Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens

It is good to know that the brain gets used to some of these effects, such as halo, over time.

I will probably make a distinction between the relatively bright halo, which I see close to a light across the street, from the almost 7 perfect concentric circles around the light but outside the main halo , with the diameter of the outermost circle being about 3-4 times that of the halo width. The circles have unlit bands in between. I doubt that the other IOLs could produce this number of clearly defined circles, even if they create halos.

Do you remember if you actually saw such concentric circles?

 

Thank you for sharing your experience with the Symfony Lens Concentric Circles and also giving me a tip on how to find the related David Taylor experience.

Looking at David Taylor's experience pictures, my lens vision issue is similar to that depicted in picture 2, although in my case, I have been struck more by the various concentric circles than by the starbursts. The starbursts can be affected by the required spherical / astigmatism correction, but the concentric circles seem to be an effect of the Symfony lens design.

I counted 7 or so circles, but those could have been more. As you know, those can be hard to count exactly.

As I mentioned earlier, inspite of this issue, I like the Symfony Lens on the whole. Even then, I also wish that this issue should have been at least mentioned by all the doctors or users who just say all the positive things about the Symfony lens.

 

Do you also see 7-8 Concentric Circles around the light or its halo, even though you don't have Symfony lens?

I see halos around any light, but I have never looked hard enough to be able to say they are circles. They  are so distracting that I'm usually too busy trying to avoid looking at them. It's worse when I'm driving, because I can't just look away. 

Oops, I meant the halos from monofocals tend to be more concentrated in one center ring/blob than those from diffractive IOLs like the Symfony and multifocals.

Thanks for your feedback. It is nice to know that I am not the only one with the issue of seeing the concentric circles with the symfony lens and that the vision may get better as the time passes.

However, I do think that to call 10 concentric circles extending about 10 feet each side of a head light also just a halo, when it may cover just a small area near a monofocal lens, is highly misleading. At least it was misleading to me. Let us just call a spade a spade. If there are many circles extending many feet beyond what a single-circle halo for a monofocal lens may extend, let us make sure that the potential users understand that. May be, we can tell the people that while one may have a halo with a monofocal lens, one may see many concentric halos (if one wants to call a concentric circle as a halo) with the symfony lens.

Even if one does not notice the halos after a few months, that should not excuse the manufacturer and the doctors from telling the people about this issue and mislead them by saying the halo is just like that for a monofocal lens when they are trying to make a decision about the lens selection.

With my limited driving at night up to this point, I can deal with this problem by just avoiding looking at the car headlights or other bright lights, just like I deal with someone driving a car with high beams (instead of low beams) coming towards with me, but that is not an ideal solution.

 

It has been about 3 weeks since my first post (and a month since my cataract surgery) on the visual issue of the undesirable concentric-circles, which I have been having with Symfony Lens. Thought that I may provide a quick update of my related experience for the benefit of the people who may be considering Symfony lens. so that they can make a more informed decision.

Even though my corrected distance vision (with glasses for correcting astigmatism) is 20/16 (6/4.75 in the metric scale), there has been no change in my seeing the undesirable concentric circles. If I look at a light in front of a house 50 yards away at night, I see a 1 to 2 feet diameter relatively-bright circular area around the light. I know that that can be an issue with even monofocal lenses. However, in addition to that area, I see 8-9 lighted circles (with dark bands separating them). These circles are less bright, but extend to about 10-12 feet diameter around the light, which is a huge area. I can see through the circles, but it is like seeing the world through a large spider web or even a dirty windshield in a car.

Of course, I see similar concentric circles around car headlights at night, with the concentric circles extending much wider than the width of the car. This would be a bigger issue for the people who have to drive a lot at night.

One can obviously learn to live with these effects and just enjoy the benefits which the Symfony lens offers. But it is important to be aware of these while making the lens choice after a cataract surgery.

To end this on a more positive note, I don't see the concentric-circles in the day time or at shorter distances inside a building.

As I've noted before, most studies on halos with lenses report results after 3-6 months since many people who see halos initially adapt to them and tune them out within a few months, so its still possible that will happen for you, or that they will at least become less noticeable. I see the concentric circles, but they are so translucent and minor that they aren't a problem. My night vision is better overall than I can remember in the past, I think perhaps there is less glare, so overall its an improvement despite seeing the halos. 

