experiences with Symfony IOL, or trifocal IOLs?

[SoftwareDeveloper]

Has anyone here gotten the new Symfony IOL, or heard from others who have, or know more than the research you can find with google? It was just approved in June for use in Europe, but initial studies on the web seem to indicate it provides better odds of having good intermediate/computer vision, and better than the AT lisa trifocal except at very near distances. It refers to it as having an extended depth of vision rather than   calling it multifocal (perhaps because it doesn't divide itself into 2 or 3 discrete focal points but in essence it must still have a range of focuses to provide "extended depth").

I've seen detailed threads about the FineVision but only brief comments on the AT lisa trifocal.  Any more comments on any of these lenses? I'd  be curious if anyone has more comments on getting a multifocal in only one eye with the problem cataract and wearing a contact lens in the other (which is still correctible to 20/20 with only an early cataract). The hope would be that perhaps before it goes bad a new generation of lenses might come out, like an accommodating lens that is more likely to work well than the ones out there now.

Any suggestions for good doctors to get them from, preferably laser cataract surgery? I'm open to considering doctors in any country since I'm in the US and will need to travel to get the lens, the UK would be easiest since I only speak English, but I'll consider other options. I've heard the Czech Republic may be cheaper but still have   high quality clinics. Its worth a bit of hassle to get a good lens. I'm only 52 so I'll hopefully be using it a few decades, so thanks greatly for any information you can provide.

[SoftwareDeveloper]

Coincidentally before I saw your post I had gotten into contact with the person running the trials in the US. The details are still being worked out, but they will be randomized trials with 50% getting this lens and the others a control lens (it didn't sound like they knew what that would be).  I would rather not risk that, and I'd rather not  wait for the trial regardless I decided since this has started interfering with vision.

I will note that i have been cautioned btw by an experienced US surgeon to be sure if I use a non-US doctor to be careful of the fact that in even in good  European clinics their standards may not be as high as US doctors in terms of things like complication rates and hitting the refractive target.

As with anything however, prices vary for many reasons between countries and there are good surgeons who are lower cost, but it is best to be cautious of course to ensure you are getting high quality treatment.

[rwbil]

I thought his interest was in the Tecnis Symfony not the Synchrony IOL.  If you are willing to cutting edge, what is the latest news on the Light Adjustable Lens.  I called AMO and they said they haves some trials for Symfony in the US but I have not followed up it yet.  Might be something to explore

[SoftwareDeveloper]

PS, in the last paragraph when I said "hoping they might be available" I meant of course the next gen accommodating lenses, I'd moved the paragraph, I need to go and didn't take time to proofread. They should let you edit posts on this site.

[SoftwareDeveloper]

When I was first diagnosed with a cataract a couple of years ago I was checking on the Synchrony, and contacting them about  clinical trials in the US. Aside from limited power availability  I recall getting the impression that some aspect of the Synchrony's  accommodation  might not have worked well due in most  myopic eyes due to some physical attributes they tend to possess,  but unfortunately I can't recall what the issue was so I might be wrong. I  just remember the impression there was a reason there weren't lens powers available for myopes other than simply focusing on the most common powers required. If it had higher odds of accommodating than it does, even  for myopes,  but merely weren't in the right power, it might have been worth just getting laser enhancement (or  contact lenses),

re: "for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. "

I can understand the desire to have good vision at all distances. I had hoped I could postpone surgery until  a future   generation  accommodating lens that works well is approved.

I am curious   as to why you didn't think the trifocals might be a better bet to get useful vision at a variety of distances  given the odds of trouble with the Synchrony. I see a reference in a prior post of yours to reading speed, but it was only regarding some version of the Restor, and lenses differ of course. I'm not sure which paper you were referring to, I see one that notes reduced speed in Restor vs a monofocal , but not quite as much as you indicated. I also  only saw the abstract  (I hadn't searched to see if there is free version of the full text) and can't confirm things like how long postop the reading speed was measured  (e.g. did they give the patients enough time to adapt).  I see other papers that suggest for instance:

http://www.sciencedirect.com/science/article/pii/S0886335012011625
"Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions...

Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL."

I  hadn't seen the full text of that, or  researched this issue in depth. I didn't have the impression reading speed was a reason to avoid the newest multifocals.  If anyone does know of a reason to be concerned about their impact on reading speed  I'd appreciate input since I read a great deal (mostly at computer monitor distance), I may try searching a bit more this weekend.

People's priorities vary obviously, I'm just trying to figure out of there is any drawback I've missed aside from the commonly mentioned ones (like halo risk, etc). Was your concern  a strong a preference for trying to get more natural accommodation since you were hesitant to trust that using a different method to achieve   functional vision at different distances  due to multifocality was going to really feel close enough to natural vision to be worth it?

I'm guessing  I might have had more of a concern over multifocals if I hadn't already tried multifocal contact lenses to deal with presbyopia. (though I do know the optics is different than those of the IOLs). Unfortunately at your age I'm guessing there would have been no easy way to usefully try multifocal contacts since you still had enough accommodation.

I can't wait any longer to get one eye done (difficulty merging images now, I should have had it done already), but I'm hoping they might be available by the time my other eye's vision degrades (though I can't know how long I have before that,  my left eye lost quite a bit of visual acuity within a few months when it first caused trouble. My right eye showed the beginnings of a cataract two years ago  but has stayed 20/20  so far).

[KayakerNC]

"Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field."

I have the Trulign IOLs, the toric version of the Crystalens.   After reading for 10 - 15 minutes or so, when I look up at something distant it is a little blurred for a minute or so, and then gets clear.  Same situation going from distance to close reading.  So, for me, it is a lot more than just depth of field.  It is accommodation.  

[Anomalychick]

The method of accomodation that the synchrony used was only supported by a limited range of lens powers. It came in 16D-28D. I had a friend who tried to get it after me. The closest to plano they would have been able to get him was like a -10. There is no toric version. If  you needed glasses before you had cataracts chances are you aren't a candidate.

In 30% of cases, there was no accomodation. It depends on the size of the capsular bag. The lens comes in different powers, but they're all the same size. Not everyones capsule is the same size. Dr stated it was not possible to tell pre surgery who it would work for and who it wouldnt. 30% end up with a very expensive monofocal, and see below for what else they win.

Because it shifts inside the eye after implantation, refractive outcomes are VERY unpredictable. They only hit target refraction in 7% of cases in a study I read. You're going to need glasses or lasik. In my case, lasik because not only did they miss target by over 1 D with both eyes, but they also landed them 2.5 diopters apart.

The size of the lens means explantation is only considered in SEVERE cases. Its nearly impossible to remove safely. It is guaranteed they will tear the capsule at least partially, and there is a frighteningly large chance they will completely wreck the capsule and you'll need the new IOL sutured to your iris. Its not something they would do for refractive reasons.

Due to its size, a piggyback IOL is also not an option, there is no place to put it.

The surgery is much more difficult to perform than other IOLS. And they need to paralyze your eye temporarily which carries some additional risk.  You always need a backup IOL as an option should the capsule tear in surgery, which is more likely due to the additional manipulation required.

Those are the reasons to stay away. Now for those of us who are desperate to maintain accomodation after cataract surgery, it was so far to date, THE ONLY OPTION. (Crystalens and tetreflex are theoretical, nobody has ever actually seen them move inside the eye, its more likely they work by increasing depth of field) When I look at a piece of paper, its a blurry mess for a second. Then it shifts into focus. I got what I was after.