Choosing between a monofocal IOL vs Symfony IOL
Posted , 14 users are following.
Hello everybody I'm writing this because I am a 26 year old guy getting ready to get my cataract surgery in my left eye due to an accident that made me rapidly develop bad vision and require surgery in order to see clearly again out of that eye. (Although I have small cataracts in right eye as well) I have been waiting and waiting for a couple of years because at first, I wasn't comfortable getting a monofocal IOL which the opthamologist has been reccomending for me for quite some time; Because I had hopes of newer technology becoming available in the near term. I was eager about the Symfony when it was first announced it would be available here in the USA and after reading the specs I was determined to get this IOL implanted in my eye. on paper these lens seemed like the best lens possible that was available here in the USA but however it doesn't seem like many people are satisfied about some of the adverse effects that these Symfony lens are starting to becoming more and more frequent among people that get these implanted. My main worry about the IOL lens is that they have a risk of troublesome halo's, starbursts, and glares associated around bright lights. I am a young adult so I can fathom having to struggle with that issue for the rest of my life.
My main focus and passion that I want to do for my career will require me to be working on computers most of the time since I want to pursue a 3D animation and graphics engineering career in the entertainment industry. I love the idea of having the Symfony lens because it would be really convenient to work in that setting and atmosphere not requiring multiple types of glasses to see on the fly at screens and monitors and distance. Etc and I certainly would not mind using reading glasses for the near. but Im a bit Disappointed to see numerous reports of people complaining about the night time visuals in regards to bright lights. I feel like this would be something that would seriously make me question if it is truly worth having seamless distance/intermediate vision but not being able to handle going out at night from headlights/city lights/ bright. I'm only 26 years old and I know That I can not NOT avoid going out at night. Especially if I had to go to big cities like Los Angeles New York etc. what if I want to go to a night time festival with lots of LED lights or light projections? (Not that Thats all i do but if having Symfony lens makes those experiences unpleasant?) is it worth it? I honestly feel like if some of those issues were a problem for so many people would also apply to watching a cinema in the movies or viewing some types of hi resolution Video animations in dark environments would recreate that dramatic effect of bright light sensations like halos, glare that it makes that viewing unpleasant for their experience... most of the people say their fine for tv's and computers but what about dark scenes or when light is highly concentrated and dispersed might make somebody with Symfony dizzy? Would a monofocal IOL be safer just to avoid adverse reactions and sensations to extreme lights?
For people here that been implanted with the Symfony IOL vs a monofocal IOL do monofocal really have less glare and halos.
Also Monofocal IOL implants how are you doing with night vision? And also how is your computer time like quality of vision and light sensations etc. I see that a lot of people are satisfied with the Symfony for computer usuage because it offers more range towards intermediate but I honestly might consider trade off for monofocal and wearing those glasses to avoid those light artifacts associated with the Symfony.
Whenever I research articles on review/reports on the internet about the Symfony IOL their is a lot of contradicting information that makes choosing that lens extremely difficult for me...
I honestly don't know which studies to believe because I've read several and most of them say something different about the Symfony IOL. The one from medscape says that the nighttime problems are actually worst than multifocals and the case study from healio points out to it being comparable to a monofocal.... most people that post about the Symfony say their is a significant amount of glare/halos. And Not to mention that their is under the radar trait in Symfony that so many people are having several concentric circles around bright lights!! I can not deal with that if I were to pursue a computer graphics career. Although it may not be a make or break factor...
I know it's hard to compare subjectively. Anybody here with both a Symfony IOL and a monofocal IOL in the other eye?; that would probably be the best annodoctal experience to have. I have to make my decision soon in about a month. I really am having such a difficult decision to choose which IOL because this is likely going to be a permanent choice for the rest of my life and I'm still relatively young at 26. I know people talk about getting a new IOL lens swapped for their current IOL in the future but I would imagine this brings along repercussions because there are major risks involved with doing extra surgeries after your lens has healed into your eye. Vision may become worse afterwards despite switching lens for supposedly better tech. What I'm trying to say is the choice I make for my cataract surgery of IOL lens is most likely going to be a permanent decision for the rest of my entire life. I will have to think this over again but Thank you for taking the time if you read all of this.
