Looking for Feedback on Tecnis Symfony

I also had the Tecnis Symfony lens in my left eye 3 months ago.  The doctor put the wrong lens in and I could not see at a distance (still cannot in that eye).  I complained to my Dr and she did an erbuim laser...big mistake because once the eye is lasered it is risky to take the lens out.  I could see close up and about 10 feet away.  I could not read a street sign..very difficult especially when driving in an unfamiliar  place, also halos day and night.  I went to a big University eye center and was told that the left eye lens left me nearsighted!!  As cataracts progress some people find that they  could see close up better..so thats why I was totally nearsighted.  The University Dr told me of the risk of removing the lens after the laser had been done.  I was livid because I told the Dr who did my left eye that the most important vision in my life was seeing at a distance because I play tennis 5 days a week..and of course I tried to play but struggled.

The University dr did all of the measurements on both eyes and he did the surgery on my right eye a week ago.  The lens he implanted was based on the measurment of both eyes and a lens in my right eye that would hopefully work with my left eye.  So far it's ok.  There is a new laser coming out waiting for FDA approval and the Dr thinks he may be able to use it on my left eye to achieve a vision "I can live with".  Those are not the words I wanted to hear but I need to go forward because I cannot have the left lens removed.

As a side note to my experience...if you feel something is wrong with your lens implant get a second opinion before having a laser.

I am sorry to learn that not only you have the night vision issues associaed with the Symfony lens, but also have not achieved the day vision you were hoping for.

Leaving aside the fact that one should not expect good vision at distances less than about 26 inches with the Symfony lens (set for distance) under the best of circumstances ,e.g. no astigmatism etc,  (which makes your doctor's statement that the "near vision may not be perfect" a big over-sell), you should have good vision beyond that distance. If you don't have it, it is probably because you have some astigmatism or you are slightly far-sighted.

Do you know what your eye prescription for the left eye is and what your best corrected vision is with that prescription? If you can share that, it will help to understand the best step going forward.

Also, I am curious about the reason why your glasses help you with the night driving. Is it because the glasses provide the distance correction for the right eye? Also, which is your dominant eye, left or right?

Just to be clear, a laser is used for quite a few procedures associated with eyes. It seems that the laser procedure, which you had. was to get rid of the Posterior Capsule Opaqueness. That makes a hole in the posterior of the capsule, which makes replacing the IOL a much more difficult job because the lens can fall back through the hole behind the capsule.

The laser used for LASIK enhancement for vision correction (essentially the eye prescription correction) modifies the shape of the lens to change the eye prescription. This does not make changing the lens any more difficult. However, obviously, it does not make sense to do so until one knows that a correction in the eye prescription is all that is needed.

You sound like you know your stuff...are you an MD?

I am not an MD. Have just picked up information over the years.

Hi Chris - I just had a Symfony lens implanted 12 days ago. The other eye will be operated on In about 4 weeks' time.

For me the Symfony lens gives me good vision from about 18 inches outwards. My doctor said when I was considering this lens that it isn't as good as a multifocal for near and may need reading glasses for fine print or if I do a lot of reading and may be slight compromise on distance vs monofocal set for distance and could be some glare and halos to deal with at night.

The intermediate vision is really good - TV, computer monitor are excellent. Will look forward to having the other eye done as I don't like reading with one eye.

My night vision isn't as bad as I was expecting. Lights from car headlights and streetlights have glare and are a little fuzzy but nothing yet that I would consider bothersome. Others also see concentric rings with this lens around lights which I think are more bothersome. Hard to say what you would experience as everyone's eyes are unique.

For most people these are great daytime lens so if you are active they should provide better all round. I soon than a monofocal would.

Good luck to you as you make a decision.

Thanks Sue - sounds like you can't wait to get to when both are done and settled. 

Yes you have that right. Doesn't make me any less nervous about 2nd surgery though. After reading all I did prior to first surgery my expectations let's say were not that high (although I was hopeful). Getting diagnosed with cataracts in early 50s and I still am very active (have teenage daughter) did not want monofocal lenses. I am very pleased overall with outcome in first eye and hoping 2nd just like it. Although I imagine my eyes still settling and healing the intermediate distance is where this lens excels for me.

