EDOF Zeiss At Lara

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So I am looking at this lens as it is apparently the best EDOF out there and was wondering...

  1. What is the advantage of having such a rectangular haptic? I mean the rectangular part that extends out from the circular lens part? Seems like will be headache to fit it in the eye capsule?

  2. Why does it have those 2 holes in the normal version and 4 in the toric version?

  3. Those holes seem like welcome entry doors for PCO cells to move around in the capsule bag?

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  • Posted

    they are called plate haptic. the symfony haptic are called loop haptic.

    i am speculating that the hole helps stitch the lens to the iris when the capsule ruptures.

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  • Posted

    Background:

    The purpose of this prospective, randomised study was to interocularly compare the visual performance after implantation of two different toric IOLs with different haptic design.

    Conclusions

    Both the Tecnis and the Zeiss AT TORBI toric IOLs successfully reduced ocular astigmatism. Emmetropia could be better achieved with the AT TORBI IOL, whereas the Tecnis showed better positional stability. This trial is registered with ICMJE

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  • Posted

    Being curious, I thought I'd research the answer.

    On haptic design, there is no clear best design. So just like German car manufacturers use lug bolts for wheels, while US and Asian car companies use lug nuts, it's just a company preference thing. The most common ones seem to be plate haptic (Zeiss), and open loop haptic (Alcon and Tecnis), with other designs being two closed loop, and four closed loop.

    For a good article that explains different haptic designs. Search using this exact phrase:

    site:cdn.intechopen.com Toric Intraocular Lenses for the Correction of Astigmatism

    The purpose of the holes in plate haptics is to secure the IOL more firmly. I found the following reference: positioning holes allow ingrowth of lens material, fibrous tissue, or both through them, which helps fixate the lens more firmly in the capsular bag

    To find this reference search: Security of capsular fixation: Smallversus large-hole plate-haptic lenses

    Don't know why non-toric has two holes while toric has four holes. I would guess that stability in all dimensions is particularly important for toric lens, so four holes provide more secure hold (but I could not find any reference to confirm that).

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  • Posted

    I had a Symfony EDOF implanted in right eye and Symfony EdOf TORIC in left eye and couldn't be happier with my results. My surgury was last year in August and September. At my visit with my doctor last month, my vision was 20/20. I do not need glasses at all for any distance. I was a challenging patient since I had LASIK surgery 11 years ago and also had severe dry eyes when I first started seeing my eye doctor.

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  • Posted

    I have spend several hours each day the last month reading about lenses, especially Zeiss lenses, because my surgeon mainly uses Zeiss.

    I have read many different articles and studies, and I really mean many.

    And you will find different answers about every detail on every single lens, manufacturers all say something different, and surgeons also have different opinions about it all, you will be able to find a study that proofs exactly what you would like it to proof, and you will also be able to find a study that proofs the opposite.

    In the end I think the most important part is that the surgeon feel safe with the lens type and are experienced in using it, then all lenses work fine in the hands of a skilled surgeon, and the surgeon will use the best suited lens in the particular eye from his/hers experience.

    The idea behind the rectangular haptic is better stability, some surgeons says it works great and use it for that reason, other surgeons are more used to other designs.

    One of the things the two outer holes is used for is for unfolding and rotating the lens during implant, with a little tool that fit in the hole, so the lens can be rotated into position.

    The two extra holes in the toric version is a part of the marking of the centerline, so the surgeon can align it precisely with the Y-axis, because rotation is very important when it is toric.

    I have the toric Lara, the surgeon did draw a line with a special pen on my eye when I was sitting in a chair before the surgery, so he had this line to align up against during implant.

    The eye was sedated with eye drops, so it was just a bid odd, no big deal.

    I don´t think the holes matters at all regarding pco, when you look at the Symfony there is no material at the same places, where there is a hole in the Lara.

    For some reason pco only matters on the backside of the lens on the side pointing against the retina, nobody have ever troubles with pco on the front side of the lens.

    And to be honest I think the hype about the Lara is a little bit too much, I think the Lara and Symfony are very similar in performance, but I am very happy with my Lara.

    In fact the good result with the Lara have actually day by day made me a little more brave, and the more I get used to the Lara, the more I lean against trifocal in the second eye to add reading power, the Lara have really given me faith towards these Zeiss lenses, but we will see in two weeks what I end up choosing 😃

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    • Posted

      I am curious too to see what you end up choosing.

      Wouldn't it be interesting to be able to see what someone else sees or be able to view through a viewer to see differences between symfony and atLARA.

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    • Posted

      Yes, and it would also be very intersting to see through a trifocal before deciding as well 😃

      I think a lot of the info about the Lara is made by the manufacturer or by surgeons that have got a good deal to promote specific results.

      Statistics can be made how you like it, you just need to include the right patients in the statistics.

      I have seen many studies where the Symfony and Lara are compared, and I have compared individual studies as well, funny they get to very different conclusions from time to time.

      But I have also seen studies with real life outcomes that seems trustworthy, here they don´t really find any noticeable difference between the Lara and the Symfony, neither regarding performance or downsides, at least not more difference than you find in the population in general, I think in the end these two lenses are very similar.

      Just like the trifocals, many different outcomes can be found on these in different studies, but when you find studies that seem to be trustworthy, there are no clear winner among the trifocals as well, they all have their strong sides and downsides, but they all work well.

      It is kind of funny, for each day that passes I get a sort of more greedy, i would like to have even more from the next lens.

      It is funny because 3.5 weeks ago, before the surgery, I would never have believed that my vision could be as good as it is now with the Lara, but now I find myself wanting even more, it almost makes me feel embarrassed about myself, I feel I should be more thankful than greedy at this point.

