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

I am very sorry to learn about your very bad outcome with the Symfony Toric lens. The Symfony lens has its advantages, but has been and seems to be continued to be oversold because it makes more money for the surgeons.

Unfortunately, some otherwise-good surgeons also seem to have set up an assembly-line operation for cataract surgery. That was my wife's experience (fortunately not mine). Just as an example, the day after her cataract surgery, 6 of his cataract patients had been given the same appointment  time for follow-up in the doctor's office. That was unbelievable!

It will be definitely a good idea to get a second opinion with a good ophthalmologist. But considering that you live near New York City, there should not be any reason for you to go to Philadelphia for that. If you need to have something done to follow up on the second opinion recommendations, you don't want to be traveling again and again to Philadelphia. Please ask your friends or your personal physician for their experience or suggestions.

 

My doc tried to tell me that my experience was the first he was aware of problems with the Symfony in his practice -- I think not!  Since his assistant told me how many they had done, they should have seen at east 10 with my experience, and I think that stat is way low.  In any case, just to share my experience -- I refused to have another Symfony in my dominate eye, and opted for a monofocal. I LOVE the monofocal -- should have had 2 of them! That being said, the monofocal  tamps down the starbursts and concentric circles, so driving is doable. I still must use readers for reading a novel, with a very bright clip on light.  I use them for computer work, too.  But in a pinch, if I close my monofocal eye, I can see dress tags, menus, and the like. I guess that is a plus, sort of, kind of.  Recently, it seems like the vision in the Symfony fades in and out -- could it be that OPC thing coming on?   I know my distance vision is less than optimal with the Symfony, but I knew that would be a trade off, for supposedly, good near vision.  Even so, it bugs me, so I will return to my optometrist for glasses to tweak the distance vision for tv watching and driving. 

​Your ability to read easily without your glasses is a trade off with a monofocal IOL, but I truly sympathize with you, since we were all told we would be able to see up close (you will be able to read a novel with not trouble!) with a Symfony -- NOT.      

Amy - so sorry for the frustration you must feel.   I can relate to you and a201’s wife experience with clinic or in my case hospital- although being from Canada I knew in advance the ‘cattle-like’ experience with sitting with 15 other patients all waiting for our turn for cataract surgery.  Good thing is government paid for my surgery but one has to be prepared for the assembly line experience.  I am surprised by the use of anesthetic as for my own they used numbing drops for the eye - that is all.  I felt very nervous but the procedure didn’t hurt.  

I do have the Symfony lenses and for me I do like them.   There are concentric circles (like spiderwebs) around certain outside lights at night but minimal glare. Difference is I knew about these prior to surgeries and trade off I was willing to make.  I don’t need glasses for anything and see very well to read and distance to drive.  I do see it as very well unfortunate (and maddening) that doctors don’t take the time to full explain the trade offs to the lenses you choose.

I wish you well and hope you find a sympathetic ear with 2nd opinion opthamologist.  Did you have surgery on both eyes?  If the other eye requires cataract surgery perhaps a standard monofocal lens targeted for best distance would mitigate the halos and glare from the Symfony Lens enough that you would haven’t to undergo a lens exchange.

Wish you all the best.

sorry you had a bad experience.Perhaps dr having you go to people working out of wills eye hosp in phil.tney did trials on the lens.

i had a great experience at a major nyc hospital eye dept.Eyes were  measured over 20 times between the 2 eyes and corneas etc.i never knew much about astigmatism.Now i do.It seems as perfect as possible is tne goal.Doubt anyone there would bamboozle anyone to make more money..Major centers have the best with ethical standards.My dr does not want unhappy patients and never pushes multifocal or edf lenses.They are yet to be perfected.However i have not needed glasses at all...and find halos etc not that bad.With a cataract i had worse.also some cars have easier to deal with headlights..

Hi Wnderlnd - I am Wonder if you have seen your regular optometrist since your cataract surgery.   

It must be frustrating situation to be in with only needing one surgery for cataracts and having to cope for years.

