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

No

And neither do all the other people I know who rarely if ever need any glasses with non-toric monofocals for distance.

Hi, Andi77  I've been reading your informative posts about your non-toric monofocals, and wondered...did you have any significant astigmatism prior to your cataract surgery, and if so, why did you decline toric monofocals?  Was it perhaps to avoid the rotation with them that sometimes occurs?  I find myself mostly agreeing with your decision to choose monofocals, partly because of all the complaints concerning the premium lenses, partly because my optometrist insists they're not ready for "prime time" in her opinion, and lastly, because Medicare covers their cost. However, I've got moderate astigmatism, enough to need torics, so I wondered if you had your great monofocal results because you didn't need torics. I'm worried I'd need glasses for everything if I choose a non-toric monofocal.  (And, naturally, the ophthalmologists I've consulted here in the U.S. have both pushed me hard to choose a toric Symfony or a toric monofocal, so they are no help.) 

 

Do keep in mind people here are the unhappy symfony patients.By far are thousands who are happy.I am here as a curious sort who researched everything prior to cataract surgery as i had a retinal repair

if you drive alot at night or  looking for absolute  perfection symfony might not be for you..For me 20/20 and j1 close vision is tbrilling each day compared to before.

I live alone, so I want to be able to drive at night if I have to or want to, and the only person I personally know with toric Symfonys had to stop driving at night, which he's understandably not happy about.  And like you, I had a retinal tear years ago, and I also had a mother with macular degeneration (though so far I don't, knock on wood.)  I have to wonder if monofocals wouldn't be a safer bet for me, though the ophthalmologists I consulted deny any problem with premium lenses for me in that regard.  I want sharpness, contrast and clarity for reading, computer, and seeing at all distances, even if I have to wear glasses to get it, and the most reliable way to get all that still seems to be monofocals. I also don't want to have my eyes corrected with laser, if premium lenses missed the plano mark or left residual astigmatism. At this point, I'm trying to decide between a plain vanilla monofocal or a toric monofocal. You are one of the fortunate ones, if Symfony works well for you.  (Yay!)  But to me, they seem like a bit of a gamble, probably more than I am willing to take.

Hi Lynne 75659

I too have Symfony (non toric lenses) and have good vision with them and do drive at night whenever I need too - and with living where I do in Canada means driving 4 months of the year home from work in the dark.  Yes I see the concentric circles but I have adapted and although difficult to drive at night at first - it had gotten better.  I am almost a year out from first surgery.

That being said it is your decision and the the odds would be in favour of a monofocal lens for night driving.   My recommendation would be to go with a toric lens though if you have significant astigmatism over 1.0 otherwise you would need glasses to correct at every distance.  If you go with a toric lens take extra care during healing process - wear eye shield every time you nap or sleep for minimum 2 weeks.  Careful not to bend down or lift anything heavier than 5 pounds those early weeks.  In other words be extra cautious.

I also would recommend targeting first surgery on your dominant eye for plano and waiting 4 weeks for healing to take place.  If that target is achieved and you have good distance results ask the surgeon to target your 2nd eye .50 or .75 diopter nearer to give you more range of focus.  Most people tolerate this slight difference between the eyes well.

Good luck to you Lynne 

I don't have any astigmatism in my right eye and very mild astigmatism in my left eye. If I did have enough astigmatism for toric IOLs though, I personally still wouldn't have gotten them mainly due to the fact they can rotate. I don't know statistically how many people who have moderate or worse astigmatism and have gotten non-toric monofocals don't have to wear glasses most of the time (or never). I don't remember reading any posts on here from people with moderate or worse astigmatism that chose that option.

I personally don't think any premium IOLs will be "ready for prime time" ever and I also think they're basically only a money-maker for doctors, especially since I basically don't need any glasses at all and can read very tiny print without glasses (my eyes got better for reading as time went on). I also was able to drive to the doctor the day after my first surgery with crystal clear vision at all distances from around 18 inches out (reading vision got progressively better over time - it probably took around 2 months for it to get really good).

