Looking for feedback on cataract lens options
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I will need cataract surgery. Thought I had settled on Symfony after my consult with surgeon however concerned about glare after visiting our family optometrist for my daughter today. She indicated she's had many patients after opting for premium lenses who have problems with glare and starbursts. She would stick to Monofocals. She said my pupils are a bit larger than others and this would contribute to my having issues with glare. Now I am more confused than ever. Guess now is the time to second guess rather than after surgery. Any feedback would be welcome.
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softwaredev Sue.An
Posted
re: "many patients opting for premium lenses who have problems with.."
The vast majority of people who get premium lenses of any kind are happy with their decision, would do it again, and would recommend it to others. Unfortunately some eye doctors are by default conservative and don't wish to deal with any patient complaints, preferring to merely get patients coming back for contacts or eyeglass prescriptions.
Unfortunately it is true that premium lenses do have a greater risk of certain issues than the best monofocals (though the risk is low with the Symfony, not all premium IOLs are created equal despite the optometrists lumping them all together). A tiny minority do have problems, and a minuscule fraction consider it worth a lens exchange to a monofocal. So those who are risk averse should consider other options since there is no guarantee (but then there is no guarantee even with a monofocal, some have problematic starbursts, glare or halos with those, starbursts can come from wrinkles in the capsular bag that happe with any IOL)
In my case though it seemed to make sense to bet on the high odds of having more convenient vision for the rest of my life, as long as I was comfortable with minuscule risk of wishing a lens exchange to a monofocal. Its partly since I was atypically young for a cataract and may live with the results for some decades more, and I'm likley more active than the typical cataract age patient in their mid-70s, so it seemed a good bet for my particular situation. Also in my case I'd been highly myopic before surgery and needed to wear correction to have any useful vision, so the thought of perhaps not needing correction the rest of my life made it worth it. In my case it was even worth traveling from the US to Europe to get a better IOL that wasn't approved here. At the time there were only high add bifocals here that weren't good for intermediate, so initially I'd planned on a trifocal, and then the Symfony was approved in Europe (but not yet in the US) and I decided to go for that.
That said, obviously the odds area bit different if you have a risk factor that suggests a higher risk of issues. However I'll note that if pupil size is an issue, I don't know how old you are, but the maximum pupil size declines with age, and there are drops that can help before you get there.
Though in terms of weighting odds, of course it is pretty much guaranteed you'll have less of a range of vision with a monofocal than a premium IOL. A tiny minority of lucky people with a larger than average depth of focus in the rest of their eye manage get a decent range with one (someone posted great results on this site recently), but even those people would have had a better range with the Symfony. Its best to expect average results with any IOL, hope for the best, but also be ready to handle the worst. Not everyone can adapt to the typically higher level of monovision some get with monofocals, that is a risk (ideally a contact lens trial would be done if the cataract isn't yet clouding vision too much to make it useful to try). Also although most who adapt to it don't notice the issues, a high level of monovision can reduce stereopsis, 3D perception, and depth perception since you are mostly using 1 eye for certain distances.
Since they moderate links, if you google this:
"High rates of spectacle independence, patient satisfaction seen with Symfony IOL"
You'll see one surgeons summary of the risks of night vision artifacts with the Symfony,which isn't as low as the best monofocals (e.g. the Tecnis monofocal they use as a control), but in the same general range of monofocals in general, so the added risk isn't that high (since you might get them with a monofocal, the issue is how much higher the risk is)... but there is added risk . Someone winds up being the statistic.. but not many.
It partly depends on your visual needs and how important spectacle independence is. I always tended to think about the issue of having some emergency where I lost my correction or it broke (if I were wearing glasses), or e.g. didn't have backup correction with me and I needed to dipose of my contacts, and so it gives me peace of mind to know I have a usable range of vision even without correction, I can see to drive or read a map or smartphone.
