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

I am in the same boat and waiting . I almost can't drive well in practice I shouldn't but I do not have a choice and a bit more carefull

And yes the doctor did not explain very well if at all the side effects for the lens choice and did not have much of a discussion for what choices he asked me only what I am doing and what I want to achieve well so far disappointed

He was very detailed about the risks of the operations . And he is one of the top eye surgents in my area.

But that does not compensate for the choice of lenses

I did not understand How long have you been with the lense so your second doctor says too long . And the first one says to wait ?

And if you can send a link i do not mind to pay for the report as I have not seen a single person who says that the halo disappear 100 %

Did you submit a complaint via the FDA?  I wonder if anyone else here has done that.  It helps to share concerns here but it may do more good by providing that info to the FDA. I am going to look into doing that myself.

Did your doctor mention halos?  He should have.   Even a monofocal lens can produce them but chances are less. With multifocals and EDOF lenses that is the trade off for being more glasses independent.

I was told that it is best to have it removed less than six weeks after surgery before it has fully healed into place but of course you are also told to give it time to heal and for your brain to adjust and that the symptoms will subside.  After 2O months I am still delaying YAG under the assumption that I can still swap it out but of course wonder if it is worth the risk and potentially just exchanging these undesirable symptoms for something else like worse acuity or drawbacks with monovision, not to mention that fact that it may cost me $10K since insurance will probably not cover it and I don't trust my original surgeon to do it even if for free.

You might want to check back with your doctor.  I am under the understanding explants can take place within 6 months - after that it is more difficult.  Full healing (if no complications arise) takes 6 weeks.

Anyone considering lens exchange should seek out a cornea / retina specialist (certainly someone with considerable experience with exchanges).  It takes a surgeon with considerably more skill.    My own surgeon told me upfront he doesn’t do them so it is highly likely that the surgeon who did your cataract surgery isn’t skilled enough either.  At the very least you’ll want to know how many they’ve done.  

john56935 & vlad873, In one video at EyeTube, an eye-surgeon removed a toric IOL that had been implanted over a year ago.   The patient that was referred to him (eye-surgeon) had a "close posterior capsule" which made it a lot easier for him to dissect the lens and remove it.

I still think that a highly skilled cataract surgeon with a lot of expertise can eliminate unwanted surprises.

I last saw my surgeon about a month ago. When I asked him how long I had to decide on whether to do a lens exchange or not, he made it seem like it wasn't a big deal (which I have a hard time believing). But he told me it can be 6 months from now or a year ... it didn't matter. (I'm already at the 7+ month mark). Then he added that it would be much more difficult if it was 5 years from now.

When I went to another surgeon for a 2nd opinion at about the 4 month mark from my surgery date, he told me that I didn't have much time left to make a decision.

So who knows?  I don't know what to believe anymore because so much of the information is inconsistent. Like you, I'm having a difficult time having confidence in my original surgeon.

All you have to do is enter Symfony in the search box on the "Simple Search" form on the FDA Maude database and then change it to 500 records per report page and ALL YEARS and it's free to read the reports. 500 report records will show up on the first page. If you start reading around 1/4 of the way down the page (or if you're so inclined you can read every report), many if not most reports are visual complaints from patients. You have to click on the links in the center column and the read the complaints in the second paragraph of each report. I never heard of the FDA charging to read MAUDE reports.

From 5/4/18 (and I found a lot more and pasted them in another thread on here, but the thread got deleted) "The patient reported that she was having difficulty driving at night due to glare on the left eye (os) after the surgery and was continuously experiencing visual disturbance. Per account, during the day there was no issue with glare or ''spider webs'', but her vision is still not good. The physician advised her to wait till symptoms disappear and vision improves. For that reason, the doctor decided not to pursue any laser treatments at this time. The patient's visual acuity pre-operative was 20/40 and post-operative was still 20/40. Per patient, her near vision is fine, but distant vision is still experiencing some issues. As a result, the patient's vision has not improved due to glare and ''spider webs''. Iol remains implanted and a planned or performed intervention is not required at this time. No additional information provided."

