Is Symphony for me?

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I have uncorrected vision of 20/380, and a retinal detachement of 1/4 of one eye.  I now have minimal cataracts which do not permit my Optometrist to correct to 20/20.  The eye surgeon gave me 4 options of lenses to insert; symphony is one.  I also l do a lot of photography.  My question is with that large of a correction will the Symphony really give a full depth of field, and how much is compormised in dark light or foggy times?  Has anyone had difficulty driving at night or in foggy conditions?

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  • Posted

    I don't believe that by itself, the large amount of correction will directly affect the depth of field provided by a monofocal lens or a Symfony lens. The Symfony lens will provide more depth of field than the monofocal lens, but has a higher chance of causing night vision issues than a monofocal lens. Thus, you should consider these factors with your surgeon to select what option is best for you.

    I have a Symfony Toric lens in my right eye for distance and a monofocal lens in my left eye for close-up. With this combination, I have good day vision at all distances beyond 16 inches. However, I wish that my night vision were better, the main issue being the seeing of multiple concentric circles or halos around lights at night time. Many other people seem to have had the same issue. Rather than repeating the details here, I will encourage you to read my post, “Has Any One Else Had This Very Unusual Vision Issue with Symfony Lens?” on this forum. You should be able to find it by clicking on my name and then looking under “Discussion”.

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    • Posted

      Thanks for your help.  Is there a difference between the Symphony, and the Symphony Toric?  I am less concerned about the starbursts and halos since I have them now with my glasses, although, they are not extending 7x beyond the source.
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    • Posted

      There is no basic difference between the Symfony and the Symfony Toric lens designs, except for the type of prescription you can get. Just like if you have astigmatism, then you have spherical as well as cylinderical corrections in your glasses prescription. Similarly, if you significant astigmatism, then the Symfony Toric lens allows to correct for that astigmatism by providing the desired cylinderical correction. In contrast, Symfony provides spherical correction only. 
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  • Posted

    re: "with that large of a correction"

     

    Tthe 20/380 figure you give is your visual acuity, not how large a correction you need to wear. Its likely only in the range of being moderately myopic, not highly myopic, and is likely  well within the range of lens powers for most   IOL models, definitely it would be for the Symfony. You'd need to tell us your prescription, the refraction, which is the lens power needed to give you the best possible distance vision. Cataracts tend to reduce visual acuity, so someone who doesn't need glasses might still be 20/80 with a cataract. Even people without cataracts can require the same prescription, but have two different visual acuity measurements.  There are estimates around the net for what prescription corresponds to what visual acuity (for someone without cataracts) and 20/380 would likely  not even require  -5D correction, perhaps only -4D (with a cataract its likely even a smaller correction), and you are only considered highly myopic with a presctiption stronger than -6D.  If you have astigmatism, the lens power might be even weaker, but with an astigmatism correction.

    Actually those who are nearsighted have a natural lens power that is too strong, so the more nearsighted you are the lower the power of the IOL you'd need for good distance vision. A typical IOL for someone with good uncorrected distance vision for instance might be say 21D, while one of my IOLs is 10D, the other 13.5D.

     

    The amount of nearsightedness you have doesn't impact the depth of focus of the Symfony, only the power of the lens implant does.   Some studies show contrast sensitivity with the Symfony being comparable to that with a monofocal IOL, others show only a slight reduction, and   within the contrast sensitivity range of someone with a natural lens the same age without a cataract. I used to wear multifocal contacts before my cataract, which reduced vision in dim light, but I got used to it and didn't mind. The Symfony provides better low light vision than I had with multifocal contacts. It had been too long since I'd worn single focus contacts so I didn't remember well enough to know if there is a difference. 

    Most people have no complaints about their night vision. Its only a small minority that have problems with it due to halos or other issues. In my case I feel like I have improved nigh vision since I have less disability glare, a bright headlight is much less distracting to me and doesn't make it hard to see the surrounding scene the way it used to, even before cataracts. I don't know if that is merely due to having an IOL, or if the Symfony's optics differ, I hadn't seen data on the issue. I'm one of the minority that see halos, but I don't consider them a problem since they are so mild/translucent I see through/past them, and they are more than made up for by less issues with disability glare. Lately they've started to fade, I don't see them around certain lights where i always did before, and they are milder around others. 

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    • Posted

      Thank you.  That is helpful.  I will need to check my correction.  As a photographer it makes sense that night vision would decrease a bit when you increase focal length since focal length increases on a camera when the lens opening gets smaller.  The question then is how much is it affected.  Your comments imply that it is not much.  The Technis ad says that poor visibility may occur in dim light or in fog.  Initially, I was concerned about halos and starbursts... until I realized that I have that now  with street lights and headlights with my glasses.
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    • Posted

      In terms of halos, google:

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

      to see a discussion of study results. Yup, a fair % of people have halos with glasses/contacts now. In terms of the tecnis ad, I suspect you are familiar with adds for medications that need to play it safe to list every possible uncommon side effect.

       

       This site moderates links, but If you google for:

      "Additionally, we found that the new lens offered better contrast sensitivity than the comparative lenses in our study (Figure 2). This result has been attributed to proprietary technology featured in the Tecnis Symfony called Achromat, which helps to minimize the chromatic aberration between shorter blue and longer red wavelengths — when all wavelengths of colour do not converge onto the same point, an image can be distorted."

      That is a study where the Symfony did better than a Tecnis monofocal in terms of contrast sensitivity.  If you search for this:

      "Emilio Pedrotti, MD: I explain the technology to surgeons in terms of image contrast based on the amount of defocus measured by degree of modulation transfer function (MTF)."

