I have to make a decision for the 2nd eye soon
Posted , 12 users are following.
my left eye has Symfony and i have poor near vision with it and i see lens edge at night due to large pupil. my right eye is constantly tanking.
i am OK to managing dysphotopsia through eye drops and limiting night driving. due to travel restrictions i am leaning towards PanOptix as that is the only one available in US. near vision without glasses is important to me. the near glasses are weird and thick. i am OK to wear distance glasses. ideally near vision from 30 to 60 cm would be important without glasses.
i would later decide whether to get symfony exchanged with other PanOptix or not. holding off YAG for that.
my concerns are:
PanOptix lens scratching while implantation.
glistening?? what does it even mean.
not having enough near with PanOptix. i want to be able to shave without glasses.
yellow tint PanOptix and non tinted Symfony.
i would have liked a 7mm multifocal but they only have a 7mm monofocal.
0 likes, 34 replies
Kel76 soks
Posted
speaking of edof lenses i think the vivity is better then the symfony , but i am not sure how long you are willing to wait for that lens. my surgeon has much better statistics with the vivity then with the symfony specially in comparing sideeffects, so the vivity seems to fulfill what an edof lens should be about. vivity seems really without the common sideeffects of an multifocal lens and i would sign that , too.
as you have seen in my vivity thread i have a very good near vision for an edof lense, but this results maybe on the fact that i am a little undercorrected.
so in your case hitting the right amount of power for your lense is crucial to become a good near vision, but this isnt as easy calculated as i thought, at least the effect on my operation wasnt planned at all.
so mostly your decision should be about a secure results regarding near vision without glasses (panoptix) or to maybe still need glasses for near vision closer than 40-30cm but lesser sideeffects and a little better contrast and quality of vision (vivity).
so if you cant wait for vivity, i would go for panoptixs. i wouldnt get another symfony for two reasons, most studies show that the sideeffects are similiar to panoptixs and second in your personal case the lens doesnt provide the perfect outcome for you.
glistening is some kind of optical effect in bright light from a trifocal, but never really heard of it
Sue.An2 soks
Edited
A hard decision soks. I wish you well no matter what you decide. Hopefully 2nd surgery is better and pupil doesn't dilate beyond IOL.
marc14910 soks
Posted
I exchanged my Symfony for a mono-vision last spring. I'm very happy with it.
soks marc14910
Posted
how long after initial implantation due u exchange symfony
rwbil soks
Posted
I cannot believe the moderator deleted my nice long post. Only thing I can figure is I had links to articles related to the lenses. Are links not allowed?
I am going through the same situation as I had the Tecnis MF Low Add (2.75) put in my left eye and now need to do my right eye. Overall I am happy with the Tecnis MF, but the splittig of the light does cause more darkness at night and I have a hard problem driving at night.
Not going to retype everything, but I one of the things I asked is have you looked at the new Tecnis Symfony Plus, the ZHR00 lens. It is supposed to have closer near and less dysphoria. Maybe also using micro monovison might give better close. Probably would not solve your lens edge at night due to large pupil problem.
The other possbility is the new Vivity Lens. It is not defractive and no light splitting. It is hard to get a lot of good information, but someone here got it and posted their response and they seem to get sharp vision as close as 14" away.
soks rwbil
Posted
hi rwbil
lens edge is a foregone conclusion for me. when i use alphagan drops to address it the pupil size decreases causing more darkness. but the edge glare is gone.
i saw symfony plus zhr00. but if it is only giving +0.5 near then that is not much difference to the symfony. it is fda approved but not yet launched anywhere.
vivity will not have halos and other night effects. it will not resolve my lens edge. i don't think it gives good near to everyone. there is only a certain slope you can achieve in 6mm radius iol. so steep drops are required to give better near.
before panoptix local surgeon told me that people not happy with symfony near get a tecnis MF,
rwbil soks
Posted
One concern I have with mixing lens is if the right and left eye images are not close enough how the brain will handle that.
If Symfony did what it original claimed to do and that was provide EDOF with the same level of dysphotapsias as a monofocal, I would be all in on that, but from what I read people get spider webs and other issues and it still seems to have 2 main points of focus. I would provide a link to a presentation on that except that seems not to be allowed.
Some articles I read make it sound like the PanOptix actual has less halos and the like, but I find that hard to believe as would it not be splitting the light even more.
Patrick Versace a doctor that has a youtube video claims the Femtis EDOF is the best of the best, but you never know if he is affliated with that company or not and maybe a bit biased. His video talks about most of the premium lens so you might check it out. Of course you would have to go outside the US for that lens.
I tell you one of the greatest inventions ever would be a realistic simulator where you could see how the different lens would work in your eyes before getting surgery to find out. It is so sad the only way you can really tell is get the surgery and see what happens.
One well know clinical and article writing Dr. told me I should get the new Light Adjustable lens. I know they are doing some tricks with that lens like MF, but mostly it is just being used as a monofocal. I guess you at least will nail Plano or whatever your goal is.
