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Symfony IOL at Codet in Tijuana
I had the Tecnis Symfony IOL implanted in my left eye 12 days ago. I am a high myope about -10 in both eyes prior to the cataract advancing in the left eye. No astigmatism is left operated eye and about 1.50 in the right. Axis lengths are 26.4 left and 26.0 right. These measurements made it more likely to end up with a refractive error. I am 20/20 with an RGP multifocal in the right eye with good near and intermediate vision.
We decided to shoot for a micro mono result leaving the operated eye about .50 myopic hoping to result in 20/25 to 20/30 distance with 20/20 for intermediate and near down to about 16 to 20 inches (30 to 40 cm's). The evening after surgery when I removed the plastic cover to put antibiotic and anti-inflammatory drops in I tried out my vision which was excellent as I looked out of the hotel window to test my distance vision. I had virtually no clear vision within about 6 feet at this point, but that improved by the next morning to 20/30 at 60 cm and 20/40 at 40 cm during follow up before flying home. My IOL pressure usually runs about 20 or 21, but had spiked to 29 when checked during the followup. My fight was a few hours off and Dr. Chayet wanted that down before flying. He gave me some drops for that, which brought the pressure down to 21 over the next hour. I had no pain or discomfort from the procedure and was allowed to fly home on time, but advised to have my pressures checked when I run out of the drops.
My distance vision has remained stable and excellent over the last 12 days since surgery. My near which was really not clear at any distance under arms length has improved gradually each day. Using only my operated eye in very good lighting I can read fine print like that on a eye drop bottle at about 50 cm and newspaper print at 30 to 40 cm. In daylight even on a cloud covered day I can sit in the car and read pretty much any size print and see at all distances clearly. I can read my smartphone and computer easily if the brightness is most of the way up. In poor light or not near a window letting sunlight in I cannot sit at the table and read the newspaper comfortably while it lays flat on the table, I need a bit more distance like 3/4 arms length to full arms length or more light to bring it in to comfortable focus.
I think there is some more neuro adaptation to be had in particular my pupil learning it's best size at different distances. I can look at something 20 or so inches away and not be in focus initially,then relax and not try to see just to have it suddenly come into focus. I am hopeful of getting a little better near vision in lower light over the next couple of weeks. I have used a plus one lens over my operated eye and it lets me see easily down to 9 to 12 inches even in poor light, while the distance vision would still be good enough for daytime driving with only that eye. I think that what we did was hit emmetropia. Because I was such a long time wearer of RGP's I may still get another quarter or so of steepening of the cornea which would help me a bit more for near. I will post again in about a month or so report on any shifts after complete healing.
I have had good overall vision using my contact lens in the unoperated eye, but it did take about a week to get used to judging distance and to lose that disoriented feeling when walking around changing my view constantly as when in a store. I have noticed when I only use my operated eye with no contact in the unoperated eye, my near vision remains better in that eye than when wearing the contact in the other eye. My distance vision seams to be equal and very balanced between the eyes, but because my contact lens eye sees better near, my brain picks that eye and does some suppressing in the operated eye for near. Over a few hours i notice that my operated eye goes from seeing pretty well near to not seeing well at all...letting the contact lens eye do almost all the work to see near. If I take the contact out, within an hour or so I start seeing pretty well near again with the operated eye. When I am knocking around the house I have been leaving the contact out and making my operated eye work as much as possible and have seen improvement each day in what I can do with that eye. In all I am glad we tried for -.50 because in would have reduced the useful range of the lens a good bit had I ended up +.50 instead of plano.
The Codet facility was immaculate, My limited Spanish was not an issue as the Drs, and Patient coordinators were fluent in English as was the facility manager/driver named Guillermo who picked me up at the San Diego airport and drove me to the hotel and to all of my appointments. and back to the airport. He told me about his wife's experience with the LAL and how she was very happy with the blended vision option that they used when adjusting her lenses to make her spectacle independent. I asked Dr Chayet about maybe going with the LAL for my second eye when it goes south in order insure getting the proper power to insure a blended full range of vision, Although he is very high on the LAL he suggested it would be best to go with the Symfony again to reduce issues with neuro adaptation and seemed confident that they could do a lasik adjustment to get where we needed to be if we missed a bit on the second eye also. With my eyes being difficult to predict lens power I am ver happy that we got within .5 diopter of our goal. I will be elated if we hit the target on the second one, because I think the micro mono vision with this lens is going to allow me to see very well binocularly at all distances without glasses.