And obviously since I'm the only person posting on here with non-toric monofocals for distance and the fact that I hardly ever need glasses (and right now I don't wear glasses 100% of the time on most days - I can read things like store receipts fine without glasses), I am going to have the opinion that premium IOLs are not only not necessary to get in an attempt to avoid having to wear glasses, but unnecessarily risky (from the stories I read here). I realize there are lots of people that got Symfony and other premium IOLs and love them and that's fine. I just think if people don't want to spend the money and risk having problems with premium IOLs, they shouldn't be afraid to get non-toric monofocals and chances are they won't need glasses like I don't most of the time, if not all of the time (not referring to people with moderate or worse astigmatism). For me it wasn't worth the expense and risk.

And about the astigmatism, I didn't research anything about toric IOLs except that they can rotate (and I know people on another group I'm on who had toric IOLs rotate). Like I said before, I personally wouldn't get them since I wouldn't want to risk my eyesight to avoid wearing glasses, but everyone's risk tolerance is different. That's just my personal opinion and I know most if not all others in this group disagree with me.

Hi andi77 - I too have read your posts with interest.   Not sure if most here disagree with you.   I am pleased to learn that monofocals set for distance provided you with good all round vision.

That being said I don’t know how wise it is to base their decision (even on my own with Symfony IOLs) on one or even a few people’s experience.  Certainly it shouldn’t replace their own research and counsel of trusted surgeons.  Each person’s situation is unique.

Living in Canada I had to have this surgery through the hospital (for it to be covered under Medicare - and it was even though I chose premium lenses and paid only for the difference between monofocal and Symfony- so I am not out thousands of dollars for them.  But I was one of 25 or so people my surgeon operated on that day and I saw same group of people at both 24 post op checkups.  I can tell you in group I was with I was only one with Symfony- all the others got monofocals.  And as there is such a long wait for our turn to see the surgeon we chatted about our experiences as we watched each person be called for eye test before seeing our surgeon.  The eye test which consisted of reading eye chart on the wall was in full view of those of us waiting our turn.   I was only one who could read at close distance and the others asked me why I could read as they said they couldn’t read at arm’s length.  

So I am truly puzzled why some (if both eyes targeted for plano) are able to read whereas some cannot.

What I do know is there are no guarantees that anyone premium lenses or not that they will be totally glasses free.

Right, that's why I decided to save my money and go with monofocals instead of premium IOLs (response to your last sentence).

Hi lynne75659, I empathize with your situation. You mentioned in your other post that IYO especially for those who truly would be better off with the lenses that Medicare or insurance pay 100% for. I have monofocal lenses and cataract surgeries completely paid for under Medicare. I am 9 months post-Op, and I just realized that I no longer can spend long hours perusing as before. After 4 hours max., my eyes get so tired and I am exhausted.  My husband who has had premium lenses for 2 years now, does not have this symptom.

For the benefit of others who may browse through this discussion in the future, I took a cursory look at the accessdata. Though the parameters are insufficient to draw a conclusion, out of the 100 or so reports that I looked at only 14 were related to Symfony EDOF, 2 infections 10 others either wrong IOL power or visual disturbances. The rest were related to monofocals and multifocals, etc.  Of the 6 cases of capsular rupture (some requiring vitrectomy), none was attributed to EDOF. Of the 22 cases of malfunction, not one of them was an EDOF.

And what I mean by that exactly is I would rather spend $750 total if I might have to wear glasses instead of $6,000 total if I might have to wear glasses.

Did you ask your doctor why you had such an amazing outcome?  If everyone had your outcome with monofocals, why would anyone get anything else??  From what I have been told, I should expect blurry vision within the first 5 or 6 feet with distance monofocals (not 18" so this just adds more uncertainty about what I should get for my second IOL to go with the Symfony.

