IOL Exchange or not?

[JohnRay2016]

October 2106 had Cataract Surgery with Technis Sympony lens implant. From the first follow up appointment I complained about starbursts, halos, and washed out vision. I was told to be "patient". Three or four follow-up appointments later (still no change) I was referred to a retina specialist. Every thing seemed fine with retina. Three month follow-up no change in starbursts or washed out vision. still complained. "Be Patient' it takes time sto neuro adaptation. Dr.Suggest a "touch-up" with lasik. Lasik Doc. said to try glasses first as lasik could actually increase  halos to see if a lasik touch up would have the desired effect. Did that  with only a slight change as classes had anti glare lens. Then, (December / January) follow-up with retina specialist revealed I had a Macular Pucker and vision had worsened. Scheduled Vitrectomy with a membrane peel. That was February. I thought that surgery would fix the problem. Nope. Followup with retina specialist was OK. Follow-up with cataract surgeon still no change as retina surgery need time to heal. Follow-up with retina specialist. Things healing as normal, but no change in my vision. Retina specialist said i had build up of cells on my capsular bag. Referred back to Cateract surgeon for evaluation. Scheduled a YAG laser procedure to remove cell build up. I thought that would cure the problem. Nope. Complained again to Cataract surgeon and showed him an internet photo of what the starbursts I was seeing looked like. He then mentioned a lens exchange. But now I had high eye pressure (30). Had to get that under control first. Later he called in an eye drop that would cause my pupal to restrict at night so that perhaps my starbursts would be eliminated or reduced. That did not work, head aches and extreme darkness at night. Cataract surgeon said he had discussed with retina specialist as being a second on the exchange surgery. Next follow-up (Now July 2017).; eye pressure was down but not low enough. Added an additional prescription for pressure.I asked what the exchange involved and he explained that when he cut out the IOL he would have to leave in the anchors to the lens as they were probably now embedded and not removable but not to worry. (How can I not worry?). July 2017, follow-up with retina specialist who said my eye pressure was back to normal and my macula was looking good. I reiterated my continuing vision problems and mentioned that the cataract surgeon was planning a lens exchange. The retina specialist seemed somewhat surprised if not shocked and proceeded to tell me how risky the procedure would be, things like the lens could fall into the back of the eye, and that replacement with a mono focal may still leave me with halos. Scared me to death. She said she was going to discuss my situation with the cataract surgeon. I have another follow-up in a couple of weeks. I left out of this my episodes of anger, frustration, inability to focus and depression. I am truly disheartened. What should  I do?
Explanation  and replace with mono focal and ad mono focal in left eye?
Keep right eye multi focal and implant same multi focal lens in other (Left) eye?
Keep right eye multi focal and implant mono focal lens in other (Left) eye?
Something else?

[JohnRay2016]

Dr. Hagan, Thank you for your kind advice. If I were in K.C. or closer I would consult with you. Can I do that long distance?  I am in Georgia.  I have a friend who has a relationship with another ophthalmologist surgeon who is outside of this group practice. I am planning on contacting him for another opinion.

When you say "If your fellow eye needs surgery a monofocal IOL and planning on wearing glasses would likely be the simplest, least complicated, least expensive road to travel." Does that mean I do not exchange the Symfony and try to deal with the starbursts and glare in the affected eye or proceed with the exchange to a mono focal? (Subject to another (formal) opinion.) I do not mind readers as I still need them with the Symfony.

Also, I have had borderline high pressure for several years. The spike occurred after the Vitriectomy and peel. I also have dry eye in the affected eye which started well  before the cataract surgery and persists.So not sure if steroids were the cause but I had been off them for several weeks after vitriectomy and before the follow-up.

[JohnHaganMD]

I trained at Emory University Department of Ophthalmology one of the best in the world with considerable experience at dealing with IOL complications. I would suggest you get one consult there. You would start with seeing a cataract/cornea/refractive specialist.

Cataract surgery is so low complication that most surgeons have little experience dealing with complications. all communities have several surgeons that specialize in complex problems like yours. I'm sure there are many other fine post surgery complications surgeons there but none I know personally. Most of my generation have stopped during surgery or retired.

What I meant is that I would not suggest a symfony, multifocal or accommodating IOL in the unoperated eye. Unless you have a high degree of corneal astigmatism I would avoid a toric IOL also. What you do about the operated eye is problematic and would depend on the exam and testing of your cornea, IOL and how much it bothers you. If its merely annoying its not likely the risks ae worth taking, if its incapacitating they the risk/benefit ration changes.

[JohnHaganMD]

there are some people on this forum that are very happy with Symfony IOLs including "Software Developer" who is so happy that I fear people get a distorted view of the risks. As the symfony has been out longer more and more people are finding their way to this forum with complaints and problems. you are not the first and will not be the last.  I think you should start by find a 2nd and 3rd cataract/refractive/IOL surgery and get independent opinion.  I have a 2nd opinion practice and in a situation like this it would seem that a symfony or other IOL in your fellow eye would be like asking the snake to bite you twice. If your fellow eye needs surgery a monofocal IOL and planning on wearing glasses would likely be the simplest, least complicated, least expensive road to travel. Given your disheartening experience I would give up on not wearing glasses and plan on wearing glasses post surgery on the fellow unoperated eye.

When you get these second opinions you can also ask about IOL exchange. Again it would make little sense given the story you've posted to have a multifocal IOL put in the eye at exchange.

I wonder why you have glaucoma unless it is steroid glaucoma due to steroid drops or a surgical complication of your retina membrane peel. In either case you should be able to get off glaucoma medications at some point. Remember also when you have problems in one eye often they occur in both eyes. It's possible that your macular pucker might have been due to cystoid macular edema and you might check with your first cataract surgeon to see if they did a macular OCT when you had those complaints.

In any case you get additional opinions as I suggested that is a real handful of problems.

[JohnHaganMD]

CORRECTION:  I have a 2nd opinion practice and in a situation like this it would seem that a symfony or other MULTIFOCAL IOL in your fellow eye would be like asking the snake to bite you twice.