Symfony , good? or..........?

Currently I prefer to use monofocal lens same materail of Symfony, it seems the material has the low index, some lens have lower index, but lots of problems,

This Monday I saw a doctor, asked him which lens has less external reflection, he said:

all the lens have it, either you do not do the surgery, either yoiu accept it.

His attitude, I guss many of friends in this forum has the same experience, as if cataract is our fault.

Of course monofocals have the tradeoff of a reduced range of vision. I'm atypically young for cataract surgery, but also figured it makes sense to consider what things will be like in a couple of decades as I get older. Those who get monofocal IOLs and wear bifocal or progressives(/varifocal) glasses have risks when driving due to decreased reaction time due to the narrower field of view and need to position their head to look in the right place.  The issue also arises when walking, if you google this quote, one article   notes that :

"Falls are the most common cause of traumatic death in over 65s.5 Wearing of bifocals is said to double the risk.6 "

There is also concern that monovision with contacts or IOLs reduces depth perception and depending on the person's natural depth of focus, or where the monovision points, may leave only one eye providing clear vision for what is underfoot when walking. It effectively reduces the visual acuity for whats underfoot, and one article notes:

"a small decrease of visual acuity to 20/30 or worse in one eye increased risk of hip fractures by 1.73 times"

(oops, though google doesn't seem to turn it up as the first hit, it turns up related articles on the issue). 

I may not have the sort of risk of falling someone elderly does, but being active its helpful to have good vision underfoot. I've been getting back into trail running, and with the Symfony all the rocks and snow and black ice spots at foot level are in crisp 3D from both eyes for safe foot placement, reducing the risk of taking a spill. 

If you do consider a lens exchange, you might check on the idea of the  Crystalens accommodating IOL rather than a monofocal. It is a single focus lens, which merely may accommodate to provide at least a bit more near than a monofocal. It depends on how picky you are about visual quality at distance, since its likely not quite as good as a good monofocal like the Tecnis. Though actually at least the FDA approval data for the lenses show the Crystalens has more of a risk of halos&glare than the Symfony lens (which is an extended depth of focus lens, not a multifocal), but I can understand that  someone who had difficulty with a lens with diffractive optics like a trifocal might hesitate about using another lens with diffractive optics. 

Unfortunately some people do take longer to adapt to multifocals, even if some adapt very quickly, and 3 weeks is fairly early on so its still possible you'd adapt (though a risk that you won't). 

You say your distance vision is worse, do you know if you were left myopic perhaps, or with some residual astigmatism (which can happen even if you had none preop),  do you know what your residual refractive error is? If that is the issue it could be addressed via laser correction. (the small amount of laser correction used for fine tuning vision after surgery isn't viewed as being a problem for a multifocal, its only the larger corrections people with high prescriptions get that is a concern).

Unfortunately some of the symptoms you refer to like halos are things that many people see in the initial period after surgery, but which fade over the first few months due to healing and neuroadaptation. Most studies on IOLs only report data on issues like halo&glare at the 3 month or 6 month point after people have adapted, when most people don't report problems (though unfortunately *someone* winds up being the "statistic", even monofocal IOLs cause trouble for some people).

The reference to things being "misty" makes me wonder if there is any chance you might have a rare case of early PCO (posterior capsular opacification) which happens to a minority of people with IOLs. It usually happens some months (or years) afterwards, but it can happen right after surgery.  Though if you'd seen another surgeon I'd have hoped one of them would have noticed it.

You say your eyes were healthy, but did you ever have refractive surgery before  this, like LASIK or PRK?  (those who used surgery to correct their distance vision when younger are often the ones who seek out refractive lens exchange for presbyopia). Sometimes multifocals work well for those with prior refractive surgery, but other times, especially if their surgery was done using older laser technology, there is corneal irregularity from the surgery which doesn't play well with the optics of a multifocal IOL. (other times its not an issue, good doctors will do scans to see if its an issue).

Alternatively, if you are one of those lucky people that had good distance vision without correction and without having had sugery, and were just looking for a solution for presbyopia, you may be more sensitive to any reduction in visual quality than those who have been used to having poor vision without correction. Those doing refractive lens exchange also  often have higher expectations than those with poor vision from cataracts where usually whatever they get will be a big improvement from their cataract-impaired vision.

Although a trifocal has less of a drop at intermediate than a bifocal, it still does have a bit of a drop. I almost went for a trifocal, but chose the Symfony partly due to its focus on better quality intermediate and lower risk of halos. My distance&intermediate vision is better than I remember it ever being with contacts&glasses (part of that is the visual quality of the Symfony, though I gather in general with high myopes that is sometimes true after cataract surgery when the correction is done via IOL rather than contacts/glasses).

 I second your suggestion that people do a contact lens trial. In your case you didn't have a cataract to interfere with it.  Unfortunately often by the time people have cataracts, the reduction in visual quality means they can't do a good test. I think eye doctors should urge anyone old enough to be presbyopic, *before* they are more likely to get cataracts, and even if they don't normally wear contacts, to do a contact lens trial with multifocal contacts and monovision contacts to see what they prefer. (also of course anyone reading this should urge friends/family to do so). 

Sorry to hear about the results, and that they didn't pay attention to the results of your multifocal contact lens trial. Although its true that the optics of a multifocal IOL are usually different (and better) than those of a multifocal contact lens, it should be a warning sign if someone doesn't adapt to those. They still might adapt to a multifocal IOL due to its differences, but its best to be very cautious, especially if someone is doing elective refractive lens exchange rather than cataract surgery that is needed.