If you’ve only tried over the counter or mail orders for glasses those may not be best.   An optometrist could likely find a better solution to balance out your eyes. Custom made glasses are better quality and take into account your exact prescription.  Might be worth seeing one if you haven’t.   I had 6 weeks between surgeries and poked lens out of a pair of glasses but it wasn’t ideal- I know what you mean by being nauseous at times.

I think I would first try and see if an optometrist could resolve the balance issue before going through an IOL exchange as that too may still cause a balance issue for you.  In some circumstances when there is s big difference between 2 eyes cataract surgery on the other eye can be considered.

Your other issue of the shadow like seeing the rim of glasses when bridge is too big (especially as you notice this in dim lighting) could be that you are seeing edge of IOL.  You mention being in your 40s (very young for cataract surgery).  A younger person’s pupils do dialate more in lower light and could be the reason you are noticing the shadow.  Most cataract patients are 60s and older so don’t have pupils that dialate beyond the IOL.  Good news is that issue will resolve itself in time (but of no help now).  Symfony lenses are 6mm and I don’t believe there are lens any bigger than that in diameter.

I wish you well and hope you are able to find a solution to the balance issue. 

Thinking more on your situation - do you know what the diopter difference is between your 2 eyes post surgery?   

Basically there are three choices: (1) a contact lens in the unoperated eye; (2) cataract surgery for your unoperated eye; (3) LASIK for your unoperated eye. Although there are some individual difference in what we can tolerate, nobody can see well when the difference in refractive error between the eyes is more than 3 diopters. The problem has to do with image size--it's not possible for our brain to fuse the two images when their size is this different. (A contact lens does not usually affect image size but a glasses lens does.)

Again if you haven’t yet seen an optometrist to get your exact prescription that would be best place to start and then see if one of the 3 choices would work for you.

If you are only doing an IOL exchange because of the diopter difference between your eyes - you’d still be faced with same problem.  Given the Symfony Lens provides a greater range of focus the issue is a little easier to resolve ca a monofocal lens.

Good luck to you.

I will agree with the advice which Sue.An has given you.

Although you are bothered by the multiple concentric circles or rings around lights at night due to the Symfony lens, your main issue seems to be not being able to use glasses because of the significant difference between the prescription of the 2 eyes, which cause different image sizes for the brain to deal with.

There are many other better ways to deal with that issue than replacing the Symfony lens with a monofocal lense.

The best way to resolve your issue depends on what your prescription is for the 2 eyes. Thus, if you can share that information (your doctor should have it even if he/she has not written it out for you), we may be able to give you more specific suggestions.

There is another Extended Vision Lens, Zeiss AT LARA, which seems to have been been approved in Europe and is undergoing trials in USA (my thanks to Night-Hawk for bringing that to my attention in another post).

It seems to have slightly wider range of good focus compared to Symfony (based on Zeiss data on their web site).

They also have a subjective ranking of the different lenses in night driving conditions, which I find rather interesting.

The Zeiss site states: "In pre-clinical tests using the "virtual implantation" setup, 48 subjects compared four different IOLs in a typical night traffic situation in a random blinded manner: one monofocal IOL, two EDoF IOLs (ZEISS AT LARA and J&J TECNIS Symfony), and one trifocal IOL."

The rankings for night driving conditions (1 being the best and 4 being the worst) were about 1.1 for monofocal, 2.5 for AT LARA, 3.0 for Symfony, and 3.4 for the trifocal lens.

As an additional clarification regarding the study quoted above, everyone did try all  the four lenses using the "virtual implantation" setup, even though it is hard ti know how representative that is of the real world conditions.

After looking at the night vision with all 4 lenses in simulated conditions, everyone rated them 1 through 4 (1 being the best). The posted scores are the average of the ratings by all 48 people.

One problem “trying out “the lenses prior to surgery is the cataract itself.That  can distort night vision.