      I guess it shows why we humans continue to evolve, we always want more 😃

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    • Posted

      the defocus curve comparison in the LARA brochure is not clinical and with virtiol. why don't they make virtiol available to public to simulate what they will see with a potential lens.

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    • Posted

      I have seen and studied all the arguments Zeiss are putting out to promote their products.

      In the studies I have seen with outcomes in real life, ( those that I find trustworthy), there is no difference in the visuel side effects from the Lara and the Symfony, at least not any significant difference.

      My own side effects from the Lara seems to be very similar to the side effects I have read about people are having with the Symfony, even that it varies a lot from person to person.

      I have also read about surgeons that claims the edof are very similar to the trifocals when it comes to visual side effects, and I believe this could be true in some cases.

      When you really dig deep in all the nerdy stuff (yes, I am a nerd!) truth is that the Lara is a manipulated trifocal, with the three focal points at approx. 0, +1 and +1.75.

      You think I am making a joke now, but it is actually true, this is shown when the lens is testet in a test bench, where you can see the focal points and it acts almost like other multifocals.

      But with clever engineering in the lens surface, they "bend" some of the light that are wasted in other trifocals, and use this light to fill out the gaps, so it gets a continuos defocus curve, and the single focus points are not visible any longer.

      This is why they can not make a bigger range on the edof than it have now, because they can not fill out the gaps if they are placing the focal points further apart.

      And it is also the reason why Lara and Symfony are very similar, both manufacturers are up against the physics, and none of them can change the laws of the nature.

      What they all tend to agree about, is that the older generation multifocals (bifocals) are significant worse than both the trifocal and edof lenses when it comes to visual side effects and contrast loss.

      I have also seen surgeons claiming that they stopped using bifocals back in time because of too many unhappy patients, but have started to use trifocals and edof when these became available, because these makes patients happy.

      For me the Lara was the right choice, I would not change it even if I could, I rarely have used glasses since I got this in my dominant eye, but if you do not want any visual side effects at all, monofocals still are the safest choice.

      Yesterday i visited my sister, and drove home at night, in dark and rainy weather, i would say the worst/best conditions you can have for driving and being blinded by traffic.

      And yes, I have starburst from other cars headlight and concentric rings around brake light, but I had no trouble seeing where I was going, my night vision under these circumstances was so much better than they was when I had cataracts. And visuel side effects tends to faint as time goes by, I think my side effects has already fainted some in only 3 weeks, but side effects is a part of the package, this is just how it is.

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    • Posted

      Did Johnson and Johnson provide it?

      Either way I don't trust any of these companies as it is all about money first anyway.

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    • Posted

      Really interested to see which IOL you will pick for your second eye 😃

      Btw love reading your long posts, my wife loves them too 😃 Oh Sue. An2's too!!! Both of you consistently type so much 😃

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    • Posted

      It used to be in their brochure but I see that they have updated it. But basically conclusion this study was how they had come up with the defocus curves in the brochure.

      Purpose

      To evaluate depth of focus following the “virtual implantation” of 2 EDOF IOLs: the AT LARA 829 (Zeiss Meditec) and the TECNIS Symfony (Johnson & Johnson Vision).

      Methods

      Prospective, “cross-over,” subject-masked, clinical trial with a total of 100 eyes in 100 patients between 18 and 50 years of age with healthy eyes. The IOLs were “virtually implanted” using the VirtIOL, a unique device capable of placing the IOL within the subject’s optical path where performance was directly measured under a variety of conditions. The IOL power was fixed at 22.50D.

      Results

      Mean visual acuity for subject eyes with the AT LARA 829 and TECNIS Symfony, via the VirtIOL at 0.00D defocus (baseline) were -0.13D±0.08D and -0.09D±0.10D, respectively (pair-wise comparisons p=0.005). The AT LARA 829 demonstrated higher acuity than the Symfony over a wide range of focus distances and the area under depth of focus curve was +4.08D compared to +3.86D for the Symfony (p=0.033). Widest 2-sided depth of focus was obtained with the AT LARA 829 at a visual acuity level of 0.1 logMAR and 0.0 logMAR (p=0.01 and p=0.02, respectively). Widest 1-sided DoF was obtained with the AT LARA 829 at visual acuity levels 0.22 logMAR, 0.1 logMAR, and 0.0 logMAR (significant at the 0.8 logMAR level).

      Conclusion

      Optical path testing using the VirtIOL device in a clinical trial demonstrated that the average defocus curve of the novel AT LARA 829 EDoF IOL had higher visual acuity than the TECNIS Symfony over a wide range of focus distances. The AT LARA 829 also provides a wider range of focus than currently available EDoF IOLs.

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    • Posted

      Danish_Viking

      How much reading do you have now with the LARA? How many weeks has it been since the surgery. If you has Sue.An like results would tri-focal even remain a consideration (great vision at 8-12 inches)?

      At what distance is the video on your smart phone no longer Hi-Def?

      Do you think that your near could get better in a matter a time at which point a tri-focal would be moot. You are probably the only LARA poster on here and your LARA input is very valuable.

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    • Posted

      reading your description of driving conditions at night I would say same of my Symfony lenses. Where next advance is for IOLs I have no clue. Perhaps there will be a cure or drops to remove cataract - that would be better and render IOLs unnecessary

      I have worn glasses so few times in last 2 years since surgeries that I too am satisfied and do not regret my decision. But you are right about human nature and being greedy!

