Both eyes at once

Hi Bmag, isnt there any way you could get another consultant to do your second eye sooner, May is a bit far off.  im glad that at201 agrees with me, your first eye should recover before getting the second one done, its bad enough having to care for one eye operated on without having to do it for two.

Could you get, if you dont have already glasses that would suit your operated eye and the other one so that you could pass whatever vision test that has to be done.  What a lovely occupation you have.

Again please let us know what you decide

Regards Agnes

Hi bmag78, since you are a ship captain, a good vision at night is probably more important to you than it is to an average person. Therefore, you should be aware of a night vision issue seen only with the Symfony lens. Please see a more detailed discussion of the issue under "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens." Essentially, at certain distances at night, looking at a  single light may result in your seeing not only a halo within couple of feet around the light, but in seeing about 10 different lighted concentric circles or halos covering a much wider area. For example, if I am looking at a car headlight, the outermost circle may be as wide as twice the width of the car. This has not been publicised by the manufacturer or the doctors involved in the lens study, but this is a unique issue for the Symfony lens. For me, I don't drive much at night and I like the vision with it during the day, so I am glad that I got it, but the tradeoff may be somewhat different for someone in your profession.

The issue of halos isn't only with the Symfony lens, its shape merely differs from the halos with other lenses. Even people with monofocals or the Crystalens can get halos. Multifocals can lead to halos with concentric rings, just like with the Symfony, though the exact details vary with the lens. Even people with their natural lens sometimes have issues with halos (I seem to recall its more common with those who are farsighted than those who are  nearsighted).

Since this site moderates links, I'd suggest googling 

"High rates of spectacle independence, patient satisfaction seen with Symfony IOL" for information about studies on halos showing the low risk with the Symfony. Unfortunately low risk doesn't mean no risk, but then there is risk of problematic halos with a monofocal as well. Unfortunately no lens that exists that doesn't give people problematic halos.  The risk with the Symfony seems to be comparable to that with monofocal lenses, perhaps not as good as the best monofocal but better than others.

Whether those halos are centralized blobs or a single ring  or concentric circles isn't the  major issue to those who get them, the issue is whether the halos are considered a problem for the person who sees them, and often they aren't if they are mild and if you see through them.  For instance search for "My experience implanting the Symfony lens this past year" for comments from a surgeon regarding things like halos, most people don't see them, and most who do don't consider them a problem.  In my case I see concentric ring halos, but they are so mild/translucent that I see through/past them and haven't considered them a problem (even if obviously I'd prefer they weren't there). Overall my night vision is better than I can ever remember it being, perhaps partly since there is less of a glare issue than I recall from even before my cataract appeared, which balances out the mild halos.

Most who do see halos initially see them fade away after the first few weeks or months. Others can see them fade over a year or more. I sometimes now don't see halos around lights where I always used to see them.  For various reasons I haven't spent as much time outside at night as I used to so it may be that it merely took longer to adapt since I wasn't spending as much time doing it. (and the same issue may be true for others who don't drive much at night, they may not see the halos fade as quickly as others who are out at night alot and adapt quickly).

 

I know that it is very hard to compare the unique type of halos associated with symfony lens with the usual type of halos experienced with monofocal lens, However, I hate to say it but I don't have much faith in the so-called studies showing that that the risk with the vision issues due to halos associated with the symfony lens are comparable to those with monofocal lens. All of these were done with the direct financial support by Symfony lens manufacturer. Even the surgeons who install IOL lenses tend to not highlight any unusual vision issues associated with the premium lenes because at least in USA, they can make more than twice the money installing a premium lens instead of a monofocal lens with minimal extra work.

Unfortunately even with an issue that is low risk, *someone* winds up being the "statistic" and its natural for them to not wish to believe they are unusual and to therefore question studies. It may just be bad luck, and not that the studies are off. Those who post online often tend to be those who have issues, so its hard to get a sense of the rate of problems from posts, and its impossible of course to get a senses of the rate of problems from 1 persons experience.

The studies for the other premium lenses show more of a risk of halos than for the Symfony. I don't see reason to assume the Symfony results would be more biased than those for other lenses (including other lenses from the same manufacturer).  The results reported at conferences post-approval are often by people with no funding from the company, and they seem to match the approval studies. The comments I see from surgeons using the lens, who have no connection to the manufacturer, seem to match the studies, e.g. google "My experience implanting the Symfony lens this past year" for the results from one surgeon who comments on the halo issue.

I guess we can keep on arguing about the percentage of people who have problems and whose data to believe. Based on the experience of my friends and my wife (which I observed first hand) with other premium lenses, the surgeons are not anxious to hear about any problems with the lenses. (my surgeon at least acknowledged the probem and did not seem surprised by the concentric circles which I see). It is in the financial interest of the surgeons (even if they are not subsidezed directly by the lens manufacturer) to push the patients into premium lenses because they make a lot more money from putting those in the eyes and thus, they seem to tell you all about their advantages and not their problems.

The makers of different premium lenses have  an incentive to discover  if their competitor's lenses have problems, and they have an incentive to fund studies to discover this. The potential for the profit incentive to distort results cuts both ways, and tends to be overblown by those who haven't dealt much with the issue of research studies.