I find after having both eyes done night vision has  mild halos and star burst which i only notice if i look for them..It  ay be a personality thing in deciding what to choose,Just how accepting is a person.

my dr told me perfection is not yet available and compromises need to be made.Many have such bad cataracts that even imperfections are acceptable after surgery

 i had surgery in a big hospital opthamology dept where every visit involves complete eye exams and measurement with lenstar,etc..The ora is used during surgery to further check the lens power.After surgery cornea checks to see if astigmatism gone.I think surgery can affect the cornea slightly.It took awhile to get both eyes working smoothly.

people on forums often have not had perfect outcomes but no doubt many more have no issues at all.

i find this a confusing forum lay out for discussion.,Every question and answer is helter skelter date wise

Hi Bravogoldenk - yes hopefully forum improves format where responses go in chronological order.  But these are the better forums.  I recall first being diagnosed and posting a question on a couple of others - still waiting for a reply - lol.  The only other place I got a few responses were from Disboards believe it or not.  Not one negative comment.  Questions mainly dealt with cataract surgery and sailing and excursion activities (Disboards is a Disney forum).  People there generally very helpful on all things Disney so this sub topic was not filled with cataract gone wrong stories).  Everyone was generally happy with their results - so gave me impression this goes right more than wrong).

Nice you had so much personal care and attention.  You’d be amazed how it’s handled in Canada.  A long wait with others for same surgery - but once your name is called you are in and out 15 minutes tops.  My surgeon was good though and gave me confidence I would be right candidate for Symfony lenses.  

well as to care.We have excellent health insurance which covered all but the symfony lens, laser etc..However the price charged had i not insurance was over 47k..exhorbitant and not something i understand..

new york university opthal is first rate but i warn people to be sure about their insurance coverage..I do think they accept medicare with symfony etc extracharge but hang onto your wallet..

And one gets very fast treatment and no waiting..but again must be good to not go to the poorhouse for care

my dr felt multifocal and edof lenses not for everybody..

they are having annual meeting in wash dc today where they offer videos of speakers..Look up Eyeworld magazine and see the i terviews.This was where i got information on lens in 2016..we ha ebecome quitesophisticated!

There are advantages and disadvantages to having a national healthcare system.  Nice not to have to go in poorhouse - but wait times are long.  Had a fall on ice 3 weeks ago and thought i’d broken my clavicle- 9 hour wait in emergency.  Not fun!

My surgeon too was careful about patient selection for premium lenses.  In fact didn’t even mention them till I brought it up.  

Considering the few but vocal complaints it is wise for surgeons not to offer anything but monofocals.I did my research and read up on pro and cons....and am very thrilled not to need glasses .Find print tends to fade but not in bright light.So I go over to the window to read tiny stuff..

Yes I do the same.  Good lighting is important.  I can read even pill bottle stuff in very good light.

I too am glasses free.  Thought my insurance would cover up to what they cover for glasses each plan year. I fought hard but in the end they wouldn’t budge so decided to be a bit passive aggressive and got cute Coach frame sunglasses - plano both eyes but given I have slight astigmatism .25 in one eye and .50 the insurance co forked our for those.   Got my eye on a Michael Kors pair which I will get next plan year and every 2 years.

But all in all happy I went with these. 

I think we got the best of surgeons who measured perfectly..if a bit off and things do not look as good.. my dr said they aim for perfect but it can still be a bit off which they fix with laser or people have dry eye which affects clarity unless tended to...but no wonder they do not push multifocals edof etc and have lots of complaining.

Actually, when different persons tried the different IOLs in a Virtual Simulator, the effect of the cataract was taken into account.

Interestingly, it seems that at least  some doctors have started letting people evaluate the vision they may get with the different IOL designs after cataract surgery (even though obviously, simulation cannot match reality perfectly), For example, in one of the articles in 2017, Barbara Fluder OD states:

"I also use an online visual simulator which shows patients simulated visual results with an IOL for activities including golfing, gardening, shopping, and night driving. Enter the patient’s astigmatism, level of cataract development, and IOL option to demonstrate the visual outcome. Obviously, results may vary, but it is a great way to demonstrate a patient’s expected visual results with various IOL options.

Would be a great tool to use.  Managing expectations and setting those would benefit the patient in the long run.  Perception is reality.