Yes I get that and not everyone values things the same or have same funds to spend.  Glad I was still covered by Medicare and paid $1,900 for my Symfony IOLs - spent more than that on vacations that are over and done with within a week as opposed to my eyesight which I will have for years to come God willing.

According to the Symfony data filed with FAA, with the vision corrected for distance in each eye, 1.4% of people with monofocal lenses can be expected to read 20/20 at 16 inches and 34.5% of people will do better than 20/40 at 16 inches. There does not seem to be any understanding of why some people seem to do so well, while the majority does not.

Use of a Symfony lens in each eye improves the odds, with 8.2% of people expected to read 20/20 at 16 inches and 90.5% of people doing better than 20/40 at 16 inches.

$6,000 sounds cheap to me. I don't have the exact figures in front of me, but I spent at least $6,000 for my one Symfony eye.

EDIT: "$6,000 sounds cheap to me. I don't have the exact figures in front of me, but I spent at least $6,000 for my one Symfony eye." ... that's including the total cost of the facility, anesthesia, etc.

I guess your surgery was a lot more than mine was. How much was the actual Symfony lens? I was quoted $2,700 per lens. And did your insurance pay for any of your medical expenses? It almost sounds like you had elective refractive/clear lens exchange (that insurance doesn't pay for) without having cataracts in that eye (or without having cataracts bad enough to not allow you to drive legally in your state), but you did have them right? My entire cataract surgery for both eyes with everything included (followup visits, IOLs, surgery, surgical center, surgeon fees, eye drops, testing, etc.) was at the most $750 (I tried to tally it up, but went with a high estimate, so it could have been $600 total, I'm not sure - and I have an HMO).

Sure I had the money but decided to invest it in the stock market instead lol

It really sounds like you had refractive lens exchange. I know someone who had that and her surgery was $11,000 for both eyes since insurance doesn't pay anything for that like they do for cataracts that are bad enough to not drive legally. Do you have insurance and did you submit the claim for the cataracts?

Anyway, if I lived in Canada I might have done the same thing you did, but since I don't, I think $5,400 is a big chunk of change and I don't like wasting money. Also, I'm extremely happy with my outcome, so I guessed right and used the money for something else.

I had mine done in Dover, DE.  Everything was covered by Medicare & my supplemental with the exception of the Symphony Lenses.  They were an additional $5,600.00

Ha ha - I am a banker Andi - stick markets can be riskier than the IOLs.

Thanks for your reply, andi77 (and everyone else who replied with helpful information, too!)  You are lucky having such a great outcome with monofocals, and I suspect the fact that you basically had no astigmatism to begin with may have contributed a lot to that.  There IS a huge price difference here in US, once you go to a premium lens.  My ophthalmologist charges me/anyone over $1,000 just for the operating room alone (when getting a Symfony lens), with the surgical center explaining to me that they share the proceeds from this "windfall" with the surgeon.  In addition, the surgeon charges around $5,000-$6,000 per Symfony lens, with toric monofocals being priced somewhat less, at probably $4,000 per IOL or so, if I remember correctly, along with the added approximately $1,000 charge for the operating room in an outpatient surgical center.  (That's in addition to what they bill Medicare for, which is the standard allowable amount for cataract surgery and IOLs.)  Having said that, if I could be assured of a good outcome, it might all be worth it.  However, one more thing that Symfony and other premiums seem to have more complaints about is feeling as if you're wearing hard contact lenses, or just discomfort or grittiness in the eye. I wore hard contacts for years, (plastic ones in the 1960's, gas-perm later on) as that was the only way I could see well, and I shudder to think I might end up with anything resembling that eye discomfort again.  In fact, comfort alone might be 50% of the decision for me, lol. (My personal "nightmare" involves knowing you can take a contact lens out, but not an IOL)!  At the end of the day, it's also important to realize that my (and elsewhere, I've read most) optometrists don't like the premium lenses, and I wonder if it's because they have to unsuccessfully try to correct the premium lens issues as best they can, while usually it's easier to correct monofocals with eyeglasses. My optometrist practices in an HMO, so she does not benefit in any way from selling more eyeglasses or contact lenses, though I suppose that might be a factor in some optometrists opinions of premium lenses, as some people won't need prescription glasses after premium lenses, which would hurt their bottom line.  (It would be great for any optometrists out there to chime in with their opinion as to why most of them don't like premium IOLs!  But I digress...)

