewing distant lights through both the near and far focusing zones of the lens. They do not obscure the vision, but rather can create a distracting ghost image. Fortunately, these halos become less noticeable and distracting over time as the brain learns to selectively ignore them through a process called neuroadaptation. This is the same process that allows us to ignore background noise, such as traffic sounds or an air conditioning fan. Another analogy would be the temporary distraction of wearing earrings, jewelry, or a seatbelt for the first time. As these sensations become more familiar over time, we become less aware of them. How quickly this adjustment occurs varies for different individuals. However, experience has shown that neuroadaptation is a gradual process and that suppression of the nighttime ghost images continues to improve throughout the course of the first year.
Even a standard lens implant can produce some halos at night, but they are more evident with a multifocal lens implant. This is because the pupil dilates in the dark allowing more light to enter the interior of the eyeball and to scatter off of the peripheral parts of the lens implant. Halos are always very noticeable during the first 24 hours after surgery when your pupil is still dilated. Do not be alarmed by this temporary artificial situation. The first generation multifocal lens implant that was introduced in the late 1990’s produced very prominent halos that were difficult for many patients to adapt to. The newest multifocal lenses have been successfully re-engineered so as to significantly reduce the halo effect compared to the earlier model. "
And the Symfony is supposed to be more like a monofocal in terms of the incidence of problematic halos.
I didn't see this post in february. The symphony must be implanted in the capsular bag because it is a one piece IOL. (Like the crystalens, the nanoflex, and the 1 piece technis.) Only a 3 piece IOL can be placed in the sulcus and the symphony is built on the platform of the 1 piece technis although a 3 piece technis monofocal also exists. With that said, the capsular bag must be intact because a one piece cannot otherwise be stabilized within the eye.
It is possible to have an intact capsular bag after IOL explantation, but it is much less likely than having one after the initial surgery. Even after the initial phaco any patient selecting a one piece IOL has a 3 piece available as a backup should they be unable to place the one piece. The likelyhood of being able to give this patient a one piece symphony after he has already had a YAG would be possible, but very unlikely.
I am also from Florida. One of the Doctors I talked to when deciding on my IOL was Dr. Tyson. He is a highly respected Ophthalmologist and performed the FDA trials for the Symphony lens. He writes papers and lectures at Symposiums. He probably knows as much as anyone about the Symphony lens and he is not that far of a drive from you. His advice was one of the reasons I got the Tecnis 2.75D MF IOL. I would definitely recommend giving him a call.
I forgot to mention the fact that I know what you are talking about because my 2 eyes's vision has not aligned for years. I can see where it can drive one crazy, but after time I have gotten use to it. I just had cataract surgery in one eye, so my 2 eyes do not align up again for different reasons. I now notice it mostly at intermediate and close up. I can wear reading glasses to compensate for the one eye, but again I have just gotten so use to it over the years I usually do wear reading glasses, but sometimes I will close my right eye and just look out via my left eye. Another example is distance during the day time. My left eye is now clear while my right eye with the cataract is blurry. Just keep in mind no IOL is going to be as good as the human lens so you will not have 20/20 across all distances. Also I would not feel bad about your decision, I think there are a lot more patience that get a MF lens and want it removed and have a monofocal lens than vice versa. Though I think the latest Tecnis MF are much better. For my results with the Tecnis 2.75 you can read my post.
I see several years have passed since your question.I also had a vitrectomy, scleral buckle and now face cataract surgery.The symfony lens has just been approved here in usa. and i am hoping to get it.I was left with one eye quite nearsighted and want to be bifocal and not monofocal with poor depth perception.
Ibelieve the inner condition of tne eye left by retina surgeon, macula health all contribute to type of lens .I have been using s multifocal contact lens in tne eye but even that cannot work against the deeping cataract.
so in this country one needs to find a cataract surgeon experienced in working with a vitrectomized eye and also knowledge of the symfony.