0 likes, 33 replies
Sue.An miguel20862
Posted
Hi Miguel I think I posted a few comments on another thread I am on.
I wish there were a better more perfect lens available but for now there is not. You might check UK or other places in Europe as they tend to get the advanced technology before we do. In Canada the approval for Symfony came in a year ago.
I did find it helpful to know what my compromises were in advance of surgery (still gave 3 weeks to go and debating mixing and matching my lenses although leaning towards another Symfony).
Be aware you can experience halos and glare with a monofocal lens too. Just prior to my surgery chatted with someone that chose them vs multifocal as they wanted best distance vision as they play golf every day. He was surprised to be affected by halos and glare. Given your age and depending on pupil size when dilated you may experience those with monofocals.
I can tell you that if you have a good surgeon with experience implanting premium lenses and get the typical results inside lights will not be bothersome. I have been to the movies and had no issues. Likewise I work on a computer most of my workday with no issues. Symfony lenses excel at this range. I also have a teensger who
Plays soccer at night. The big floodlights do not impact my viewing of her game. For last year cataracts prevented me from distinguishing one player from another (couldn't even read their jersey numbers) and now I can see njoy the game with just one eye done.
The issue will be driving as you'll see glare and halos from oncoming traffic headlights (some find these bothersome without cataracts with new brighter LED lights. Taillights too in front of you when someone breaks you'll see translucent concentric circles. Some say these diminish with time. But if you do a lot of night time driving this might be more troublesome.
I like to walk every evening. I see some glare around streetlights or porch lights but these aren't troubling.
it's too bad there atenr special machines we could look through to see how the affects are in advance.
For me came down to how much driving at night I would be doing compared to daytime activities and my work. Even daily tasks like cooking from a recipe or on my iPhone or putting on makeup - the thought of losing my near vision was equally as troubling as facing night vision glare etc...
Perhaps you should see a few surgeons tomget 2nd and 3rd opinion. I would be wary of any surgeon that pushed any one lens especially a premium one. They might be motivated by the extra fees.
There are some good threads to read through on these forums. I encourage you to read through them and ask questions.
My surgeon was brutally honest with me and said the younger you are and more near vision you have makes us more unhappy about the decision. He said there is definitely a compromise to make and it is up to individual what kind of compromise to make. Most cataract patients are much older and lost there near vision years ago as well as distance so they gain something and usually happier with whatever lens they get.
michael74313 miguel20862
Posted
Hello - I had cataract surgery in both eyes earlier this year (early March for my right eye and early April for my left). I have a toric monofocal lens in both eyes and I'm extremely satisified with my results. I sit in front of the computer all day long (I tend to lean back in my chair about 40" away from the screen and have no problems at all). I used to be VERY nearsighted. My vision is now excellent. At first, I felt like I lost my near vision and only glasses would correct it but my eyes continued to improve and my excellent doctor set my second eye 1/2 diopter in from my first eye set to distance which provides me a wide range of vision. I would never do monovision but 1/2 diopter is more like a mini-monovision with a monofocal lens in both eyes.
I can see at almost all ranges of distance from near, mid-range and distance. My RIGHT eye has had trauma in the past and the cataract in my right eye was FAR worse than my left. They could only correct my right eye to 20/50 before the surgery so it was time. They set my right eye to distance and my left eye (much better eye with no history of trauma) to about 1/2 diopter in so that I would get better all around vision. I rarely ever need to use reading glasses so long as I don't have read phone or papers up too close (I read them about 14" out). I have NO PROBLEMS with night vision at all - none. My left eye has a slightly better range (near to far) than my right perhaps due to the past trauma in my right eye.
IMPORTANT --> One thing people don't talk about that I read is that the multifocal lens not only can have the problems of halos, but also do NOT have the same clarity has a monofocal lens. If you are looking to get into the world of 3D animation, I would think you would want that "clarity" of contrast with colors, etc. I've read that you just don't get that same clarity and some report colors being a little "washed out" so to speak with a multifocal lens.
