Have an appointment tomorrow with highly regarded Cataract Dr... any suggestions.

Sounds like you had a good in-depth consultation.  I live in Canada so not much experience with your choices of surgical units.  I do have 2 Symfony lenses though.  I am just wondering about Dr Tal Raviv’s comment that the Symfony lenses are better now.  Not sure what he meant except surgeons may now have more experience with them in getting the power calculation better as well as patient selection but to my knowledge the lens itself has not changed.  Just be prepared for the concentric circles - as far as I know everyone does see them as they are part it the lens design.

I do have good vision with them from 11 inches beyond.  Good light is essential - but I can read even J1 type on Snellen chart.  Given options today I would still choose them even knowing about the night time visuals.  At 53 I work full time and am very active - that played a big part too in my decision.

Wish you all the best.  Keep us updated.

Thanks for sharing. I would be interested in knowing what surgery center you choose. 

During the surgery he showed me the picture of the circles around street light.  The earlier optometrist also said that all the reported side effects can happen. 

The power calculations for Symfony are same as Technis monofocal with IOL master so I don't think much would have changed there. 

Likely not Soks - just curious what was meant by Symfony lenses are much improved.   Thinking it must be the calculations, technique etc that’s improved.  

Sounded to me like there is an improvement in the lens design itself. I did not question the doctors comment after I asked about halos /starbursts. But I may contact Abbott & see if that is confirmed?

Sue when you say you need good light... does that mean you have problems in normal room light or driving at night? How are colors viewed?

In normal lit rooms or daylight I see just fine and can read.  In low lighting conditions (upscale restaurants) I have difficulty reading the menu.  Use the flashlight on my iPhone in those situations.  There is as much as a 15% reduction in contrast with an IOL - sometimes 20% with a multifocal lens (Symfony is an EDOF lens so more like a monofocal when it comes to contrast) .

Colours I think are natural and normal however my cataracts caused everything to have a yellow/Brown tint.  This was especially noticeable after first operation when I could compare.  Colours were especially bright with Symfony.  But that is also when I compared reading in low lit conditions.  In low light my naturalneye could read whereas I need e tea lighting with Symfony eye.

I am not sure if you call Abbott if they’d admit Symfony causes halos (concentric rings) around certain light sources - they didn’t mention them even after trials.  Perhaps their subjects didn’t drive much.  But at 53 I work still full time and drive plenty at night.  Living in Canada it is dark driving home after work November to February.

The rings are visible on the Symfony lenses - what provides the elongated focus (like a camera) so I am not sure how that design changed in the year since I was implanted with them.

Do t want to alarm you but if you are opting for them thinking you won’t see the concentric circles you may be quite annoyed with your doctor for not being forthright about it.  There is a compromise as far as I am concerned when choosing g to be more glasses independent.

Dennis you may want to check out the newer posts here of those who’ve received Symfonylenses - all are saying they do see the concentric circles.  Those of us who are happy though with Symfony experience very good all round vision so the trade-off of night vision deemed worth it.  If the all round great vision not achieved - it just adds to a person’s dissatisfaction with the lenses.

I really want you to be aware of these concentric circles that appear at dusk and night time around certain light sources. Starting at 50 yards or so and then disappear as you get nearer the light source.  If you are going on the words of your doctor then you may be disappointed.   Again I am very happy with Symfony lenses but they aren’t perfect due to the concentric circles.  I do drive at night and have been able to adapt.  Given choices of lenses available today in Canada I would still choose them.  But have to be frank - I am a little perturbed by surgeons underplaying the night time halos.   And you are paying $6K (not sure if that is one eye or both).  In Canada everything was covered and I paid the difference between a monofocal and Symfony Lens ($900 Canadian - at today’s exchange rate is 28% less than USD).  With the kind of money you are paying I would want the surgeon to be motivated by more than money and inform me of the pros and cons of the IOLs.

Again not trying to alarm you but do want you to be fully aware of Symfony’s night time halos.  My own surgeon didn’t relay the huge concentric circles but did take the time to say there is a compromise to make with Symfony lenses and there were more halos than a monofocal.  In fact he met with me twice prior to surgery which was unusual for Canada as our Medicare system although generous doesn’t allow for a lot of consult time.  He said at the age I am I will be somewhat unhappy and it will be a compromise no matter which lens I chose.  For older patients who’ve experienced a lot of vision decline they gain something lost years ago but someone in their early 50’s and myself who was not experiencing presbyopia yet I would have to choose what to lose.