       

      It continues to say: "The Symfony IOL provides higher MTF values at 50 c/mm1,3 compared with competitive aspheric monofocal IOLs (Figure 1)."

      That figure suggests its comparable to the Tecnis monofocal, though the FDA approval study found the monofocal did a bit better.

       The key factor is that the Symfony corrects for chromatic aberration, which counters the expansion of the depth of focus. As one article notes:

      "As Drs. Holladay and Chang explain it, with optics you can’t gain an expanded range of vision without losing something in terms of the sharpness of vision; this is just the nature of the beast. However, by correcting chromatic aberration, even without using diffractive optics to expand the visual range, the lens would have extremely sharp distance vision on the order of 20/12 or even 20/10. The process is not yet done, however, in the Symfony. The diffractive optics are then used to expand the range of vision. Expanding the depth of focus degrades the tack-sharp “starting point” (something must be lost, as Dr. Chang pointed out), but since the lens started with such sharp vision, it only degrades to about the level of 20/20. “So the amount you degrade takes you back to the level of a good monofocal IOL,” Dr. Chang says. "

      Though actually the results on average are a bit better than 20/20, one surgeon talked about expecting 20/17 with an aspheric monofocal as a typical result, with 20/18 for the Symfony, though some studies put the Symfony ahead of the monofocal, others tied. My results may be a bit better than average, with at least 20/15 distance vision. 

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    • Posted

      the Optometrist says my right eye has sprere -10.5, cylendar -1.25 axis 160 and add +2.25

      The left eye is sphere -9.0 cylinder -.5 axis 065 and add +2.25 if that means anything to you.

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    • Posted

      I have a Symfony toric in my right eye for 2 weeks and the starbursts are so bad I'm afraid to drive at night. My left eye is the one with the worst cataract so I definitely need to do something for that eye. I don't know if I should wait to see if the starbursts get better before I do that lens or put a Symfony in that eye cause it will help me adjust and then the hope would be the starbursts would go down. My vision with the Symfony is very good but I don't want to give up night driving. Anything you've read that could help me with this decision. Or other option I'd put s diffetent lens in that eye.

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    • Posted

      My suggestion will be to start with having a monofocal lens set for distance in the left eye.

      If the left eye is your dominant eye, that may be enough to help you drive at night without being bothered excessively by the starbursts.

      If the right eye is dominant, it may or may not be enough. Then, you may try using glasses (or a contact lens) with power of about +1.0 in the right eye and the needed power for distance (if needed at all) for the left eye. That will essentially force your left eye to be your dominating eye for distance, which should help your night driving.

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    • Posted

      I'm wondering what you decided to do.  Like you, the symfony in my non dominate eye caused such starbursts and concentric circles, that I did not feel I could have a symphony in my dominate eye and still drive at night.  I am planning to just have a standard IOL in the dominate eye, but I am so disturbed by the symphony that I am scared to do anything so continue on with a contact lens in that eye.  I am not buying that 2 symphony lenses will iron it all out.   

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  • Posted

    Your doctor can probably tell you if you will be able to get adequate correction.

    My depth of field is excellent.   So far, my night driving is difficult, but my friends who has had these lenses implanted says she learned to ignore the starbursts and shadows.     I am giving it more time as I am only one month post-surgery and she is four months post.    

    I have no knowledge of foggy driving as of yet, but there is ample fog where I live so I'm certain I will soon find out.   

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  • Posted

    I decided to go with Symphony, but the surgeon was reluctant to use a Symphony lens because I have a detached retina for ¼ of my eye.  He said that the Symphony lens would have more problems than a univocal lens, and that if I were to need corrective surgery for the detached retina, the Symphony lens would make it harder to do the correction.  I can buy that.  So I asked him to put the Symphony lens in the other eye.  He doesn't want to do that because he doesn't want to mix univocal and multifocal lenses.  He has already put a univocal Torric lens in the eye with the torn retina, and I tried a 7.5 correction contact lens in between the two surgeries.  That gave me great distance vision, but I couldn't read a word to save my soul up close, so I talked to the surgeon, and he is willing to try contact lenses temporarily to determine a correction that suits my lifestyle more.  Today, I am trying a 5.5 correction, and get good near, tolerable mid range, and pretty good distance vision, but always with a blur or like a floater sensation on top of it.  Does one get over that in time?  Is it true that a univocal and multifocal lens should not be mixed?

     

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    • Posted

      Correction.  The contact lens corrections were -7.5 and -5.5, not 7.5 and 5.5.  They also have me trying -5.25 and -5.75 to see what works best.
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    • Posted

      I am a little confused. If you already have a monofocal lens in one of the eyes, why do you need high prescription contact lenses in both eyes to have a good distance vision.

      Also, as I mentioned before, there is no problem in mixing Symfony lens in one eye with a monofocal lens in the other eye (I have that combination with zero issue because of that). A monofocal lens can be combined with any of the other types of lenses. I will have more concern with mixing lenses with different materials (for example, silicone and acrylic).

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    • Posted

      I don't have contact lenses in both eyes.  We are trying some different strengths (_5.25, -5.5, -5.75) in the eye that has yet to be done to see how I like them to know which univocal lens to put in because the surgeon says that he doesn't like to mix a monodical with a multifocal leans.  I get the impression that he doesn't do much with Symphony lenses.

       

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    • Posted

      Just my two cents worth.  If you are thinking of going with Symfony Lens find a surgeon that does implant them a lot.  
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