The biggest problems I have read with monofocal lens are that people don't get the same range of vision which is easily corrected with glasses. However, as far as I know, those that cannot tolerate halos, bad contrast or any other problems that a multifocal lens might give them, have no solutions other than a lens exchange. Don't get me wrong here, many people love the multifocals and accommodate well to the halos and other things that might initially be present. However, almost everything I have read says to NEVER do a multifocal on an eye with a history of trauma.
The best advice I can give you is to find a really good doctor who as a lot of experience. If I had to do it all over again, I would still choose a monofocal lens. I have no regrets at all.
Also, these days some doctors do "ORA" guided where they retake measurements again after the cataract is removed so as to fine tune everything to get the best results. My doctor did ORA guided.
I don't know if you have an astigmatism or not. I do/did in both eyes which is why I needed a toric monofocal (so as to limit or not need glasses after surgery).
I'm kind of surprised you would even be considering a multi-focal lens with an eye that has had trauma. I'm also surprised that your doctor would even consider it. But again, putting that aside, you don't have the same clarity with a multifocal lens and if you don't mind reading glasses, a monofocal lens seems like a "no brainer" to me. If you go with a monofocal, you can choose the IOL for distance, mid-range or up close/near. Most go with distance. I went with distance and the second eye distance set 1/2 diopter in for slightly better range all around. Maybe I was lucky in that I don't need reading glasses except when reading really small print but I don't mind that at all.
Seems to me like you would not want to risk halos or artifacts or washed out colors with computer graphics jumping around on the screen along with virtual reality, oculus rift and other future technology you might be getting into. If I were you a monofocal would be a "no brainer" and it's more a question of whether you should set your eyes both for distance or whether to set one for distance and the other slightly in as I did mine. Check with your doctor. Good luck to you.
Night-Hawk michael74313
Posted
michael74313, your eye situation sounds EXACTLY like my own!
I too had moderate trauma to my right eye (40 years ago) that apparently many years later eventually caused somewhat higher than normal eye pressure in that eye leading to the start of glaucoma in that eye only, now controlled and kept stable with pressure lowering eye drops for the past few years. My right eye also has developed a cataract over the past several years, making that eye more near sighted and for the past year its been unable to be corrected better than about 20/50. The left eye has the start of a cataract but its very early so it could take years for it to affect the vision in that eye which can still correct to 20/15. I also have significant astigmatism in both eyes, 2.0D cylinder left eye and 2.75D cylinder right eye.
The past couple months I've been getting cataract surgery consulations with some top local eye surgeons and they don't recommend any multifocal IOLs (even the Symfony) in the right eye due to needing the best possible contrast sensitivity for that eye and those type IOLs can reduce contrast. So the recommended IOLs for that eye are monofocal toric or the Trulign (accomodating) toric.
A top eye surgeon I consulated with last week, does not use femtolaser assisted surgery but does offer using the ORA equipment for possibly better refractive result. They charge $485 extra to use ORA but it sounds worth it. He has used both Alcon and Tecnis monofocal toric IOLs, and I would prefer the Tecnis since it claims higher contrast sensitivity and other advantages. They charge $1495 extra for a toric monofocal IOL and $1895-$1995 extra for multifocal/Symfony/Trulign IOLs.
My right eye is also my dominant eye, so I plan to go for a Tecnis monocal toric IOL in the right eye set for good distance maybe a -0.25 to 0.0D target (don't want to overshoot to far sighted) and eventually when my left eye needs it to target it for mini-monovision at -0.50 to -0.75D which at that offset I currently can still get close to 20/20 with using glasses since that eye gets 20/15 or better at 0D.
I have considered for the left eye in the future possibly going with a Symfony Toric to get not only decent distance vision and good intermediate vision but some decent near vison as well. However a monofocal toric in the left eye as well is a possibly to avoid the night vision issues - trade off vs better near vision. But your results with a similar setup using only monofocal toric IOLs is very encouraging to me!