He never once pushed me towards a monofocal or a premium lens.  I will say after my 2nd surgery at 24 hour post op when he handed me the reading chart and I could read all the way to smallest print (I had tears in my eyes) and he was very pleased with the result and he commented he knew how hard the decision was for me and he was exact same age as myself he would have made same lens choice.  But he did remind me before I left the hospital that I would see halos at night and to give it time as it would get better.

I would much rather make a decision with all the facts than be bitter afterwards and wonder why no one said anything.

Thankfully you’ve come on the forums and gained  some insight prior to surgery.  

If you’d like info from another top cataract and cornea specialist in Singapore I encourage you to google Dr Por Yong Ming (cannot paste links here) but google him and Symfony Lens as he has a specific blog about that lens as well as others and after blog you can post a question - he answers these himself.  But he does talk about drop in contrast and halos.  Here is a copy and paste of a few of his comments:

2. Because of light sitting there is a drop in contrast compared with a monofocal lens. Patients with multifocal lenses tend to be more sensitive to low light conditions-ie when it starts to get a little dark, they start to feel the drop in vision faster than patients with monofocal lenses. A person with a monofocal lens and reading glasses could read in dimmer conditions than a person with a multifocal lens.

3. The rings on the IOL give rings of light (halos) around light sources. This can be an issue when driving at night because of the halos around car headlamps. Having said this, many patients get used to the halos and do not notice it as much after a time.

Last but not least, there is the Symfony lens which I covered in my last post. As mentioned, this is an 'in between' lens, ie in between a monofocal and a multifocal. It has no intermediate vision problems, and less halos than the usual multifocals, but does not give quite as good very near vision.

Currently, I offer patients a choice between a monofocal, an in between lens like the Symfony, and a full fledged trifocal like the AT LISA tri. I believe there is little to no benefit to be gained from using older bifocals such as the Restor and Tecnis Multifocal currently. Exactly which of those 3 choices gets implanted comes after a careful discussion with my patient regarding the pros and cons of each option. (So that we get big smiles all round afterwards!)

I don't think the Symfony lens has improved either.  I don't know why Dr. Raviv may have said that.  

My ZXR00 IOL (Symfony) calculation is the same as my ZCB00 IOL (Technis Aspheric Monofocal) calculation at 16D.  Hence I think that the calculation do not vary for Technis.

On another note, Dr. Por Ming indicated that Zeiss IOLs have higher PCO rates and also the plate haptic shape does not fit all capsules.

That is the Lara & Lisa have higher PCO rates? Guess all IOL's have compromises from your original

natural eyes.

Guess everyone facing cataract surgery faces a compromise.  And I am pretty certain there has not been an improvement in the Symfony Lens.  There are a number even here on the forums who recently had them implanted that see the concentric circles.

Thats true Dennis. Wish there was a way they could determine before hand that a Monofocal will give you near, intermediate and far  like some have reported. 

Else the multi/EDoF has longer range but night time artifacts. 

How bad age the circles and that too when there are many light sources?  

The circles will probably be an improvement on my current night time light mushrooms. 

I too had trouble with cataracts with glare and halos - driving at night was becoming a problem so I know what you mean.

The concentric circles don’t appear around every light source - I haven’t experienced them inside my home.   They are big - from traffic lights they extend to the ground but as car gets nearer the circles get smaller and then when car is stopped at light they disappear.   They also do t appear on every light.  Car brakes for example when I am travelling behind vehicles don’t have the circles but if the driver applies the brakes I do see them.  I don’t see them around overhead streetlights either.  

You will notice them but as time passes you get used to seeing them and tune them out.

I know it’s a hard choice to make.  I guess I figure my time is spent more in other activities vs driving at night so would rather see better most of the time.   Really individual choice and each person may place a different preference on that.  I do think though no matter which you decide - most people get satisfactory results and you will adapt.  I honestly think there is more than one right solution.

Well put, Sue.An. I think part of the problem is that there are docs who will gloss over the nightly things while extolling the benefits. It's totally up to us to decide whether or not the risks outweigh the benefits. For me, the vision headaches and 1001 other problems made life hell. It was worth the risk. For others, maybe work won't allow necessary compromises. Regardless, you're absolutely right when you say we learn to adapt. I'm so thankful we live in a time when cataract surgery doesn't mean coke bottle glasses!

soks, have you contacted contact Dr Y.M. Por or read about his comments on Zeiss IOLs having higher PCO rates etc. Because when I first came across it I was quite doubtful, as the source was from China Yunan (province) Kunming (city) Medical University, 1st affiliate, Ophthalmology Hospital.