Here's another one and I know I can find at least 20 more without even reading more than 50 reports, but I already had my other thread deleted for pasting reports on it or whatever other reason they deleted it: "It was reported that a zxr00 23. 5 diopter intraocular lens was implanted in the patient's right eye (od) on (b)(6) 2018. It was later explanted on (b)(6) 2018 because the patient experienced halos and visual disturbance. There were no complications, no capsule tear, no incision enlargement, no vitrectomy, and no sutures used. The replacement lens was a non-johnson and johnson lens. Reportedly, there was no patient injury. No additional information was provided."

This is the search to use (copy and paste then remove spaces) www . accessdata . fda . gov  / scripts / cdrh / cfdocs / cfmaude / TextSearch . cfm

More FDA MAUDE Symfony reports (and these are mandatory reports made by Johnson & Johnson - the manufacturer of the Symfony lens - from voluntary reports made by patients who complained directly to Johnson & Johnson or if their doctors reported it to Johnson & Johnson which is not mandatory to do, so this database certainly doesn't contain every complaint) and the one where the doctor blamed it on dry eyes, yeah right:

"It was reported that a patient had bilateral symfony lenses implanted (b)(6) 2017 respectively. The lenses were explanted in secondary procedures (b)(6) 2017 respectively because of patient experiencing intolerable glare and halos. This report will capture information for the explant that took place on (b)(6) 2017, a separate report will be submitted for the other explant that was performed on (b)(6) 2017. No further information provided."

"It was reported that patient was having visual issues since (b)(6) 2017. Per account, the patient had persistent blur, streaking image from moving tennis ball, glare from overhead fluorescent lighting while playing tennis at night, and loss depth of perception. As a result, zxr00 intraocular lens (iol) sn (b)(4) was explanted from patient's left eye (os). Lens was replaced with a model pcb00 12. 5 diopter. Post-surgery, patient is happy with complete resolution of all symptoms and there was no patient injury. Product will not be returned as it was discarded by the surgery center. No additional information provided."

"It was reported a zxr00 19. 0 diopter was implanted in a patient's left eye (os) on (b)(6) 2018. The lens was later explanted due to the patient experiencing intractable haloing with mechanical complication of the lens. Reportedly, the patient's symptom started right after the implant; however, the doctor waited to see if there is an improvement. At explant the replacement lens used was from another manufacturer. There was no capsule tear and no vitrectomy was performed. There was no incision enlargement made and no suture was required. It was confirmed that there was no patient injury and that the patient outcome at the time of discharge was good. No additional information was provided."

"It was reported that zxr00 21. 0 diopter lens was implanted in the patient's left eye (os) on (b)(6) 2017. It was later explanted on (b)(6) 2018 due to the patient being unable to drive and see at night. There was no incision enlargement, no vitrectomy, and no sutures used. The replacement lens was a non-johnson and johnson lens. There was no patient injury and the patient states that their vision is ''better'' after the exchange. No additional information was provided."

"It was reported that a tecnis symfony intraocular lens (model zxr00, +23. 5 diopter) was explanted in a secondary procedure from patient¿s left eye because of the patient experiencing intolerable glare. There was no significant residual refractive error and no dry eye. There was no incision enlargement. A model zcb00, +24. 0 diopter lens was used as replacement for the patient. Patient was doing fine at discharge. No further information provided."