If your left eye like mine didn't really need cataract surgery as of yet compared to the right eye, how did you get your right eye done so soon? Did you have to pay completely out of pocket for that eye since it wasn't deemed "medically necessary" yet by insurance? Or was there a big imbalance between the eyes after correcting the right eye such that was enough to make the left eye covered before it couldn't correct to better than 20/40 or so? If that is possible, I don't know how much imbalance between the corrected eye and the other eye there has to be to do that?
michael74313 Night-Hawk
Posted
Both my eyes were extremely nearsighted and I chose distance for my right eye. So, in a sense, I had FULL monovision for several weeks since my left untreated eye was nearsighted while my right eye was set for distance. Whether that made a difference regarding insurance, I'm not sure. I have a very high deductable so money was not so much the issue but either way I would still get the "contracted agreed rates." My doctor went on to say that the multifocals work best when they used in both eyes. Perhaps he meant that he wanted to see my eyes always "working together" (and so did I). But, I also kind of got the feeling from him that there is a higher dissatisfaction rate with the multifocals. After doing ALL the research it became more and more important to me that my eyes "work together." So, by setting my left eye to 1/2 diopter in, it allows for a greater range of vision. My right eye did continue to improve as time went on.
Both eyes see fantastic anywhere from around 18 inches to inifinity (18" to distance). Also, because my eyes are for the most part working together (mini-monovision), both eyes see better at all ranges than either of my eyes separately (if that makes sense). Most of the time, my left eye sees a little better near and it also depends on the day. Like anyone else even pre-cataract, we just tend to see slightly better or worse on some days than others either due to allergies, dry eye, tired eyes, wind or other factors that might affect vision in either or both eyes. I find that if I turn up the brightness ever so slightly on my phone it helps a great deal to read it easily without glasses (especially in low light/at night). Both my eyes see around 20/20. Some days it is as good as 20/15 and other days maybe 20/25 at worst. My near vision is around 20/30 and again some days it's as good as 20/25. If the print is really small, I just use a magnifier or throw on some reading glasses but it's not often that I need to.
In my right eye, the toric lens shifted ever so slightly after surgery, so my right eye could be improved a little with a minor laser tweek (because of the minor astigmatism) but I haven't bothered at this time because my eyes see so well as it is. But, AFTER surgery in my left eye, I sat up VERY slowly (right after surgery) just to be sure the lens didn't shift post surgery and was careful for a few days not to do anything sudden or jarring so the lens would get fixed solidly in place. It's great - no problems at all.
I don't know what it would be like to have a monofocal in one eye and a symphony in the other. I think it would bother me if color, contrast and clarity were different in both eyes. Perhaps for some on this board it works out great, but I'm happy with "mini-monovision" and monofocals. The error factor alone would support doing it.
Night-Hawk michael74313
Posted
Since you got an Alcon toric IOL in your right eye first (which has a blue filter) it would probably be odd to mix that with an extended focus IOL like the Symfony or a Trulign since those don't have a blue filter.
Thats why I want specifically the Tecnis brand monofocal toric to start with in my right (dominant) eye for good distance vision since it doesn't have the blue filter, leaving me more options for the future for my left eye. Fortunately I found a good eye surgeon last week that does both Alcon and Tecnis monofocal torics and lets you pick between them. He also is against mixing types of IOLs between the eyes and since he did not recommend a multifocal or even the Symfony for my right eye, that left his choices to only monofocal toric or the accomodating Trulign toric.
However the Trulign only has limited astigmatism correction range (max 1.83D corneal cylinder) and my right eye is 2.75D+ cylinder so that would leave me with probably 1D+ astigmatism uncorrected and I don't want that much. Plus its a much more complex process with the Trulign IOL as he described it and a higher cost too, plus quite a few patients don't get much additional focus range over a monofocal with that lens.
So monofocal toric seems to me the best bet for my right eye, plus I need best possible contrast sensitivy in that eye due to it has mild glaucoma and had past trauma. The Tecnis monofocal toric IOL should be best for that.
I wore bitoric RGP contact lenses in both my eyes for over 25 years until the last few years with glasses only. So after I get my right eye done hopefully for good distance vision, I could go back to a RGP contact just for my left eye and try mini-monovision again to determine what might be the best target for the left eye in the future when I ever get that eye done since it could be years before its cataract affects the vision significantly compared to my right eye.
Night-Hawk michael74313
Posted
You mentioned your eye surgeon used the ORA equipment, which the surgeon I consulted with last week uses as well.