The % of people who have halos they consider a problem (regardless of whether they are concentric circles or centralized single rings) tends to be comparable between the Symfony and monofocals, with some like the Tecnis monofocal perhaps being a bit better than the Symfony, but others not being as good as the Symfony. Unfortunately there is no way to predict in advance who will have a problem with what lens, it may be you'd have worse problems with a monofocal, or not have a problem at all.

you mentioned the "benefits which the Symfony lens offers"   From your perspective what are they?

That would be very helpful to know.  They sound good on paper....but all the issues have me worried.

thanks

The main benefit of the Symfony lens, which I notice, is that they do provide a slightly larger range of useful vision. My rough estimate is that I get useful vision over about 1.25 diopter range with the Symfony lens (used for my right eye) compared with about 0.5 diopter range of useful vision with a monofocal lens (used for my left eye).

thanks....but could you interpret this for me......did the lens improve your...

...distance vision

....medium distance vision

...."near"...say 20 inches

....reading??

thanks a lot

When corrected to get very good vision at distance, the Symfony lens in my right eye provides good vision down to about 32 inches. I suspect that a monofocal lens would have provided me good vision only down to about 6-7 feet.

For reading or computer work, I depend on the left eye with a monofocal lens.

Three weeks out on the first Symphony implant and one week out on the second....  Over all I think the lenses are good, but really have no basis for comparison.  The only negative I am experiencing are the same symptoms you and others are talking about.  Very down played when the lenses were being sold.  Under certain conditions the concentric circle effects are really annoying.  My Doc tells me they will be much milder as the eye heals.  Zero improvement in three weeks, so we will wait and see if this happens.  For a total of $5,600.00 for both eyes I was expecting better with this issue.  It was much less severe with my Cataracts.....  Also using 1.5 reading glasses for most close up stuff, like menus, phone, and tablet work.... I can live with that... but for the bucks you would think they would improve on that too.

Sorry to learn that you also are having the issue of seeing multiple concentric circles with the Symfony lens.

As for me, I have not seen any change in my seeing the concentric circles around lights when it is dark over the last 10 weeks since I had the Symfony lens after the cataract surgery. Surprisingly, the intensity of the concentric circles has been the same with the uncorrected eye (which had astigmatism), with the eye glasses, and now after the LASIK Enhancement (fortunately, my eye surgeion includes free LASIK enhancement as part of the premium lens price). I have 20/15 eye sight after LASIK enhancement (as it was with eye glasses). The glare around the lights has been reduced both with the correction of astigmatism and  and the passage of time, but there has been no change in my seeing the concentric circles.

I don't expect my seeing of concentric circles to change because this is not due to something related to my eye, which will heal with time. These circles are due to the feature of the multiple “diffractive echelette design” circles in the lens. When my surgeon looks into my eye, he can see all these circles in the lens. So, he is not surprised that under the right conditions, I can see various circles corresponding to those circles in the lens design.

All of us learn to live with bad things in our lives, specially when we can't do anything to correct those. But it is a shame that we have to be surprised after getting these Symfony lenses because of the half-truths in their selling.

Unfortunately there is no lens in existence that doesn't give someone problematic halos. Actually many people who see halos during the initial few weeks see them subside over time, which is why when they do studies on IOLs they usually only report statistics on halos after 3 or more usually 6 months. Even those with monofocal IOL can initially have problems with them. The issue is how many continue to have problems after the initial healing and neuroadaptation period. Oddly over the last month or so, despite being at 2 years postop, there are lights in my home where I used to consistently see halos where now often I've noticed that now I don't. It may be that I haven't been spending as much time outside at night to adapt so its taken longer and so perhaps they'll continue to subside. For most people it doesn't take this long, but with some they never do go away. 

 The issue of halos should be raised by doctors beforehand, and if they don't thats a problem. I suspect the issue is more often that people hear there is a low risk, and automatically assume they will be the lucky ones and won't get the halos. Then they complain when they get the problem they were warned about, when it was their fault for thinking "low risk" is the same as "no risk".

Unfortunately even if there were some rare issue with only 1 out of 1000 people getting it, its likely they would   misguidedly whine to the public as if everyone were guaranted to have the same the problem merely because they do.

Unfortunately out of vast numbers of people, even though its only a minority who have problems, they are the ones that tend to come online and post about it so they give people a skewed impression of the odds of issues. Unfortunately *someone* winds up being the statistic, but just because they have a problem doesn't mean everyone else does.

At 1 and 3 weeks postop you are still too early in the process to know what the results will be like. In terms of needing glasses for near, you don't mention what your refractive error is, i.e. whether they got the lens power right or whether they left some astigmatism. If there is some remaining refractive error, that is usually correctable via laser. 