"It was reported that a patient is experiencing vision issues. She sees blurry/glary and has large floaters. During follow up, the customer reported that since surgery she has experienced halos, strobe lighting, blue colour, glare around lights, tv etc. The early symptoms improved somewhat but not the glare. Two years after her surgery, there is still substantial glare around commercial lighting. Night vision is much worse than before surgery. Street lights, house lights, and car headlights were reported to be huge. Lights in the distance are misshapen, bell-shaped with similar shaped rings around them. The issue is particularly worse with colored lights. It is impossible for her to read street signs now if it is grey, rainy, or foggy out. The patient can see the outer edge of the lens in her left eye, in any level of lighting. About seven years ago, the patient had vitreous gel detachments in both eyes. After seven years, the floaters are still positioned in her central vision. The patient believes that the surgery has caused an increase in the number of floaters. The patient¿s vision is 20/20. The patient¿s doctor believes that the problems are caused by dry eyes. The patient has tried many drops, ointments, shampoos, dry and wet compresses, electric heated glasses, and massage, as prescribed by the doctors. All helped for a few minutes but the only thing the patient is left with is a permanent divot in her lower left eyelid, which she did not have before. In the last two months, the glare and blurriness has increased. When her eyes move, there are flares of light across the letters that make reading very difficult. The patient mentioned that she is certain that light enters her eyes, bounces off the lenses and shines onto the floaters, causing the greasy glare. This seems to be confirmed by the fact that some lights at night show perfect concentric rings, and she is certain these are the rings of the lenses that are reflecting the light. The patient mentioned that she is otherwise very healthy and medication-free. She takes omega 3 for her eyes. Apart from the initial post-surgery prescriptions, her surgeon has prescribed the omega 3, hy-lo eye drops, ocunox, and the electric heated eyeglasses, as well as the maintenance procedures all of them to reduce dry eyes. The patient had a 2-year check-up with her surgeon this week. Once again, he declared her vision was 20/20 and her eyes as being very healthy. The doctor believes that laser-tweaking would have a negligible effect on her vision. He declared her tear film to be a bit better. No additional information was provided to johnson and johnson surgical vision, inc. Note: two mdr¿s are being submitted, one for each affected eye. This mdr captures the information pertaining to the right eye."

"It was reported that a zxr00 20. 5 diopter lens was implanted in the patient's operative eye on (b)(6) 2017. It was later explanted on (b)(6) 2018 because the patient did not tolerate the lens. There was no incision enlargement, no vitrectomy, and no sutures used. The replacement lens was the same diopter, but different model zcb00. There was no patient injury. No additional information was provided."

"The patient's spouse contacted johnson and johnson surgical vision, inc. To report that his wife is experiencing halos nine (9) months post op of the symfony lens implant, (b)(6) 2017. The patient''s symptoms have not improved. Further, the wife is unable to drive at night anymore. No further information was provided."

"It was reported that post implantation of a zxr00 intraocular lens (iol) in each eyes of a male patient, he experienced excessive glare, halos and visual disturbance. It was indicated that the outcome significantly interferes with patient's daily life activities. Both lenses remain implanted. No further information has been received. This report pertain to the lens in the left eye (os). A separate report is being filed for the lens in the right eye (od)."

 

I'm sure there's way more than this, but they'll probably delete these posts also, so I'm not sure if I want to bother to check them all.

Here are more records I found - I personally don't like toric iols whether monofocal toric IOLs or premium toric IOLs, but I left the records for toric Symfony complaints since besides the fact that they can rotate in the eye, they can also cause the same vision problems that non-toric Symfony IOLs can cause:

"It was reported that a zxt375 18.0 diopter intraocular lens (iol) was implanted in the patient's left eye on (b)(6) 2017. It was later explanted on (b)(6) 2018 due to visual disturbances. A vitrectomy was required and it was noted the replacement lens was a non-johnson and johnson surgical vision iol. The patient has recovered. No additional information was provided."

"It was reported that surgeon is planning to exchange a tecnis symfony toric multifocal intraocular lens (model zxt300, +19. 0 diopter) from patient's operative eye because of the patient experiencing blurry vision. The blurry vision occurs when the patient tilts their head in different way at distance and also reports having difficulty seeing near. No further information provided."

"It was reported that a zxt150 21.0 diopter lens was implanted in the patient's left eye (os) on (b)(6) 2017. However, there are plans to explant the lens because the patient experienced issues with glare. The planned replacement lens will be a toric lens from another manufacturer. There is no set date for the planned explant yet, as they are waiting for the patient to heal from the first procedure. No additional information was provided."

