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Avatar universal

Symfony IOL resuls

Surgery on my right eye was yesterday. Vision was blurry for about 6 hours and then cleared. But movement was very disorienting. It is less disorienting today. The vision in the eye is very good for everything except for very close. I had a hard time pitting my eye drops in, but am slowly adjusting.

My contact lenses prescription was -10 and -11, so this is amazing for me. I can't wait for the second eye which is scheduled for April 13.  The anatomy of my eye is very long and narrow so the surgeon is cautiously optimistic about the results. But it is looking good so far.
36 Responses
Avatar universal
1-day post op results

Distance 20/20 minus 2
Intermediate 20/15
Near 20/20 minus 1
Avatar universal
Has the Symfony been approved in Canada?  I am in the process of deciding between the Tecnis Low Add MF or the Symfony, but the Symfony lens has not been approved in the US.  Just curious did you Ophthalmologist compare the patient results he has seen between the Tecnis Symfony to the Tecnis Low Add 2.75?  Also which Ophthalmologist is offering the lens in Canada?
Avatar universal
Symfony was approved in Canada in January. My surgery was done by Dr Ziai at the Eye Institute at the Ottawa General Hospital. I don't believe that the Technis Low Add 2.75 has been used there. It was not one of lenses offered to me.
Avatar universal
I don't understand what the minus 1 means after the 20/20, but surely that's a very good result .. And do you have any glare / halos ? Glad it's all looking very positive for you.
Avatar universal
It means that I read all of 20/20 line except for one letter.  So I have almost 20/20 for distance and near, and better than 20/20 for intermediate, which is an excellent result.

No glare or halos but it is only day one.   And one more eye to go.
Avatar universal
re: "No glare or halos but it is only day one. And one more eye to go."

Actually most people who ever experience halo&glare issues with any IOL  have them starting on day 1, and then for most of them they subside with time and often disappear entirely.  Obviously its possible you might get them with the other eye, but hopefully this is a good sign that you won't.

Glad you have had a good result so far, often vision isn't quite as good day 1 postop since things are still healing. My near vision especially was fluctuating quite a bit the first couple of days so I didn't even bother remembering the day 1 postop results. I am assuming those visual acuity results were just on the operated eye, monocular results. I'm just curious, did they see any remaining refractive error or did they hit the target? (with those results I'm guessing you might be plano, but since you weren't  quite 20/20 at far I figure there is a slight chance you might have a tiny bit of myopia, or it might merely be because you are still healing). Again however your vision may change a bit over the first few weeks so you can't tell what the final result will be yet.

Avatar universal
They hit the target but werent sure what the result might be given the shape of my eye. They had to do some fancy calculations to make this lense work for me. After measuring my eye they thought I might not be able to get the Symfony lense at all.

The surgeon was thrilled with the first day results.  There was a bit of fluctuation when I was reading the charts.

The other eye is getting the Toric lense so we will see how that goes.
Avatar universal
One week post-op, the lens is sitting very nicely. The distance visionIsn't as good but the intermediate and near vision is stable. I forgot to ask for the numbers. I think the distance is around 20/30.

I was having trouble adjusting as I found any movement of the head disorienting. But the doctor says this is similar to adjusting to progressive glasses which took me only two days. It is definitely taking longer as browsing in the grocery store was difficult. Hopefully it doesn't take too much longer.
Avatar universal
Two weeks post op and the distance vision is definitely off. This lense is definitely not good for high myopes.
Avatar universal
The distance vision being off seems most likely to not be related to the lens choice, but be due to them having missed the refractive target and leaving you myopic in that eye. You reported almost 20/20 1 day postop and suggested they hit the refractive target, so your lower result later suggests that the refraction changed. After surgery for the first few weeks your eye is still healing and the refraction can change and it appears it did in your case. Usually they wait 3-4 weeks, and sometimes not until 6-8 weeks, before prescribing new glasses/contacts since they wait until the refraction has stabilized.

It isn't clear why you suggest the lens isn't good for high myopes, my left eye was -9.5 before the cataract shifted it. My distance vision with the lens was almost 20/15 by one week postop, and its likely improved since then (though at 2 months postop they only checked to see both eyes were at least 20/20, they didn't check to see how much better).  The distance vision achievable with the lens shouldn't depend on your level of myopia before the lens was implanted, just like with a contact lens that should only impact what lens power they use. The concern with high myopia is that the lens power that is required is harder to predict beforehand to hit the refractive target, but that is true of any lens. All the reports seem to indicate that distance vision with this lens should be fairly comparable to a monofocal.

