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

Thanks for letting everyone know about the latest Medscape article, concluding that the Symfony lens resulted in similar patient rating of halos as the multifocal lenses. Based on the experience of many  people on this post (and the fact Symfony lens has another design feature which could cause halos) I expected the halos for the Symfony lens to be worse than those seen with the monofocal lenses, but did not expect them to come out nearly as bad as the multifocal lenses. This is definitely a different conclusion than in the original studies for the Symfony lens.

As I already noted regarding this, that study has only ten patients in one of the groups, the age of one of the groups is 55.5, while the Symfony patients average age is 70. It is too small to be of any use at all in distinguishing between the incidence of halos between those IOLs, and the comparison lenses are among comparatively recent IOLs with among the lowest incidence of halos to begin with. Statistically its not meaningful, in addition to being a poorly designed study. Seriously, they choose patients with 15 year age difference on average, and only 10 patients in one of the groups? Younger people neuroadapt better than older folks (even if older folks do have less sensitivity to light). Studies like this only can broadly confirm things like getting vaguely in the same range as large studies. They can also be inadvertently cherry picked, if there were 10 other small studies done at small clinics that showed nothing new, then this was picked because it seemed different. 

Just not willing to admit that the Symfony lens can have more night vision issues than monofocal lenses. Amazing!

Maybe he's trying to get a job for Abbott Labs.... Or doing PR for Trump!  :-)

 

re: "Amazing!"

What is amazingly unfortunate is that they don't teach people in school about the basics of examining studies and experimental results, given how commonly they are reported in the media.

The study itself  refers to "eyes", but its patients that neuroadapt. Having 10 eyes in one study group each added 1 patient having an issue is a change of 10% (if both eyes are operated on each), statistical fluctuations on such small groups render the result not statistically meaningful, with such large error bars,  if they'd also had a monfocal control lens  there is a good chance the  difference with that wouldn't be statistically significant either. The fact that the patient demographics are so different on top of the size makes it not too useful a study in terms of visual artifacts. The visual acuity results may be somewhat useful even if its still small, unlike the visual artifact results, but when differences aren't statistically significant they don't mean anything useful. (and due to patient variations, may be more about that than the IOLs).

I'm hoping the surgical results (e.g. residual refractive error) are at least the same between the groups, but its possible the ages vary because they were done by different surgeons in different practices with different patient demographics, in which case the surgical results may also vary which impacts visual acuity and night vision artifact results.

That was a study presented at a conference. Such small studies are useful to generally confirm that the large studies are in the right ballpark, which is what I look to them for. If you saw a few small studies with visual acuity results rather different than the large studies, that would tend to make one wonder, but the studies tend to all be in the same ballpark (with small studies,  a study or two out of a dozen would likely indicate statistical change rather than any suggestion of an issue). Unfortunately in terms of visual artifacts that aren't common, such studies aren't that useful in terms of determing statistical prevalence, they are fairly meaningless.

 

oops, I meant having 10 patients in one study group (20 eyes or less) means each added patient having an issue is a change of 10%, and statistical fluctuations in outcomes impact such a small study and make it rather useless in terms of  night vision artifact assessment.

re: "Or doing PR for Trump!  "

I voted against Trump, and you seem to have that backwards anyway, its Trump that would be basing his views on anecdotes and having trouble understanding scientific studies and what they mean, when they are outliers from large studies and not large enough to be meaningful.

Another long pitch trying to explain away the untenanble position!

There is is nothing wrong with people not being interested enough in science and math to understand them. What is unfortunate is when people mindlessly disparage what they don't understand and pretend as though their views based on anedotes should be taken mores seriously by others than actual studies.  Those who actually value science grasp its important to evaluate the strength of studies, not merely whether they say something you wish to believe or not. You disparage multiple large studies that say things you don't wish to believe,  then when a flawed small study appears you latch onto it, which isn't the rational way to deal with the existence of competing studies. When at study only has 10 patients, and a phenomenon is indicated by large studies to occur only a few % of the time, the small study really can't say much useful about the issue regardless of the results.  It is your attachment to anecdotes rather than science that is "untenable" from the perspctive of those who support science based medicine rather than pre-scientific superstitions and intuitions.