Seeing the amazing results of bK and her husband, and the good feedback here from Nz and possibly Jn, Zeiss IOLs are quite promising.

The same source also mentions that FINeVision IOLs and Mini WELL IOLs are perhaps more suitable for those  requiring a lot of night driving. Those with a love for reading, gardening or requiring long hours spent on computers, then LISA tri, AcrySof IQ PanOptix are good choice. Those with very high myopia, the choice of large diameter IOLs should be considered.

I contacted him. 

Jantje@  see your direct messages. 

DO NOT THINK LISA IS AVAILABLE IN USA... amazing how long these IOLs take for approval.

I do not think atLISA or atLATA will be approved in Canada any time soon.  There are some lenses offered elsewhere that may never be FDA approved in Canada or USA.  I suppose if money is not an issue  one can travel (as one does for other medical conditions.  Have a friend that went to Europe for MS treatment who was much better for a number of years.  But now that she’s in need of medical treatment doctors here won’t get involved as what she had done was not approved here).

Again everyone has to decide what’s best for them, with knowledge and funds they have.   But there are no guarantees all works out.

I would not travel to another country or more than 100 miles for this procedure. 2 years ago people were traveling to other countries to get the Symfony. There will always be something better in the future.i feel it is good to have original surgeon close by if needed.

Sue.An, I skimmed through info relating to Zeiss IOLs by chance, as I am now aware that after cataract surgery(ies) one could still develop PCO or RD. Scary.

Hi denniss39810, I really like atLISA's specifications, but 2 studies (done in Czech and Madrid Spain) confirmed the Nd:YAG capsulotomy rate of 33% and reaching a probability of 35% for eyes with a follow-up of 34 to 44 months. It seems that neither Zeiss IOLs nor any other trifocal lenses are available in the US.  Potvin R  (Science in Vision, Akron, NY, USA) and another Ophthalmologist from Norway concluded that PanOptix is the winner, as it has better intermediate vision at 60 cm. "This may be important to users of tablets and other handheld devices." How did Dr Potvin came to this conclusion unless he has been implanting PX or FV on his US patients?

My surgeon said 25% of his patients experience PCO after cataract surgery (I have read sites where that percentage is much higher).  

The PCO rate is 40%. So 33% would be lower than average. 

Is there something I could do to prevent it? I get tired so easily that I find myself compressing my thoughts in half-a-sentence that often does not make sense or distorts the meaning. Last night while watching a concert on DVD for the umpteenth times, I saw the audiences beaming red light emitting devices at the musicians on stage. Then I heard my husband said those were "heart-shaped" toys. .. shock .. the devil is in the detail (Symfony)!

Unfortunately there is no way to prevent PCO as far as I am aware.  IOLs with a square edge do a better job at preventing it than round edge IOLs however there is higher incidence of edge glare with square edge IOLs than round ones.  I know Symfony has a square edge.  My surgeon did say younger patients will tend to have more incidences of PCO than older patients just because as one ages things grow at a slower pace or hardly at all (which I know from my family doctor when I was dealing with skin cancer.)

So don’t worry about whether it will or won’t happen.  I am a year out and don’t think I have any PVO.  I will see my regular optometrist in January and ask her about it.   

They say YAG is simple, uncomplicated procedure - but then again some here on the forums who have had it said their eyesight is worse afterwards not better - so that does make me worry a bit.

I had a routine non-dilated eye exam last week by my ophthalmologist and I asked him if he could check for any PCO with my right eye.  He looked with the slit lamp and said it had only a very slight PCO after 9 months since the surgery.  Far too little to consider YAG, so apparently its normal to get slight PCO and it might take many years if ever for it to get to a significant enough level where they would consider the YAG procedure.  But its good to know the eye doctor can check for it if you ask them at each eye exam to monitor it.  I personally would avoid the YAG as much as possible.

Yes, that LISA and LARA have higher PCO rates. 

Did you research between NYEE and the retinal ambulatory center?

Found minimal info & no ratings on ambulatory center. They do not have a direct web site. Seems that a group of ophthalmologists created the center in same building as their practice. NYEE had real bad ratings for walk in eye emergency procedures... much better for patients with pre-appointments with their Dr's. On the paper work they gave me from Dr Raviv's office- said if you have emergency go to NYEE. Dr Raviv does about 10 surgeries a day. Hoping all will be OK with Dr Raviv & NYEE so I booked NYEE which seemed to be my best choice.

What date did you book?  I may book there too. 

Also, how old are you?

Booked Aug 17th... you must be near NYC... if I knew how to send you a private message we can talk on phone.