If you can fly Southwest Airlines to San Diego your expenses for travel and nice Hotel and meals should be between $500 and $1000 round trip. the cost of the Symfony lens and procedure ran about $3500.
We decided to shoot for a micro mono result leaving the operated eye about .50 myopic hoping to result in 20/25 to 20/30 distance with 20/20 for intermediate and near down to about 16 to 20 inches (30 to 40 cm's). The evening after surgery when I removed the plastic cover to put antibiotic and anti-inflammatory drops in I tried out my vision which was excellent as I looked out of the hotel window to test my distance vision. I had virtually no clear vision within about 6 feet at this point, but that improved by the next morning to 20/30 at 60 cm and 20/40 at 40 cm during follow up before flying home. My IOL pressure usually runs about 20 or 21, but had spiked to 29 when checked during the followup. My fight was a few hours off and Dr. Chayet wanted that down before flying. He gave me some drops for that, which brought the pressure down to 21 over the next hour. I had no pain or discomfort from the procedure and was allowed to fly home on time, but advised to have my pressures checked when I run out of the drops.
My distance vision has remained stable and excellent over the last 12 days since surgery. My near which was really not clear at any distance under arms length has improved gradually each day. Using only my operated eye in very good lighting I can read fine print like that on a eye drop bottle at about 50 cm and newspaper print at 30 to 40 cm. In daylight even on a cloud covered day I can sit in the car and read pretty much any size print and see at all distances clearly. I can read my smartphone and computer easily if the brightness is most of the way up. In poor light or not near a window letting sunlight in I cannot sit at the table and read the newspaper comfortably while it lays flat on the table, I need a bit more distance like 3/4 arms length to full arms length or more light to bring it in to comfortable focus.
I think there is some more neuro adaptation to be had in particular my pupil learning it's best size at different distances. I can look at something 20 or so inches away and not be in focus initially,then relax and not try to see just to have it suddenly come into focus. I am hopeful of getting a little better near vision in lower light over the next couple of weeks. I have used a plus one lens over my operated eye and it lets me see easily down to 9 to 12 inches even in poor light, while the distance vision would still be good enough for daytime driving with only that eye. I think that what we did was hit emmetropia. Because I was such a long time wearer of RGP's I may still get another quarter or so of steepening of the cornea which would help me a bit more for near. I will post again in about a month or so report on any shifts after complete healing.
I have had good overall vision using my contact lens in the unoperated eye, but it did take about a week to get used to judging distance and to lose that disoriented feeling when walking around changing my view constantly as when in a store. I have noticed when I only use my operated eye with no contact in the unoperated eye, my near vision remains better in that eye than when wearing the contact in the other eye. My distance vision seams to be equal and very balanced between the eyes, but because my contact lens eye sees better near, my brain picks that eye and does some suppressing in the operated eye for near. Over a few hours i notice that my operated eye goes from seeing pretty well near to not seeing well at all...letting the contact lens eye do almost all the work to see near. If I take the contact out, within an hour or so I start seeing pretty well near again with the operated eye. When I am knocking around the house I have been leaving the contact out and making my operated eye work as much as possible and have seen improvement each day in what I can do with that eye. In all I am glad we tried for -.50 because in would have reduced the useful range of the lens a good bit had I ended up +.50 instead of plano.
The Codet facility was immaculate, My limited Spanish was not an issue as the Drs, and Patient coordinators were fluent in English as was the facility manager/driver named Guillermo who picked me up at the San Diego airport and drove me to the hotel and to all of my appointments. and back to the airport. He told me about his wife's experience with the LAL and how she was very happy with the blended vision option that they used when adjusting her lenses to make her spectacle independent. I asked Dr Chayet about maybe going with the LAL for my second eye when it goes south in order insure getting the proper power to insure a blended full range of vision, Although he is very high on the LAL he suggested it would be best to go with the Symfony again to reduce issues with neuro adaptation and seemed confident that they could do a lasik adjustment to get where we needed to be if we missed a bit on the second eye also. With my eyes being difficult to predict lens power I am ver happy that we got within .5 diopter of our goal. I will be elated if we hit the target on the second one, because I think the micro mono vision with this lens is going to allow me to see very well binocularly at all distances without glasses.