"It was reported that a zxt150 21.0 diopter lens was implanted in the patient's left eye (os) on (b)(6) 2017. However, there are plans to explant the lens because the patient experienced issues with glare. The planned replacement lens will be a toric lens from another manufacturer. There is no set date for the planned explant yet, as they are waiting for the patient to heal from the first procedure. No additional information was provided."

"It was reported that patient was dissatisfied with the zxt225 intraocular lens on the right eye (od). The lens was explanted from patient's eye. The lens was replaced with a zct225. No additional information was provided."

"It was reported that a model zxt150 intraocular lens (iol) was implanted into the patient's left eye (os). Post implant the patient disliked the lens and the lens was subsequently explanted. The explanted lens was replaced with a model zct lens. No additional information provided."

"It was reported that a zxr00 19.5 diopter lens was implanted in the patient's left eye on (b)(6) 2017. It was later explanted on (b)(6) 2018 because the patient experienced dysphotopsia, halos, glare, and visual disturbances. The patient also complained of an inability to read and intolerance to the lens. Reportedly, these symptoms significantly interfere with activities of daily life. There was no incision enlargement, the patient has recovered, and the replacement lens was a non-johnson and johnson lens. No additional information was provided."

"It was reported that tecnis symphony toric multifocal intraocular lens may be explanted from patient's operative eye in secondary procedure because the patient is experiencing glare, near vision is 20/70 and distance vision is worse than 20/40. Reportedly, the explant has not yet been scheduled or performed. No further information provided."

"Patient reported having blurred vision with no near vision and was uncomfortable after implantation of a zxr00 intraocular lens (iol) in the right eye. Additional information was provided in a follow-up, the patient has blurry vision up-close and stated it is worse than prior to the surgery. She feels like there is something in her eye and is attributing it the lens that is implanted. She is experiencing headaches and had an infection and just completed taking the medication. She will find out if the infection has cleared at her next doctor's appointment. She also stated she has a surgery appointment scheduled for friday (b)(6) 2018 but will try to get it re-scheduled until she gets results of the investigation. She does not know what the surgery is for but believes it is for a lens replacement. No additional information provided."

"It was reported that a zxr00 18.0 diopter lens was implanted in the patient's right eye (od) on (b)(6) 2017. It was later explanted on (b)(6) 2018 because of patient complaints of excessive halos, glare, and starbursts. At explant there was no incision enlargement, no vitrectomy, and no sutures used. The replacement lens was a non-johnson and johnson lens. There was no patient injury and the patient states that the halos and glare are ''better'' after the exchange. No additional information was provided."

"It was reported that tecnis symfony multifocal intraocular lens (model zxr00 +13. 5 diopter) was explanted from patient's left eye in secondary procedure because of patient experiencing halos and glares, blurry vision, visual disturbance, and intolerance. Post implant the lens had minor dislocation which surgeon attempted a relocation and a laser procedure, however the patient was not happy and chose to go for an exchange. Non-amo monofocal lens was used as the replacement lens for the patient. No incision enlargement, vitrectomy or any other medical or surgical intervention was required. The patient was reported to be doing well when discharged. No further information was provided."

Here's 3 more - the second one is particularly interesting:

"It was reported that a tecnis symfony intraocular lens (model zxr00, 23.0 diopter) was explanted from the patient's left eye in a secondary procedure due to the patient experiencing terrible glare, poor distance vision and cannot read. A non-amo intraocular lens of the same diopter was implanted as the replacement lens for the patient. There were no complications reported and the patient was doing fine post op. No further information was provided."