Have you tried the on-line abbott IOL simulator?  It is better than nothing, but it does not show the concentric rings in the night view so who wouldn't pick them?  I guess if they showed what many people actually see at night they would scare away potential customers, and they also have a disclaimer that the website is not necessarily accurate, so like so much, buyer beware!

No I have not tried the Abbott IOL Simulator. It a shame that you can't trust the IOL manufacturers (or even the doctors who participate in their lens certification studies) to provide you complete positive and negative information about their lenses and the patients are left to discover the whole truth by themselves!

Actually I have yet to see any reference on the Abbott site about the multiple concentric circles around lights one sees with the Symfony lens compared with a single circle, which one may see with a monofocal lens. The just lump those together under the term halo and think that they have done their job!

I just tried the online Abbott IOL Simulator. Maybe I'm doing something wrong, but it isn't even close to what I'm seeing ... and not for the better. I see big bright rings around lights and glare/starbursts that aren't represented at all in their simulator.

Looks like the same experience with the Abbott simulator as of John56935. As I said in my response to him, It a shame that you can't trust the IOL manufacturers (or even the doctors who participate in their lens certification studies) to provide you complete positive and negative information about their lenses and the patients are left to discover the whole truth by themselves!

Yes, I saw several optometrists. What I learned is that with multifocal IOLs you cannot wear progressive (multifocal) contact’s on top of them, which is my preferred type of contact. I also learned that due to my age(yes, young for cataracts, but any age can have cataracts and mine is from steroid injections and oral steroids for something else), I’d likely have a difficult time adjusting. That may or may not be true. Finally, I learned from two other specialists they the lens had shifted and I was looking through the wrong power, especially in low lighting when my pupils were more open. That was never going to change. Plus, I couldn’t do anything needing close up or mid-range without glasses and I needed so many pairs because I constantly needed to take them off, too, to see far. I was nauseous. A lot. 

I needed to have surgery again to correct to the lens shift, but we decided to switch to a monofocal set for close up to mimic my good eye. The sureguery was riskier, but it’s been one month and it has been fantastic. 

I can do so many things unaided now, and glasses set for far are great. That’s what I’m used to. No more haloes, no more spirals, no more rings on lights, and no more nausea. My vision is now crystal clear. I had the IOL exchange 3 months the after the first surgery. Now That I’m on the other side, it was worse than I realized. I have justvunder two weeks until I see the optometrist for my prescription update for far. 

surgeon really wants happy patient and does not want to hear endless complaints so only offers multifocal to those who have studied the pros and cons

no one can actually see what each of us sees

they do thousands of surgeries over their career...as Softwear guy said only unhappy people show up on lists..i got on list prior to surgery as i was a bit scared..

Happy you have a better result.  Wishing you all the best.   I find so much we do is more in that mid range / near vision.  Perhaps if I had considered or realized monofocal lenses could both be set for intermediate I would have gone that way.   I am relieved to have near vision with Symfony as I do need that kind of vision to function at work.

And yes the more reading I have done since surgeries I am convinced steriod use for my eczema and a painful issue I had 18 years ago when I was put on prednisone has led to early cataracts.  I wish I was told all the side effects of those so that I could have explored other options (something I am doing now with some success).  Too late to prevent cataracts but I am convinced those kinds of prescriptions can cause other unpleasant side affects

Again very pleased you have a good outcome this time.  I understand the surgery is more involved with a lens exchange.   Did you have to find another surgeon or did the one who performed your initial surgery have the skill do do exchanges as well?

Sounds a bit like me.  Because I was so shocked by diagnosis of cataracts I started reading right away and stumbled on the forums.   I do think most people do the reverse and only go on forums when something goes sideways.  I think knowing what to expect helped me decide.