In terms of "for the bucks you would think the would improve on"

Lenses have advanced a lot over the decades, there are companies competing to improve the technology, but it isn't easy. It isn't like they don't realize that improving it would be useful.  This isn't like the sort of lenses used for eyeglasses, look up "diffractive optics" to get a sense of how different lenses like the Symfony are which rely on diffractive optics are compared to the typical  eyeglass lens. The IOL corrects for chromatic aberration, it doesn't merely use a material with a low abbe number like eyeglasses do. The math&physics involved aren't like the straightforward optics some might have learned in high school or introductory classes in college, so it takes time to develop better lenses.

1. Unfortunately, seeing many concentric circles with Symfony lens is much more prevalent than a rare issue. You have it, I have it, and many other people on this forum have it.

2. We have already agreed to disagree on whether we should believe the published studies on the visual issues associated with Symfony Lens which claim them to be the same as with monofocal lenses. You obviously believe them. I don't because I feel that they are biased because of the inherent financial interests of the parties pushing them.

3. We know that the visual issue of seeing many concentric circles with the Symfony lens can't possibly happen with a monofocal lens because this phenomenon is a direct result of the new feature of the Symfony lens. I am not aware of any design feature in Symfony which makes it less susceptible to causing the traditional glare or halo compared with a monofocal Technis lens. Thus, it stands to reason that a Symfony lens has more potential of causing the visual issues at night than a monofocal Technis lens.

As I have said before, inspite of my having more visual issue at night than I was led to believe, on balance, I feel that it was a good choice for me. But everyone should be given better information about the pros and cons of the different lens choices for them to weigh those for their specific needs.

re: "is much more prevalent than a rare issue. You have it, I have it"

You seem to have some problems grapsing that you can have absolutely no idea how many people have the issue based on posts online.  If you don't grasp the concept of "sampling error" leading to a skewed result then I'd suggest learning about it. 

re: "believe the published studies"

Once again, other lens companies have a vested interest in disproving flawed claims of their competitors. If they suspect bias in the studies done on the Symfony, it is in their interest to undermine it via doing their own studies. All studies should be taken with a grain of salt and skeptically evaluated by those that grasp how to evaluate data rather than those that don't grasp basics like the problem of biased samples vs. random samples.  

re: "can't possibly happen with a monofocal lens"

Yes this particular type of halo doesn't happen with a monofocal. The issue is whether a halo causes a problem, and halos shaped differently, one blob/ring vs. multiple ones, can cause troubles also. The issue is the number of people that consider a visual artifact a problem, not whether the exact shape of the artifact is the same. The mere fact that the Symfony has some feature a monofocal lens doesn't have doesn't indicate anything about the relative prevalence of a visual artifact. It may be that those prone to see halos with a monofocal would see them with the Symfony also but merely see a different shape. There is no apriori conclusion that can be drawn in terms of prevalence of the issue from the fact that the Symfony's halos are a different shape and it has a different lens feature. 

re: "has more potential"

What matters in the real world is the data assessing what that "more potential" equates to. In theory "more" could mean a 0.0000001% more chance. In reality the data suggests its some small few % compared to a Tecnis monofocal which seems to have a low risk, but within the range of other  monofocals.

I don't tend to have bothered tracking studies on monofocals, partly becaus there are fewer of them. However they are often used as controls in studies comparing them with monofocals. Studies for approval of multifocals by the US FDA compare them to a monofcal control lens. In this case the April 2015 approval of the Alcon Restor +2.5 lens includes a comparision with an Alcon monofocal (one of the most widely used monofocal lenses, and possibly the most widely used though I don't have statistic). Since this site moderates links, google this:

"ACRYSOF IQ RESTOR +2.5 D MULTIFOCAL INTRAOCULAR LENS" 15M-1325

The page that shows up has a link for the summary of safety and effectiveness data. In table 12, the monofocal result shows mild halos: 26.9%, moderate 7.5% and severe 3.8%.

Unfortunately comparing different studies is problematic since they vary in patient demographics and the questions asked and whether responses are directed or not. So you can only get a rough sense of order of magnitude of problems. Other studies don't merely ask about the visual artifacts, but ask about things like the degree of difficulty they cause for night driving, and monofocal halos can cause problems with that

As you note, the other features of a lens can balance that out. In the case of the low add Tecnis multifocal, the +2.75, the studies show more problems with night driving for the monofocal control than for the multifocal, presumably in part because of the difficulty seeing the dashboard. 

