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

Am happy to learn that you have had good results with Symfony lens. I also am learning to live with seeing the multiple concentric circles at night, although I wish that that those were not there.

I am glad that you enjoy seeing the concentric circles around lights. Unfortunately, I still think of them as a nuisance ruining my night vision.

While it is't ruining my night vision, it surely is very annoying and not showing much improvement....  Much worse than pre lens implant.  

They must be a lot worse for you. I can't imagine anyone would seriously complain about what I'm seeing.

Just consider yourself lucky. If you look at this thread, some people have found them so annoying that they have chose to replace them with monofocal lenses.

I am very sorry to learn that you also have the problem with seeing the spider web with concentric circles or the halos due to the Symfony lens.

Hopefully, other people will learn from our experiences and think about this issue with Symfony lens when they evaluate it for themselves.

I'm guessing this "slight film" is PCO (Posterior Capsular Opacification). It can cause issues with glare and halos. Since they moderate links, I let people google quotes if they want the source. One article notes the symptoms of PCO (which can occur with any IOL, it has nothing to do with the optics):

"Blurry vision is just one of the symptoms that patients may experience. Other signs and symptoms include hazy or cloudy vision, decreased visual acuity, decreased contrast sensitivity, glare or halos around lights, double vision and asthenopia."

So its possible that the visual artifacts are partly due to the PCO rather than the Symfony. You may still learn to tune them out, but if that is the cause it may be more difficult if the PCO gets worse so there is more to tune out. 

In terms of the risk of halos with the Symfony, this article reports on the results of the largest studies:

"High rates of spectacle independence, patient satisfaction seen with Symfony IOL ...

Most subjects who reported symptoms rated them as mild or moderate. In the U.S. study, for example, reports of severe visual symptoms were less than 2.8% for halos, none for glare and less than 1.5% for starbursts.

Historically, we have seen that 3% to 5% of patients implanted with monofocal aspheric lenses report glare and halo, so there is only a small increase in these studies. "

Its unclear what all the risk factors are for halos (I hadn't found any data on how those who get them compare  to those who don't, other than that residual refractive error can play a part). I don't know your age but anecdotally  I've noted some folks that are younger than typical cataract patients mentioning them, perhaps since their retinas are more sensitive than older patients, which would seem to make them more likely to get halos with any IOL. Halos with a monofocal don't have the concentric rings, but that doesn't mean they can't be problematic. 

Unfortunately the minority that have trouble have difficulty believing others don't for some reason. 

Starbursts can be caused by things like creases in the capsular bag, which are independent of the choice of IOL and could be there with a monofocal. 

 If by "last December" you mean Dec. 2016, then despite the doctors claims that it will "likely NOT go away", that isn't the case since some studies don't even record the incidence of halos until the 6 month mark (though usually its 3) to wait for initial halos to subside. Even after that point with multifocals many report halos continuing to subside over the next several months or few years.  There are some drawings people have made showing how they subsided over time even among those who still saw them after the first few months. Although my halos have never been problematic with the Symfony, they only started to go away at 2 years postop for me.  There are some lights where I always saw halos before, and don't anymore, although with they are still there (but even milder than they were before) with some other lights. 

Its especially unfortunate for a doctor to be pessimistic about the issue since the literature actually explains that patients who worry less about the halos on average tend to be more likely to see then fade away vs. those who worry about them.  It may be akin to a placebo affect, but a positive attitude from the doctor reportedly makes a difference in the outcome.  It may be partly since the brain tends to see things we pay attention to and so those paying too much attention to them may lead the lower level brain processes to conclude "the conscious level of the brain is paying attention to the halos, we need to keep passing them along..". However even those people usually aren't paying attention to them so the brain will likely mostly still be trying to tune them out. However  I'm guessing those convinced they are never going away are more likely to see that be a self fulfilling prophecy.

 

Thanks for the info!

yep, the surgery was December 2016

She intially indicated that they probably would go away after 3 months.

I guess I need to stop even thinking/worrying about them at the end of the  day, my vision is pretty goos (almost 20/20), and I don't need reading glasses!