In my case I preferred multifocal contacts to contacts in monovision. I'd worn monovision contacts for a few years before trying multifocals, with the difference between the eyes slowly increasing. I hadn't noticed I was losing depth perception,  monovision had worked ok. However   when I tried multifocal contacts it seemed things were subtly more 3D, I had the sense that I'd been missing something with monovision, which is part of  why I'd figured I'd get a premium IOL rather than monovision with IOLs.

Hi sotwaredev, many thanks for your reply. Maybe our responses will help others decide what to choose or help ask the right questions beforehand.

I still have healthy eyes, the surgery was done correctly, it is just that my brain will not adapt. That's what the UK opthamologist surgeon told me when I visited him just over a week ago. He wasn't the surgeon who carried out the lens exchange. There is no cloudiness of the capsule, the lens is correctly aligned. 

I am 52, never had laser or any eye problems, mine was just age related, presbyopia. I would have coped with reading glasses, (I was using +1.75) but my middle distance was becoming worse, such as walking around shops or watching TV. I had to carry two pairs of glasses around with me, both separate prescriptions. It was frustrating to have to keep taking one pair off to look at labels and then back on to see other things around me. I often forgot to take at least one pair with me. I'm quite scatty. 

The UK surgeon thinks that anything other than monofocal lens exchange would not be suitable for me, based on what I am currently experiencing. He also told me that I would probably not be truly happy with those either, as I would need glasses for reading. However, I would rather have good distance and mid range and still have to wear glasses for reading, than live in a foggy world full of gigantic halo's....

I will google crystalens and discuss this possibility. Thank you. 

I have a couple of weeks to decide what to do, as it is not advisable to explant and replant after 6 weeks. 

I 

Crystalens accommodating IOL, from what I learned from internet, have very NOT GOOD review. so ,,,don't make the decision so quickly

What is your refractive error, is it actually 0? It would help to confirm what it is to know whether that may be part of the issue. Although it sounds like your brain hasn't adapted yet, that doesn't mean it won't even if it takes longer. Unfortunately some people do take longer to adapt. 

One anecdotal in depth review of the Crystalens was written by someone I know, google "Cataract Surgery with Crystalens - My Experience". Unfortunately he was left somewhat hyperopic which reduces  his near vision so his results aren't as good as average in some ways in terms of near, though his distance is great.

I will also  note that when you look into the Crystalens, that it has evolved over the years and so some comments may be on older versions of the lens. It does have some risks that other lenses don't have like z-syndrome, however I gather that risk is far lower with the new version. I hadn't run into data on its prevalence with the new version, but I hadn't explicitly searched for it. The data may exist, or perhaps if its now not a problem no one has bothered collecting data since its rare. I felt the Symfony or a trifocal was a better bet (partly since the Crystalens seemed to not always accomodate), but if I didn't use one of those, I'd likely go for the Crystalens over a monofocal. 

That said, it partly does depend on how picky you are regarding the quality of distance vision since a high quaility monofocal may have a slight edge, and there is some risk of halo&glare issues. I've read that surgeons find that those who have always had good vision are more picky about any reduction in distance vision, no matter how minor, unlike those who need correction who often don't have ideal correction as their prescription shifts before they get back in for an update (and see blur when they remove their corretion). Though in my case I also have at least 20/15 vision at distance with the Symfony, I doubt I'd notice the difference with a monofocal.

The reason I'm suggesting the Crystalens (or the Symfony if you wished to consider a non-multifocal lens, though also has diffractive optics and some surgeons who are more into medicine than optics confuse it with one since it looks like one, so it scares off some folks who are avoiding multifocals) is of course that going with a monofocal guarantees less intermediate&near, unless you go for monovision which reduces stereopsis. I also don't know if you'd tried contacts in monovision, since it is possible that you'd have trouble adapting to that as well, just as you did with multifocals. It does require the brain to tune out the blurry eye, though that is easier than tuning out the blurry images from othe focal points in a trifocal. Most people adapt to small amounts of monovision.

I just figured that since you went for trifocals to combat presbyopia, it would seem a shame to wind up with essentially worse presbyopia with a monofocal.

I can understand not wishing to deal with presbyopia, or the need for reading glasses, that is why I tried multifocal contacts and was fortunate to be able to adapt to them. Then when my problem cataract hit at age 49, I really disliked the thought of losing all my accommodation with a monofocal and perhaps living  with the result a few decades,  so I sought out options. At the time in the US the only multifocals approved were high add bifocals, which skip over the intermediate vision range. I tried to wait for the US to approve one of the trifocals (since my other eye remained 20/20) or some other option, and finally had to give up and go to Europe when the cataract got too bad to get a better lens. The Symfony had come out and seemed a better bet for my needs than the trifocal. So I can understand going out of your way to avoid presbyopia.

re: poor reviews of the Crystalens, unfortunately there are some people who didn't have good results, but most have good results. Overall I think other premium lenses are a better bet, but the point is that the Crystalens may be a better bet than a monofocal for someone who had sugery in the first place to avoid dealing with the loss of accommodation. It is important to research any IOL choice since it has a major impact on your life, especially for those of us who may have a few more decades left.

 Unfortunately no lens out there is perfect, even monofocals have issues, and out of > 20 milllion cataract surgeries a year (perhaps > 480,000 of those with premium lenses) even a small % with problems will generate lots of complaints visible on the net, while those with good resuls are less likely to post. (though some of us  researched things themselves online before surgery and wish to be of help to others going through the same thing, or others have unrelated eye issues).