 

Another long rant from someone not willing to change his mind. And let us not start comparing our backgrounds in Science and Mathematics!

The point is that there is no reason to change my mind when I've not been presented with logic and evidence to do so. If you have a background in science, your comments don't indicate an understanding of the basics. Unfortunately some folks are taught the results of the work scientists do, but not the process to evaluate science that is a work in progress, for instance competing stuides.

 

Then let us agree to disagree, which I have suggested many a times before, but you keep trying to act as if you are the only smart one.

Looking back at my quick response to your post yesterday, I should have spent more time addressing some of the statements made by you during the last few days before my suggesting that “let us agree to disagree”.

Firstly, you have a right to think that you have a “superior” brain, but you should not be insulting the intelligence of other people (such as Diverebb or me) on this post. I am sure that we are as intelligent and have as much as scientific background as you have. We can think as logically as you think you can. So, let us stop going there.

Secondly, we know that you have complete faith in the original studies conducted for Abbott during the Symfony lens certification, which seemed to have showed that the night vision issues associated with Symfony to be not any worse than the monofocal lenses. Obviously, I also got fooled by the results of those studies before I decided to have the Symfony toric lens for my eye. Looking back, it is not surprising (at least to some of us) that the conclusions of that study were too good to be true, and were in contradiction of the fact the basic design features of Symfony introduce a new mechanism for creating multiple circles or halos around lights (without any feature to reduce the glare associated with Technis monofocal lenses). Thus, the results of the study were suspect, probably because of the inherent bias in the manufacturer (and the associated doctors) studies.

More and more people at this site have come forward to tell us of the night vision issues, such as the unique multiple circles or halos, associated with the Symfony lens. Now, a new study done by surgeons in Germany and published on the Medscape web site on May 9, 2017, concludes that the patients in Symfony lens may see halos as troubling as the the multifocal IOLs (which unarguably cause more halos than the monofocal lenses).

All these experiences and the Germany study results published in the Medscape should raise the red flags about the results of the original Abbott study during Symfony certification.

However, it seems that instead of recognizing that there may be an issue with the original studies, you have simply chosen to belittle the night vision issues of the people on this site again and again by calling those highly unusual and now to ignore the German study results by saying that it did not have enough people. What is most surprising is that all these night vision issues of the people and the German study results have not made the slightest change in your thinking! No, in my way of thinking, that is not the result of a good scientific thinking.

Any way, please take a step back and really think about your position on this issue. Also, any time someone shares his / her bad night vision experience with the Symfony lens, let us not jump in with the same pitch on how rare this issue is and how wonderful Symfony lens is. Symfony lens is good but not as good as originally advertised to be.

Hi SD - just a word of thanks for all your input on Symfony lenses. Although we have differing opinions I do thank you for being a balance to negative and positive outcomes. Just had 1st Symfony lens implanted yesterday and do far do good. Just saw my surgeon today post op. He is pleased with my outcome. Could read at 20/20. He said once 2nd eye done it would easier to read. Colours are different between 2 eyes so can't help compare them. Haven't yet gone outside at night so not sure if I have concentric circles glare and halos to look forward to. That may be the compromise but sure is terrific to see well during daylight hours.

I saw him on another site arguing with an opthalmologist who volunteers his time to post on the site! Unbelievable!

IMO he either works for Abbott or has LOTS of stock in the company.

Too funny

I know, right? The doctor just gave up and stopped responding to him lol.

I also got very frustrated with trying to convince him that the Symfony lenses have more issues than reported in the the original studies done for Abbott. Unfortunately, one can't always trust the studies funded by the medical suppliers, when there is a lot of money riding on the published results of the studies.

Companies go to great lengths to bias results of testing to the positive side.  Down playing the potential negatives of this lens is a prime example.  The Doc I used really pushed this lens too.  I am sure he also makes a lot more money on each pair he sells.  While the lenses are good.... For over five thousand dollars plus what the insurance companies pay, they should be darn near perfect!

