Looking for feedback on cataract lens options

Thanks for your feedback. My surgeon put me down for the Symfony lenses but I am 2nd guessing now and leaning towards monofocals. I am 53 and use a lot of computer and arms length work so will not like having to have glasses for those tasks but thought of halos and glare have me concerned. I experience them now with cataracts and do not enjoy driving at night.

If bright sunlight is an issue, one thing   people need to be prepared for is that for people who had cataract surgery with *any* IOL, for most people   bright sunlight is initially more of an issue after surgery. People's visual systems adapt  to seeing through a cloudy lens that let through less light (even merely an aged lens without a cataract lets through less light), and they suddenly are coping with more than they are used to, though your brain learns to adapt to it so it seems more normal (though the world still seems brighter in a positive way rather than a problematic way). I had to turn the brightness on my computer monitors all the way down to 0 initially. I'll note that of course its important to wear sunglasses even after surgery to protect from UV.

That issue of sensitivity to brightness is different than the sort of disability glare you are talking about (though the light sensitivity can make it worse).

A fair % of people have issues with halo&glare&starburts even from wearing contacts or glasses with their natural lens. 

Glare can be a problem cause by  cataracts, so for many people it will be reduced with any IOL.

As I just posted, the majority of  people don't have problematic glare with the Symfony, but if any risk at all is too much then people shouldn't consider it (but should be prepared there is also a tiny but > 0% chance of problematic glare with a monofocal).  

Unfortunately what people think when they hear the term "glare" varies, there are different kinds of it and some think of it more like a halo so its hard to be sure how to interpret some studies..

In my case even before a problem cataract it always seemd like I was bothered more than others I know when driving at night due to  what I think is called  disability glare, dazzle glare, where the bright headlights make it harder to see the surrounding scene.  After getting Symfony implants, the disability glare is much less than I remember even before catarats, my  night vision seems much improved and usable than I can remember in the past.  I don't  know if I'd have experienced the same thing with a monofocal, or if it is due to the optical design of the Symfony.

I am in the  minority that sees halos, but they've never been a problem for me since they are translucent/mild, I see through past them, and because the reduced disabilty glare more than makes up for them so overall my night vision is better. Also although it took much longer than usual, they are starting to go away, they've disappeared around some lights where I consistently saw them before and are faded around others.

 

That's interesting. Currently driving at night with cataracts (especially in rain) the glare from incoming traffic does blind me to seeing road. Of course car manufacturers are installing lights that seem much brighter these days too not helping the situation as my husband who does t have cataracts is bothered by those too.

Does TV watching bother you as well or no issues there?

Headlights are definitely less of a problem for me now than I can ever recall them being in the past even before cataracts. I recall finding it odd during the first few days because in general the world seemed much brighter, and the headlights seemed brighter.. but despite that they didn't cause problems as many problems seeing things nearby in the visual field. 

The reduced disability glare more than makes up for translucent halos. Again, I don't know if that result would have happened with any IOL, or any diffractive IOL, or if its peculiar to the Symfony. It may be I'm an atypical data point and its something odd about my eye anatomy, or it may be common, I don't know.  The problem as I said is the varied things people think when hearing the word "glare", and most studies don't bother being specific to define or describe what they are asking about when they ask about glare.  I hadn't seen any studies that explore rates specifically of disability dazzle glare with IOLs, making sure people  know what they mean by "glare" when the question is asked (since I've seen varied definitions even on sights related to vision).

TV watching hasn't been a proble postop. I'm not sure if that was referring to the brightness issue, but I guess because of the distance from it I never needed to alter the brightness setting on my TV after surgery.  

 When posting on this site I often rush through it and don't take time to edit glitches or word things perhaps as clearly as I should. I did mention that I had to turn my computer monitor brightness down *initially*, but I should have explicitly noted that  although having it brighter bothered me at first, after  a few days I don't think it would have bothered me much or been uncomfortable, it merely would have seemed too bright. I think it was a few months before I tried and saw that raising it wouldn't be a problem, .. but wasn't actually needed.

 The increase in  brightness of ligths was  only really something I felt was a much of  problem for just the first week or two if I remember accurately, aside from a definite need to wear sunglasses consistently, especially the first few months,  though thats important anyway to protect from UV. Ever since it still seems like the world is brighter overall, but in a positive and not problematic way. 

 

Thanks, that's very informative and has given me food for thought.  I'll certainly discuss the situation you have outlined at my next appointment.

