Does this strategy make any sense?

Hi Sue.An.    I'm not sure I understand your first sentence: "I watched that same video yesterday as Night Hawk on these forums let me know."    The video I saw was one involving Shannon Wong.  He is apparently an eye surgeon himself and he'd had a Symfony lens put in one eye.   

Are the concentric rings you're experiencing very bothersome?  I hear some people have good luck and some don't.   It concerns me a bit.  Yet also, there's something like a 97% satisfaction rate (I think I read) on the Symfony lens, so maybe I'm making more out of it than is reasonable.  Is night driving intolerable? I expect I will do some night driving but I'm not sure if the potential halos will bother me or not.  I guess it's unique in each case.    Are you happy overall with the Symfony lenses?   

Oh, lastly, do you think the halo effect would be minimized to a degree if only implanted on one eye..and if necessary at some point, I could get a monofocal lens in my other eye?  Gosh, this is so confusing.  I just want to make the right choice.  I'd like to be glasses free if at all possible. 

IG

The concentric circles from my understanding do not gradually go away.  The lens itself has rings (this allows the extended depth of focus. ) It has been 7 months since my first surgery and the concentric rings are still visible for me.  Others who have had the lens longer still see them.  I found the strong glare and starbursts worse and am thankful those did subside significantly.  Those were so bad I had to plan my driving routes to where roads had overhead lighting.  Dark unlit roads were very bothersome in the beginning.  The concentric circles are huge but very light and as you get nearer to the light source they disappear.  And they aren’t on every light source.  I see them when car brakes are applied but not on brake lights as I am driving behind a car.  See them around red traffic lights too or amber turn signal light is flashing and certain LED porch lights.

I did know about this before my surgeries and agonized a lot about lens selection.  I was young for cataracts at 53.  I work for a bank and use a computer a lot for work and still only needed glasses for distance so losing near vision with monofocals bothered me equally.   I chatted with a few people who had Symfony lenses and in the end chose them.  I figure as I age I won’t do as much driving later in life.   Glad I had surgeries in summer where it is still daylight till 9:30.  And now that time has passed I drive comfortably at night - even on dark roads.  I wouldn’t say it bothers me to drive now in the dark.

Yes the visuals will be minimized if you opt for a Symfony in one eye and a monofocal in the other eye - although reading distance may not be as optimal.  I found after 2nd Symfony I went from reading distance at 18 inches to 11.  So not sure if that is important to you.

As my surgeon said there is a compromise to make and really only you can decide which you want to make.  Should mention that I live in Canada where our surgeons are paid same amount regardless of lens I chose so he had no incentive to talk me into a lens.  I kept asking what he would choose and was frustrated that he wouldn’t answer.  Was only after my 2nd surgery at 24 hour post op visit he said he was my age and if he had cataracts he too would opt for Symfony but he said everyone is different and his choice may not be right choice for someone else.

I am happy with my choice although you’ll read here on these forums not everyone is happy with Symfony.

I will say I have noted that dissatisfaction level with Symfony increases if your surgeon doesn’t get the power right.  Reason for my comment about finding an excellent surgeon.

I have noticed that those looking for info prior to surgery are usually very happy with whatever choice they make.  Information prior to surgery manages your expectations.  Most of those who are unhappy find this forum after their surgeries and they aren’t pleased with result.  Happy patients mostly don’t post - unless they were here first looking for info.

Lastly you should be aware that premium lenses don’t guarantee you are glasses free.  It definitely lessens your dependence on them.   You may still need readers for tiny print (pill bottles) or for more contrast when doing extended periods of reading like novels.

Wishing you all the best.  Even though I didn’t take my own advice - I can honestly say this side of surgeries you’ll be fine no matter which lens you choose.  one adjusts to a new reality well.  It is better than vision you have now with the cataract.   

Hi Sue.An,  Thanks so much for taking the time for your thorough reply.  We seem to have a lot in common.  I'm about your age and work in banking as well and I've been pining over this decision for weeks as to which approach/lens to take.  I'm so torn.  Part of me wants to just pop in the mono-focal in the left eye and be done with it to minimize the risk of a bad halo experience, and hopefully get mono vision.  But my consultant/surgeon has told me that my diopter difference between the eyes will be slightly more than 2.  He thinks that's the mono-vision as a result may be a stretch.   I live in the UK by the way, but I am American. Nice that you live in Canada!  A great system there.   I can't get a lens like the Symfony on the NHS nor can I pay the difference between that and an NHS covered mono-focal.

But then there's a part of me that says, "Go for it" and get the Symfony in my left eye and hope that it achieves both my eyes working together to get distance, intermediate, AND supported near vision and hopefully allow me to chuck the glasses the great majority of the time.   Decisions decisions.  

And like your doctor, mine also plays his cards quite close to his chest.  I asked him in an email yesterday which options are his two best options for me to be glasses free and he really didn't answer that question directly but rather replied that 'it's fine' if I want to choose my strategy of the Symfony in one eye with the caveat that I may not adjust to it and we'd need to do the other eye as well with that same lens.  So it's an answer, but not really HIS answer.  He's just letting me rummage through my own options until I decide on one.  It's a bit gut wrenching.  

But you're right, I can't imagine anything turning out much worse than what I'm dealing with now.  My left cataract eye is pretty bad and I have to think that any reasonable result will be a great improvement.  Thank again for replying. 

