Anyone with experience with Tecnis Multifocal IOL?

Thanks, Ron. I should have waited until after my appointment this morning to post. The lens I'm considering is the Tecnis MF +3.25 (Model ZLBOO). Who knew there were so many different lens available? I don't see a way to edit my title question. Am I missing something?

I had already figured out that "premium" lens should be taken as you're paying an amount above the usual charge and that the lens may or may not be the best fit. And I have to give the cataract coordinator credit for making it clear from the very beginning that perfect vision is not to be expected. I've read about halos around lights, but as I've been seeing halos and rays around lights at night for several years now (and avoid driving at night anyhow) I feel like I can live with that.

Hopefully others with more knowledge of the Tecnis lenses will comment. About all I can say which comes a little research I have done is that it is one of the older lenses compared to the ones I listed above. It is like a bifocal eyeglass lens. It should let you read very well, and see in the distance, but it may leave a bit of a hole in the intermediate range where you may not see so well. For example if you golf or play tennis it might compromise the hand eye coordination in that 2-3 foot range. And, it sounds like you already know about the halos, starburst, etc issues.

Again from my limited knowledge, the Tecnis Synergy may be a better lens as it is more like a trifocal, and provides better vision in the intermediate range. A comparable lens in the Alcon brand line would be the PanOptix, which is also like a trifocal.

Also keep in mind that the other alternative to a multifocal lens is mini monovision. That is when you get a monofocal lens in both eyes, but the non dominant (usually) eye is under corrected by about -1.25 D. This eye gives you some reading vision, while the other eye gives distance vision. The best way to try out this option is to simulate it with contact lenses before you get the IOL surgery. You do have to have good enough remaining vision to give it a fair try though. That is what I am currently doing, and I am thinking that is the way I will go when it comes time to do the second eye.

Thanks, rwbil. I've been reading your other posts. Although I've worn glasses or contact lenses for 53 years now, I've been able to read without assistance. The book may only be 6 inches or so in front of my nose but I can see it, so I think having to wear corrective lenses for all reading would be frustrating. I don't mind using off the shelf readers or grabbing a magnifying glass for tiny print, though. Having good distance vision would be wonderful.

One thing I'm curious about is what it's like to experience the less than optimal midrange vision with the older Tecnis MF. I don't golf or play tennis and I've been trying to figure out if there's anything I do that would be affected by the midrange issue. I really wish there was a way to see the difference before a decision has to be made.

Midrange - A lot of it depends on your starting point. I think one of the biggest issue is when someone does a clear lens exchange or only had a minor cataract and then get an IOL, so they notice how different it is.

When I first got my lens and my other eye had a minor cataract, I could notice it doing the cover one eye up thing.

But now that my other eye cataract is so bad I get use to it and there is nothing to compare it to. So when I look now it seems fine, but when I get the other eye done maybe with Symfony Plus which has better mid range and if I do the cover one eye up thing I will notice the difference.

My biggest issue with the MF is splitting the light and night driving. It definitely makes a difference in low light. I remember after getting the MF walking down my stairs and the stairs light was off but the downstairs light on so dimly lit. And then I rubbed my good eye and Wam Bam I could not see any steps out of the MF lens.

So for me, I want a lens that gives the best vision across all distances with the least light splitting possible, which is why I was looking at the Symfony Plus.

I would think the Symfony Plus does better in low light than a Trifocal.

Started looking at Synergy more as Ron and others mention it. The advertisement is great, but who knows the results will be as many patients get it and we get real world results over time. Reading here I have read some bad results, but maybe that is the nature of a forum like this.

There is an ophthalmologist who had synergy implanted who has a you tube video on it and according to him it is the greatest IOl ever. But he might be associated with JNJ; who knows.

But I can not help but think Synergy has to be worse in Low Light than the Symfony as it does both EDOF and MF.

I am waiting for more doctors who implant Trifocals, Symfony Plus and Synergy to start writing articles or making videos of there patients results.

If Synergy is truly leaps and bounds better, I would expect Ophthalmologist to start writing about it and saying how this lens is revolutionary. And being the lens is based on Tecnis Symfony and Tecnis MF and not some completely revolutionary design I would expect doctors implanting the other lens to start using it quickly to get results.

IMHO I think the Synergy (assuming it get FDA approval), Symphony Plus and PanOpTix Trifocal and IQ Vivity are the best options in the US. And the next revolutionary type of lens like Juvene are far into the future.

So as right now I plan to get 1 of those lens. Which one is the question.

Maybe you can be the Early Adopter and let us know your results, LOL.

I think you're more than likely right about it depending on your starting point. Although I have to say a sister-in-law who had refractive lens exchange in 2011 has been very happy with her experience and said she hasn't had any issues with intermediate vision. She didn't remember which lens. Just knew that it was a bifocal type. (I thought she was nuts for replacing a clear lens, but have to admit it has turned out well for her.)

Turns out that another sister-in-law has the Tecnis MF +3.25 and she said intermediate vision hasn't been an issue for her either. Her only problem was getting used to the halos. Apparently no one told her about them before her surgery so it was a surprise. That said, neither sister-in-law plays golf or tennis, etc., so I assume their lifestyles are part of the reason it hasn't bothered them.

Not being able to see in dim light is disconcerting. Having that happen on the way down the stairs would be horrible. With our uncovered transom windows in our bedroom I've always been able to see when I awaken during the night. Now I have to get lined up just right to even see the windows. The first time the "black fog in front of my eye" happened I thought I might have gone blind, but turning on a light solved the problem. Now that I've gotten used to it, I just make sure I know where my phone is so I can use it to light the way.

Decisions, decisions. One is easy for me, though. With my not being a risk taker you can place bets on my not being an early adopter. LOL

Alright @RonAKA, as usual you present Top Quality information, which makes my decison that much harder.