 

I just had the Posterior Capsulotomy (laser) procedure done a couple hours ago to remove the film that you have mentioned. In my case, once the film appeared, it got gradually more cloudy over the next two weeks. When going for another post opt visit today... using the laser at a low setting, my surgeon was able to remove the cloudy capsule. Very small bites at a time so as to not nick the Symfony or damage the retina. Eye Drops 4x a day and tonight in the process of healing.

Had mine done in January and it's pretty much unchaged since then.  Great daytme lenses, but they leave a lot to desired driving at night when looking into lights...  either glare or the circles, depending on the type of light and the background around the lights.

Sorry to learn that you also haven't seen any change in the night vision issues associated with the Symfony lens.

I am almost at 6 months now since my cataract surgey and the Symfony lens installation on December 1, but I also  have not seen any noticable change in seeing the multiple circles around the lights. We just learn to live with issues like this, specially when there is no other good choice at this stage.

Why can't you "see clear"? The odds are the lens power is off (which is an problem that arises with any model IOL, they use the same formulas for all lenses, with just different constants for the particular IOL model), that you were left either nearsighted or farsighted, or with astigmatism at all distances. That can be corrected via lasik or prk or a variant of those, or with contacts or glasses. 

Most people don't have problems with halos after a few months (which is why most studies on them only report on them after 3 or 6 months when the initial healing&adaptation period is over), even if they still see them they've faded to not be an issue, but unfortunately there is no way to predict how long you will have them since everyone is different. A minority don't get rid of them, but its only a tiny fraction that continue to see them as a problem. (though of course those people post so people get a distorted sense of how common the issue is). Unfortunately some people get problematic night vision artifacts with any IOL, even monofocals. 

 

It is funny how you can't let go of your notion based on the so-called "studies" that the Symfony lens has more of the night vision issues than the monofocal lenses

re: "so-called 'studies' "

These are the studies that for instance the FDA used to approve the Symfony, or an article that I've referenced noting: "At the American Society of Cataract and Refractive Surgery meeting in May, I reported on the results of four prospective, multicenter clinical investigations of Abbott Medical Optics’ Tecnis Symfony IOL ... The studies were conducted at 69 sites in the United States, New Zealand and Europe, with 3- to 6-month follow-up of 1,464 eyes of 735 subjects.".  Are you claiming that your personal anecdotal experience is more important for others to consider than these studies that  you denigrate? Those aren't the only studies, there are a number of smaller ones as well done by varied centers in various countries. If you are relying on anecdotes, there are anecdotal comments by surgeons in various publications and their blogs and websites also indicating a comparatively low level of night vision artifacts. 

I gather that you have night vision issues with the Symfony, but the mere fact that you do says *nothing* about the incidence of such issues, even if their presence amy be personall compelling to you. The presence of other posts from people mentiong issues also says *nothing* about their prevalence given that most people don't post unless they have a problem (aside form some trying to keep some balance to avoid seeing people needlessly scared off if they don't have perspective). Science long ago realized that whats important to pay attention to are well designed studies rather than anecdotal data points that can be unrepresentative. 

Some people have problematic halos even with their natural lenses, or with contacts or glasses... and every model IOL made so far. The shape of them may vary, but those who have problems don't care that they aren't multiple concentric rings, what they care about is whether they have a problem. 

 

You can continue to refer to the same studies irrespecive of how believable they are, whenever someone brings up any problem with any problem with Symfony lens. Yes, we know that you had a good experience with Symfony lens and that you are enamored with it, But, instead of blindly believing these studies and belittling any issues which people bring up with Symfony lens, may be, instead of just calling these as unusual problems, you can start to update your thinking on this.

I've never doubted that people have issues with the Symfony as they do with any lens. The issue is that people need to make informed decisinos, and the way to do that is based on expert evidence from studies when such information is available.

I have been concerned about anti-science sentimient  and scientific illiteracy for decades, being an odd child who subscribed to the Skeptical Inquirer concerned about the issue (well before there were Marches for Science, though I dislike the idea of mixing politics with science). I've posted lots of messages around the net bashing the anti-GMO crowd, the anti-vaccination crowd, and others who refuse to bother to learn the basics of science and evidence. So of course on this topic I'm also going to bash those  that try to elevate anecdotes above science, those who mindlessly are blinded by their personal anecdote and ignore actual evidence and reasoning.  What drives me is  antipathy to those who willfully bash evidence and study in an anti-intellectual manner, whether its regarding the Symfony or anything else.  That anti-intellectual mindset is counter to the very routes of scientific evidence based medicine that led to the current state of modern cataract surgery.