"It was reported that a zxt450 17.0 diopter intraocular lens (iol) was implanted in the patient's left eye (os). Post-operatively, more than 6 months after surgery, the patient is experiencing 7 - 9 halo rings at night, which the patient is claiming to cause him not to be able to drive at night. Also, the patient's photopic vision is function, but there is also one ring around lights in a day. The patient also claims that when he looks at an object and moves his head suddenly, he loses the peripheral vision and after two or three seconds the vision becomes normal again. Reportedly, the patient did not have any kind of dysfunctionality in the eyes and for more than three years he was subjected to regular examinations by the doctor. No additional information was provided. The patient had bilateral lenses implanted. This report will capture the lens implanted in the patient's left eye. A separate report will be filed for the right eye."

"It was reported that a zxr00 23.0 diopter intraocular lens (iol) was implanted into the left eye (os) of the patient on (b)(6) 2017. It was reported that the patient can not see near and or computer vision, and the patient feels that there vision is worse than before surgery. To date, the lens remains implanted. No further information was provided."

CONTINUED FROM ABOVE:

"It was reported that a zxr00 20.5 diopter intraocular lens (iol) was implanted in the patient's operative eye. It was later explanted due to the patient experiencing dysphotopsia/ starbursts. Further information provided reports a suture was placed, there was no patient injury and the patient was reported as fine post op. The lens was replaced with a monofocal, model zcb00 21.0 diopter lens. No additional information was provided."

"It was reported that a zxr00 22.0 diopter intraocular lens (iol) was implanted in the patient's right eye (od) on (b)(6) 2017. Post-operatively, the patient had and continued to have problems with vision. There was a yttrium-aluminum garnet (yag) performed on (b)(6) 2017 (right eye) and (b)(6) 2017 (left eye) to resolve the visual issues, but the patient stated their vision became worse than before the cataract surgery. Reportedly, there was no follow up appointments after the yag procedures. The patient has a follow up appointment with the doctor on (b)(6) 2017. Reportedly, there was no patient injury, the lenses remain implanted, and vision has not improved. No additional information was provided. The patient had bilateral lenses implanted. This report will capture the lens implanted in the patient's right eye. A separate report will be filed for the left eye."

"It was reported a zxr00 22.5 diopter was explanted from the left eye on (b)(6)2017. Post-operatively, the patient complained of glare with night driving. The doctor and patients tried resolving the complaint with time, pilocarpine eye drops, and glasses. However, these methods did not help and an explant was performed. The was no incision enlargement or vitrectomy and the patient has recovered. No additional information was provided."

"It was reported that a zxr00 intraocular lens (iol) was explanted due to patient experiencing visual disturbance. Lens was replaced with a non-amo device. There was no patient injury and an incision enlargement was not required."

"It was reported that a zxr00 intraocular lens (iol) was explanted from a female patient's left eye due to the patient experiencing too much glare. There was no patient injury post-op. The lens was replaced with a model zct150 22. 5 diopter iol. No additional information was provided."

"It was that a zxr00 intraocular lens (iol) was explanted due to halos. The lens was replaced with a non amo device. There was no patient injury or incision enlargement required."

"It was reported that two symfony intraocular lenses (iols) were implanted in the eyes of a xx year-old female patient during a bilateral surgery on (b)(6) 2017. Reportedly, a little over 2 months, post-op the lenses were giving a myopic shift. The patient¿s vision was reported being great for near as she was ok with working with the computer and reading; however, the distance vision was blurry and -2. 75 ou (oculus uterque - both eyes). As a result of follow up additional information was received and both eyes are myopic -2. 00. The surgeon would like to offer her an iol exchange on her dominant eye (unknown which eye is the dominant eye). Currently the surgeon is trying her with a pair of distance glasses. No further information was provided. This mdr is to record the lens implanted in the patient's right eye. A separate report will be filed for the lens implanted in the left eye."

obviously screening of which patients should get edof or multifocal lenses is not strict enough.Nothing beats the natural healthy lens in ability to focus so sacrifices must be made..Prior to surgery a savvy patient can do research on tneir own..The information is out there.There will always be halos and starbursts at night with varying intensities.it is the rings in lens extending the focus.