 

I understand what a rare issue and the visual isue of concentric circles with Symfony lens is definitely not rare.

What I don't undestand is your motivation for belittling the issues raised about the Symfony lens on this forum. Let us let the people talk about their issues so that the other people are aware of it, offer a positive advice to deal with the issue if possible, and not  jump in like a salesman for a product to keep saying that there are just pros and no cons for a product.

Some people see the concentric circles and some don't....  Regardless of the ratio, I am wonering why that is the case....  Is it QC in the manufacture of the lens, only in certain sizes of the lens, positioning of the lens by the Doc, something in the indiviual's eye make-up or nerve/brain wiring, environmental, or some other variable?  Then is thee some type of filter, other than dark glasses, that can be worn at night to reduce or eliminte the issue....  Would seem like a fairly large market for halo reduction....  Maybe they already exist....

The other thing I notice is while watching a Flat Screen TV is a soft white glow around white letters on a black background.....  The soft glow surrounds the entire group of words, not each individual letter.....

My guess is that since the the concentric circles have lighted bands separated by dark bands, one of the major factors determining the ability to see them will depend on the Contrast Sensitivity of the individual eye. Persons with better contrast sensitivity will tend to see them more. Typically, an individual's contrast sensitivity is the best at about 20 years of age and then begins to decline as one gets older, which makes it harder for some old people to drive at night (even if they don't have a cataract). Just like a Snellen chart is used to determine visual activity of an eye, a Pelli-Robson chart can be used to evaluate an individual's contrast sensitivy, but is not usually done at the time of an eye examination.

Will have to look for this effect. Will share with you accordingly.

re: "is definitely not rare."

How the heck do you know? I see halos, but i grasp that logically says absolutely nothing about their prevalence in general, nor does the existence of other posters here. What crystal ball lets you magically know how common an issue is based on some random data points of online posters, in contrast to actual studies?  

re: "your motivation for belittling the issues raised about"

I have a background in science and have long had concerns over the rise of junk science in our society driven by a lack of critical thinking skills and a lack of understanding of the basics of science such as how to evaluate evidence and the utility of actual studies rather than anecdotal data. 

Of course there  is nothing wrong with being uninformed about a topic, like how to evalaute evidence. The problem is when people who don't know much about a topic seem unaware of it and insist on spreading their misunderstanding to others.  

What I am belittling is someone exhibiting problems reasoning about evidence, since its an issue I have concerns about in general in our society.  I'd suggest learning the basics of evidence and logical reasoning about it before wasting the time of others here.

re: "just pros and no cons"

Contrary to that silly statement, I've noted a few times that some people who may need more near should consider a trifocal for instance. There is no lens yet that is perfect, which is part of the point, to not pretend monofocals are perfect since they also have a risk of halos.  The issue is to assess pros and cons logically. I spent a lot of time researching issues and looking at data on various options, and have kept up with  some of the research afterwards out of curiosity, and perhaps lose patience wasting time responding to the posts of someone who doesn't exhibit a basic understanding of how to evaluate evidence and seems to refuse to bother attempting to learn before taking up our time.

 

As I said earlier, "We have already agreed to disagree on whether we should believe the published studies on the visual issues associated with Symfony Lens which claim them to be the same as with monofocal lenses. You obviously believe them. I don't because I feel that they are biased because of the inherent financial interests of the parties pushing them." So, I am not sure why you have to keep bringing it up.

Also, as I said before, "Let us let the people talk about their issues so that the other people are aware of it, and offer a positive advice to deal with the issue if possible," And let us not insult each other's intelligence.

There are multiple causes of halos (even some people with their natural lens get halos, apparently its more common in farsighted people, which makes myopes more likely to complain about them with IOLs). In the case of the Symfony there are likely two major issues  that might be at play regarding issues described here of the "soft glow" and the concentric rings.

If you search the net you'll see that there are reviews of camera lenses that use diffractive optics commenting that they sometimes lead to halos in certain circumstances due to a tiny amount of light scattering off the edges of diffractive rings. It isn't due to a manufacturing glitch, but merely due to the existence of the diffractive rings which have boundaries. Usually the small amount of scattered light is dwarfed by the general ambient light level and its not an issue with camera lenses, or IOLs, but it can be in certain cases. Even refractive multifocals where the lens power varies can have issues related to the boundaries between powers, even when there aren't visible rings to someone looking at them the way there are with diffractive optics. 