Kind Regards,

IG 

I have an Alcon Toric lens.  I'm not sure why my doctor chose that over tecnis but I have read about people with glare and halos from the tecnis.  I think Alcon has less of that and I remember reading somewhere something about a "blue filter" in the Alcon mono focal that might not be in the others.  Obviously nothing is perfect and I've heard that some people sometimes have minor starbursts and halos just with their own natural lens.  For me, I've never had that problem before surgery and don't have it after with the Alcon either.  I'm not sure how much of that is me and how much of it is related to the filter in the Alcon.  Also, I'm not sure if the blue filter in the Alcon was (or does) prevent halos and glares or if it's there for retinal protection and to reduce long term risks of macular degeneration.  Maybe someone else here knows more about all that.

Thanks so much for your reply.  I suspect that the reason for the good intermediate vision in your monofocal lens eye is your small pupils, as you mention....which I don't have, unfortunately.  Both of the ophthalmologists I consulted told me I would have good distance vision with toric monofocals, but would need glasses for mid-range and reading.  I am now strongly considering going that route and using the micro-monovision approach to perhaps achieve some intermediate vision, as well as the long-distance.  However, I have more than 2D difference in myopia between my two eyes and was never happy with my contact lens mono vision attempts, probably because of the 2+D difference between eyes. (I found I had mediocre vision at all distances with mono vision contacts.)

Anyhow, it's wonderful to know you've been able to achieve good range of vision with your monofocal. What a relief for you, I'm sure!

I've never read or heard that the blue filter of Alcon's IOLs affects halos, glare, starbursts one way or the other.  The eye surgeons I asked about Alcon vs Tecnis that didn't push either lens didn't see any evidence that the blue filter was beneficial at all and no studies proving that - if there were they thought Alcon would make a big deal to show that off and other manufacturers would add a blue filter to compete, but apparently they don't have to.  The blue filter in the Alcon just makes the color balance of the eye similar to that of a typical eye of a person in their mid 30's since the eye gradually yellows with aging.  The other brands like Tecnis that have a clear lens with only UV filter are like the color seen by a child's eye!

You sound like you are in a similar situation as I am.  I require toric IOLs since I have over 2D cylinder astigmatism in both eyes.  Only my right eye had a cataract far enough along that it affected my vision reducing best corrected in that eye to 20/50 or worse, so 4 months ago I got cataract surgery in the right eye. Since my right eye had higher astigmatism a little over 3D, the Symfony toric wasn't available in a high enough cylinder model to reduce the cylinder enough so I went with a Tecnics monofocal toric IOL set for good distance vision (-0.25D) in that eye since higher cylinder models were available in the USA for it. 

I believe there are higher cylinder models available for the Symfony Toric but only currently available in Europe for some unknown reason, maybe in a few years they will eventually get to the USA too.  My left eye has only an early stage cataract that doesn't affect its vision yet, it corrects to 20/15 or better with glasses, so I will wait probably a few years before that eye needs surgery.  But the left eye has about 2D cylinder so the currently available in the USA Symfony toric IOL models could handle that one, so I would consider it for that eye eventually or the alternative is another Tecnis monofocal toric set for slightly nearsighted to get intermediate vision maybe -0.75D or -1.00D.  But a Symfony toric could get a range from about -0.25D to -1.50D if it hit the target closely, that would make it easier to read a smartphone closer which I'd like of course in addition to computer distance viewing of about 28"

alcon iol blue filter advantages

The first link in the article (from eight years ago) at healio points to a doctor Henderson from Harvard who mentions the blue filter has advantages in reducing glare and halos as well as providing increased protection from macular degeneration. They list both the advantages and disadvantages but indicate the advantages seem to outweigh the disadvantages.

In a way,you were lucky not to have had the Symphony for a choice (for right eye). Unfortunately or fortunately (at this point I'm not sure which) both of my eyes' prescriptions are eligible for either the toric Symphony or toric monofocal here in the US.  I know someone who has toric Symphony in both eyes and says he sees great at all distances, and doesn't need glasses anymore except for reading in dim light, which sounds great to me! He did mention that he can feel them in his eyes, and someone else on this board mentioned that her eyes hurt a lot with the Symphony lenses, which sounds like a nightmare to me!  Do you find that your toric monofocal is comfortable?

I haven't had any issues regarding "feeling" the IOL since day 1, the eye feels the same as it did before surgery.  If someone had a problem in that area, its more likely they are feeling the small incision they do on the cornea to insert the IOL in the eye.  The eye doctor should monitor the eye for weeks after surgery to make sure it doesn't get swelling or infection, thats why its important to take all the Rx eyedrops including antibiotic and steroid drops for several weeks.

Thanks, that's a relief to hear.  (And btw, like you, I occasionally get vertigo and am wondering if, as we get older, it might be important not to have to find our glasses to see enough to get around in the house safely. I hate having to do that now, as I'm so nearsighted.)

Thanks, that's good to know. I'll be diligent about using the eyedrops.

The thing is once you make the deye vision and surgeries done don’t look back and wonder what if.  There will be a compromise but this compromises year’s ago were so much greater.  I am thankful to have vision back - for a year living with cataracts double and blurred vision was not fun.