Oh for sure, in the US they're pushing the premium IOLs the same way they push refractive eye surgery like LASIK, PRK, LASEK, refractive lens exchange (RLE) regardless of whatever complications someone may have from any of those either right away or in the future. Can you say cha-ching ($$$$)?

Just my two cents as I have seen the arguments going back and forth with softwaredev and I think both sides are correct to a point but I agree with you that the Symfony marketing is deceptive and I think that is most likely intentional due to greed and unethical behavior.  While we may be the unfortunate minority that have these night vision issues, a logical person will read the literature and conclude "better range of vision with a similar incidence of halos compared to other multifocal lens" makes it a no brainer to implant Symfony.  The flaw that softwaredev seems to refuse to acknowledge is that what we are seeing is apparently much worse than with the other lenses--it is not an issue of frequency but of severity. Had I known that and been properly informed, I probably would have picked accommodating lenses with better nighttime vision and would have risked wearing glasses for reading rather than having my nighttime vision ruined.  It has been 16 months since I had it implanted and the rings are no better than the day after surgery after being told repeatedly "they will get better over time" and "use more eyedrops".  Nightime vision inside and outside for me is a very negative, disturbing experience and the only time I get emotional relief is during the daytime when I can tolerate this IOL.  I still don't know what to do--have the lens swapped out at considerable cost and risk, double down and hope that Symfony in both eyes will somehow improve the outcome, try a distance monofocal in the other eye, or just live with it as-is and hope for some breakthrough lens to come on the market sometime in the near future.  I know there is no perfect solution and I can live with the fact that I may have been in the unlucky minority with my negative outcome but saying what we see is no different from what others see with other IOLs is an egregious injustice.  If I had the time and money I would go after Abbott, the people that did these flawed studies and approvals, and the unethical doctors out there that profit from these at the expense of trusting, unsuspecting misinformed patients.

Thanks for sharing your experience with the Symfony lens, which seems to be very similar to mine. I have not seen any change in seeing the multiple circles around lights at night since getting the Symfony lens in my right eye about 15 months back.

Actually, if I remember right, at the time I was looking seriously at the Symfony lens, the Symfony lens was being touted as providing

"better range of vision with a similar incidence of halos as the monofocal lenses"

and thus much better than implied by

"better range of vision with a similar incidence of halos compared to other multifocal lens"

I like to think that with forums such as these, people are more informed about the pros and cons of the Symfony lens so that they can make a better choice for themselves.

I've had them in both eyes for over a year now....  Both eyes are identical as far as the rings and glare.  I wouldn't expect a second one to be any different than the first.  If it is truly limited as to the number of people experiencing this problem you might think that Abbott would know why and be able to tell this group not to use their lenses.

There will always be halos with any multifocal or edof lens.There are vision simulators on the web.Drs must choose patients carefully for them or just offer a set focus lens.Personally i love my vision with the symfony.Night driving offers 20/20 clarity a d i see past any car halo effects.Plenty of light offers very good close vision as well.

I was told the perfect lens has not been invented yet.I do not think Big Lens Maker is out to rip me off.I am grateful my blurry cataracts are gone and vision is fresh and bright.

I did warn my dr about the people complaining on these forums.I suggested he just offer  monofocal lenses to anyone who seems difficult to p,ease.Make his life easier.

I too am pleased with the Symfony lenses.  I knew about the compromises from my doctor and read about them here on these forums.  It was a compromise I was willing to make.  Needed good vision for my job and didn’t want multiple glasses to do it well.  Couldn’t risk losing near and intermediate vision.  I will always likely see the spider webs but have adjusted and do drive at night.  You’re right no perfect lens out there so no matter which lens I chose I would need to compromise and my doctor made sure I understood that.

It’s a shame more doctors don’t have fuller conversations with their patients whether it is motivated by greed or time I don’t know.  They need to match lenses with right patients.  But there is also plenty of tools and info on the net.  people that want to know find that info.  Yes onus on doctors who took oaths to do no harm but there is a responsibility for individuals to do their own digging too for answers.  As soon as I was diagnosed at 53  and shock wore off I started researching.  Glad I did.