 

Multifocal IOLs tend to have halo issues which can also sometimes be from diffractive rings, but they have a more major issue, which might explain the "soft glow" around white letters you refer to. The   major issue for halos with a multifocal is usually viewed as being the fact that there are 2 or three focal points which means there are 2 or 3 different images on the retina, in focus or out of focus, and the brain chooses to pay attention to the light that is in focus. It is amazing it somehow manages to do this, but I had multifocal contacts back before the cataract and had this happen. (and I don't recall halo problems with the multifocal contacts btw, which is why I had thought I was at lower risk of seeing them).  However it can't always as easily  figure out what is "in focus" when there isn't enough information, e.g. at night with just a source of light (vs an object it can more easily tell is blurred or not).   A point of light   should ideally come to a focus as a point on the retina, and it does for instance with a monofocal set for distance if the light is in the distance. With a multifocal, part of that light passes through 1 or two other lens powers and isn't focused on the retina as a point, but instead as an out of focus circle (since if you view light being focused in as a cone narrowing to a point and then spreading out on the other side again, on either side of the focal point the point is a circle rather than a point). The out of focus light from the wrong focal points on a multifocal can appear as a halo. Somehow the brain usually does manage to eventually sort out somehow which image to pay attention to and tunes out the halos.

With the Symfony, a wider range is in focus at once, but

its possible that some of the less well focused light might contribute to a "soft glow" you mention surrounding white letters on a black background. The surrounding glow is the slightly out of focus light from those white letters. When in a dimly lit room at night and watching TV, I did notice a bit of what you are referring to surrounding the lighter screen areas, but its something that the brain tuned out better over time.  

 The fact that some people see it and others don't is likely not due to any manufacturing issues with the lens, but due to variation between people in their their retinas sensitivity (I keep meaning to research to see if they've noticed correlations with measures of retinal sensitivity, or indirectly with age since the retina is less sensitive as we age, or with contrast sensitivity)  and in how their neural system adapts to it, and perhaps minor variations in lens placement and angle, the power of the lens and the size of the retina the image is projected on to (e.g. how many cells the image containing the stray light falls on)  and attributes of the cornea which vary the exact image the retina gets that the neural system needs to adapt to. Unfortunately neural adaptation  isn't well understood at all. When they don't understand well how people do it at all, unfortunately its harder to understand why some people don't do it as well.

As I had indicated earlier, I did look for this effect last night. Did not have the right background on the TV to judge it. Did find that in the dark, there was a soft glow around the group of numbers on my digital clock, somewhat similar to the way you describe it . It was more noticable when the eyes were more used to the darkness, but was still not bothersone. This effect is probably due to our eyes not focussing perfectly.

I should add that although some have tried to imply the issues with the Symfony are unique, although the main halo  issue with multifocals tends to be due to the multiple focal points they have in a way the Symfoy doesn't, it appears the diffractive optics in a multifocal can cause multiple rings with those as well. To avoid the moderation due to links, if you google:

"He tells me he sees 2 definite light rings around the main light, and then much fainter rings outside that. "

It is a writeup of someone with a bifocal lens, which if it were merely the focal points would only see 1 ring around the object. It includes one drawing of the halo a patient sees. An attempt to reproduce the effect outside the eye to photograph it directly is found googling this:

"Nighttime image quality & multifocal IOLs"

For those who seem to struggle to acknowledge that monofocal IOLs can cause problems as well, google this for a patient describing her problems and with an image of what things appear like to her:

"Unfortunately with my left eye I saw wide starburst halos with fine radial spokes around all the streetlights when driving at night"

An artists rendering of their multifocal halos, *and* showing how they reduced over time due to neuroadaptation, is found in the Google preview of the book this search turns up:

"The best images of this process come from Michael Woodcock, MD and an artist he implanted with multifocal IOLs several years ago"

 

I am 2 months out on my symphony lens from my first eye and one month on my other.  I find the night halos and concentric circles very annoying.  Yesterday I went to see my granddaughters in dance convention.  The theater dark and lights on the stage.  There were concentric circles around the dancers.  I could hardly wait to get out of the theater and had a headache afterwards.  Also, when I first awaken in the am and in is low light, I see the concentric circle in front of my eyes.  Ie been trying to ignore and work through this.   My doctor would be very reticent to replace them.  I agree that this issue was glossed over very lightly in the literature.  I wish I had had more information and this website to have made my decision.