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    • Posted

      Guess we are both big blabber mouths - lol. But know myself well enough that for me helps to communicate and waffle back and forth when it comes to big decisions.

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    • Posted

      Curious though why Canada and USA gave not approved any of the Zeiss lenses. Might be Zeiss doesn't want to gave the expense of rigorous approval process. But big markets that would more than compensate.

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    • Posted

      Based on the above images, I notice mild in some of the modern street lights and I don't have cataract! Some of them are LED ones I think.

      I only noticed them because my wife keeps asking to compare her cataract vision with my "normal" vision.

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    • Posted

      zeiss is a large enough corporation so i dont think they r trying to save money. i am more curious as to why Technis doesnt have a trifocal.

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    • Posted

      Worried_Husband

      the picture is still twilight. so the halo glare isnt quite in full effect until it is dark really for me. it is mild with miotic drops and somewhere between moderate and severe with normal pupil dilation. also the picture is more blurry than the glare.

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    • Posted

      About US and FDA approval - I know that.....

      One of my freinds works at Novo Nordisk Pharmaceuticals here in Denmark, he have worked a lot with FDA approvals.

      For some reason the CE approval is not accepted by FDA, even though CE is accepted in most of the rest of the world, in some countries with minor adjustments.

      You know, people like the Germans really don´t have any sense of humor when it comes to these approvals, so CE is not that bad.....

      Off course European companies apply for CE approval, to supply the European marked.

      And then they can use the CE to sell to most of the world, about 7 billion people.

      Then FDA says "No, we will not allow that, you need to pay us a hole lot of money and use a LOT of man hours on paperwork, if you want to sell your stuff in US"

      FDA needs to be updated each year, so each year it all stars over, staff from FDA come and live and work for weeks, checking paperwork and production line, they need office space and help from staff, and ALL expenses is covered by the company that wants to keep their FDA.

      Then companies like Novo and Zeiss look at the numbers, is it worth spending a hole lot of money and man hours for selling their stuff to 320 million US people, when they can sell to the 7000 million people in the rest of the world without spending more money...

      I know from my friend at Novo, that some of their products never come to US for this reason, only if they see a special marked in the US for a specific product, they spend the money to get FDA on this product.

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    • Posted

      I would say mild. The concentric circles are well defined - not fuzzy and the inner 4 rings are brighter and outer ones very faint. They appear in some lights and not others. But when I do see them - like red traffic lights they are big extending to ground when I am about a football's length of field away and they shrink and become smaller as I get nearer the light. When car is stopped at light they completely disappear.

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    • Posted

      Reading vision and Lara - well, in natural light and good artificial light I can push myself to read J1 at 10", I can read J3 relative comfortably at 16"

      It is only 3.5 weeks since surgery, and it actually vary a little from day to day, yesterday was not as good, today is quite good.

      The smartphone is not my best friend yet, the light is somewhat disturbing even that I see it fine and use it each day, but it improves day by day, I think soon we will be best friends again.

      I am sure overall vision will improve still, and when I have the second eye done and have the advantage of binocular vision, this alone will improve vision a lot.

      So I think I would get by just fine with two Lara, but since the Lara came out, more and more surgeons are using the mix and match with Lara and Lisa, and I guess the surgeons must be doing this for a reason, it must be based on their experience.

      The last couple of days my interest for the trifocal have increased, I think maybe it is because the Lara works so well, so it really make more sense to add something else the Lara don´t have, than to add more of the same, because from far and through intermediate I really do not need more, so why not try to get the added up close vision.

      But I change opinion all the time these days 😃

      About the halo and glare thing, I think it is quite different than these single pictures.

      I see starburst around headlights as severe, streetlights/trafficlights as moderate, taillights as mild, stoplights as severe, but I see the road, roadsigns and all the other stuff as none, so I see the road just fine even that there these things around the lights.

      I feel it has fainted a little, I have a feeling it will get better day by day.

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    • Posted

      Interesting, I just googled that a clinic In Toroto offers the Belgium Finevision trifocal.

      This was the first trifocal that came out in Europe in 2010, but it is still going strong and are widely used in Europe, it is in many ways comparable with the Lisa tri, that came out two years later.

      It offers +1,75 and +3,5 for midrange and reading vision.

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    • Posted

      I suspect we'll see more come to Canada if demand increases. Which I think it will. There are more people without cataracts showing a lit of interest in clear lens exchange to correct presbyopia

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    • Posted

      Yes, clear lens exchange with trifocals are big business here in Europe, and many people like their new vision.

      My surgeon also make a lot of clear lens exhanges on people 45+, and younger people get laser treatment a lot, but also laser have improved a lot within the last 5-10 years with better and safer methods.

      In fact my friend was asking a lot of questions the other day, I realized he was also considering a clear lens exchange because of presbyopia and astigmatism.

      I don´t think I really would recommend that to anyone, but we all make our own decisions i guess.

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    • Posted

      For myself I would not risk doing clear lens exchange knowing what I know about cataract surgery. Plus pupils dilate more the younger you ate so the chance of pupil dilating beyond IOL is there and could cause much dissatisfaction. But everyone is entitled to their personal opinion but do hope those surgeons go over all the risks associated with clear lens exchange.

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    • Posted

      I mentioned in my experience, that my private clinic in Toronto is currently choosing between the PanOptix and the FineVision tri-focals as the premium lens option. Just over two years ago, these were not available, and the premium lens option was the Tecnis Symfony.

      I asked my doctor about how they select between PanOptix and FineVision, and it depends on what power lens you need and which IOL best fits. But based on what I saw at my clinic, PanOptix was almost always selected.