Sue.An softwaredev
Posted
I appreciate your input very much. Perhaps because I am younger than most (53) and cataract diagnosis was a surprise. Really thought I just needed stronger glasses when I went for regular optometrist appointment. I am not highly myopic and just started with progressive glasses a year ago. In fact often take off glasses when using iPhone, reading or computer. I havent minded wearing glasses - opted not to have lasik to correct vision as a lot of my friends/colleagues have (don't like risk). I still have another 10 years to work (I am an exec assistant and use computer most of my day). I also have a grade 10 daughter who plays premier soccer. I drive her and teammates to games/tournaments and watch all their games under bright lights. So night vision is as important factor as intermediate and near distance - hard to choose. As I am assuming those near and intermediate distances won't be as good as I have it now with glasses with a monofocal lens. If I had assurances halos and glare were minimal and driving wouldn't be an issue I would prefer the Symfony iol. I have been getting feedback from someone in UK who had Symfony lens implanted well over a year ago. His daytime vision is good for intermediate and near but night vision is not good. He's tried the drops to reduce size of pupil and night vision glasses but this hasn't improved. He too is younger and opted for Symfony implants instead of lasik (no cataracts). I do have cataracts and have to make a decision but I am very unsettled in that decision. I admire your attitude to accept things aren't perfect and at peace. Hoping to get to that place.
softwaredev Sue.An
Posted
In my case I'd had good luck with multifocal contacts, so I guess I was less concerned about having problems with a premium IOL.
btw, I think there are trifocal IOLs approved in Canada now (they are in most places outside the US), which give a bit more near than the Symfony, but with slightly less intermediate, and a slightly higher risk of night vision issues. I figured the tradeoffs weren't worth a bit more really near I don't use as often. For those who want a bit more near than the Symfony, some surgeons also mix and match the Symfony with a low add bifocal.
I figured that if my near wasn't as good I could always keep readers around, or use a phone app, so intermediate and distance were more useful to have good without correction.
re: "accept things aren't perfect and at peace. Hoping to get to that place."
The thing to remember of course is that its the most common surgery out there, with the vast majority of people having great results, and the procedure itself was easier to go through than any dental procedure I've had. The visual improvement with any IOL afer having a cloudy lens is quite a relief for most people. However its obviously stressful needing to replace a body part with an artificial one you might be living with for decades, though worst case they can replace it. I'm hoping they'll eventually have in a decade or two IOLs that'll give you the vision of an 18 year old (perhaps a bit further off one with a computer display overlay thrown in :-) ) that'll be worth exchanging the Symfony for.
Yup, the cataract diagnosis was quite a shock in my case also of course, coming even a few years younger for me than it did for you. At least we experienced presbyopia and are used to thinking about the issue of losing near vision, some unlucky folks have cataracts in their 20s or 30s and have surgeons giving them monofocal IOLs without preparing them for their near vision disappearing.
Though oddly in my case it was a relief in one sense to know it was a treatbale problem. My optometrist had discovered vision deteriorating rapidly in one eye and had no explanation for 3.5 months and had to refer me to the MD for diagnosis (the changes to the lens were so minor she didn't think they could be causing the issue, the referral to the ophthalmologist just described the lens changes as "trace nuclear sclerotic changes", though eventually it was easily visible to her as a cataract) so I feared I was going blind and had been spending lots of time reading on the net about possibilities.
In my case I did have 2.5 years to prepare after the diagnosis before I got surgery, due to the other eye remaining 20/20 correctible so I tuned out the bad one. Initially I was going to get a trifocal, but then decied on the Symfony when it came out as a better fit for my needs (intermediate being more important than near). It started having trouble tuning out the bad eye eventually and finally had to get surgery, deciding to get a Symfony for the good eye to get it over with at the same time.
I'd never bothered with lasik since contact lenses worked well enough for me so I hadn't seen a need to take the risk. I just figured though if I needed surgery anyway, I may as well try to get rid of the need for correction. I've researched lasik&prk though since I knew the IOL power might be off, and I think the latest technology is something I'd risk for a small tweak.