I am so sorry to learn, gmajoyce, that you also have a serious night vision issue due to the multiple concentric circles around lights at night. Unfortunately, all we can do is to make sure that other people learn from our experience and are at least mentally prepared for this effect when they make a decison about the lens to use after cataract surgery.

Again unfortunately, contrary to the standard line offered by many surgeons, the brain does not seem to adjust enough to stop seeing these circles. I have not seen any difference in the 4 months period since my cataract surgery. As I mentioned before, all of us do learn to live with the bad things which we experience on a regular basis by working around those.

re: "unfortunately, contrary to the standard line offered by many surgeons, the brain does not seem to adjust enough to stop seeing these circles."

That should really have said that *your* brain hasn't yet adjusted enough to stop seeing the circles. One person's experienced doesn't somehow negate the experiences of those who do see halos reduce, which is well documented for multifocals, even if there doesn't seem to be good data on the less common issue with the Symfony. Some people with halos from multifocals see them go away quickly, a minority see them take several months, or even years. I never considered the halos a problem (they were counterbalanced by less disability clare and better night vision overall), but mine have noticeably disappared around some sources at 2+ years postop, though they are still there for others so the process is still ongoing. I suspect having been spending far more than usual time inside working at home at night rather than out using my night vision likely has led to slower adaptation in my case since the brain needs to be presented with many examples of them over time to learn to tune them out.

Just because people learn to live with the halos, get used to them, and stop complaining about them to their surgeons, who often don't want to listen about any complaints any way, it does not mean that the eyes / brain see the halos any less.

re: "eyes/brain see the halos any less"

Yes it does when they say they stop seeing the halos, or see them vastly reduced. There are pages with artwork people have done indicating the images they have seen at various time points which show them fade and go away. There are some lights where I used to see halos where I simply do not see any halos anymore, they are gone. The brain can adapt to tune them out.  