No doubt - it’s a lot of money to part with.

Lynne- not sure where you heard premium IOLs are like wearing hard contact lenses - simply not true.   Cataract surgery does induce dry eye which is what causes that grittiness.  I fortunately only experienced that for a few days.  If eyes are tired I can feel it again time to time.  Artificial tears and taking a flaxseed oil supplement help with dry eye.

Optometrists don’t like premium lenses as the ones they have as patients usually have complaints.  My own optometrist was not happy I was considering them (as I had a visit with her after consult with opthamologist she referred me to).  She was very vocal and unhappy he would even discuss these lenses with me.  She cautioned me about unhappy her patients were that got these and the glare and halos they experienced. 6 months after my surgery night hawk in these forums recommended I go back to my optometrist to get a baseline of my vision after cataract surgery (I wasn’t going to as my vision was great).  But I could see night hawk’s point and did make an appointment.  my optometrist examines my eyes very thoroughly - tested distance and near vision and she said I got a very good and surprising result.  I went home wondering if many that would get a good result would go back for an eye exam - unless something went wrong.   That could account for their opinions on premium lenses.

Thanks for your response, SueAn.  I already have problem with dry eyes, and actually had a period of time where my eyelid would stick to my eyeball (very painful).  Thanks to some eye medication sold over the counter and Systane gel eyedrops, I'm just about clear of that and hopefully ready to get on with IOLsurgery.   As for possibly feeling like hard contact lenses, that's my own irrational fear more than anything, I guess, but it does seem that more people with some premium lenses complain about how their eyes feel, including the one person I personally know who has Symfony torics.(Maybe it's just as bad with monofocals, I hope not.)  As your optometrist says, you got a surprisingly good result, which is wonderful! You also were lucky not to need a toric Symfony, as I would, and it does seem that toric Symfonys have more complaints than non-toric Syfmonys.  So all in all, results with premium lenses, especially the EDOF and multifocal ones, seem to be a gamble, a bit like going into a casino....even when ophthalmologists recommend them, which they do in the US for most people. As for people with premium lenses never going back to the optometrist for an eye exam, I'm guessing that might be true for the first year or two, but eventually they'd go back for a routine eye exam (glaucoma check, yearly check for other changes, etc.) so even for the premium IOL's best-outcome recipients, the optometrists would eventually see them again for an eye exam at some point, though not necessarily for vision complaints.  

Thanks again for all your helpful advice, I'll be sure to ask about those eye shields you mentioned if I go for the toric monofocals.

My Symfony lens was about $3,000 which was not covered by insurance. I think insurance covered everything else ... although my deductible is so high that I paid the whole thing out of my pocket anyway. I had cataracts in both eyes. They did the Symfony implant on the worst of the 2 eyes first, which was my right, dominant eye. I was devastated by all the artifacts I saw, got really scared, and after discussing it with the surgeon ended up canceling my surgery in the 2nd eye. The surgeon told me to give it "a few months" to see if it would get better. It never did, which is why I still have only 1 implant in today. I gave it 6 months (for various reasons) before going back to see the surgeon. That was 2 months ago. My optometrist said that there's no hurry to do my 2nd eye because the cataract in that eye isn't that bad yet. Although I've been functioning like this, I'm far from seeing well ... certainly not as well as before the surgery. Everything might be great except for the night vision and vision watching movies in a theater (or sometimes on TV). So I'm at a point of choosing between another Symfony lens, a mono-focal lens set for near or a mono-focal lens set for far in my unoperated eye. I'm trying to fully understand what's going on before making that choice. I'm finding it difficult understanding where I'm at right now and/or getting answers. Maybe that's too much information, but that's my situation in a nutshell.