 

 The issue is to keep those concerns in perspective and to not give others a false idea of the level problems due to a willful refusal to understand even the simple underlying basics of science that I would have hoped most educated people in the UK and US (the predominan countries on this site) would have picked up.  There are > 20 million cataract surgeries a year, and 480,000 surgeries with premium IOLs a year. I don't know what % are the Symfony, but I'd seem some early reports from US surgeons that they'd doubled the % of surgeries with premium IOLs due to the Symfony in their practice (but of course others don't do premium IOLs at all), so its taken off quickly. The point is that with high numbers, only a tiny % of people with problems choosing to post can skew the perception of issues and people need to understand that to take risks into perspective.

Yes, I get that having a problem personally magnifies the perception that "but everyone else must have the same problem, I can't imagine that they don't!", but in reality people's experiences will differ, not everyone has the same results you do. Even with uncommon results, *someone* winds up being the statistic... but that doesn't change the reality that their result is uncommon. Its doing a disservice to others to pretend that your result is typical when it isn't, either if its atypically good or atypically bad. 

 

Sorry, not quite awake (early morning here), I usually don't correct typos but this one stood out,  this: "counter to the very routes  of scientific evidence based medicine" should have been "counter to the very roots"

Also again, science can make mistakes, there are problems with studies that aren't reproduced, etc. This is a case however where there are multiple studies with similar results, so contrary anecdotes are questionable. Its in the interest of competing companies to find flaws in studies. When they don't see a problem, they instead resort on differentiating products to play up their strengths, e.g. Alcon plays up the better near of their multifocal vs. the Symfony. They haven't been calling the studies flawed, despite their monetary incentive to do so. The trifocal makers have tried to push studies that play up their better near also, rather than critiquing the Symfony.  There are studies done with competing IOLs which also highlight the issue of the low incidence of night vision artifacts, though in some cases indicating they are fairly low also with the trifocals. There have only been an outlier study or two with small numbers of patients that suggest another premium IOL may have less night vision artifacts, which statistically may not be significant and still show low risk of night vision artifacts for the Symfony. 

 

"Studies" are usually sponsored directly or indirectly by the manufacturer of a Product or Medicine.  They can be very easily biased through selection of subjects and the way questions are worded.  The fact that the concentric circle issue is real and likely much more prevelant than the Docs mention is an example of this.  The people who have it in this discusson repesent a very small sample of total users.  Most people don't come on here.  As a matter of fact I hadn't seen one mention of the type of severe glare, soft focus glare or concentric circles issue nor did the Doc mention the possibility of any of this pre cateract surgery.  

I'll add that just as there is a placebo effect, there is a nocebo effect, people who believe the worst sometimes wind up with worse results. Neuroadaptation isn't yet well understood, but there is some work (not with the Symfony itself) suggesting  those who worry about visual artifacts and pay more attention to them may take longer for their brain to tune them out since the visual system adapts to give the brain what it pays attention to. So those who are undly pessimistic about prospects for the future sometimes wind up with a self fulfilling prophecy, so its doing them a disservice to play up pessimism, rather than a realistic assessment of risks. There are risks with any IOL, including a monofocal, everyone needs to weigh the pros and cons. They should do so based on expert study, not on the anecdotal complaints of someone who bashes expert work as "so called studies" without any credible contrary evidence, even though if there were problems with the studies there are companies like Alcon that would love to point them out. 

