Symfony Optiblue
Posted , 7 users are following.
About two months ago I had cataract surgery and had a Symfony Optiblue lens inserted into my right eye. Two weeks later I had the same lens put into my left eye. My near and intermediate distance is perfect and much better than I could have ever imagined (I can read clearly on my phone at about 6 inches). My distance vision is okay but not perfect with the left eye being a bit better than the right. With the left I can read most of the letters on the 20-25 line and with the right I can read one or two letters. For example, while watching TV, I can definitely read the subtitles but they are not crisp. Also, my vision gets a little worse throughout the day, but I assume that is because my eyes get tired from all the reading I am doing during the day? In fact, if I take a 15 minute nap late in the day, when I awake my distance vision is improved. Also, at night I do see moderate halos when driving but I can still drive without much of a problem. Anyway, I'm hoping some of you can help with a few questions:
- Would you consider this a very good result or do you think I should talk to my doctor about a lens replacement? While I assume my doctor could insert another lens that would improve my distance, I would expect that that would cause my near and/or intermediate vision to worsen. Is that right?
- My doctor has scheduled me for a quick laser adjustment for about a month from now. She'll be starting with my right eye and said by "cleaning it up" it will improve my distance vision. I know that once I do this, a replacement lens will not be an option so my second question is whether I should expect the laser to make a real difference?
Any help is appreciated!
0 likes, 22 replies
RonAKA Rsko
Posted
My first thought would be that you were left a little too myopic. Do you have the eyeglass prescription for your eyes? That is the most accurate way of determining where you actually ended up for sphere and cylinder (astigmatism) and most helpful in deciding what to do about it. Also think about whether this shortfall in distance vision progressed over time since the surgery vs being there from the start and never improving to get good 20/20 distance vision. I say that because PCO (Posterior Capsule Opacification) develops over time.
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If you can post your current eyeglass prescription I can make some more specific comments.
Rsko RonAKA
Edited
Thank you so much, this is really helpful! I have my prescription from about a year ago, but this was before my cataracts started getting really bad. Here's that prescription:
OD: 1.25 sphere; 1.25 cylinder and 180 axis
OS: 1.00 sphere; 1.25 cylinder and 075 axis (I think that's the axis, it's a bit hard to read)
+2.50 add in each eye
In terms of whether this progressed since my surgery, for my left eye there hasn't been any change. My right eye seems to have gotten a tiny bit worse in the two months since the surgery. My doctor was planning on doing the laser in my right eye. I'll ask her what it is but I'm pretty sure it's YAG (she said it would only take a minute and would be done in her office). For whatever it's worth, my doctor has a great reputation in NYC.
EDIT: I just realized that you are asking for my current prescription and not the one for before my surgery. I don't have that, all I know is that on an eye chart I'm 20/25 with both eyes but the left eye is a little closer to 20/20 than the right eye. I would need to get a new exam, which I can easily do but it will take a few days.
trilemma Rsko
Posted
What is your prescription NOW?
To understand where you sit, you might go to an optometrist and pay $65 or whatever. Do not get dilated.
Or maybe your surgeon has the numbers for you already if you ask.
Maybe it is LASIK.
The term "a minute" is often corrupted by some people, so as to be meaningless.
RonAKA Rsko
Edited
It is the refraction post cataract surgery that is important. I would get an eyeglass refraction done by an optometrist independent of the surgeon's clinic. If it shows refraction error that explains your less than 20/20 distance visual acuity, then it is a bad decision to do YAG. It is not going to correct refraction error at all. And although risks are quite low there is a 1 in 200 chance of retinal detachment. Also, the lens can be pitted by the YAG laser, and the flaps created by cutting the hole can get in the way of your vision and cause starburst effects in addition to your halos.
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When you get an eyeglass refraction done with the phoropter you will immediately see if you can be corrected to 20/20 vision. Ask to see the eye chart with and without the prescribed correction.
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Do not go down the YAG road unless you really have PCO that is impacting your vision.
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If you get an eyeglass refraction it is normal practice for optometrists to report cylinder as a negative value. It is also normal to calculate the spherical equivalent to combine the effect of sphere and cylinder error into one value. The concept is to add 50% of the cylinder to the sphere number. For example:
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-0.5 D sphere, and -0.5 D cylinder combine to give aspherical equivalent of -0.75 D. That is in the range you may expect to see from your refraction results based on your reported visual acuity of the 20/25 line in the eye test.
phil09 Rsko
Posted
I agree with RonAKA that this sounds like a pretty decent result, and a touch-up with LASIK or PRK on one eye only could get you to a very good result. I am especially impressed by your reading vision at six inches!
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Just one additional thought: It might be worth considering making the adjustment to the eye furthest from plano, rather than the one closest to plano. The reason being some ophthalmologists, including mine, have said that nearsightedness worsens the halos of the Symfony OptiBlue lens. So maybe your halos could be reduced by touching up your more nearsighted eye. It sounds like the vision in your two eyes is pretty similar, so it may not matter a whole lot which one you touch up.
soks Rsko
Posted
for a myope like me it would be a great result. fixing distance will make near worse. symfony can address only distance-intermediate or intermediate-near.
sounds like she wants to do yag for your pco. if you needed yag your near vision would be affected. when i had symfony, pco first affected my near vision. so be 100% sure before you get the YAG laser.