I guess if my daytime vision didn’t meet my expectations I would upset and say differently.  

Even if less than 1% have these symptoms, if they implant 500K of these that is still up to 5000 people impacted.  I still think most people would play those odds and still choose it, but if they described it like we have here (10 bright rings radiating out 5-10 feet or more from most light sources), I think people would think twice which is probably why they bury that info.  Anyway, what is in your other eye?  I just think that it would be easier for the brain to adapt to both eyes seeing the same way than mixing lenses or only having one eye done.  When my IOL eye is sharp, the other is usually blurry and vice versa.  At least I found a good doctor that says he never recommends these to people who pay attention to detail like doctors, engineers, and pilots as he finds they have a harder time adjusting.  I appreciate he doesn't label them perfectionists or difficult to please like many others do.  It has been a year since I saw him so I may add a comment/update when I go back soon.

Did your vision improve at least when you had the second eye done?  Even if the rings didn't improve, hopefully you feel like they work better together.

where are these vision simulators--I only see ones that show diseases not different types of IOLs.  If my doctor had told me there will always be halos with these that don't go away, I probably would have gone with monofocals.  Only after did I learn that others have screening questionaires to identify certain personalities that may have a harder time with premium IOLs.  Furthermore, my vision was not bad prior to this so it seems worse now to me than someone who had poor vision to start and feels that almost anything would be an improvement.

Even the Abbott site does not pretend that the number is as low as 1% for the night vision issues. Without making a distinction between the different types of halos associated with different lenses or a distinction between no or mild halos, they just stated that 85% of people had no or mild halos.

And seeing multiple circles or halos around lights at night has nothing to do with seeing more detail; it is about seeing things like large spider webs around lights, when no such thing exists in real life

John I think you hit on something important.   Your vision prior to this surgery was pretty good so I assume (maybe wrongly) but you may have had this surgery to be less glasses dependant?   This is one of the main reasons I am so against clear lens exchange - I think these patients are more than others lured by the promise of better eyesight without glasses due to greed of that industry.  Lately I have commented on their ads that pop up on Facebook and comment on them.  

I am sorry if you were deceived by this type of marketing.

You are right those of us (me included) had poor eyesight due to cataracts so we see an improvement whereas if you compared to good eyesight IOLs may sadly come up short.  Possibly accounting for some of the differences in opinions here on the forums.

I use an ipad.In the App store is the Technis family of Iols.It shows various outcomes of various lenses.

The symfony was just approved in usa when i got it..I had researched it myself having had retinal surgery and subsequent  cataract.Was told multi focal was not wise.My own research of clinical trials pointed out symfony worked quite well for those with mild retina issues,

My dr asked me if i would let prospective patients talk to me about my experiences.Many people getting cataracts are older and do not drive that much at night anymore..I told them about halos, reading in bright light etc..I said if very fussy really think over halos..I know people who cannot tolerate anything like that..

In any case just getting surgery without  the blur from cataracts may be a disappointment.I daw halos and worse on headlights prior to surgery  so everything is a big improvement.Ha ing 20/20 vision is a pleasure

I went to a big eye dept in a major hospital and between retina and cataracts had over 20 visits with measurements taken each time. y dr was very concerned i was comfortable with results.I know lenses can be exchanged if people are unhappy..However not sure how it works outside usa where there is a national health service.

I do know neither my dr nor his colleages are interested in getting rich by deceiving me.Rather tney tend to people who do not see well from macular degeneration,  ornea issues and many horrible things.I am glad he is there.

The clinical trials initially were in europe.Most patients had significant cataracts and were older.I, too can report though i see galos they do not bother me compared to those from cataracts.

i must add this is a difficult site to use.Replies are all over the place and i find it hard to fix typos without it suddenly being sent.Replies from an hour ago are mixed in with months ago..

Yes.... Vision improved with the second implant....  Not the night stuff.... but over all.