Did your surgeon also use femtolaser to make the cataract surgery incision or did he use the manual diamond blade conventional approach?
michael74313 Night-Hawk
Posted
That I'm not sure of but I do know they are "state of the art" in what they do. I will say this though and that is I was in a sense "lucky." My left eye has a greater range (near, mid range and distance) than my right. I don't know if that was due to the trauma in my right eye or due to the toric lens slightly shifting a little. My doctor thinks it's due to my eyes.
The point I'm getting at here is you said your right eye has had trauma so it might not have as great of a range of vision with a monofocal after surgery as your left. In that situation, it might make more sense to do what I did and set your right eye for distance and then your set your left eye for distance but ever so slightly in.
I tried my left eye with a test contact lens (to go more nearsighted) before surgery and the post results were WAY better than the test contact lens. In other words, I tried a test lens where I could read OK up close but the distance was 20/70. I decided at this point I wanted better than that in the distance and my near vision turned out to be a LOT better than with the contact. I attribute this to the cataract affecting my vision at all distances.
My greatest concern (and the reason I set my left "good" eye to just shy of 20/20) is I knew over time if I started to not see as well in the distance then I would need glasses for both up close and near. I suppose if one loves the mid-range that's great but that was the last thing I wanted. In the end, it all worked out great because the left eye is seeing 20/20 even though it was set just shy of it and it's also seeing very well near. Not everyone of course can expect that but it worked out for me.
michael74313
Posted
rose39842 michael74313
Posted
What is the miner lazer tweek you have mentioned on your post? and how its done? Is it invasive?
if I set both eyes for distance ( mono focal ) is this tweek possibly help to elemente the reading glass?
i have clear vision with mono focal in one eye for intermediate and distance. Thank you
michael74313 rose39842
Posted
Hello - in answer to your questions for me contrast is much better after surgery (since the cataract is gone). I believe the type of IOL (mono focal, multi focal, etc) affects contrast but not so much the setting (distance, mid-range, etc). But, I do believe overall things are better for most when their eyes work together or are close. Also, I've read that contrast and clarity are best with a mono focal lens. Depth perception should not be a problem when doing mini mono vision but can definitely be a problem for most with full mono vision.
I think most laser tweaks are done in the doctor's office and are relatively minor procedures (just like Lasik).
Rather than set both eyes for distance, my doctor set my second eye 1/2 diopter in from distance so as to allow for slightly better near vision but not compromising depth perception. By doing it this way, you might not need a laser tweak at all post surgery depending on how things turn out afterwards. If the cataract surgery measurements are slightly off and leave you too farsighted or nearsighted then a laser tweak post surgery can fine tune things where you want them to be. The doctor should be able to perform minor adjustments (if necessary) in their office after cataract surgery. I think you're supposed to wait at least 3-6 months so that vision stabilizes before considering any kind of laser tweak/lasik. The doctor can easily have you try on some "test glasses" with a minor prescription and then a laser tweak can easily adjust your eyes to that setting.
I can easily read most print as long as I hold it about 16" - 18" away. That's the trick - I had to reprogram my brain to hold things further away if I don't want to use reading glasses. It's about finding the new "sweet spot." I used to hold my phone and other things I wanted to read only around 5" away. I could never read anything that close anymore without reading glasses. So, rather than quickly go for the glasses, I've learned to hold things further away and I almost never need glasses. I should also mention that I have an iphone 5s (that's a smaller phone than the normal phones these days). But I haven't upgraded to a larger phone because the 5s is very easy for me to operate it with one hand. I also never made the font size any larger in settings on my small phone, but as long as I hold it at the right distance, I can read it.
Sue.An michael74313
Posted
michael74313 Sue.An
Posted
Yes - I had increased sensitivity to "being out in the sun" also for about 3 weeks. Everything looked very bright outside in the sunshine and without sunglasses I had to keep my eyes half closed and they would still produce excessive tears/water so I just wore sunglasses. It slowly gets better each day. I still always wear sunglasses when I'm driving (as I did before surgery). But, my eyes are no longer sensitive and don't tear anymore in normal daylight (unless I decide to look at a solar eclipse without proper protection - but who in their right mind would do that)?
Sue.An michael74313
Posted
at201 miguel20862
Posted
Sorry to learn that you have to get cataract surgery done at such a young age. It is smart for you to be well-informed before making a decision about the IOLs, with which you may have to live all your life (changing an installed lens is a difficult and complex process and you should avoid that option).