We have agreed to disagree on this issue many a times already on this forum. You can continue to believe in the studies while I (and many others) don't completely believe. Why do you continue to start  the same discussion all over again any time any one brings up an issue with the Symfony lens

re: " "Studies" are usually sponsored directly or indirectly by the manufacturer of a Product or Medicine. "

Or the competitors. If a company suspects a problem wtih a competitors lens, then they would do a study to try to highlight problems.  Sometimes there are competitive studies between IOLs since  surgeons need to decide which lens to use, and there are some decent size high volume clinics and chains of clinics that can do at least some small studies to confirm for themselves whether the large studies seem on target, and you'll see those on the conference sites for the trade conferences like ASCRS and ESCRS. Surgeons aren't likely to risk damage to their long term reputations and income stream by biasing a study noticeably.  In this case although as I've noted anecdotes are *not* a reliable way to assess things, and confirmation&expectation bias may be at play, there are a number of surgeons who write or speak confirming their results match the studies.

re: "nor did the Doc mention the possiblity of any of this pre surgery"

That is a problem, surgeons should diclose potential problems (though sometimes they do and the patient tunes them out assuming they won't have a problem, and most don't). 

re: "likely much more prevelant than the Docs mention is an example of this."

Let me guess, you have some crystal ball which lets you magically know that they are much more prevalent? Contrary to the assumptions of people who assume that they can magically know that how common they are based on their personal experience, that is precisely the reason people do studies. Even doctors often suffer from falling for their anecdotal view of something based on a few patients, and then engage in confirmation bias. 

re: "represent a very small sample of  total users"

?

That is the point, there is no way to assess the prevalence of something from posts here, but some people seem to be leaping to conclusions based on either their 1 personal experience or seeing some other self selected users come here.

 

re: "Why do you continue to start the same discussion"

I was responding today to your critique of my posts. When people post about the issue, I attempt to put their concerns into perspective. If people make unsubstantiated claims that studies are flawed with nothing to back them up, seemingly based on their difficulty grasping that someone is the "statistic" even in uncommon occurances, then I'm going to point out their unproductive attempt to rebel against the basics of science based medicine.

 

You have put the same long comments over and over on this post. I suggest that you create a post of your own with all your good experience with the Symfony lens, with all the results of the studies and why you believe in them, why all the lenses have the problems etc and everything else you think is important. Then, simply refer to that post whenever you feel like you need to respond to whoever has an issue with the Symfony lens. (just like I simply refer to my post whenever i bring my night vision issues with Symfony to any one's attention instead of repeating my own experience in those posts). That will be a lot let less work for you and others.

It's been 38 days since I had my Symfoni Lens Insertion I still see the same series of concentric circle of light on head lights, red light and I see also white see white straight light horizontal beam of light. I always avoid not to stare when driving but can't help it. I have an appointment to see my opthalmologist in 2 weeks to do Yag to remove this horizontal light across when I see white light. Starburst spider like concentric I permanent it's the way this lens in engineered.

I called Johnson and Johnson last week they have not return my call. I will call them again and let them know the outcome of this lens.

Estella

1. Sorry to learn that you also have the issue with the multiple circles around lights due to the design characteristics of the Symfony lens.

Will be curious to find out what Johnson and Johnson person says when they return your call.

2. Obviously, you must also have Posterior Capsule Opacification for which the opthamologist has suggested using YAG to clear the film. Hopefully, that will go smoothly: it is a standard procedure for this problem. Best wishes for a successful procedure.

 

re: "remove this horizontal light"

It sounds like that might be a wrinkle in the capsular bag, which can  happen with any model IOL, and can cause artifacts like that as well as cause starbursts (which are separate from the halos).

re: "permanent it's the way this lens is engineered"

They aren't necessaril permanent, the odds are good they will go away. Anyone who claims they are necessarily "permanent" at this point  isn't a reliable source of information (even if they are a doctor). 

38 days is still early. Most studies don't bother asking about night vision artifacts until after 3 or 6 months because many people who see halos in the initial healing and adaptation period see them subside.  Again, most people at that point don't have halos they consider a problem. Even those who still see them may see the halos subside and go away over time.

Our brains learn to tune out visual artifacts to focus on the "real" image. The process is mostly subconscious, but there is some indication that conscious attention can guide that process since it exists to provide the conscious brain the information it wishes to pay attention to.  Those who panic about the issue are more likely to continue to focus on the halos, and less likely to see them go away.

There is no lens yet that doesn't give someone problematic halos.

re: " I will call them again and let them know the outcome of this lens."

It doesn't hurt to do so, though I don't know that it'll help either rather than being a waste of time since it doesn't provide them any useful information about the statistical prevalence of the issue. To determine that they need controlled studies, and there have been studies, and are more ongoing. 