It is possible you have other eye issues which leave best corrected vision to be less than 20/20, though your day 1 preop suggests you should be able to get to near 20/20 or better with correction. However perhaps there is some postop temporary swelling or other issue that cropped up that'll resolve itself.  You may wish to keep one eye myopic to get a bit better near vision while targeting your other eye for full distance vision.  If you prefer both eyes to have full distance correction, I don't know if your surgeon did this, but some surgeons bundle in a lasik enhancement with a premium lens (which of course they wait to do until after the refraction is stabilized, preferably doing a contact lens trial to confirm what adjustment they should target).

re: the issue of things being "disorienting" like with progressive glasses initially , that may be partly because  of the difference in optics between the two eyes being a bit confusing. I had my 2nd eye done the next day so I was out of the bandage for only a couple of hours or so before the other lens implant. However I noticed a sense of imbalance between the IOL eye and the eye with a contact lens (hard to describe)  during that time which went away as soon as the other eye was done. I don't know it was partly due to image size difference (wearing a contact lens in that eye shouldn't leave much of an issue with that, but there might have been enough to notice for the first short while at least) or if it was mostly due to the difference in optics between the Symfony and a natural lens.
Avatar universal
i suppose I am expressing my disappointment too soon. Others have suggested that the change could be due to swelling. But the surgeon did say that they had to do some fancy calculations to get the lens to work with my eye and that she was no longer certain that she could get me to 20/20.

The disorientation is gone now, so I have adjusted to the differences just in time for my other eye to be done.

I have an appointment with the neurosurgeon in a couple of weeks so we will see if there are possibly other issues.
Avatar universal
re: "she was no longer certain that she could get me to 20/20. "

I'd suggest the fact that you had almost 20/20 day 1 postop suggests you should be able to get back to almost 20/20 when you heal from some temporary swelling or whatever it is,  and hopefully better since often day 1 postop people's vision hasn't fully recovered.  It may be that you have other eye health issues that won't let you get fully to 20/20, if so its likely you wouldn't have gotten to 20/20 with any lens. Even if you only got to 20/25, that is still good vision that shouldn't cause trouble with   regular activities (unless you were like a professional marksman or jet pilot perhaps or something).

The "fancy calculations" to get the lens power would have happened with any lens, the issue isn't unique to this one (at most what differs is a constant or two that varies with the lens). The odds are whatever quality distance vision you achieve with this lens is comparable to what you would have gotten with other lenses. The place where the vision would differ between lenses would be intermediate and near vision, and your day 1 postop results suggest that those should be good as well once you recover from whatever issue you have now.

Avatar universal
I should add that although I brought up the possibility of other eye issues, it seems like the fact that you had 20/15 vision at intermediate initially suggests that you should be able to get to at least 20/20 at distance, or worst case at least get that with correction.
Avatar universal
Left eye was done today and already, there are differences. My recovery on this eye is going to be much longer. The vision hasn't cleared up to the same extent at the end of the day and there is more pain. Putting the drops in is excruciating.

Post op check up in the morning for both eyes.
Avatar universal
It seems my eye got nicked during surgery as putting in the eyebrows has been excruciating. It is supposed to heal quickly.

The proliferations have started already, so a follow up laser surgery will be necessary in about 3 months. Both eyes are now 20/30.  But given the shape of my eye, the surgeon says that the lense may shift forwards or back as it heals. If I want corrective laser surgery that would be 3 months after the next surgery.

My near and intermediate vision wasn't tested today. It is definitely not 20/20.  All the tests will be done next week.
Avatar universal
re: "there is more pain. Putting the drops in is excruciating. "

Its unfortunate you have pain, I didn't have any pain from the surgery (or during), that isn't typical, hopefully it'll go away soon and they give you appropriate pain meds.

re: "The proliferations have started already, so a follow up laser surgery will be necessary in about 3 months. "

I assume you mean PCO (posterior capsular opacification)  in the first eye (you don't say), which is a fairly common side effect (it used to be most people got it, now its only a minority since lenses like the Tecnis ones have been designed to minimize the risk). Its is an easy issue to treat. That could explain the reduced vision in that eye.  Although I gather PCO can form in the first  first few weeks,  it more commonly takes months (on average 2 years I'd read from one source) to develop.  I would have thought swelling or some other issue more likely  but I hadn't checked statistics, and I gather some people are more prone to PCO.

