Audience Poll for my Next Steps
Posted , 14 users are following.
44 years old. symfony in left eye in 10/2018. PCO getting severe since 8/2019. poor near vision since surgery. contrast loss noticeable compared to natural eye. positive dysphotopsia PD due to large pupil. can see lens edge in dark. miotic drops help with the PD. right eye tanking fast. double vision. distance prescription from -2 to -3.5. options as follow.
A. get another symfony and YAG the left eye
B. YAG the left eye and wait for synergy of symfony plus to hit the US or get synergy in right in Europe. synergy and symfony plus have the yellow tint for UV filter so may mismatch with symfony in the left.
C. get synergy in right eye and if liked then exchange left to synergy. then YAG left eye.
D. get monofocal or eyehance in the right eye and YAG the left eye.
E. get Aspira AXA monofocal in the right eye in europe which is a 7mm iol and will prevent PD in right eye. YAG left eye or exchange it to Aspira AXA and then YAG it.
F. Get Pan Optix in right eye. if like exchange left to Pan Optix.
G. get pan optix in right eye. YAG the left eye.
H. get BnL sofport in both eyes.
What do you vote for?
0 likes, 35 replies
john56935 soks
Posted
I hope your poll doesn't confuse you more and I may not even follow this thread so i don't start second-guessing myself. My vote is for A and if it is so bad then wait for the Eyhance to get approved here and then exchange it. Hopefully you can get good daytime vision and then just live with the nighttime issues. We are in the same boat with the same issues except i already did YAG on my first symfony and this is what I am planning on doing so at least you will have someone else on here that is going through the same thing.
W-H soks
Posted
Was your vision every good with the Symfony? If not then I definitely would not put another Symfony.
soks W-H
Posted
it was decent. near vision was always poor. and PD was present since day 5.
Deb03 soks
Posted
I don't know anything about the lens, but if it's a good lens, then I pick option E.
soks Deb03
Posted
i wish they made 7mm multifocals with more near add with the extra surface area. you would lose the extra near as the pupil got smaller with age.
kevin77191 soks
Posted
I have the Symfony in Feb 16 on my right eye, got YAG, regret it big time as it caused a s**t ton of side effects.
Now June 2020 I'm planning to get a monofocal for distance because I cant stand the side effects of the symfony.
what is this eyehance lens you speak of? do we know when it will be approved in Canada?
soks kevin77191
Posted
eyehance is a new tecnis monofocal which gives a little bit more intermediate than a monofocal. the way they advertise it is eyehance is like someone in their 50s while symfony is like someone in their 40s.
george05887 soks
Posted
so, i am 46 i had bilateral catarac surgery in October 18. had symphony in dominant right eye & tecnis multifocal in left. I immediately got pco in both. He yagged both big mistake. I had issues after yag with a crystaline material in my eye causing me ti have to get vitrectomy in both eyes. cleared that up great. problem now is i just cannit see good at all with either lens. This is the most painful thing ive ever gone through. before surgeries bith eyes were 20/10. My symphony eye near vision is TERRIBLE. the tecnis multifical is only good around 18-22 inches. I am meeting with him to see what to do. He wants to do prk but i dont think will fix probelm beacuse i then lose distance with symphony. I am so frustrated now. I wamt to do a bilateral exchane and would love to get the panoptix trifocal. I dont know if this is even possible. Any advice would be greatly appreciated. Im desperate for improvement .
Best
George
soks george05887
Posted
sorry you are experiencing this. if you are in the US dr. safran is experienced with lens exchanges after yag. it is risky procedure as it exposes the vitreous to the anterior chamber (front side of the eye). it can lead to retinal issues.
scott10751 george05887
Posted
Keeping in mind I'm no expert, I've read that a there is typically a myopic shift after a vitrectomy, search for this and you will find several studies. My first thought is now your prescription is off, but if it's typically a myopic shift (.5 to 1.5ish), I'd think your near would be better, not worse. Perhaps with prk he wants to try a minor correction to make up for that? I've also read that the vitreous is more stable than after you've had a vitrectomy, were either of your lenses toric? They could have rotated and need to be rotated back. Hope this helps.
RonAKA soks
Edited
My vote would be to do the YAG in the left eye, and get a distance monofocal for the right eye. I believe the Alcon AcrySof material is less susceptible to PCO.
soks RonAKA
Posted
i think all alcon lenses have the yellow tint. so for monofocal i would probably go with tecnis or the aspira. i think the pco is a foregone conclusion.
RonAKA soks
Edited
I believe that Alcon did make a non blue light filtering lens (SA60AT) but it may be discontinued now. I wonder if having the eyes matched with or without blue light filtering is an issue? Right now I have a significant cataract in my right eye, and fairly insignificant one in my left eye. My right eye vision is blurry, double images, and whites are turned to a light tan/yellow colour. My left eye still has crisp focus, no double vision, and the whites look bright white. I notice the differences most when viewing whites on TV while closing one eye at a time. However with both eyes open, everything still looks pretty good. It may be worth asking a professional if having the blue light filtering matching is an issue or not.
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Here is a graph of a study which compared the AcrySof material to other for risk of post op PCO. I believe the hydrophobic one highlighted in yellow is the Tecnis material -- about 3 times higher risk. And the Aspira is potentially the hydrophilic? one at 9 times the risk... The AcrySof material is represented by the risk level of "1".