In certain fields where there is difficulty or great cost involved in doing studies, some studies aren't likely to be redone by others and so there is more of a danger of studies being biased by those conducting them. In areas where studies are often repeated by others because they are relatively easy to do (since surgeons are doing cataract surgeries all the time anyway),  researchers have little incentive to risk their reputation by doing biased studies that may be proven wrong, leading their reputation to be undermined.  

Most surgeons involved in doing studies earn their living from their surgery primarily and not from doing studies, the studies tend to be things they do mostly since they wish to be involved in the leading edge of new products, and see it as good for their reputations. Most aren't going to consider it worth risking their reputations by doing a flawed study. 

Surgeons themselves need to know which premium lenses to use because they don't like dealing with patients with problems afterwards, so if one premium lens is better than another they wish accurate data indicating that. The surgeons involved in the study wish that information themselves, and that is what they talk about in the trade literature and at conferences, and what they participate in studies to find out. In addition, many doctors obviously got into the field not merely because the pay is good, but because they wish to help people, and they wish to find out the best IOLs to use to do so. Yup, there are some doctors purely motivated by greed, or at least subconciously biased by hope for profit, but the issue gets overblown since most are just reasonable people trying to study things to see what works.

 

Let us just agree to disagree on this. You can continue to believe that the visual issues at night with Symfony lens are not worse than monofocal lenses and I will continue to believe that the very design features that give the Symfony lens the extended focus capability make them prone to giving the people the unique visual false image of many concentric circles extending over large area around lights, which is completely different from monofocal lenses. Thus, if a very good night vision is important, then symfony lens may not be the best option.

Even if only 1 person out of 10,000 had a particular problem with a lens, they might think it must be common because they had it, be upset that the risk   wasn't stressed even though its rare, and people reading an online forum would have no way of knowing the issue's prevalence prevalence merely from anecdotes.

Science has often discovered that intuitions don't match reality, and that anecdotal data points can be misleading, even if they are very emotionally compelling,  especially when they happen to you. I see the concentric ring halos (though some are fading) and so its natural to assume "that makes sense because of the diffractive rings on the IOL" and to be puzzled as to why others wouldn't see them. However  in reality most people don't even if that may seem surprising to someone who sees them, and many who do see them disappear. Diffractive multifocal lenses also have   rings, and can lead to halos with concentric rings, thought the exact pattern of halos will differ between lenses and people, and again with those not everyone sees them. The only way to determine how many people, if any, see a visual artifact is through studies. 

It is important for people to be skeptical of all studies (I'm a skeptic by nature and have been concerned about junk science and studies for decades, I subscribed to the Skeptical Inquirer when it first appeared in 1976, though thats focused on more obvious junk science). However   again the degree of skepticism should take into account the likelihood of people trying to do studies to find a contrary result.  It is natural for lens proponents to try to bash other IOLs and that makes it likely for any potential flaws to be uncovered, though there is a need to skeptically evaluate those claims as well.

A co-inventor of the FineVision trifocal for instance did an optical bench study comparing chracteristics of that vs. the Symfony to try to show its benefits vs. the Symfony. The study was misleading  as critiques pointed out since  it was done using 1 wavelength of light rather than the broad spectrum of light that we use to see in the real world. Other lens manufacturers presumably would like to have studies that undermined the Symfony in comparison to their products, e.g. to say "use our multifocal, don't bother with the Symfony since the low halo&glare statistic claims are bogus in addition to our lens giving better near".. yet such information hasn't appeared (though of course there is no guarantee it won't).

The Crystalens is another premium lens targeted at better intermediate vision (with not as good near as high add bifoclas).Due to the fact that it is single focus, but claims to accommodate,  you'd guess the rate of halos would be low, and your view of studies as being biased would suggest the results should say that. Yet the FDA data for that lens suggests the rate of problematic halo&glare issues is higher than it is for the Symfony. It would be in the interest of those who profit from the Crystalens to undermine the Symfony's claims of  low halo&glare issues, if you were merely focused on the superficial issue of biasd studies, yet I don't see results indicating that. Surgeons have multiple IOL options, if there are flaws in one then info wil come out about it. (such as flaws in the Crystalens, which led me to decide on the Symfony).

Despite the   potential for profit, many surgeons are conservative and shy away from multifocals due to problematic side effects, and so it makes sense to consider the views of those who lean that way (especially since some of them therefore push options like the Crystalens instead). I cited a blog post from one such surgeon above. Before I had my impants, I  had email contact with the surgeon  from Singapore I mentioned above who made the post "My experience implanting the Symfony lens this past year" . I know he has no connection to AMO since we were comparing notes trying to figure out the pros and cons and technical details of the Symfony lens before I got it back in 2014, since he wasn't involved in the studies and was also trying to find out about it before it hit the market in his country. When googling for info on the Symfony I saw   he'd posted a blog entry indicating he initially heard about the lens through family who'd seen a writeup in a UK paper and was surprised that he hadn't yet heard of it since its his field, and was skeptical of the hype in the popular media and was investigating.   I'd emailed out of curiosity to see what he'd found out about it and compare notes, and while considering where to go outside the US to get my surgery in case he was an option  to consider when it was available there (valuing the idea of  rational skeptical surgeon). His posts after he had experience with the Symfony are merely anecdotes from more than one patient, not a formal study, but its one data point from a non-AMO funded surgeon.