As you already know, the Symfony lenses will give you more depth of field than the monofocal lenses, but have a higher chance of giving you night vision issues. So, it is going to be a trade off between these two.
I have a Symfony Toric lens in my right eye for distance and a monofocal lens in my left eye for close-up. With this combination, I have good day vision at all distances beyond 16 inches. However, I wish that my night vision were better, the main issue being the seeing of multiple concentric circles or halos around lights at night time. Many other people seem to have had the same issue. Rather than repeating the details here, if you haven't had a chance to do it already, I will encourage you to read my post, “Has Any One Else Had This Very Unusual Vision Issue with Symfony Lens?” on this forum. You should be able to find it by clicking on my name and then looking under “Discussion”.
My suggestions below are a repetition of those already provided on this forum, but am summarizing again to make it easier for you.
Based on what I know now, I would suggest using a combination of a symfony lens and a monofocal lens like I do, but in a different set up. (for my surgery, I knew less and also did not have that option because of first eye having been done 20 years back). My suggestion will be to start with having a monofocal lens set for distance in your dominant eye. That will provide you with a good vision for driving at night. If that turns out to be as planned, then have the Symfony lens in your non-dominant eye set for about 32-40 inches range, which will give you the capabilty of reading as well as overall good vision at all distances with both eyes. You should not have the night vision problem of seeing multiple concentric circles around lights in the distance with this combination.
This is a unusual combination of lenses which the surgeons don't usually suggest. But, you may want to talk it over with your surgeon.
The other option is to try to use 2 monofocal lenses, and If you are willing to try some amount of mini monovision (like I do), set the 2 monofocal lenses to provide best focus at different distances (the dominant one at far and the other one at about 40 inches). This will provide you a wider range of distance over which you have good vision and you should need glasses only for reading fine print at 16 inches or so. This amount of minimonovision is easy to adjust to, but to be safe, you can try mini monovision with contact lenses.
miguel20862
Posted
Question for everybody.... I heard that toric IOLs have a chance of rotating after cataract surgery. My opthamologist was recommending that I use a toric when I first consulted for my operation over almost two years ago to treat my astigmatism. Now he saying that my cataract in my left eye has too far progressed and now it will be difficult to get accurate measurements in that eye which I kind of have doubt because my eye has always been severely impacted from the cataract initially (has anybody ever been turned down for having too much cloudiness for a toric IOL?) Now he is saying I only have slight astigmatism which can eventually be corrected with lasik later on. He is now telling me to go standard IOL but I really liked the idea of going for toric because it meant less surgery to achieve clearer vision. I think my surgeon is just more comfortable/confident doing a non-toric IOL because of less margin of error etc. although he did suggest that doing a Symfony IOL would be a decent option as well. I'm just confused right now but My question is how reliable are toric IOLs and the risks of it rotating after surgery and is lasik actually a good option vs just trying to fix astigmatism with a toric option. I like the idea of a toric option IOL and heard lasik isn't even permanent in that I may need additional treatments later on. I'm only 26 and would think toric has more longeivity in treating astigmatism even if mine is slight (I'm now sure exactly how much)
Also since now he is recommending going for standard IOL lens or symfony and just doing lasik later on to correct any residual astigmatism is that going to be better results than just doing toric and just trying to fix it in 1 procedure? My understanding is the toric has a high chance of it rotating which may need additional addjustments afterwards. I' don't know yet but I will definitely have to discuss further with my opthamologist/surgeon regarding this manner. Still have to weigh my options out.....
Sue.An miguel20862
Posted
Is that the only opthamologist you've seen? Perhaps you should get another consult or two with different specialists.
I live in Canada so our setups are s little different. But from reading here seems there could be additional costs to you for lasik enhancements. Not sure why you still wouldn't be a candidate for toric lens. But perhaps seeing more than one specialist would clarify that for you.
at201 miguel20862
Posted
I had a Symfony toric lens installed, but needed LASIK enhancement any way due to the lens rotation. In my case, I let the surgeon choose the option because the price of the Symfony lens and the Symfony Toric lens was the same and included LASIK enhancement free of charge.