Keep us updated with your decision and results.
I am going to see an Ophthalmologist that did a clinical trial with the Symfony Plus and get his opinion. I know he has also implanted the other Tecnis Premium IOLs so he should have real world results. It is very hard to find a Dr. that is familiar with them all especially in the US.
One last question. Do you know if there is much difference in the Tecnis Enyhance and the IQ Vivity as far as close vision and dysphotapsias.
soks rwbil
Posted
concern about mixing lenses is a valid one. with one symfony and one cataract eye the brain is choosing the symfony image from my non-dominant eye. the only problem is at night when it chooses the worst of both.
symfony dysphotopsia for me is a blur light halo around the light source. the yellow street lights and new car led lights shows the concentric circles but those are not that bothersome. as you get close to the light source they are replaced by the blur circular halo. starburst are also there with symfony for headlights and some other lights. in addition i have the lens glare that lights up the whole lens.
i am beginning to believe that trifocals have leas halos. splitting light only makes them a bit darker especially in the dark. my symfony eye is darker than my natural eye in the dark.
"I tell you one of the greatest inventions ever would be a realistic simulator where you could see how the different lens would work in your eyes before getting surgery to find out" --100% agree. they use something called virtiol in non clinical trials but not available to public. zeiss mentions it in their lara brochure. another greatest invention would be a 7mm trifocal.
steve safran who is the lens exchange expert in NJ told me about the symfony plus and he said i could wait for them if i wanted better near. but i would like to see their defocus curve first. also at the time panoptix had not launched.
vivity advertises itself as edof while eyhance does not. vivity may be better at intermediate than eyhance but defocus curve comparison would be helpful to compare them.
RonAKA rwbil
Posted
No for some reason you are not allowed to post links here. Too bad, because I think it really limits the value of this forum. What you can do is post the exact name of an article and author so others can search for it with Google. Clumsy but it usually works.
RonAKA rwbil
Posted
"I tell you one of the greatest inventions ever would be a realistic simulator where you could see how the different lens would work in your eyes before getting surgery to find out. "
Yes, that would be something worthwhile. To some degree you can simulate monovision by using contacts, but that depends on how well you can see with the natural lens prior to making the decision. As far as simulating the EDOF and MF lenses that does not seem currently possible. There are similar ideas in contacts but how well they would simulate an IOL would be questionable.
Sue.An2 rwbil
Posted
i think we'd all love to have an advance view for the various types of IOLs. It may create disappointment if reality doesn't meet that expectation it would create . There are variables that cannot be controlled - astigmatism, settling of the lens, refraction error.
rwbil soks
Posted
Soks,
I just saw an article on the RX Light Adjustable lens, but the interesting part was it being used as an EDOF.
Sadly no link allowed but if you google I found this at their site:
"RxSight also has been able to demonstrate extended depth of focus (EDOF) with postoperative adjustability. In 18 patients, or 36 eyes, given EDOF adjustment at the Codet Eye Institute, 100 percent achieved 20/20 UCDVA or better, 100 percent 20/20 UCIVA or better, and 100 percent 20/25
UCNVA or better. This EDOF treatment is approved in Europe and Mexico, and a US investigational device exemption (IDE) is
underway."
I don't know if there are halos or so forth or what makes this EDOF different from other EDOFs, but on first glance those are impressive numbers. I mean 20/20 at both distance and intermediate and 20/25 at near is impressive, but 18 patients is not a lot.
I will see if I can find more information on this and keep you posted.
soks rwbil
Posted
light adjustable iols help with avoiding refraction error. it would be good to know how they are able to provide that good visual acuity at 3 distances with an edof. and yes u need at least 30 random readings for a significant sample.
rwbil soks
Edited
I searched and can find virtual no information on it. I am no expert but if this lens allowed EDOF and then you could even make adjustment like monovision to get more close and try that and then if you did not like that could go to trifocal and if not like that go back to monofocal. If it does all that it is transformational.
But who really know what was done with those 18 patients, maybe they were given monovision to get that good of close vision. You never know the "Whole" Truth until many Opthamalogist are performing it and reporting results and that could be awhile.
But having said that, it is hard to imagine how it could do a better job at EDOF than an IOL specifically designed for that purpose. I would not want it if it created a pinhole effect like IC8, as I have read some bad results with that lens.
It would really be nice to find an Opthamalogist that has done it all. I am talking LAL as EDOF. Symphony, Trifocal, Vivity and had real results with many patience, but most seem to just seem to be narrowly focused.
Right now I am leaning towards Symfony Plus to go with my Tecnis MF, but want to get more information on the Vivity. I want to avoid another lens that splits the light, but have not ruled out the trifocal yet.
soks rwbil
Posted
i am leaning symfony plus or synergy to go with my symfony. i think vivity will fall short for near for me.
for LAL i dont know if it would be anone time post op adjustment or you could adjust it multiple times.