 

Hi bmag, way over there in NY, couldnt be further away up here in the Highlands of Scotland.  

You are sounding so much more relaxed and ready for your procedure, Im so glad to hear everything is working out for you now and again your problem is significant to other in this site.

Here in Scotland or at least in my area of Scotland they generally wont do a second eye until the drops for the first eye have been completed and that takes 4 weeks, then of course if there is anything wrong with the first eye they wont do the second eye until the first one is OK, maybe its got something to do with different lens, I couldnt tell you what lens I have in either of my eyes just that whatever they are they work fine but im not so lucky in that my eyes are uncomfortable re itchy, gritty, and a bit of pain in my left eye, Im going to have to live with that but before I had the cataracts removed my sight wasnt good.

Enough of my moans and groans, please let us know how your first and subsequently the second op goes and happy sailing

Regards Agnes

 

3 weeks should be enough time to stabilize vision to get a good sense of the outcome. Although some people see a shift after that, its likely not much if it does happen. Mine was the same refraction from the 1 week postop onward, up until a  check a couple of weeks ago with only a slight shift that might even merely be due to differences in doctor doing the refraction or the equipment used (e.g. lenses aren't to perfect tolerance exactly the specific measurement).  

 

You mention wearing glasses in between surgeries, but that might potentially be a problem, many people need to wear a contact lens on their unoperated eye between surgeries.  I'll guess that may mean you typically wear glasses, and its a reference to perhaps not needing them after surgery on both eyes. The  question is how strong a prescription you have now for your glasses. After surgery the your eye will likely either not need correction for distance, or only minor correction. People who were have strong prescriptions before surgery then have a major difference between the prescriptions for their two eyes, e.g. 0D vs. -6D, which can cause problems with trying to wear glasses since glasses don't just change the focal point, they also change the size of the image (magnifying it or reducing it, depending on whether you are nearsighted or farsighted). The amount the image size changes depends on the lens power. If both eyes need around the same lens power, the image sizes are close enough that the brain can combine them without a problem. However if the difference is e.g. over 3 diopters or so, most people can't deal with that much difference in size. If your presription is lower than that then you can likely deal with glasses in between.  There are special glasses that attempt to compensate, though I'm unsure how how much of a difference they can compensate for. The magnification effect is less the closer the lens is to the eye, so contact lenses tend to work ok. (btw, some folks who wear glasses haven't tried contacts recently, they are much better than they used to be a couple of decades ago in terms of comfort).

Usually they actually don't tend to prescribe glasses until after vision stabilizes in the operated eye, but if your prescription is low, it'd probably be a safe bet to either remove the lens on the side with the operated eye or perhaps get an optician to replace the lens with a 0D non-prescription lens for esthetics.  

If you are going to wear a contact lens, if you don't now, you might just go into whatever the cheapest optometrist is to get trial ones before your surgery. Usually they require you to be out of contact lenses for a few days before a pre-op visit to get the eye measurements exact, so if you were going to wear a contact lens on the other eye you might try asking if they can do the pre-op measurements for both eyes before the first surgery.

 

Some of the argument for waiting seems to be "but what if something goes wrong in the first eye". However if someone needs surgery in both eyes, even if something went wrong in one eye, the other eye would still need to be done, and of course in this case 3 weeks is more than enough time to know if there is anything major going on. In my case even doing the 2nd eye the next day allowed a postop check to see that I already had good distance vision (and near that was somewhat good, it fluctuated a bit for the first couple of days, going in and out and then seemed to stabilize and seemed to remain the same).

 There is actually a rise in the number of surgeons outside the US doing both eyes on the same day since there are some benefits to neuroadaptation to getting both eyes done at the same time, in addition to the convenience of only going through one period of doing eye drops and postop visits. Apparently the major reason it isn't as common in the US relates to lower insurane compensation for that approach, rather than an explicit consideration of its pros and cons. In places where that is done they use seperate operating rooms and equipment to ensure if e.g. there is some source of infection or an equipment problem in one room, that it doesn't impact the other eye.

I'm assuming they must not require bandages afterwards, in my case I wore a bandage after surgery over each eye until the postop the next morning, but I've seen people posting indicating in their surgeries even on just one eye at a time they didn't have a bandage afterwards, so I'm wondering if it might be an old protocol established before modern surgical techniques and it isn't really needed.

 

"I've encountered three people who've done the symfony lens recently here in new York and they're all thrilled with the results. All describe halos tho at the minor nuisance level. They seem to be a result of every eye procedure."

I had one eye done using the Symfony lens and haven't had any halo issues at all.  I had ICLs (an implanted lens that's removable) in both eyes; the one in the operated eye was removed during the cataract procedure, I still have the one in the other eye.  I did notice halos with the ICL, especially looking at lights in the dark (streetlights, or even LED lights on deviced in a dark room).