      Also based on Alcon investor disclosures, PanOptix has been extremely successful in Canada since it became available in Canada roughly two years ago. I would say all the clinics in Toronto are opting for the PanOptix as the premium lens of choice, unless for some reason the PanOptix IOL does not fit your eye measurements.

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    • Posted

      While my other reply awaits moderator review, I don't think approvals in Canada are as difficult as in the US (which is why we see FineVision available in Canada, but PanOptix is being selected over FineVIsion).

      I think Zeiss is very strong in the surgical equipment field, and many eye surgeons in Canada have Zeiss equipment (lasers, eye measurement devices).

      But the reality is Zeiss is a relative youngster in the IOL business. I believe Zeiss only entered the IOL space in 2005. And in 2007, they acquired Acri.Tec AG a European IOL manufacturer. At the time they made the acquisiton, the following was said:

      **Jorge L. Alió, MD, PhD, OSN Europe/Asia-Pacific Edition Chairman of the Editorial Board and a former Acri.Tec consultant, told OSN he thinks Zeiss’ move underscores the company’s desire to play in the same arena as Alcon, Bausch & Lomb and Advanced Medical Optics.

      “In terms of market sales, that will take some time because it is clear that the power of the big companies is really big and their place in many markets is difficult to overcome,”

      So as far as the US market is concerned, it's not just the cost of FDA approval, but the bigger players in the US have strong market positions and strong relationships. So Zeiss may feel that it is too early to make a big push into the US. Canada, the

      ophthalmologist seem to be very willing to work with any brand, and will select what they think is best. Not sure why Zeiss doesn't test the waters in Canada first. Perhaps Canada is too small, and Zeiss is focussing elsewhere?

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    • Posted

      I guess only Ziess knows, why they are doing what they do 😃

      But Zeiss are a big player in Europe, which have double the population of US, and Zeiss are also big in many Asian countries, with a huge population, India and China together have a population 8 times bigger than US.

      So maybe they just have their hands full.... 😃

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    • Posted

      Agree Canada much smaller market and Zeiss may not think it worth the effort. Hopefully one day we will see other players in this market.

      Whether Canada is an easier market or not I have no clue. Even for some drugs hard to figure out why we don't ha e some drugs whereas they've been available for years in the USA. Every time I go on a cruise have to buy Bonine in the US (anti nausea medication) I can buy OTC Wish I could get it here. Perhaps again it is too small a market here.

      And in Canada things very unequal depending where you live. Toronto does have those trifocal lenses whereas in NB we don't. And medicare doesn't always cover if you go out of province.

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    • Posted

      Even that we know money rules the world, it just seems unfair when it comes to health issues, all should have the same opportunities.

      But yes, I forgot that Janus lives in Canada as well, and had the choice between Finevision and PanOptix.

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    • Posted

      Nothing ever is fair. But there are pros and cons to ever system including Canada's. Cataract surgery is completely covered - no put of picket expenses unless you want a premium lens. Then you pay difference between monofocal and lens you choose. My symfony lenses were $900 each. I did have a wait for the surgery but that gave me time to read up on procedure and IOLs. Many others pay a lot more than that so in that way Canada is a good place to live.

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    • Posted

      I agree, the Canada system sounds much better than what you find in many other countries, and even more fair than what we have in Denmark.

      In Denmark you can get monofocal (non-toric) lens in public hospital free, everything will be covered, except the glasses you will need, but if you are retired from work a big part of the glasses will be covered as well.

      But if you want premium lens, you go to private clinic, and then there are no funding from the state at all.

      I have payed equivalent to CAD 5050 each lens.

      A lot of money, although price includes laser or other correcting if necessary and yag within 5 years.

      And at this price many people are having clear lens exchange to get rid of glasses, it is almost a little bit crazy.

      If I had went to one of the Eastern European countries, I could have saved quite a bit, but I was scared off by thinking of what then happens, if I had complications.

      Also, a Danish company are making a living by offering package surgery/holiday trips to Turkey for different type of cosmetic surgeries but also lens exhange.

      I could have got the Zeiss premium lenses, the trip and one week holiday including hotel, for a combined price close to half of what I have payed now.

      Their clinics are very up to date, I have friends with background from Turkey that knows these places, but again, I was scared off by the thought of complications.

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    • Posted

      I can very much relate. If all goes well in another country perfect but if there are complications etc you are out of luck finding someone here at home for a follow up procedure. Know someone here that went for a new (what Canada considered experimental treatment) in Europe for MS on her neck a few years ago now. She was wheel chair bound bit able yo walk again with a cane but could get no one here to follow her. Each time she needed to see someone it was a flight to Europe.

      So wasn't something I considered even if there are more options elsewhere. At least cataract procedure done here but for something like her situation with MS and if you have the money I may make a different decision.

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    • Posted

      It does put things into perspective. I feel fortunate that I can do everything I was doing before cataracts affected my vision and more. Wore glasses from age of 12 and to see without them is marvelous. I especially appreciated going snorkeling and seeing all the colors of fish and coral. Prior to that under water was always blurry and I had to enjoy it more watching the play back on my GoPro.

      Lots to be thankful for living in 2019 vs 30 years ago.

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    • Posted

      Since Alcon became a standalone company this year there is more info on the global IOL market. Per Alcon investor presentations, in terms of 2017 global IOL market share, the four largest companies were Alcon (31% of global market), J&J (22%), B&L (6%), and Zeiss (4%). I didn't realize what a big difference there is between the two biggest companies' global market share and the others.