Wow yes your deductible must be very high if you paid so much, even more than that person with the elective surgery that cost $11,000 for both eyes out of pocket with no insurance (although she doesn't even know which IOLs she has, so she probably has non-toric monofocals and I can't judge her eyesight from having those because she has all kinds of problems from other elective eye surgeries she had in the past).

Anyway, I hope things get better for you rpk0925.

Oh and also luckily I have $0 deductible. Someone also having cataract surgery the day I was had a $1,000 deductible and didn't realize it and was caught off guard having to put it on their credit card before the surgery. I forgot about that.

You're Welcome Lynne.   The eye shields were given to me at the hospital - they were taped over the operated eye following surgery.  I was given a sheet of instructions which included use of eye shield for naps and overnight for a week - I extended that to 2 weeks as I am a terrible eye rubber and didn’t want to do that in my sleep.

I think if measurements are accurate by surgeon as well as the calculation of power there should be no issue with premium lenses other than the night time artifacts.   For some like me that is a trade off I was willing to make and as it turns out I do drive a fair amount after dark (not usually long drives).  I don’t think twice about driving at night any more.

I too use Systane drops (ultra performance) but not as frequently as I did the those early months.  I do take the supplement (omega 3 would do just as well as flaxseed) that helps with dry eye too.

Not trying to convince you on premium lenses.  Just a different perspective as I don’t live in a country that pushes them.  Our cataract surgeons are paid same amount no matter which lens is selected by the patient.  They are only pushed in private clinics for those looking to correct presbyopia vs cataracts (something I am very much against).   

Wish you nothing but the best.

I agree with you that if measurements are accurate as well as the calculation of power, there should be no issue with premium lenses other than the night time artifacts---except for the torics, which, as andi77 pointed out earlier, can and do rotate.  I hear of that happening a lot, and the ophthalmologists' usual "fix" for that is to offer laser, which does not always seem to work well, judging by what's on these boards. I guess I can at least take some comfort from the fact that, no matter what lens I end up with, I will at least finally get rid of my coke bottle thick glasses, which I've worn for nearsightedness from age 7 to now nearly 67.  So from that standpoint, any IOL be a guaranteed improvement!

Yes if you’ve always had a strong prescription and now find yourself living with deteriorating eyesight due to cataracts you will be better off.  My optometrist who I had been seeing for years (that wasn’t a fan of premium lenses) when she diagnosed my cataracts (and could not correct my eyesight better than 20/60 in one eye and 20/50 in the other eye) when she saw how shocked and crestfallen I was - said to me many people would think they won the lottery to get their vision fixed for free.   Of course I did not see it that way (still don’t) but you will see better.

I wouldn’t judge the majority of outcomes based on what you read here.  Most of the positive outcomes like my own are from people that researched cataract surgery and options PRIOR to surgery.  Most only research after something goes wrong and post on forums like these.  So I do think there are more negative than positive reviews due to that.

And there are some on here that do have toric lenses and didn’t need a fix afterwards as well as those that had a laser fix with toric lenses (including at201) and it worked out  just fine.

Something can go wrong but remember the majority of cases turn out well.

do write here after your surgery.Like Sue and myself you may be rather thrilled.I remember going home seeing a bit misty but still sharp..as tne day went on it became better and better.By morning clear and what color!gas flame was a special blue..Early am check up was about20/20- a few letters...

surgery was totally painless and fast.Here in nyc hosp they measure endlessly before and then during surgery with an ora which rechecks the power..

prior to surgery night time headlights were marred by cataracts so halos i have really kind of disappear unless i look for them.I did get cheap reading glasses but do not use them..What prevents perfection is loss of contrast, not blurring with tiny print.But bright light fixes it..driving has everything in complete focus from controls to distance..I have symfony lenses.

remember happy people rarely pop up here ..so please remember to come back with your journey

interesting how you have to throw away glasses..