I do not feel i was lied to to or taken advantage of.  my dr was clear some personalities are very demanding and monofocals with glasses are the best choice.I felt and still do that i see far better at night than  before and do not notice halos..threw away my glasses.

skilled cataract surgeons are always replacing, rotating ,working on dry eye etc to make patient happy. at least here in ny where thousands of operations are done...youtube shows lots of lens exchanges..

certain eye conditions make measuring tricky...so tweaking after eye settles may be needed.. ery far,  ear, lr lrior lasix can create problems in getting it spot on

 

Hi andi , that was a lot information and I have to admit that the myopic shift case is what i am experiencing and adding the astigmatism is making it worse. But I am not in a hurry to make any rush decision as there are post operative adjustments usuaally done 1 to 2 months after the initial surgery

Most of the examples you gave they have exchanged with monofocal lenses while there are 3 main type of lenses for people who wants no glasses or reduces glasses usage adaptive , extended range and multifocal and there are new type bifocal which claim to be very good for out door activities . For the adaptive my doctor explicictly was not happy to use as he have done 150 and the results were not consistent over all he has done over 25k operations. Even in the states I saw a few cases to replace the symphony extended lol with Crystal lenses adaptive because of the halo.

I was told that exchange if there is a reason to be done can be done any time after the initial healing is finished which is 4 to 6 weak after the surgery. As well any interventions are around that period

Also bare in mind that all lenses have pros and cons and not a single place will cover it that I found. And on top of that it is even more important what the surgeon is used to as best results are from how the implant is done and adjusted the lens

“I do not feel i was lied to to or taken advantage of.  my dr was clear some personalities are very demanding and monofocals with glasses are the best choice.I felt and still do that i see far better at night than  before and do not notice halos..threw away my glasses.”

Respectfully, I have read dozens of instances of, what sounds to me, blaming the patient for being too demanding. 

The pre approval studies from the FDA make no mention of the adverse effect of severe halos and glare. I find it hard to believe that not one of the ~150 patients in the larger study made no mention of, or had no issue with halos and glare.

My doctor did no pre op explanation of this side effect. I would absolutely NOT have used this lens if he had. My chief complaint to him was difficulty seeing at night due to the cataract. At this moment, eight months after the implant, I have NO night vision and my pre-op close vision is completely gone. I made it absolutely clear that I wanted the best possible vision I could have. I specifically said that if that required glasses, I didn’t care. 

The concentric circles I see are clearly the result of the lens design, and are responsible for my lack of night vision. 

Please understand, I have no patience for the oft repeated “some people have unrealistic expectations.” I think it is absolutely realistic to believe my vision will improve after cataract surgery, not deteriorate to the point of losing my ability to see up close or after dusk. 

Thank you VERY much for this information. It is very helpful. 

The only criteria used used is how close to 20/20 patients get with this lens. If any of the FDA reports asked a question that addressed halos, glare and night vision, this lens would clearly be difficult if not impossible to get FDA approval. 

Any my doctor that explain ts a lens should be required to submit that to the FDA.

Hi Amy57061 - I don’t discount your comments at all.  The fact remains there is no perfect lens and although we all want the best vision possible after cataract surgery (that means different things to different people - and even what you discuss with the surgeon could be interpreted by them differently).

I have had my Symfony lenses (almost 1 year in right eye and 11 months was n the other).  The patient reviews here of them were just coming out.  I could not wait for this surgery much longer asy ability to drive and perform at work was affected.  Sat inches from my computer with fonts enlarged.  I knew about the halos and concentric circles, my surgeon did mention them / I didn’t 100% know then as I know today that they affect all patients and do not diminish with time.  I went ahead anyways for a few reasons.

I have no intention of exchanging my lenses.  Yes the concentric circles are always visible.  Believe it or not my night vision was worse with cataracts than with Symfony IOLs.   The contrast reduction plus glare with cataracts made for some risky driving on my part.

I do have all round great vision by day - no glasses.  I can read just fine as well as drive and rdrive ad road signs again.   However if that wasn’t my outcome I would be explaining these Symfony lenses for monofocals.   