      I suspect Zeiss has other priorities before trying to get a foothold in the US , the home market where Alcon and J&J are strongest, and where both also have very strong products to compete with Zeiss offerings. Asia may be the neutral battle-ground as it's not the home market of any of the big companies.

      Alcon also just acquired bio-tech PowerVision, which has a long-term project to develop a fluid based IOL that reacts to the natural contractions of the eye muscles—moving fluid around to become thicker when viewing nearer objects and thinner when focusing on farther distances. this is still years away from coming to market. But it shows how competitive the IOL industry is, and how the big players keep working on the next innovation. Tecnis Eyhance is another example.

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    • Posted

      Yes, with those numbers it is strange that J&J do not make a trifocal, I would think they should have the technology to relatively "easy" use their well proven bifocal platform and make a trifocal on it, like Zeiss did with theirs.

      But maybe J&J have other stuff in pipeline, that they think will outperform the trifocal, or maybe they just needed to get the Eyhance in production before they make the trifocal, who knows.

      Symfony works great, but here in Denmark most people go for the trifocal over the edof, and when Alcon have a very succesful trifocal it seems a little strange that J&J don´t make one as well.

      Personally I am leaning more and more to get a trifocal in my second eye, even that I am very happy with my Lara now, end of next week i will have the surgery on the second eye, so we will see where it ends.

      As one of my friends said the other day, you know what you have now, why not try to get something else on top of that now that it is being offered to you, instead of more of the same, and maybe he could be right 😃

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    • Posted

      just a question and maybe won't he an issue at all as some IOLs pair well together but had anyone had issues with at LARA in one eye and atLISA in the other in terms of colors, size of lettering. Perhaps brain just melds the view. There are a few threads I read where Symfony was paired with monofocal and colors were different.

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    • Posted

      When I opted for Symfony and had a 6 week wait I did consider a monofocal in 2nd eye but remembered from 2nd consult prior to surgeries surgeon saying there is an added benefit to having 2 symfony lenses - reading would definitely be better. I can attest that is true for me. But I was considering a monofocal and not a trifocal which would bring better near vision. Just wondering if cvew from each eye would be same.

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    • Posted

      I would think that the only way you would get a difference in color perception between two eyes with different IOLs would be if they were from different manufacturers since for example Alcon IOLs have a blue filter that makes whites slightly yellow compared to Tecnis that have no blue filter for pure whites. So mixing an Alcon IOL in one eye with a Tecnis IOL in the other eye could be an issue because of that. But mixing a Tecnis monofocal in one eye with a Tecnis Symfony in the other eye shouldn't have a color difference issue since they would both be similar in their color response. Thats my own plan for whenever my left eye needs cataract surgery to match my right eye which has a Tecnis monofocal IOL - I would probably go with either another Tecnis monofocal for mini-monovision or go with a Tecnis Symfony in the left eye to get good stereo distance vision and good intermediate vision in one eye at least.

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    • Posted

      I have only seen a personal opinion from one "real" person that have had the Lara and Lisa mix, it was actually in this forum, she did not like the Lisa at all, and wished she had chosen 2x Lara instead.

      All other information I have found about the Lisa and Lara mix is made by surgeons that measure VA and all the tecnical stuff, which often turns out really well at least on paper, but these studies do not include how the persons feels about it.

      I have read about people with Symfony and multifocal mix other places as well, that says the Symfony is much brighter with better contrast than the multifocal.

      But trifocals are different than the multifocals (bifocals).

      The bifocals have bigger contrast loss than trifocals, because the trifocals (Lisa and Finevision) partly use a part of the light that are lost in the bifocal, to create the midrange focus point, so the trifocals have a total of more light than bifocals, an are therefore brighter than bifocoals, so they do not compare that well.

      I even found an exchange of experiences amongst surgeons published on the internet, where a surgeon from Spain (I think it was) said that he have stopped using edof lenses, because they were not as bright as the trifocals, and were not as sharp in the far vision as trifocals, and people with the edof/trifocal mix did not like the edof because of that.

      So it is really difficult to know what to believe, I think the surgeons all have different outcomes and experiences with different patients and base their practice on that.

      But I would have loved to find more hands on experience from real people with the Lara and Lisa mix, but I really can not find it, I think it is because the Lara is relative new on the marked, I cannot find much about 2x Lara either.

      If the brain accepts monovision, I believe it melds the images well together with the edof/tri mix, just like it would with monofocals with monovision.

      Only thing I have read that you should avoid, is mixing refractive and diffractive iols, because there is too much difference for the brain to cope with.

      That said I am sure vision will be somewhat different in the two eyes with the mix, if you close one at a time to compare.

      I believe you are right, that a second Lara would give me quite a bit more reading power as well, it would probably be enough so I don´t feel I need more than that, and it does feel like the safest choice.

      But the Lara makes +2, the Lisa have a +3.33 focus point for reading, so I believe the Lisa must add something up close, that I can not have with the Lara.

      I share your thoughts and have my own worries about the possible issues with the mix, at the same time I know my surgeon have been in this field for more than 30 years, he have made more than 20.000 lens exchanges, and the mix was his original suggestion for me, so maybe I should have faith in his idea.

      By the way, now that I have taken my nerd gene to the extreme and extensionally have dug deep in all this, I have found bench testing results as well, that shows Lara is a manipulated bifocal, where the gaps are being filled with some of light (that otherwise gets lost) and in this way it makes the continuos focal point and have lower contrast loss, so the Lara and Lisa might not be that different for the brain to cope with anyway.