If I were at the average age of those facing cataract surgery likely would make a different decision- although be aware even monofocal lens cause night vision issues albeit in less percentages as multifocal (although Symfony lenses are in class by themselves and marketed as an extended depth of focus lens).

My surgeon certainly didn't help with my decision as he made sure that I knew at the age I am there is a compromise to make and each individual has to make that decision for themselves. I guess what he meant was most of those facing cataract surgery have lost already their near sight and they gain something in getting distance vision back (or near if that is what they choose in a monofocal vs distance).

I wish you the best. You'll have to update us when you have your surgery (do you have a date set?)

Hi Chris - had my 2nd Symfony lens implanted 2 days ago.  All is going well.  At

Post op yesterday my eye that was operated on tested 20/20 and I know I could read line below that too although that wasn't tested - at postbopmon that firstveyebinhad missed 2 letters on the chart.  The newly operated eye missed 3 letters on 20/20 line but my surgeon says it will improve too.  I have another visit in 6 weeks.  Reading with both eyes done with Symfony was great at 13 inches outward.  I will need +1.0 readers for very fine print.  Ie ingredients on grocery items like soup cans or pill bottles.  For most things I am glasses free now.  I can read newspapers books iPhone wry well.  Pleased with outcome.  Now to get through heLing and all those drops.

Have you made a decision on your lens?

Sorry should have said first eye that was operated on 6 weeks ago tested 20/20 but at post op 24 hrs later I missed 2 letters on 20/20 line .  Newly operated eye at 24 hour post op missed 3 letters on 20/20 line but surgeon said that would improve with healing too.

Good luck with your surgeries if you haven't yet had them

Did you have Symfony toric lens implanted 2 days ago as that would have taken care of astigmatism. If not that may be affecting your vision.

2 days out may not be enough time - everyone's eyes heal differently. I had my Symfony lens implanted 13 days ago. I haven't been back to see doc since day afternoon surgery but I do think my eyesight is still improving bit by bit.

The effect of the scratch on the cornea on your vision is unknown at this time. Your vision change may be slightly more than usual at this time, but in general, it does not change much except possibly in the amount of astigmatism. If you received a toric lens due to your astigmatism, it can rotate some from the installed position, causing astigmatism.

In any case, you will probably have a checkup one week after the surgery. If you can share your best corrected vision at that time and the prescription needed to achieve that, then you may get more meaningful suggestions.

 

Yes, it was the toric version for astigmatism. I just noticed that when I sat away from the computer, exactly an arm's length, I could read your reply clearly! But it comes and goes--sort of fades in and out of focus, and I wouldn't want to do that for any length of time.

I am wondering if I should try to read without reading glasses more often, if that would help my eye learn to adjust. 

Thanks, at201. I hope it is just the scratch or the ointment I've put in it. I have an appointment for Friday, the 28th, so I will see what the vision is like then and report back. 

If all I end up with is distance and intermediate, I can work with that. I've never had good vision, even with contacts, so it will be nice to see at a distance unaided.

Yes arm's length (16 to 18 inches) is my reading distance with Symfony lens. Once other eye is done Mather readers for closer. But computer distance is really good now as is distance. I guess I could ask for 2nd Symfony to be set for closer to read better. I guess I like that balance between eyes and not have one take over depending on distance. If I need readers it won't bother me.

Hopefully your vision will improve once that scratch heals. Do you have another appointment with your surgeon at one week?

Yes, I have an appt on Friday. My arm is pretty long, from shoulder to tips of fingers, which is what I was measuring, so it's a lot more than typical reading distance of 16-18 inches. I even sit closer to the screen than that. I'm experimenting to see if looking at an angle makes it better/worse. Not sure where the reading field is for these Symfony lenses, or even if there is one, since they're not typical multifocal lenses. The word "accommodating" makes me think my eye will learn to accommodate. 

I have been nearsighted most of my life but when cataracts affected my vision I typically pulled iPhone closer - more like 8 inches. So this further away is not comfortable but likely will adjust to a new normal. Yes Symfony not a multifocal so near vision isn't as good as a multifocal it night vision issues are less - although some would argue they are same.