I didn't have an amazing outcome. Most people have the same outcome I had, except some need reading glasses more than I do. 5% need glasses for intermediate distances and 95% don't need glasses for intermediate distances. I did research on it, but until more people post about the same outcome I did, I'm not going to post the research anymore on here. People get premium lenses because there's misinformation spread on the internet about the results with monofocals and they don't know any better, plus doctors push premium IOLs as an income generator (I'll send you a link to an article to read).

And my brother and several people I know had the same outcome I had (especially with intermediate distances), so I guess we were all just lucky?

And I forgot to mention one other thing - my reading vision took around 2 months to sharpen up fully and my 2nd eye took around 2 months to also sharpen up fully for intermediate vision, where my first eye was perfect immediately after surgery as far as intermediate vision goes.

Yes indeed, I promise to report back, regardless of outcome, with or without problems.  This board has been so helpful to me that I'll be sure to pay it forward, for someone else...

"I wouldn’t judge the majority of outcomes based on what you read here.  Most of the positive outcomes like my own are from people that researched cataract surgery and options PRIOR to surgery.  Most only research after something goes wrong and post on forums like these.  So I do think there are more negative than positive reviews due to that."

I hate to say it, but personally I take a little offense to this. I feel like I *did* do research prior to surgery and still had a bad outcome. I might be wrong, but I think my mistake was being influenced by a friend who swore by how good her outcome was, and really pushed me in that direction (towards the multi-focal lenses) ... even sending me to the same place that did her surgery. It turns out that my outcome is very different from hers. She has no night vision artifacts ... I seem to see them all.

Sorry PRK - didn’t mean to offend.  Just saying that the majority of those posting are after surgery cases  (not prior) and usually something isn’t right.  I certainly don’t mean 100% of the time as there are obviously people that do their own info gathering and research and still have it all go wrong - reason I was so scared about my surgery.  There is always a chance no matter what you do that it won’t turn out as hoped.

Just a comment about your friend - I purposefully will not push anyone to premium lenses.   I tell my experience only and hope that no one substitutes it for their own decision.  In many cases a monofocal lens is the better choice.  No one should base this decision on someone else’s outcome.

You have mentioned in prior posts that you are more demanding than the average person and appreciate exactness.  I assume your friend would know this about you too and for that reason alone premium lenses may not have been the right fit to your personality.

I wish doctors would be more motivated by patient satisfaction than profit.  A simple questionnaire would help them in patient selection for premium lenses.

I read one humourous address from a conference to surgeons describing the worst kind of patient for premium lenses being “someone who is an engineer by trade that wants to see a knat  on the back wall of a theatre, whose hobby is astronomy and has a Jewish lawyer brother.”   Although humorous there is a nugget of truth in that.   We all perceive things through a lens (pardon the pun) that may not be someone else’s reality.

So please don’t take offence - meant none by it.   But from my perception if I were in lens selection process for Symfony today reading the hundreds of posts here of unhappy patients I would assume these lenses are rubbish.  But I honestly think the majority of patients are perfectly happy with them, never did a stitch of research or posting and we never hear from them.  

Just to add to that RPK - this wasn’t the only forum I was on prior to surgery.  I went on DISboards (forum got Disney World addicts as well as Disney Cruise line) and a diving / snorkeling site.  Interesting thing about those sites is they aren’t dedicated to discussing cataract surgery or anything medical for that matter.  But the topic came up as it related to a person’s holiday or activity and they asked for advice.   I was surprised (pleasantly) by the number of replies.  None were negative.  Just recounted their or parent’s cataract experience and how happy they were with eyesight afterwards. Only cautioned not to do certain activities too soon after surgery due to healing taking longer than doctors describe.  

These are people that obviously never posted on a cataract forum - when making my decision I took those comments into consideration.