But I did not care for Software guys attitude towards those who were questioning.  There still is very little on the concentric circles ;or spider web effect) of Symfony.  People are better able to make up there own minds when informed.  If I recall he kept insisting it was a brain adjustment thing and went away in time.   I have no such illusions and found him to be dishonest.  He had Symfony lenses and would certainly experience the concentric circles just like those posting.

i just had appt with dermatologist for eczema follow up..again in 2015 i started researching something to help, found clinical trials and got into one for dupixent.,Took care of the misery and am still on it..Dr was happy with my response.Said a few people have an eye problem and complain but this is all there is at the moment..Wonder if you have tried it?He said those unhappy end up on forums though they are exceptions 

I did do a certain amount of research before going into surgery. Now that you mention "Software guy", his posts were some of the more significant posts I remember reading, which was a part of what led to my decision to go ahead with the Symfony lens (and actually had me excited about it). He sounded so believable. It wasn't until after the surgery that I read about how wrong he was about some things (like not seeing any concentric circles). So doing research on the internet ahead of time can go both ways. These days it's difficult knowing what totrust and what not to trust on the internet.

I live in Canada and Dupixent has just been approved here but my family doctor wants me to discuss it with a dermatologist first.  I see one every 2 years as I had skin cancer 8 years ago.  But wait times have increased here and I have a 2 year wait.

But last winter I started researching some natural ways and although not cured I had a significant improvement this winter (worst season for me for atopic eczema).   Winter prior to this one was on antibiotics twice as eczema led to skin infections (my incessant scratching).   But I stumbled across some natural remedies that have been working.  My brother in law put me into it as he too suffers from this and found it helpful.

Yes it was me who was so nervous about cataract surgery and more so because of my choice.  At that time I hadn’t seen many positive reviews for Symfony.  But was able to chat to one of the first patients that got these where I live (her surgeon was mine too so that helped) and you had good things to say as well.  Knowing about the night time visuals was good to know so that didn’t come as a complete surprise.  At 7 months now I find I can drive at night just fine.  The glare and starbursts subsided and the circles although odd aren’t as difficult to see though as the glare was.  The daytime vision is really good and I am pleased with the result.  Better than the cataracts that we’re giving me double vision!

Yes very true.  I think I had mine done shortly after you.   But had a little more info that led me to believe the circles would not disappear.  I went ahead anyways and I really do like the result.  Daytime is terrific - the circles will be something I choose to live with.   I haven’t been glasses free since s child and I was really pleased with the unexpected result of having great near vision with these.

Actually Softwaredev admitted himself seeing the concentric circles around lights at night, but still kept on insisting (based on the Abbott published data at the time) that the halos for Symfony lens are no worse than those for monofocal lenses. Abbott data does not make that claim any more.

Any way, it is important to understand the pros and cons of the choices we make for IOLs (or anything else) and then make the appropriate choice for ourselves. Of course, it will be better (and easier) if the  lens manufacturers were more candid about their product data and the surgeons took the time to explain the lens options. That will save us lot of unexpected disappointments.

I definitely wish I knew more about the side effects of medications I took so long ago, but I’m not sure I would have recovered without them. Going forward; however, I take better care of myself and seek more natural helps sooner, ei: acupuncture. 

My original eye surgeon insisted the placement was fine, but did understand my need for a second opinion. When I couldn’t find someone outside his offic who was experienced in exchanges, he suggested his office partner. Luckily for me, he is someone who people go to when other surgeons won’t consider surgery due to complications. He was incredibly confident, in a very reassuring way. I did have to have an injection (after I was sedated) to freeze my eye muscles, and that did lead to a horrendous blood vessel hemorrhage, but that is much worse looking than it appears or sounds. It healed incredibly fast with the help of arnica. I still have some slight yellowing, but I’m 29 Days post surgery today. No more eye drops, other than preservative-free wetti g drops to help with dry eyes. If they get too dry, my eye aches slightly; just enough to remind me to keep those drops handy. 

Also, you were definitely right about me seeing the edge of the lens. That was very frustrating. I do recommend anyone experiencing that to see their doctor or get another opinion.  Thanks for your help! I’m so glad I had mine switched. I just couldn’t adject from being nearsighted to far sighted in one  eye, let alone looking through a shifted lens edge. (Also, if s monofocal lens shifts, the effect is not near as difficult or noticeable vision-wise according to the second surgeon.) 