Rsko
Posted
My doctor’s office confirmed that my doctor is planning on a YAG procedure and so I’m planning on talking to her to ask why she made the decision to do that. I’m also going to get an eye exam tomorrow. I have two questions:
If my doctor had used Symfony lenses that corrected more for distance is it likely that my near and intermediate vision would have suffered. Right now that near and intermediate vision is amazing and given how much I read, that means a lot to me.
If during my eye exam it is clear that my vision can be made perfect with a prescription is that pretty indicative that the YAG won’t help (my reading of some of the above posts seems to say that but I just want to make sure)? I’ll post my new prescription when I get it tomorrow.
You guys have all been awesome!
RonAKA Rsko
Posted
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Good luck with your test...
Sue.An2 Rsko
Edited
Hi Rsko. i had Symfony lenses inserted in 2017. Personally I would not get that YAG procedure done yet. I would wait till it is affecting your vision more.
Have you considered getting glasses to improve your distance vision? Most of the time near and intermediate vision is what's needed for reading computer TV viewing - anything around the house.. Perhaps the glasses only needed for driving or out on walks?
I would consider your results good and not consider a lens exchange or tweaking it with laser treatment.
The more messing about could bring on another condition you wouldn't want to deal with.
best of luck to you - i really like having near vision and if i had to choose between near or distance I would choose near.
Rsko
Edited
I just had my eye exam and here are the results:
Right eye: -050 -075 x101
Left eye: -050 -025 x140
He also confined that my near vision is perfect.
In terms of the YAG, he said I had a tiny bit of PCO in each eye. He said in the left eye it was more of a film and in the right eye it was more spotty, but he emphasized that it was very little. The vision in both eyes was about the same right after the surgeries, but the vision in my right eye has gotten a little worse since then - maybe due to the PCO?
Since there is some PCO, I'm leaning toward getting the YAG, especially since the vision in my right eye did degrade a little since the surgery. I also may consider LASIC in my right eye, but need to talk to my doctor about how much that may impact my near/intermediate vision. I think it would be crazy to replace the lens, right? what do you all think?
soks Rsko
Posted
if u got great intermediate n near with just -0.5 myopia thats a great result. dont do anything. get glasses to sharpen distance n get yag when necessary.
RonAKA Rsko
Posted
Your spherical equivalents which are the sphere plus 50% of the cylinder would be:
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Right: -0.875 D
Left: -0.625 D
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You should have better distance vision in the left and better near in the right. If you want to retain your near and improve your distance I would do the Lasik on the left eye to correct the myopia and cylinder. There is no rush to do the YAG and based on what you report there would be no improvement in visual acuity. Hold off on the YAG until it becomes visible, if it ever does.
Rsko RonAKA
Posted
Thanks! You are right, I do have better distance in the left and (very slightly) better near in the right. The same lens was put in each eye but I guess each eye is not exactly the same and that's why the results are different? What's strange is that my right eye has seemed to get a little worse since the surgery.
In terms of my spherical equivalent, is this a more or less an expected result with the Symfony Optiblue lens or is it more myopic than one would expect? Would this be viewed as very minor nearsightedness?
RonAKA Rsko
Posted
Yes, each eye is not exactly the same, and the IOLs come in steps of 0.5 D, so not unusual at all that each eye has a different outcome. In fact it is unusual to have the eyes so close that the same power of IOL was used in each eye. Keep in mind that it is not necessary to perfectly match the vision in both eyes. There are advantages to the overall range of focus to having one eye at plano or near it, and the other somewhat myopic.
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In a perfect world it may be best to be -0.25 D in the distance eye, and -0.75 D or so in the other eye. You could come close to that by doing Lasik on the Left eye. Lasik should be able to reduce both the cylinder and sphere to get you near plano. Your right eye is probably fine where it is now for better near vision. But, if you are satisfied with the near vision of the left eye, you could do the other way around, and try to get the right eye close to plano with Lasik. I would not do both eyes with Lasik, as it will reduce your overall near vision.
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I have indications of PCO in both eyes which are not impacting my vision. The laser specialist recommended waiting until it does before proceeding. There is no rush to do it, and you may never need it. Some reports show that YAG is really only necessary to deal with PCO in 8% of cataract surgeries. However, stats show 30-50% of eyes are being done, which suggest an unnecessary over treatment with YAG. It seems to be used as a cure all, when it really only resolves PCO.
Rsko RonAKA
Posted
This is very helpful. One silly question: If I had the YAG, would the PCO potentially continue requiring another YAG down the road anyway?
Rsko RonAKA
Posted
BTW - When you say the best would be to have -.025 D in the distance eye and -0.75 D in the other eye, are you referring to the spherical equivalents?
RonAKA Rsko
Posted
The YAG blows a hole in the capsule which accumulates the PCO so a second one should not be necessary. However, if the edges of the hole, or the flap depending on the pattern used get in the way of your vision or cause glare, it can be necessary to enlarge the hole in the capsule.
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Yes, -0.25 D in the distance eye and -0.75 D in the near eye would be spherical equivalents.