I have been leaning towards the Tecnis Symphany Plus with micro monovision to boost the near. Just a a reminder I currently have the Tecnis Low Add MD +2.75 in my left eye.

But then I look at the graphs you provided and Tecnis Synergy from those graphs looks like it provides the best overall vision across all distance and if I am following those graphs it does it with have less issues in dim light.

My biggest issue with another MF is splitting of the light and night driving. But maybe Synergy splits the light differently or less than the old Tecnis MFs.

Do you have any information that shows the Synergy vs the Symfony Plus in regards to low light and halos and the like.

Also any information on the Synergy regarding clinical trials, FDA and Synergy. One would think it would similar enough to Tecnis Symfony and MF, it would easily get FDA approval, but FDA is insane.

This is also why I like the Synergy as I would think it would be based on those other designs and not some high risk completely new method like the Juvene.

At this rate I will never get my right eye done as I keep waiting for a "Better" IOL to come along. LOL!

Just look at JNJ site and the propaganda sounds GREAT!!

"TECNIS Synergy IOL creates a new standard in presbyopia-correcting intraocular lens (PC-IOL) technology, allowing patients to experience continuous high-contrast vision from far through near, even in low-light conditions.1,2,7 The Johnson & Johnson Vision R&D team changed their approach to IOL development – designing the optimal defocus curve for clinical performance, then developing the technology to deliver for it. The result – a revolutionary lens with optics that outperforms existing PC-IOLs on the market.††† "

As best as I can see, the Synergy IOL has not been given FDA approval in the US yet. However, it is approved in Europe, Australia, and Canada. It can't be far away. What I saw on the Juvene is that it has been in development since 2015, and is not expected to be commercialized until 2023, according to the manufacturer.

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The Symfony Plus seems to be the Symfony with more reading power. Since the Symfony has issues with night halos and starbursts, I would expect the Plus version to potentially have more. It is approved in the US though.

That is why I was waiting on the plus to be available. Combined with micro-monovision might add a line or 2 at close. Plus they claim they added a filter that reduces halos and the like.

But now I am looking into the Synergy. If they figured out how to provide the defocus curves they showed while simultaneously this IOL has no worst night vision and halos than the Symfony Plus it might be the best IOL out there.

The problem is until the IOL is out there away it is hard to find articles on Real-World results between it and the Symfony Plus.

When I got my MF I was told the less add (+2.75 over +3.25) the less halos or at least smaller halos. I also have read on the EDOF best to go at Plano, so the more monovision one does the greater the halos. Not sure if the is 100% accuarate or not.

I looked at the FDA clinical trials site and searched for Synergy and I did not find anything, not a good sign for approval anytime soon.

Thanks for the info and defocus curves. I live in the US so the Synergy is out for me. PanOptix and Symfony look interesting, but so far I haven't found anyone that I trust in this area using them. Looks like I would have to drive 3 hr round trip for evaluation, surgery, and follow up for the Symfony. However, there's a possibility of evaluation and follow up in my area for the PanOptix with only surgery requiring a 4 hr round trip. I'll be checking on that Monday morning.

I tried monovision with contact lenses several years ago. It was fine when I was at home, but walking through an unfamiliar airport or busy shopping mall was toture. Crisp, clear vision on one side with a blur on the other was just not something I could handle. It's possible mini monovision might not bother me as much, but I'm not willing to risk it.

"so far I haven't found anyone that I trust in this area using them."

What part of the US are you located?

If you want to do a bit of research on the various presbyopia IOL options, here are some articles that I found interesting. This first one is from 2018 so is a bit dated but it gives some statistics on what lenses were most popular at that time, and those that are less popular to use. It is based on a survey of surgeons, presumably in the US. It does not include the newer lenses like the PanOptix. The Symfony seems to be the obvious popular one for presbyopia in 2018.

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Review of Ophthalmology PUBLISHED 10 JANUARY 2018 Surgeons Share Their Views on IOLs

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This one is newer and includes the PanOptix. It is still second to the Symfony in popularity, but the PanOptix has been on the market a very limited amount of time in the US, so that could be the reason. In articles comparing the two lenses, it seems the PanOptix is preferred over the Symfony by some.

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Review of Ophthalmology PUBLISHED 8 JANUARY 2020 Review’s Annual IOL Survey

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And here is another article that talks about the newest lenses on the market. I see that the Symfony Plus is included and they say it was FDA approved in May.

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ModernOptometry October 2020 IOL Roundup

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This article talks about the Synergy, and AcrySof Vivity IQ which are also very new. The Vivity is supposed to be the one with least visual artifacts like halos and starbursts. But it is not a slam dunk for reading smaller text and would likely need reading glasses, or possibly one of the Vivity lenses under corrected for distance to improve reading with one eye only.

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One option you may have is to use a different lens for each eye. Perhaps do the non dominant eye with the bifocal Tecnis ZLB000 that you were planning on, and then after 8 weeks or so do the second eye with the Symfony or Symfony Plus. That may address the intermediate distance loss with the ZLB00. Just a thought.

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@Sue.An2 here uses the Symfony lenses and hopefully checks in with her comments. @soks I recall has done a lot of research on the Synergy lens, and was looking for a place to get it in the US. Sometimes manufacturers release the lenses before FDA approval to certain clinics. Not sure if that is the case with the Synergy or not.

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Hope that helps some,

Central Alabama. Found a surgeon close by that uses PanOptix, but he did a procedure (not cataract related) on my brother's eyes which was no longer the standard of care and my brother ended up with unnecessary side effects. No way I would feel comfortable with him or his partner.

Thanks for the articles to read. It does help.

These are available now. I went to Center for Sight Venice Florida