I wonder if your opinion would change any if you had all round great vision in the day?  As stated I know mine would certainly change.

I think one can be content and satisfied with a variety of IOL options and combinations.   This is only my opinion based on my own experience and not meant in any way to change anyone’s mind.  This is a hard, difficult decision with no guarantees no matter how much pre-research you do.  perhaps this above all other reasons I am do against clear lens exchange or lasik.   People who do so are gambling with their vision - entirely different when one has cataracts and no other option.

I read the clinical trials in Europe.It seemed many of the cataract patients were quite elderly and did not drive much at night..Yes halos and starbursts which cannot disappear but can be ignored by brain over time.Just like noises however for some a bad choice as is obvious here...I found daylight gave me a full range from small print to distance but loss of contrast in low light for close..

i imagine an exchange is  a good idea for you..for me to have a locked in focal point was frightening..

I got regular non-toric monofocals for distance and I rarely need to wear glasses now except for mild drugstore readers occasionally. From the research I did, that's the norm with these lenses even though people think it's not (except perhaps some people would need to wear readers more than I have to, plus a small percentage of people need glasses for intermediate distances, but most do not). I'm not including people with astigmatism when I say this.

Also, I'm basically the only person on this forum who has posted about non-toric monofocals for distance with no monovision and no astigmatism causing my vision to be better (sometimes astigmatism can make your vision worse, sometimes better) who almost never needs to wear glasses, because the only other people who post are the ones with complications. So until other people finally post on here with the exact same situation I have and the same outcome, people will just have to take my word alone for it.

And I don't expect anyone to ever post on here with the same results I had with non-toric monofocals set for distance unless like me, it's someone who posts before their surgery to try to decide what to do and decides to get non-toric monofocals set for distance with no monovision (I'm the only person on here that did that as far as I know). There's no reason for someone to post on here who had surgery and had a good result. I was pretty sure my outcome would turn out the way it did since I know other people who got non-toric monofocals set for distance and don't have to wear glasses for intermediate distances (2 to 5 feet) or further. Some maybe wear reading glasses more than others and more than I do, but from what I have read, 1/3 of people with non-toric monofocals set for distance never need to wear any glasses at all ever. I decided to go with what I thought was the least risky choice and also the one that made sense to me economically since I was quoted $5,400 for 2 Symfony IOLs alone, plus the cost of the surgery and other expenses with my insurance which would have been around $6,000 total. My entire surgery and doctor's visits (including tests), IOLs, eye drops and surgical center fees was no more than $750 for both eyes together.

And when I say both eyes together, I mean $375 per eye maximum (surgeries were done 6 weeks apart).

Also, even though I know people who had non-toric monofocals set for distance without monovision and never need glasses for intermediate distances, I still wasn't sure if the majority of people turn out that way since so many posts online say you'll almost definitely need glasses for intermediate distances (2 to 5 feet) with non-toric monofocals set for distance without monovision. So I wasn't sure what to believe. I went with what I believed to be correct though and it turned out I was right.

I'm only writing all this for people who haven't had surgery yet and read it in the future.

Or rather I'm mainly writing it for people who haven't had surgery yet, unless someone decides to switch out their Symfony lens or other premium lens.

Oh and the other thing that made me choose monofocals for distance (and they're non-toric - they do have toric monofocals, but those are considered premium IOLs since they're not necessary and insurance doesn't cover them) is the fact that even with Symfony IOLs or other premium IOLs (including trifocals) there's no guarantee that someone won't need to wear glasses.

Aside from all the other potential problems premium IOLs can cause.

There's one other thing I want to add. I had Lasik 15 years before cataract surgery (I suggest never getting Lasik or any other refractive surgery like PRK, LASEK, Smile, etc. either before or after cataract surgery for reasons I won't go into here, even though mine turned out basically fine). Supposedly Lasik and other refractive surgery makes it harder to calculate the IOL power for cataract surgery (this is something I personally do not believe since that didn't happen in my case and I didn't have ORA either).