If you can fly Southwest Airlines to San Diego your expenses for travel and nice Hotel and meals should be between $500 and $1000 round trip. the cost of the Symfony lens and procedure ran about $3500.
I just ran into an American surgeon's recent comments about having used Dr. Chayet before, although he used him for LASIK quite a while ago, I figured it was a good reference point for people considering whether to use him (though I'd personally do more research if I were going to use him, I do have the impression he is likely a reasonable choice):
http://www.healio.com/ophthalmology/refractive-surgery/news/print/ocular-surgery-news/%7Bc6bbdaf4-afa2-465a-8594-5727794caa7a%7D/lasik-allows-surgeon-to-become-more-compassionate-toward-his-patients
"For both of these reasons, I decided to have surgery with my colleague in Mexico, Arturo Chayet, who was an experienced LASIK surgeon and had a Nidek EC-5000 scanning slit laser.
In January 1997 I was ready to go but nervous. My wife at the time was shocked — eye surgery in Tijuana?! After convincing her of Arturo’s credentials and reputation in the field, she finally bought in."
http://www.healio.com/ophthalmology/refractive-surgery/news/print/ocular-surgery-news/%7Bc6bbdaf4-afa2-465a-8594-5727794caa7a%7D/lasik-allows-surgeon-to-become-more-compassionate-toward-his-patients
"For both of these reasons, I decided to have surgery with my colleague in Mexico, Arturo Chayet, who was an experienced LASIK surgeon and had a Nidek EC-5000 scanning slit laser.
In January 1997 I was ready to go but nervous. My wife at the time was shocked — eye surgery in Tijuana?! After convincing her of Arturo’s credentials and reputation in the field, she finally bought in."
Thanks for the input I'm sure it will be very useful to many people.
1 Comments
Thanks Doc, I hope some folks are helped with the info.
At about 5 weeks from getting the Symfony iol, I am no longer using any eye drops. I thought that my near was about as good as it was going to get, but it has improved a bit more since weaning off the drops. I have good computer and smartphone vision in to about 20 inches with just my operated eye. Near is good for printed materials in very good lighting, and I feel no deficit of near vision out doors even on a cloudy day. In a room with a couple of 75 watt bulbs in the center of the room my near is more limited, but can make out news print at about 3/4 arms length with some effort. I can slowly make it out but would be difficult to read a full article. I need to be by a window with sunlight or directly under a good lamp to read at more comfortable distance. The computer and smartphone are good all the time with the brightness up most of the way. I may continue to get a little more near vision as my cornea may continue to steepen a bit for up to a year, having worn rigid contacts for decades. It will be nice if It gives me another .25 diopter of plus as time goes by. My distance and intermediate vision have remained very good and stable while the near vision has slowly improved over these 5 weeks. If you get this lens and it does not meet your expectations immediately, give it some time, I am still noticing improvements with healing and neuro adaptation.
My thought is that I will probably shoot for -.50 refraction in the other eye when I need to operate on that cataract which is not affecting me yet. I figure that if we hit that mark I should have good vision at all distances. I think that even if we miss and end up at plano in that eye also, the binocular summation effect should still give me a little better near vision than I have monocularly now in my operated eye, which is only lacking in low light.
I do see halos at night with some bigger lights, but not most street lights nor headlights if not on high beam. It seems that lights casting more yellow than white have more halo. The halo can be seen through because it is in the pattern of the echelette steps of the lens allowing you to see between the light lines. I am comfortable driving at night and have been since day one.
My thought is that I will probably shoot for -.50 refraction in the other eye when I need to operate on that cataract which is not affecting me yet. I figure that if we hit that mark I should have good vision at all distances. I think that even if we miss and end up at plano in that eye also, the binocular summation effect should still give me a little better near vision than I have monocularly now in my operated eye, which is only lacking in low light.
I do see halos at night with some bigger lights, but not most street lights nor headlights if not on high beam. It seems that lights casting more yellow than white have more halo. The halo can be seen through because it is in the pattern of the echelette steps of the lens allowing you to see between the light lines. I am comfortable driving at night and have been since day one.
Some halos with bigger lights that you find lighting parking lots at grocery stores and such places, not with headlights or most streetlights. Vision is great for driving at night.
Glad you are enjoying the lense so far. I had the Symfony lense put in 3 and a half weeks ago. How is your vision at night and halos?
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