I'm guessing the 2nd eye is still just recovering from surgery, which seems the most likely the explanation for its 20/30,  perhaps swelling is an issue, or perhaps they missed the mark on that one and left it myopic? I would have guessed 1 day postop would be too soon to have PCO concerns in that 2nd eye based on my reading, but I'm not positive since   I hadn't researched the issue in detail before  ,  since I don't have a PCO issue (and an eye surgeon guessed at 2 months postop that from looking at way my eyes are  healing that I won't get PCO).

Avatar universal
Yes, PCO has already started in the first eye so laser surgery in 3 months is being recommended.  The eye pressure has also increased so one of my meds is being switched and a new med to relieve the pressure.

The surgeon didn't seem surprised that the near vision in the second eye was poor and didn't bother to test it. I suspect the target was different for each eye with the hope that one would be 20/20, and at worst the other would be 20/30.

The surgeon has also warned me that as my eye is very long, that the lens may shift forwards or backwards and that refractive corrections could be made 3 months after the PCO is fixed.
Avatar universal
4 weeks post op for right eye is 20/30
1 week post op for left eye is 20/40
Combined eyes is 20/25 for intermediate and 20/16 for near

When asked, the doctor suggested correction of -.75 and -1.00 - that is heaps better than -10 and -11 that I started with. But vision is still pretty blurry in the left eye. The doctor (subbing for surgeon) suggested said neuro adaption would take at least 4 weeks. But the right eye didn't blur at all. Images were very crisp and clean until it started to deteriorate 4-5 days post surgery. The doctor said that they may have put constricting drops in my eyes post surgery. I think the only difference between the surgeries was that they didn't put the gel anaesthetic on my eye, they just increased the freezing during surgery.
Avatar universal
re: "still pretty blurry in the left eye"

I'm guessing you might just mean for distance without correction? You don't give the visual acuity separately for the left eye for intermediate/near to see if there is an issue (since the binocular acuity might be relying on the right eye).  The issue of most concern is the "best corrected" vision in each eye, the vision you'll get with correction, which indicates whether there is a problem or whether its merely due to being   myopic in that eye.

re: "suggested correction of -.75 and -1.00"

It seems they missed the refractive target and left you myopic which is why distance will be blurry of course.   The 20/16 for near is obviously very good, which suggests your distance vision is likely to be very   good with correction (contacts, glasses, or eventual laser enhancement after things settle down).  Based on the fact that your near is better than intermediate, I'm guessing those  correction numbers aren't fully correcting distance as much as  they could, but giving you good enough distance vision while leaving more near.  
Avatar universal
Yes for distance. Near and intermediate are not a problem. I didn't get the numbers for each eye, although it seems like the intermediate is a bit off for the left eye. The doctor says there would be no problem getting me to 20/20 with laser enhancement which would be in about 6 months. They will take care of the PCO first in about 3 months.

My optometrist isn't available until mid-May, so I will be going around blurry until then.
Avatar universal
3 weeks post op on the second eye shows that the Toric lens rotated. So back into surgery to fix it on Wed.
Avatar universal
One day after the lens was rotated and a gel inserted to hold it in place, the cornea is swollen. The vision will be blurry for a few days. But distance is now 20/20 when it was 20/40 pre-op. Now to wait for the vision to clear and see if my eye shifts the lens to 20/30 like it did on the other side.

The surgeon is very happy with the results. Me, not so much given the blurring. It could take a week to clear up.
Avatar universal
Sorry to hear you had bad luck with the lens rotating, there are a few  people who posted on this site recently with  far worse vision due to lens rotation with different toric lenses. I didn't need toric lenses so it hadn't come to mind that might be likely your issue.  The surgeon of course is presumably assuming things will clear up after the swelling goes down, hopefully it will and it'll remain at least 20/20 so you'll have a good distance eye, and an eye giving you a bit nearer, so on balance hopefully in the end the results will turn out well even if you went through some struggles to get there.

Avatar universal
So now I find out that the Toric lens is good for near and far but not intermediate. So the difference between the two eyes is markedly different. So different that I have trouble focussing and there is a bluring at all distances. The doctor says to give it time for neuro adaptation so that my brain will eventually use my right eye for near and the left eye for distance.

Left eye is 20/20 for distance, 20/25 intermediate, 20/20 near
Right eye is 20/30 for distance, 20/15 intermediate, 20/20 near

The left lense is less likely to shift as when they rotated the lense, they withdrew some gel and packed in a denser gel to hold the lense in place.

I think I will be wearing an eye patch for reading until I can get to the optometrist to see what can be done while my eyes adjust.
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