 

Why can't you have an open mind on whether the studies are to be really beliveved rather than giving the same pitch over and over again.

They are obviosly aware of the issue.  There are enough people that have the issue.  Thier agressive marketing and fee structure to the Docs who push them surely try to minimize any potential negative aspects of the product.  Over all I like the lenses, but the issue of the Circles and Glare are annoying.  It's not the type of product you can return or try another model of so there are no real points of comparison.  For some one who continuall sites "Scienticic study and method" to even mention a "nocebo" effect is absurd.  The effect is real and after four monts has shown zero degree of improvement.  I don't see it magically disappering in the next two months.  If it does...  I'll be happy to report it.  

Thanks for your comments even though it might be waste of time for you but I am a consumer of this product they need to know. Yes they have some extensive studies of this products they really need to tell consumers how other consumers feel and see after this lens inserted.

Regarding my capsular bag yes there is a crease that's why I am seeing this horizontal light, my Doctor said it will be corrected by Yag. I know it's common to some patients.

I am trying not to worry. Neuro adaptation makes me go on with my normal daily life. Yes I can see up close/intermediate with presbyopic sight especially taking care of micro premies. I have to start IV's a lot with their fine hairlike cappilaries and veins.

Halos and starbursts concentric cirlcles are not dimishing. But I am staying positive and go on with my life. Thanks for your comments.

I too had the capsule problem causing the blur in my left eye. The removal of the capsule by way of the YAG takes less than blink of the eye... easy peasy and just had to apply drops for a few days. The glare, starbursts and halos are diminishing week by week. I notice them at night, but they are no longer a bother. Certainly not the trouble that wearing glasses, putting up with scratched lens, having to replace the prescriptions every 2-3 years! 😉

re: "Why can't you have an open mind on whether the studies are to be really beliveved rather than giving the same pitch over and over again."

I've got a background in science, I focus on evidence not anecdotes, and you haven't provided any. Your mere dislike of conclusions doesn't constitute evidence. Those who value science have minds open to evidence, not special pleading.

I just saw one bit claimed bit of evidence on your side yesterday suggesting the issues may be the same as some other newest generation multifocals. However it turns out to be not enough to contradict the weight of all the studies on the other side. It was not only so small it might be a statistical fluke outlier (one group only had 11 patients),  but it turned out that the ages between the different compared lenses were rather different, e.g. the average age in one group was 55.5 while the Symony was 70, and neuroadaptation is better for those younger.  

You may have background in science and have read about lot of studies (as many others have on this site), but unfortunately that is not the same as being open-minded.

re: " The effect is real and after four monts has shown zero degree of improvement.  I don't see it magically disappering in the next two months. "

You seem to not be aware of the concept of neuroadaptation. The brain learns to tune out artifacts over time, it isn't "magic", even if the science isn't well understood yet. Studies show these phenomenon disappear over time in many people, and your inability to imagine that doesn't change that reality. I've seen halos disappear from light sources where I consistently used to see them. 

Those with multifocal IOLs actually have light from two different focal points hit their retina, yet their visual system learns to tune out the out of focus image and use the one that is in focus. It may seem like "magic", but the very fact that *anyone* is happy with a multifocal IOL illustrates neuroadaptation at work. There are hundreds of thousands of people getting them each year, and they wouldn't if the brain weren't able to adapt and tune out unwanted images and focus on the images that are wanted. 

 

re: "For some one who continuall sites "Scienticic study and method" to even mention a "nocebo" effect is absurd. "

Anyone who dismisses the concept of a nocebo needs to learn more about science, even a quick google search explains its a factor that needs to be considered when designing and evaluating medical studies, just as with the placebo effect.

 

Thanks and glad that you feel better and see better. I can't wait to have Yag. I am positive that

Glares, halos, starburst will diminish gradually. But this concentric circle will probably stay. I drive to work at night from 0530 and come home 2000 . I avoid staring red and white headlight.

I felt there's something in the surface of my eye like a foreign body like an eye lash stuck in my cornea this is a part of crease in my capsular bag. Eye drops sometimes help then it comes back. I am hopeful this will be resolved. Thanks for your positive feedback.

Don't do the yag if you need lens exchange you can't! I learned the hard way😢