Like you and some others who have posted, I did a lot of research on IOLS before having the first of two  cataract surgeries nearly 5 months ago.  I waited for the U.S. FDA trials of the Symfony to finish and the lens to be approved here after I determined back in 2015 that it was likely the best choice for the foreseeable future, which a couple of investigative consults with surgeons confirmed (they too expected it to be the top choice for relatively young and active people in need of cataract surgery).  I was willing to wear reading glasses for reading, should that prove necessary, since reading is a big part of my job, but I hoped to have good distance and intermediate vision without glasses after the surgery.  The latter is important to me because my job requires me to spend many hours in front of the computer, as well as books and papers.   I also hoped for good night vision, since I want and need to be able to drive at night and have always enjoyed walking around cities at night when on conference trips or vacations.  Sadly, I can’t say I am satisfied with the Symfony at this point, and I have held off having the second operation while I consider what to do.  I do not have good intermediate vision in the operated eye; I have to wear the same 2.75 drugstore readers to see the computer screen when sitting or standing that I did when I wore a contact before the surgery.   Though the day after surgery, I had 20/25 vision in the operated eye, I now have something close to 20/40 in it (the U.S. requires 20/40 vision for an unrestricted driver’s license).  But the most distressing problem is that I also have significant halos and star bursts at night, serious enough that I do not think I could drive at night or even walk around comfortably were I to have a similar problem after surgery in the other eye, which is why I have not yet had surgery on it.  I see a very visible and large “spider web” around lights of all colors in the eye with the Symfony, and it is very distracting unless the lights are far away, when the halos and star bursts are fainter, though still visible (they look something like what David Taylor in Stevenage, England, depicts on his intraocular lens experience page, or like a combination of the first of the halo and starburst illustrations on the “Night Vision and Presbyopia Correcting IOLs” page of the “Cataract and Refractive Surgery Today” site—but with the bigger radius Taylor sees, although my halos are perfectly circular, not flattened on one edge as his are).  As some of you have noted, the halos are the diffraction gratings of the lens itself.  It is worth noting two things about such “dysphotopsia.”  First, while Tecnis describes the incidence of Symfony “symptoms” as “low,” they do report that over 10% of people have moderate to severe halos, and nearly 5% have moderate to severe starbursts (2% have moderate night glare; they report no severe night glare).  It seems rather generous to describe such an incidence as “low,” and there is no information that I could find about how they defined “moderate” and “severe.”  More recently,   a May report in Medscape on a study of the Symfony in Europe concludes that patients implanted with the Tecnis Symfony “may see haloes as troubling as those seen with multifocal IOLs” and that these new findings suggest the Symfony's advantages over older IOLs—presumably including monofocals, since Tecnis claimed the incidence of dysphotopsias was the same for its monofocal and Symfony lenses-- “are less decisive than hoped.”  In fact, the report shows that people rated the Symfony halos as worse than those from multifocal IOLs, a 6.35 on a scale of 10, whereas the halos with the ReStor bifocal and  FineVision trifocal were rated 5 and 5.1 respectively.   I wonder now who funded the studies that have led to so many claims of a low incidence of halos and starbursts with the Symfony.  It is true that acrylic (hard-edged) monofocal lenses also can cause halos, whereas older round-edged silicone lenses did not (they seemed to lead to more capsulotomies, but another report I have read says that 50% of patients have to have a capsulotomy within 5 years of cataract surgery anyway, so it seems the acrylic lenses did not solve that problem either).   Given this claim, however, it is very hard for me to know what to do about my unoperated eye.  Surgeons do not like to implant two different lenses, especially when the lenses are from different companies.  Should I expect that I will likely have halos with a Tecnis monofocal, since Tecnis claims the incidence is the same for its monofcal and the Symfony lenses?  My surgeon’s anecdotal evidence is that there are fewer halos with monofocals, but she did not specify whether she meant Tecnis monofocals or some other brand she favors for monofocal implants.  Should I try to find a monofocal from a different company that claims a lower incidence of halos and starbursts, and if so, what lens might that be, given that Tecnis monofocals seem to be rated highly?  Should I wait to see if I require more than 5 months for neuroadaptation with the Symfony?  I have read that it can take up to a year for that, although most studies suggest that 4-6 months is usually enough.  Perhaps too some of the dry eye problem will abate with time; it is probably contributing somewhat to the relatively poor intermediate vision and the halos and starburst.  My surgeon is urging me to have a laser capsulotomy soon, but her resident said the opacification of my capsule was not very serious at this point, which my optometrist just confirmed at my annual eye exam, so it is hard to believe that the procedure will make a big difference in the halos or the intermediate vision, and once that it is done, explantation of the Symfony becomes much harder, likely requiring a vitrectomy—while the surgeon downplayed the difficulty of replacement IOL surgery after a capsulotomy, it is everywhere clear on the web that it is definitely riskier and more challenging.  And the longer I wait for neuroadaptation, the harder it will be to explant a Symfony lens more firmly healed in place in my eye.  At this point, I am thinking I will postpone the capsulotomy scheduled in two weeks and give neuroadaptation another month or two (for 7 to 8 months total), but I am worried about how that is likely increasing the risk of an explantation should I decide I have to have one—and wondering if there is any monofocal lens that can lower the odds of halos to well below 10% anyway, a rate of risk that we would not be happy about with many other kinds of surgeries (e.g., sinus surgery, which I have also had).   I wish the Medscape report had been available back in early February, when I chose the Symfony.  I might have researched more carefully the incidence of halos and starbursts with different monofocal lenses, since I don’t have intermediate vision with the Symfony good enough to enable me to do without glasses anyway.

Please see my suggestions to you at the end (as of now) of this post.

I am wondering the same thing -- is there glasses that I can use to help night vision, as I see huge starbursts around headlights?  I am seeing an optometrist soon to see if anything can be done -- and delaying a Symfony in my other eye.  Reading these posts now makes me wonder if I should have any IOL in the other eye, or continue with a contact lens.  

I had cataract surgery and the Symfony lenses implanted in both eyes almost one year ago. I am very disappointed in the results. I didn't expect a miracle but had my surgeon been very upfront with the possibility of star bursts and halos I would have done a lot more research. I was wearing trifocals and was told the only thing I might expect to wear would be very low power reading glasses. Now after almost a year I've been told I can wear OTC reading glasses and a prescription lens for distance and night driving. I've spent $7000 to discover that I still have to wear glasses. I could have saved a whole lot of money, aggravation and multiple prescriptions for 3 kinds of eyedrops, eye gel, eye lid wash and monthly visits to the surgeon and his associates. The only positive outcome was the clarity of color which is very important to me as a professional artist. My surgeon finally explained that the lenses are not specific to my personal prescription. He compared them to fitting shoes. The lenses are chosen for the best fit but not the exact size.    If that had been made clear in the first place I would have stayed with my trifocals for $700 and not Symfony lenses for $7000. I wish I knew what to do next. 