Anyway, so I have non-toric monofocals set for distance after having had Lasik and basically don't need glasses now. I wonder how someone who didn't have Lasik would do with the same IOLs? I would think even better than me barring any complications like refractive surprise (the power being off), etc. although since I don't believe it's harder to calculate the power after refractive surgery (at least not any more like it might have been years ago), I would say the results in most cases should be at least as good as mine if not better.

And in case anyone thinks I must be under 40 if I hardly ever need reading glasses now, I was 58 when I had my surgery a year ago.

Thanks for all the info ... I haven't digested it all yet, but appreciate you putting it all out there.

I think my chief objection is that Symfony was oversold—by Abbott, Johnson and Johnson and, by extension, my ophthalmologist. 

I had been seeing doctors in the practice for over 15 years. There was a (apparently misplaced) level of trust . There was NO information about EDOF higher rates of halos/glare given at the time. Again, my main reason for seeing my doctor was poor night vision —especially in low light situations— which is how the cataract was discovered. And, I specifically told the doctor continuing to wear glasses was fine if it improved my vision.

The Symfony was the ONLY lens offered besides a mono focal (which was downplayed to the point where it was discounted) despite the available information on the Symfony package insert and the FDA website that says (essentially) it is not good for low light conditions, and driving. This I discovered —after the fact —in online research deeply embedded in the search engine and difficult to find..if you look at the short film on the Symfony website, you would never know about the glare, halos etc.

If the lens lens works for you, that is good. But a doctor not fully disclosing the pros and cons of this lens, in my opinion, violates the ethical responsibility for full disclosure in informed consent. 

So  in essence:

1. The lens has a fundamental flaw that is well documented i.e. concentric circles, varying degrees of halos and glare.

2. Any ethical doctor should disclose this information.

3. It is easy to give a patient a written questionnaire that could inform the choice of lens.

4. No doctor should refer a patient to another physician when there is a problem if that physician has a financial interest in the lens—especially if that referral is to a doctor hundreds of miles away (especially when the patient is 50 miles from NYC)

5. The FDA will not take up the issue of overselling it in marketing strategies because the lens is a) paid for by the patient, b) not defrauding the government (Medicare). So any action must be a complicated class action in a civil court.

Lastly, despite some satisfaction with the lens for some people which is undeniable, many of us were misinformed with extremely serious consequences.

I hope this doesn’t encourage great discussion. It is strictly my experience and I am incredibly frustrated. I no longer trust this opthalmology practice, and I have no idea where to go to have this corrected — or I f it is even possible. 

P.S. Some doctors should not be trusted —but how can the average consumer possibly know which ones?

 

Amy, did you file a complaint with the FDA or with Johnson & Johnson? I sent you the links in a private message.

I think things may be different in the USA as opposed to Canada’s Medicare system.  Correct me if I am wrong but your USA healthcare will only cover cataract surgery if patient selects monofocal lenses whereas in Canada surgery is covered regardless of lens type I chose.  My surgeon did disclose halos and glare been more than a monofocal although did not describe halos as concentric circles.  He didn’t push premium lenses and made sure I was aware of compromise.

I really don’t believe Symfony has less contrast sensitivity than a monofocal.  They have an elongated focus versus a multifocal that splits the light between 2 or more focuses and that causes a reduced contrast as opposed to an EDOF or monofocal lens. All IOLs have less contrast than a person’s natural lens though so those seeking clear lens exchanges should be made aware that difference could be as much as 15 to 20% less contrast.

I agree the surgeons should be discussing at length the compromises one makes with a premium whether that is by questionnaire or direct discussion with patient.  It isn’t a fundamental flaw with Symfony it is the design of the lens which allows one to see better at all distances but produces concentric circles at night around certain light sources.  Even if I were making the choice today these are what I would choose.  Likely in the future there will be better lenses but for now there are compromises to make.

All that to say that I am not sure how one goes about getting a surgeon in the USA to be ethical in their discussions with patients under current set up and money a powerful motivation to push premium lenses.