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You should be able to find the full report with this search:
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"Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis"
Guest RonAKA
Posted
Authors of that report are sponsored by Alcon, it is typical marketing stuff.
Alcon hydrophobic acrylic lenses have had big issues with glistening, every manufacturer have their strong and weak points.
RonAKA Guest
Posted
I have investigated the claims that AcrySof lens have "have big issues with glistenings", and concluded that they may have initially had some issues, but they have been addressed with better manufacturing quality control. However the stories linger on. My surgeon said the same thing. I have a choice between AcrySof and Tecnis and will choose AcrySof.
I am more concerned about PD with AcrySof lenses. However that issue seems much less frequent, and there are no obvious choices to avoid the risk.
soks RonAKA
Posted
dr. shannon wong also talks about glistening problem with pan optix. it is due to the lens material. it doesnt necessitate an exchange but the problem still exists. it is his video comparing symfony and pan optix.
W-H RonAKA
Posted
He is 45 so PCO characteristics of the lens should not be his highest priority as it will come anyway. Plus those same characteristic make light behave funnily and might cause more issues.
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If I remember correctly Sok's IOL was anti PCO type anyway and it did not really stop PCO from coming.
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Quality and track record of the manufacturer of the lens should be a higher priority.
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Soks I would get monofocal for the other eye, before touching anything on your EDOF eye (YAG or replacement).
RonAKA W-H
Edited
The Tecnis and AcrySof are both hydrophobic acrylic, but they are not the same. And, of course Alcon says AcrySof is better in resisting PCO.... My investigation so far is that there is some validity to their claims of better bonding and stability. I believe that is basically why Tecnis is coming out with the Tecnis II which I believe has frosted edges to make it more stable in the eye.
Sue.An2 RonAKA
Posted
Perhaps frosted edges would help with side flicker/glare from light sources?
soks RonAKA
Posted
i think stability is important for the toric lenses so that they do not rotate. now again tecnis is advertising it so it could be a gimmick.
RonAKA soks
Posted
I think Tecnis know they have an issue with stability compared to AcrySof. This is most critical in toric lenses, but it is also an issue in the front to back direction as well as staying centered in the eye. AcrySof seems to depend on haptic design and the material bonding to the capsule. Tecnis is now trying frosted edges to improve stability, and I suspect also cut down on edge reflections. Here are the results of a study that compared Tecnis to AcrySof for toric stability:
Comparison of the Rotational Stability of Two Toric Intraocular Lenses in 1273 Consecutive Eyes
RonAKA Sue.An2
Posted
Yes, I suspect they are trying to kill two birds with one stone. The frosted edges may improve stability as well as reduce reflections. They still may be more susceptible to PCO though, because of the material difference.
Guest RonAKA
Edited
Hi Ron
Do you work for Alcon, or are you just a regular troll? 😃
When I tried in another post, to prove a point by referring to a study, you said it proved nothing, because you can find a study to prove anything, you used the word cherry picking.
Why are the studies which are paid by Alcon, that you refer to all the time, more reliable than other studies that proves different?
I kind of envy your own faith, that you have the only right answer, but most people, who have had the surgery, will tell you, that things are not that black or white.
The right lens for one person is the wrong lens for another person, that is just how it is.
I could easily make my own "Alcon" statistic, and prove that there is a red car present in 100% of all car crashes, simply by choosing only to include car crashes with red cars in my statistic.
And If I wanted to make the statistic a little more "trustworthy" I would maybe include 20% car crashes with no red cars, proving that there was red cars involved 80% of the times.
I can show you fantastic studies about Zeiss lenses, where Zeiss lenses beats all other lenses on all parameters, these studies are sponsored by Zeiss....
RonAKA Guest
Posted
No I don't work for Alcon, and I am not a troll. I am a 70 year old retired mechanical engineer from the energy industry. I do my personal research like I did my professional research -- with a lot of care. I don't find much value in opinions that are not based on actual research. I do not like being accused of being a troll either.
chen78740 RonAKA
Posted
I asked my surgeon about Tecnis Toric stability issue and Toric II yesterday. She has no idea about Toric II yet (we are in Canada) and said JnJ just had a conference days ago in Toronto and they didn't talk about Toric II at all. So she doesn't know its advantage over current Tecnis Toric.
As for the stability, she said Tecnis Toric does require additional operation process for her during the surgery than Acrysof Toric, but it won't rotate too much in the eye. She mentioned she has not seen difference between Tecnis and Acrysof. Even if it rotates, a simple op to correct it could be done.
Her option is if Tecnis Toric II doesn't have proven optical advantage over I, she will not recommend to wait for it to be available in Canada.
RonAKA chen78740
Posted
You may want to try a google of the phrase below to get more detail. On a closer read it appears that it has "more surface texture and friction on IOL haptics". It does not mention the lens edges, so the purpose seems to be to limit IOL rotation in toric lenses only, not to address any PD issues. It also is said to be in "US Post Market Clinical Trials", what ever that is. I would guess it means it is not fully approved for full market use?? Could be some time before it comes to Canada.
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Johnson & Johnson Vision Introduces TECNIS Toric II 1-Piece IOL as New Monofocal Option for Cataract Patients with Astigmatism; Launching Multi-Center, Post-Market Clinical Trials Across U.S.