      Just like the Symfony acts like a bifocal in bench testing, but are manipulated to get the long continuos focal point, using a big part of the light that are lost in other bifocals to fill the gaps, therefore it gets better contrast and less loss than standart bifocals, the Symfony and Lara are very close to monofocals when it comes to contrast loss.

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    • Posted

      Good point about using same manufacturer. I really cannot recall who posted the thread about seeing different colors but likely IOLs from different manufacturers makes sense. Guess it could happen if surgeries ate years apart. Have a friend who had cataract surgery 12 years ago and still doesn't need surgery on other eye. Guess with that many years in between that could happen too if there has been many updates on IOLs since that time.

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    • Posted

      pco is the hindrance to a truly accommodating iol. so unless they have a solution for pco an accommodating lens will not make it to the market.

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    • Posted

      Is it possible to ask your surgeon if you could chat with a patient of his with that mix? I remember when Symfony was first introduced here in my province Dec 2016 and I was concerned about trying something new a colleague at work put me in touch with her neighbor who had jy

      just had cataract surgery and went with Symfony. Felt odd about calling someone put of the blue but glad I mustered up the courage as it was most i formative and somehow a living example beats studies and opinions every time for me. And oddly enough it was my surgeon who implanted her Symfony lenses. She didn't regret with going with 2 Symfony lenses.

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    • Posted

      LOL While Danish is at it, maybe after a month he could get them both replaced and try some other combinations and then report back 😃 That is what a true nerd would do Danish 😃

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    • Posted

      I did ask my work colleague to see if she'd be willing to chat with a total stranger before I called so she knew I would be calling. Guess I thought it might be too much of an imposition to meet in person. We chatted for more than 30 minutes about procedure itself and also about Symfony and her abolity to see at all 3 distances, night driving. She was 60 years old. Found it helpful to talk to her.

      I did meet one other person but they had monofocal lenses implanted. Meeting was arranged through a friend from my church. I didn't know her prior to that and we met for lunch as she worked pretty close to where I worked. She was in her early 50s and recently had her 2nd surgery. Her first was 8 years prior. It was interesting as she did not know what lens was implanted and never knew there were different lenses. She did have a card that was provided to her from surgeon so I knew from looking at it she had an AcrySof Monofocal implanted.

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    • Posted

      LOL yes, now that I think of it, maybe I should ask the surgeon if I could try some different iols on at the same time, and then decide which one to bring home 😃

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    • Posted

      i have seriously thought about it. but i had corneal swelling causing blurry vision for 10-12 hours after the surgery so it would be difficult to know how the vision is for 1-2 days to really try them out.

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    • Posted

      Yes, and neuroadaption takes months, especially with trifocals, so we can only dream of having that option I guess.

      But then again, it would require testing in different situations.

      In plenty of natural light I have ok reading vision with only one Lara, I would not need more than that to get by without glasses on a daily basis, but in artificial light I would like a little bit more close up vision.

      I know the trifocal also works best in natural light, but still, it must be better close up than the edof i any case.

      No matter what I really can´t wait to have the second eye fixed, I am almost counting the hours even that it is in 9 days.... 😃

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    • Posted

      I will be interested in the answer to that if you go with trifocal. With Symfony I need good lighting but can read even tiny print. I am pretty sure all IOLs require good lighting whether natural or artificial. When I am in low light conditions I use flashlight feature on iPhone (in a good restaurant with low lighting for ambiance).

      You will also find if you opt for atLARA that you will get closer vision than with the one.

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    • Posted

      Yes, I think no matter what lens I choose I will be happy with it, I think I will tell the surgeon my thoughts and experience with the Lara so far, and let him decide for me, maybe there could be other details about the second eye that made him suggest the trifocal in the first place.

      I am slowly getting used to having more light around me, but it is something I am still learning to adjust to, because all my life with cataracts I have been bothered a lot with bright light.

      I have almost always covered windows and keeping natural out, so I better could control the light around me, sunlight from a window have always made it difficult for me to look at a screen, so my office have always been completely sealed off without natural light, and making my own sort of dim light, that suited me best.

      Dim light, high contrast on the screen and backlit keyboard is what have made me able to work on pc until now.

      And now I need the sunlight from the windows to see well, it is a learning curve.

      But right now I have one cataract eye that complaints over the light, and one Lara eye that loves the light, so I think a lot will change with the next surgery.

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    • Posted

      keeping ability to read aside. are videos on the iphone HD quality for you? i would think: if yes then no need for lisa. if not and you desire such then lisa would help.

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    • Posted

      Well, the Lara eye loves light, I was only oversensitive to light the first week, I see perfect outside in the sun as well now.

      But my eye with cataracts looses the ability to see anything if light is too bright, it is like the cataracts are being lit up, and no other light gets through.

      But with sunglasses on there is not contrast left at all, I become blind as a bat on the cataract eye with sunglasses, I have never before been able to use sunglasses in any circumstances where I needed to see anything.

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    • Posted

      Yes, close up is much better with +1,5.

      When I work in my garage, I keep +1,5 on most of the time, but this is also because lighting is not that great.

      And this is also why I am leaning more and more to the trifocal, the Lara makes about +2 before it tapers off, the Lisa have +3.33 focal point, and now I understand why...

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    • Posted

      +2.5 readers currently give me HD video quality on the iphone. I notice this more so because the natural eye is still j1+ for near.

      +1.25 readers gives me good reading in all lighting conditions.

      i understand this will vary with individuals but i wonder if there is anyone who would get great quality video with just the edof. what i mean is if you increase the + power unnecessarily the picture becomes worse.