Sorry your experience was not a positive one and the disappointment you've had.  Must be frustrating.  I too have had Symfony lenses 8 weeks ago for one eye and 2 weeks ago 2nd eye.  I knew about the nighttime issues from my surgeon and researching online so not surprised by that.  However I think your surgeon is covering his butt with his comments regarding outcome for daytime.  Again my surgeon told me I would need glasses for fine print only like pill bottles and ingredients on things like soup cans and again no surprise after my surgery.  I haven't worn glasses in 2 weeks.  I can read from 12 inches beyond with clarity.  That should be expected outcome with Symfony.  Not sure how measurements taken with your doc but mine did 2 separate ones.  Perhaps a lasik tweaking should be done/offered if your lens power is off.  

Was any other explanation for your results offered by your surgeon other than the shoe fitting analogy?  Which I do not buy and neither should you.  How many Symfony lenses did he implant prior to yours?  perhaps find another specialist to see if there are solutions because although the nighttime halos etc are part of the lens design you SHOULD have better daytime vision.  I couldn't be happier with mine but that was the compromise I was willing to except for not so great nighttime vision.  

I'm following up on my original post. It's now been 13 months since my surgery and Symfony implants. I wish I had never agreed to have it done. I could have had Medicare cover the cost of my cataract  surgery, purchased another pair of trifocals if necessary, saved almost $9,000 and could have seen as well as I did before. My surgeon gave me a prescription for glasses that is almost identical to one part of my old trifocals plus suggested OTC 1.5 reading glasses.  What a disappointment. 

Hello Diverreb. This is the first time I'm reading your thread. I have a Symfony lens implant in my dominant (right) eye, and my other eye is natural. My surgery was almost 5 months ago, and I'm seeing the soft white glow just as you describe it. It drives me nuts in the theater as I'm a movie buff. It's comforting to know that I'm not the only one seeing this (but not desirable). It bothers me enough that I'm still considering a lens exchange ... thinking that a monofocal lens won't have that problem ... although I'm not sure about that.

I have a Tecnis monofocal toric IOL in my right eye since 5 months ago.

In very dark environment when my eye pupil reaches its max size it gets a little bigger than the diameter of the IOL (5mm) and then I can see a circle/arc around some spot lights and glow around my LED digital clock display.

So that particular symptom in a dark environment may not be Symfony specific, more an issue with your individual maximum pupil size vs IOL diameter.  As we age the max pupil size gets smaller, so this should be more an issue with relatively younger patients say under age 60 especially.

Yes, I see those circle/arcs and glowing effect too ... too many of them! But I'm not sure if the soft white glow that Diverreb is referring to is related to those arcs or a separate issue. Very annoying though.

EDIT: The glow that Diverreb was referring to do had to do with the effect we see when there is white text against a black background on TV or in a movie theater. (Sorry that my reply didn't get listed next to Diverreb's original comment that I replied to).

Hi RPK - the glow around white lettering on black background can be something noticeable by any IOL type.  More interestingly people without cataracts or IOLs can see same thing - especially in a room without lighting like a movie theatre.  

If you google glow with white lettering on dark background you’ll see many articles (totally unrelated to cataracts or artificial lenses).  one article I read indicated that over 50% of the population have astigmatism- even if a small degree of it.  I have a close friend that recently has had trouble with reading text on her TV (particularly with onscreen guide).  She described wording  as fuzzy and had that glow.  She saw an optometrist just last week and showed me her prescription as she didn’t understand the coding.  Both her eyes (for distance were Plano and there was a small add for reading and astigmatism.) She is in her early 40s no cataracts present.

I think this is likely why optometrists always use black lettering on white backgrounds for eye exams too.

I see it too and know from my prescription I have a small degree of astigmatism 0.25 in one eye and 0.50 in the other eye.   Do you know what amount of astigmatism you have?  It’s possible if you have a higher degree of astigmatism that the effect would be worse.  

Thanks Sue.An.

Before my surgery, I didn't see any of these things ... no glare, no halos, no concentric circles, no "glow" on my TV screen/movie theater ... none of those things (and I had cataracts in both eyes). Now I see all of those things. So all of this is news to me ... I had no reason to look into it before. I do not know off-hand what amount of astigmatism I have. I need to see an optometrist to find out.

Each person is different - for me cataracts developed fast (within a year from no mention of cataracts to needing surgery).  I experienced lots of glare because of the cataracts.

Cataract surgery itself can induce astigmatism - so it would be very helpful for you to see an optometrist for your exact prescription.  Astigmatism can be corrected by a lasik enhancement (as I assume you want to be glasses independent) or with glasses.