To add to my last post ... For example, when I use the Abbott IOL Simulator on Abbott's own website, what I'm seeing through my eyes doesn't come close to what the simulator portrays. What I see is much more severe. So if you can't trust the company's own website, who can you trust?

I'm very happy that things worked out for you Sue.An. I just had to say something because I feel like I did a lot of the research things ahead of time too. I still was caught off guard with the results (quite a bit off guard). My research even included a friend who swore by multi-focal lenses, and who claims she has none of the side effects ... no glare, no starbursts, no halos, no circles.

I'm not sure what the lesson is ... don't believe anybody? (lol ... that's sarcasm). :-)

dupixent does not have the same warnings as most biologivs.What a game changer...it is very expensive but insurance covers it..The derm dr also has a phd in immunology and feels it is the safest treatment.Cyclosporine and steroids have issues...he was involved in clinical trial and i decided to see him for checks..during trial endless blood tests etc...so if you ever get desperate try it

this is one of the most confusing forums.I go to see your post and it opens something from last year.

software developer was not warm and fuzzy but had a single minded focus i liked.He added to my research 

i find it interesting i have to make an effort to see starbursts etc.. rain kind of now ignores them..spider webs come from design of lens and only a few red lights gave them...

Sorry if I went off a little bit there. I think that's a lot of frustration coming out.

So true.  I surmise that it is not always beneficial for the manufacturers who stand to gain or lose much by emphasizing all the negative results.   There is a blind study/trial going on now for Symfony lenses.  Expect once those are published there will be more feedback on the halos looking like spider webs.   

And in all honesty I am not usually the one to jump on the newest technology but felt I had little time to de use if I wanted to keep driving and being able to do my job.   This seemed like the answer.  

I believe you and a few others at that time challenged Software and I am thankful I had some idea that these lenses wouldn’t be perfect.   And now others will have more info if they do a bit of searching online.

Yes I too am looking at more natural resources before just taking prescriptions now.   All within reason though.   

If you’ve not considered it taking a flaxseed oil capsule or Omega 3 can help dry eye.  I take one a day and find it helps.

Lol - I can understand your disappointment - especially since you did look into it.  The only thing I can think to say is that even if you have an excellent surgeon / done the homework there is always an unknown variable.  It’s very likely your friend wasn’t misleading you .  Part of that is perception is reality and what really bothers one person may not bother someone else or due to shap of their corneas or how good a match the IOL power was for them may factor into their result vs yours.  I think monofocals are more forgiving than multifocals and if the multifocal shifts at all or the power slightly off the results may not be as good.  

For example I am blue eyed and all my life glare has been an issue.  Always wear sunglasses even in winter or my eyes tear up (before having cataracts). My husband has brown eyes and bright sunshine or headlights at night don’t bother him much at all.   

There have been a few that have reported very good results with their lens exchange.   If you don’t feel you can get to a point of living with the current results perhaps e changing it to a monofocal is something to consider.   

I completely understand.  I am going through another issue right now with Tinnitus that is driving me crazy - had it since January when I flew south. Can’t get into an ENT. For 18 months.  So hard never to hear silence.   So yes complete sympathize- some things are just so frustrating to deal with.   Helps to talk about them.

Oh I don’t have to make an effort to see them - lol.  I just focus on white lines on road.   I ten to see the circles too on certain red or amber lights - some LED porch lights.

I can relate to the tinnitus too. I've had it for as long as I can remember. You will adjust ... I guess there is no choice, eh? But you will.......

here i  nyc endless radio commercials for long island tinitus specialist.Might be worth coming to ny to see her.The ads say people come from all over to see her..

cannot imagine a consultation that expensive

As I might have said before, I am considering a lens exchange ... although the thought of a 2nd surgery on the same eye scares me. I'd rather not do that, but you never know.

Not expensive - free Medicare in Canada - but downside are sometimes very long waits.  Yes may be considering going to US to pay to see a specialist.  Was on tinnitus forums but it isn’t like cataract forum.  People very depressed.  No solution - just have to learn to live with it. 

Do you have days it is louder than others?  Some days I can cope but others it is so loud - I don’t sleep and hear it over the TV or white noise.