Thanks for the info. Did you have the latest Symfony implanted? My surgeon indicated this latest one is better at reducing glare and halos. I wish I could wait to learn/hear of others experiences. My cataracts progressed quite quickly over last 6 months. Eyesight prior wasn't too bad (nearsighted -2.25 left eye / -2.75 right eye). 18 months ago optometrist prescribed a bit for reading so I have progressive glasses - although find them annoying and whip them off to read. I am 53 yrs old and worried about choice I make as I will have to live with that awhile. Guess thinking if eyesight were poorer I wouldn't be considering anything other than monofocals. Was only told in Jan I have cataracts. Went in for checkup knowing something was off but figuring I needed stronger glasses. Optometrist couldn't really correct them much and referred me to opthamologist.

Yes. I had the latest Symfony implanted (approved in USA recently in July 2016). Your surgeon was probably comparing them to the other multifocal lenses, which have been around for a few years and do seem to have worse glare and halos.

Please do discuss my suggestion with your surgeon. He will probably find it a rather unusual way to do it, because that is what it is. But after thinking it over, he will probably agree that it should work.

Read through the comments on halos, glare and concentric rings. Seems everyone who has posted here is bothered by them. This is what bothers me most about cataracts now is night driving. Has anyone posted that these have been minimal?

Minimal after Symfony implants.

While many people, including me, have had problems with multiple concentric circles or halos and glare with Symfony lens, not everyone seems to have those. Others probably find them to be not any more bothersome than what they had before the cataract surgery and are thus just happy to have better vision. My suggestion to cora06849 is an attempt to build upon my experience to suggest a combination of monofocal and Symfony lens which may provide a better chance of having good day vision over a wide range of distances with less chance of night vision problems.

Been reading a little more and read comments of some who had Symfony lenses done in UK a year ago whose glare and halos did not subside and was eventually told it had more to do with light entering their largish pupil at oblique angles diffracting through Symfony lens. I am wondering if in candidate selection this is considered and what would be ideal pupil size. And would these present same issue with monofocal lens?

The  multiple concentic circles (or halos)  which I and others see with Symfony lens are, I think, due to  the unique feature of having about the same number of circular “diffractive echelette design” in the lens, which provides the extended focus capability. This effect is most probably independent of the pupil size. There are other night vision effects due to the light hitting the edge of the lenses, but those are typically due to lights on the side (and not straight ahead) and with lenses with optical diameter of 5 mm (which is about the same as the maximum pupil size) and not with the lenses with the optical diameter of 6 mm (which is the diameter of Symfony).

I disliked progressive glasses, but that may have been in part since I only wore them fulltime for a week or two to try to adapt so perhaps I'd have gotten used to them.  I always wore contacts normally but just wanted to make sure they were usable for backup. I realized that if I disliked progressives in my late 40s, that I'd likely dislike them even more with monofocal IOLs since the add required would be even larger. That means that  a smaller eye movement  leads to a larger change in focus in the area where they transition between powers. 

In my case I found multifocal contacts much more usable since  like with multifocal IOLs you don't need to change where you look. Its possible with monofocal IOLs to use multifocal contacts, though the optics aren't as good as premium IOLs, and it sounds like some people don't like higher adds with mutlifocal contacts as well as low/medium adds as I used. There are extended depth of focus contact lenses approved by the FDA, but oddly they haven't hit the market yet  (I can't recall if it was several months ago they were approved, or if it was even longer, the year before last).

That makes it easy to switch if you don't like them, though people try different models since they vary a bit. If anyone hasn't tried contacts in the last decade or so, they are much improved over what they used to be like.

My vision with Symfony implants is better than with multifocal contacts, the contacts tended to reduce vision in dim light due to the light being split (though it didn't really bother me, I never tended to think of it and just got used to it, I just notice the difference now with things being better).

 

Your low prescription suggests there are decent odds they will get the IOl power right (though not guaranteed, its   those with high prescriptions who have a more noticeable  risk of the power being off ) so things like micro-monovision, a small level of monovision that hasn't much impact on stero vision, are likely decent bets.

 

re: "And would these present same issue with monofocal lens?"

There are people with problem halos with monofocal IOLs, the statistic show the risks  are about comparable to the Symfony, though the best monofocals seem to be slightly lower risk (like the usual control IOL compared to the Symfony in studies, the Tecnis monofocal).  What some people seem confused about is that the halos may be a different shape, e.g. 1 centralized blob vs. concentric rings, but what matters to most people   is whether it is a problem, not whether its a problem and shaped like A or a problem and shaped like B. 