My current plan is similar to what you have - right eye with a tecnics monofocal IOL for distance vision and the left eye later with a tecnics symfony but set for a little nearsighted (-0.50D to -0.75D) for still good distance vision (20/20-20/25) and excellent intermediate (computer, smartphone distance ~24" plus a good chance for decent reading vision except for extra tiny text or in dimmer light.

What did your eye doctor target your left eye with the Symfony for? To get better near vision, probably need to target a little nearsighted like -0.75D to -1.00D to work with the right eye targetted for best distance vision.

The Symfony is not a multifocal or accomodating IOL.

Its called an "extended focus" IOL best for distance plus intermediate vision, though you can get some near reading vision if the power is targetted for a little nearsighted.

As far as I know he targeted it for 0, for 20/20. I think I'm at 20/40 right now, so if he'd targeted for less, I might have been more significantly affected with nearsightedness. I was high myopia--minus 8.5 in that eye, I think, while my right eye was once 10.5. 

Thanks for the clarification. I still am not sure what exactly the Symfony does, except that it is the only alternative for people with astitmatism to have any shot at getting some near vision. It was approved during the 16 month break between my two surgeries. (My left cateract, the recent surgery, wasn't very bad, but with all the other issues I was having, there wasn't any way to get my vision better than 20/50.) 

How much astigmatism (cylinder value) was your left eye where they used a Symfony toric IOL?

I have moderate astigmatism in both my eyes, left= -2.0 and right= -2.75 cylinder.

To get more near vision with Symfony they would have needed to target more like to -0.75 or so rather than for best distance (0.0) - thats my plan for my left eye if my right eye (first) gets good distance.

Have your refraction checked after the eye has healed, its possible they missed the target of 0.0 a bit and you got farsighted that would make good intermediate and near vision tough.

The only other type of toric IOL I considered besides Symfony for getting good intermediate and possibly some near vision and correct for astigmatism, is the Trulign accomodating toric IOL.  But it has a maximum cylinder correction of about 1.83D and my astigmatism is quite a bit higher than that.

Symfony's toric cylinder correction is available up to 2.57D in comparison.

I don't remember the figures, only that I had a moderate amount of astigmatism in my left eye yet after inserting the Symfony. My surgeon went back in with a laser and corrected the cornea to reshape. I can see close up on my iPhone 6 at 10" with no problem. I do not need glasses. Close up, middle and far distance is very good 20/20 or 20/15. I do have a little glare in certain lighting. I almost have no problems with halos or starbursts. Maybe I am just getting used to them... but they are no longer an issue and it's like I never had a vision problem.

Astigmatism was -1.75 x 155. Seems like I remember being told it was in a non-common axis which is why many contacts didn't work for me. 

My intermediate vision seems a bit better today, three days after surgery. Seeing a bit more even at half an arm's length, but still wouldn't be comfortable reading for any length of time without magnification.

Good to know that your intermediate distance vision is getting better.

Incidentally, while the axis of the astigmatism may be important in a contact lens because the contact lens manufacturers may not produce a lens at an uncommon axis, it does not make any difference for an IOL. It is the same toric lens which is used for all axis angles, with the indicated position of the axis marked on the IOL. The surgeon then lines up with that position indicator with the desired angle during the surgery. Of course, the lens often rotates from the desired position as the eye heals, but that is a different issue.

Symfony toric lens comes with 4 different cylinderical powers. The closest ones to your needed cylinderical power seem to have cylinderical powers (at corneal plane) of -1.54 and -2.06. So, you probably have one of those two.

The card says "Diopter: +09.5D SE 2.25D CYL" if that means anything. It's not the same as my contact prescription, which makes sense based on what you say. 

 

You probably have a Symfony ZXT225 toric lens with a spherical correction of +9.0. It has a nominal cylinderical power of 2.25D at the IOL plane (the value which you see on the card) . Since there is a small distance in the eye between the location of the IOL lens and the cornea, for comparison purpose (with a contact lens where a contact lens sits), the corresponding value of the cylinderical power at the cornea is indicated to be slightly different at 1.54 (the value published by the manufacturer for that lens). Thus, it is consistent with your contact lens power.

The astigmatism value can be  prescribed either as positive value or as a negative value (different doctors prescribe it either 1 way or the other). There are some associated changes made in the spherical correction and the axis, but going through those will be a little bit harder to explain.in this forum.