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    • Posted

      PCO would be a problem for accommodating for sure. During the Alcon investor conference, Alcon said that they've been watching PowerVision's technology for a while, and If it works, this fluid- filled IOL will be a game changer. They said it's a long-term project., but I guess they believe the potential is worth the risk to buy the company now, and take over the development from here.

      I read that the design currently uses a very large bag shaped haptic that pretty much fills the entire capsule, and that is how they hope to prevent PCO. There have already been clinic studies underway for a few years, but this is still a long-term project.

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    • Posted

      Yes, with +2,5 you are moving your far vision very close to reading vision, even Symfony are stronger at far distance than midrange. You could even use +3,5 and move your far vision all the way in to 30-40cm, and your eye won´t mind it, since it can no longer accommodate.

      The edof lenses simply do not make enough + power for near, some get a reasonable near, but even they would have better near with readers.

      Some years ago multifocals often had +4 focal point for reading. The trend is to use lower adds, to give more midrange to pc and tablets (and to reduce side effects), so now we see +3,25 and +2,75 bifocals.

      Finevision trifocals have plano, +1.75 and +3.5

      Lisa tri have plano, +1.66 and +3.33

      The Symfony is a manipulated bifocal with plano and +1.75.

      So no matter what, the Symfony set for plano simply does not have enough + power to deliver what you would like it to have in near vision.

      Off course it varies from person to person, but only to a limit.

      We just don´t have that iol that replicates a healthy 25 year old eye, but the lenses we have now is pretty fantastic, compared to the lenses that hit the marked when I was a teenager and considered lens implant the first time, so I am grateful for the opportunities we have today 😃

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    • Posted

      interesting.

      is the lisa fixed at +1.66 and +3.33? can one opt for a +1.5 and +2.5 lisa?

      also can they calculate what you need for near or is it fixed and they only calculate distance plano?

      we in US do not have a trifocal options which is unbelievable.

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    • Posted

      Only far distance plano is calculated and the lens is picked from this number (and some other numbers)

      The +1.66 is for midrange

      The +3.33 is for near

      These are fixed according to far distance plano, because in reality it varies very little from person to person how much +add to the far distance plano we need to see at different distances, so as long as the far distance plano is on target, the midrange and near will fit us all this way. But some get better vision than others, the same way as some are able to squeeze a little more out of the Symfony than others.

      Yes, it is really strange that no trifocal have found their way to the US, the Finevision came out in Europe in 2010, the Lisa Tri in 2012 and the PanOptix in 2015 (I think)

      And others have joined, there are more trifocals to choose from, even India are making their own "local" trifocal that works really well, and has a very low price tag, a few countries in Europe are using the India trifocal to cut down price.

      In Denmark no eye clinics have used bifocals for years, they started to use Finevision and Zeiss as soon as they came on the marked, and the Panoptix have also become very popular, many are getting clear lens exchange without having cataracts, just to get rid of reading glasses when presbyopia sets in, or if they maybe are using glasses for other reasons.

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    • Posted

      both my Symfony lenses were targeted for plano and although I don't use them often I have a prescription for +1.25 readers. If I am reading extended periods of time or reading tiny print I will use them.

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    • Posted

      Yes, no doubt your brain is very good at compensating, I am happy for you, that you have got such good vision from the Symfony.

      I hope I will have the same, if I go for another Lara 😃

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    • Posted

      reading acuity is different from video quality i feel. for example there is no improvement in video quality for me after +2.5.

      do you see video on your phone better with the 1.25 readers than what you would see without them? or there is no improvement.

      also can you thread a needle without the readers?

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    • Posted

      Hi Soks - yes can thread a needle without my readers. Have also had to screw in that tiny screw on hinge of my sunglasses when that fell out without readers.

      Went and watched a couple of movie trailers in my iPhone and the images are slightly bigger (even when reading with readers) so slight improvement or it's just different due to size difference.

      What is odd though if I wear the readers much my eyes seem to adapt to that and when I take them off it takes several minutes till I adapt back to that and things are clear. Is that same for you? Odd how our brains are like that.

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    • Posted

      How about

      1- EDOF + Monofocal set to near?

      or

      2) EDOF + Monfocoal set to far?

      Is that a good combination for brain to deal with? Could be a good option or am I missing something?

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    • Posted

      When both eyes see the same thing at the same time, you get a "bonus" at about 25% more vision aquity and 40% extra contrast.

      It is this bonus we hunt for, when we choose premium lenses over monofocals with monovision.

      To combine monofocal and edof would only be in an attempt to have fewer side effects from the premium lenses, or if you are in a situation where one eye maybe not be suited for premium lens.

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    • Posted

      i have come to a conclusion that monofocal set for near is a tricky business. the reason i say that is because a lot of diopters are needed to cover only a short range. for example if i use +2.5 on the symfony eye the range of clear vision for that eye is 8 to 16 inches. with a +1.25 i can read the iphone at 8 inches but the video is not HD.

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    • Posted

      Will have to try that out this evening. Used to carry my readers in my purse but I haven't done that in a long time. Funny how one gets used to glasses free! At work don't need them - good overhead florescent lighting and I have a desk lamp too if needed.

      But does your near vision get a bit blurry for a short while after taking off readers?

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    • Posted

      Agree with Danish on this. I had a 6 week wait between surgeries so can really attest to benefit increase after 2nd surgery. Reading distance greatly improved once 2nd implant went in. I think only someone wanting to diminish the night vision halos would combine monofocal with EDoF lens. And to do that you'd need to target dominant eye for distance.

      I tried to find an article I had read about Symfony and losing a benefit if a mini monovision was attempted with them. Article said targeting them for same distance is best. I actually 2 years on do not have any difficulty driving at night. Driving with my cataracts was far worse.