The concentric ring halos with the Symfony are due to scatter off the edges of the diffractive rings of the IOL, which can also occur with diffractive multifocals. I think there is less talk of that because the larger cause of halos with multifocals is due to having 2 or 3 focal points, and the halos ar caused by light from the other focal points. Most of the time ambient light leads the brain to have enough clues to only pay attention to the focal point that is in focus, but at night with just a pure light source, there are less clues for the eye to figure out to tune out the other focal points (though it usually learns to).  The amount of light from the other focal points tends to dwarf the mere stray light scatter off the diffractive rings so there is less talk with multifocals about several concentric rings.

re: "Did you have the latest Symfony implanted? My surgeon indicated this latest one is better "

A minor point, there isn't a new version of the Symfony, any updated version would have required government approval so there would be news about it.  The Symfony is better than other premium IOLs in terms of lower risk of artifacts, likely that is what is being referred to. 

re: "Seems everyone who has posted here is bothered by them. "

The problem with taking that into account is "selection bias", that most people don't post unless they have problems. The vast majority of people have great results and don't bother posting (mostly those of us who say did research beforehand and then post to "give back" to keep perspective). I don't know how many Symfony IOLs have been implanted, but to give perspective, there are > 20 million cataract surgeries a year, and > 480,000 surgeries with premium IOLs implanted, so a minuscule fraction of them with problems can lead to lots of posts. 

The only way to know the odds of issues is to look at studies designed to figure that out, and those show low odds of problems..  but no guarantees.

People's sensitivity to light reduces as they age, mostly noticed starting in their 60s, so I've wondered if people atypically young for cataracts might have more sensitive retinas and be more prone to halo issues, but I hadn't found any data on that. Its possible it might be counterbalanced by younger brains also being more "plastic", more adaptible, more neuroplastic brains can more easily neuroadapt to tune out visual artifacts.

re: "am 53 yrs old"

I was 49 when I got a problem cataract (rapidly developed over 3.5 months, eye wewnt from 20/25 best corrected to 20/60 best correctd, though my other eye remained good so my brain tuned it out so I could postpone surgery in hopes of a better IOL. my optometrist also didn't diagnose the issue and had me go to an ophthalmologist) and decided on a premium IOL partly since I was already disliking dealing with presbyopia and loss of near vision, and didn't want to deal with the larger loss of visual range. I was 52 when I got surgery, and my visual range improved. It seems  like early presbyopia when I first noticed that I'd e.g. to see the fine print on a medicine bottle I'd need to  find the right distance to hold it, or struggle with threading a needle and need readers.  I may get a laser tweak to micro-monovision and perhaps it'll be more like before I really noticed presbyopia (though there would stil be a need for  readers for tiny closeup tasks).

My cataracts (although worse in right eye) must have progressed rapidly too. At my previous appointment Fall 2015 at optometrist appointment only change in glasses was my adding of slight progressives (took me a few weeks to get used to but I did) my distance in one eye then actually got slightly better. By summer 2016 wasn't seeing as well for distance (couldn't see the soccer games as well or numbers on players jerseys). Jan this year our plan year for work health benefits restarted (vision coverage every 2 yrs) went to see optometrist and learned I would need cataract surgery. Happy to hear that because my prescription is lower getting the power right is often easier. Although I live in a smaller region in Canada so wonder how many premium implants they do.

re: "how many premium implants they do"

 The Symfony is implanted the same way as the common Tecnis monofocal, it is the same size and overall shape and material. Picture them as being by analogy like 2 pairs of eyeglasses that have use  same model frame, but one pair is progressive and the other single focus, its merely the lenses that have different optics. Overall there isn't much difference in how the newest modern IOLs are inserted even between brands.

The formulas to determine lens powers are also the same, aside from merely the value of a constant or few that varies with the  IOL model and sometimes with the surgeon. There are are a number of lens formulas out there, and often they use a piece of equipment called an IOLMaster which takes various eye measurements and then runs a few different formulas and gives the surgeons the results to compare. For people with low prescriptions the formulas will tend to agree, unlike say for a high myope like me  where they varied a bit. 

re: "getting the right power is often easier"

You are in the range of "low myopia", its usually more for those who are high myopes, -6 or worse, that the risk of the lens power being off becomes more noticeable (though often the data talking about accuracy of IOL powers is discussed  in terms of "axial length", which is usually longer in myopes, one cause of myopia, but they don't usually measure that until the preop within a few days of surgery to decide what lens power to order). In my case my -6D eye was on target, it was my -9.5D (before the cataract at least) eye that was left +0.5D farsighted.