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    • Posted

      "But does your near vision get a bit blurry for a short while after taking off readers?" -- No. But putting on the readers even the mild +0.5 makes crystal distance quite a bit blurry so i think going plani may have been a good idea.

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    • Posted

      night driving is really worse for people with dysphotopsia. i think there is a confusion between symfony artifacts and dysphotopsia and i can understand why. there is an element of IOL lighting up with dysphotopsia which combines with the symfony artifacts. symfony artifacts on their own are hardly bothering. the alphagan drops get rid of the dysphotopsia symtpons but the pupil is constricted at night and i can say that in that condition i have made a turn into the wrong oncoming lane in the dark.

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    • Posted

      "But does your near vision get a bit blurry for a short while after taking off readers?"

      I don't have cataract but to test-

      1. Computer screen with no glasses = 95% sharp
      2. Computer screen with reading glasses = 100% sharp
      3. Computer screen after taking reading glasses off = 85% sharp for few seconds before returning to 95% sharpness.
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    • Posted

      OK then my experience of vision getting a bit blurry (reading distance) may not be normal? At first optometrist appointment after surgery was give +1.75 readers those I felt were too strong and I didn't wear them much as it strained my eyes. At 16 months after surgery I was changed to +1.25 and those are fine for reading and if I am doing long period of reading (novel) I will wear them.

      I am now curious if vision blurs a bit after looking into distance with them. From what I recall when looking up when I have readers on all is blurry in distance - like I am trying on someone else's glasses and it is wrong prescription.

      So you ate saying your near vision is totally same after you take off readers? I wonder if my eyes take time yo adjust more than a normal person's would. I know ever since I can remember when optometrist had me cover one eye and read chart with the other I had to take a moment before covering the other eye as it took time for my vision to adjust - chart would be blurry for a good 30 seconds.

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    • Posted

      I think without the dysphotopsia you wouldn't find contrast or Symfony's artifacts bothersome. First few months I experienced a lot more glare off lights at night than I do now so if what you are experiencing is like that (and worse) I can see how bothersome that would be. I only see a slight fuzz around outside lights (ie tail lights of cars or overhead street lights - no concentric circles that Symfony does have around red traffic lights) And I really don't recall a time lights weren't a bit fuzzy at night even prior to surgeries. Could be just a variance between people I don't know. The moon too is very sharp - no issues with it - no weird circles around it.

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    • Posted

      Yes same here - that initial 15 or 20 seconds after taking off readers is blurry (not as sharp as you described) - have to wait a bit and blink.

      Will try the experiment tonight with distance vision after I take off readers

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    • Posted

      i think i know what u mean when u say slight fuzz and the sharp hallows around lights have mellowed into something normal. i think that is probably because of PCO in my case or maybe the capsule shrink wrapping around the lens. but it actually makes it look normal then immediately after the surgery coz the circles are pretty much gone. alpahagan does show me how it looks without the dysphotopsia and it is quite good. not happy with near so if technis had a trifocal i would probably get that in other eye.

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    • Posted

      "So you ate saying your near vision is totally same after you take off readers?" - after taking off readers the distance becomes clear and near is blurry immediately and remains that way. i use +1.25 too and the HD +2.5 does strain my eyes. also the readers smudge a lot.

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    • Posted

      Would you consider making a trip to Europe for 2nd surgery to get a trifocal? I just got back from visiting family in England and sering sights of London for a few days and couldn't help but notice a lot of private clinics there.

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    • Posted

      Yes likely the shrink wrapping around lens is what makes lights look more normal at night. That process takes about that amount of time.

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    • Posted

      i think i would. i do have the same concern that you did which is that if the lens had to be taken out would the US doctors know how to cut it out.

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    • Posted

      I really do think it's only a matter of time that Canada and USA get trifocals. The clear lens exchange (my personal feelings set aside) will be driving that market. Surgeons will see their dollars walk across the pond. The CLE customer is wanting near vision - whole basis of them opting for this kind of surgery in first place. Cataract patients (although wanting more) still more of a conservative group and satisfied with available lenses here - although I see that changing too as there are younger and younger people afflicted with this. It may gave to do with sun and environment as there is an increase in skin cancer too in young people. Could affect our eyes as well.

      At time of my surgeries EDOF was so new here - hadn't even had trifocals on my radar but given I went with Symfony - I likely would have equally considered trifocals.

      I do have a lot of family in England so I would at least have a place to stay.

      But it really is something to consider. It is a real shame the issue of IOL diameter for larger pupils hadn't been addressed.

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    • Posted

      If you have any locator details on that article, however vague, I'd love to have them. That article that I referenced in the other thread investigated the same kind of thing (same lenses), but was more about tradeoffs between visual coverage of all three ranges and increased nightime effects, For just that axis, they were talking about 0.5D to 0.75D difference between eyes being a "sweet spot".

      That study was not really talking about lost synergies, so it would be interesting what datasets were used in the study that you read, and what was taken into consideration.

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    • Posted

      OK soks did the experiment I put the readers on - distance vision obviously blurs with my +1.25 readers but when I take readers off distance vision goes to normal clear vision no blurring. Unlike near vision which takes 15 seconds or more with blinking to clear.

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    • Posted

      Hi Sue.An, is $900 the total cost of operation or Symfony lens itself? The two private clinics I went in Toronto don't carry Symfony at all. A hospitalized surgeon quoted $1905 per eye for multifocal lens (she thinks EDOF is multifocal). This price includes $600 measurement fee. Very expensive.

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