My Synergy IOL Experience So Far

He actual did, but being it was Wed, he did surgeries in morning and I saw him about 2 hours later. He only looked to see if the IOL looked position correctly as too soon to tell anything else.

But while waiting I talked to another person, a 70 year old man, who got a monofocal implanted and he was telling he could already see good, when my eyesight was a complete blur.

I was going to comment on the anesthesia used. I was quite out of it, but somewhat aware of what was going on with my IV administered drug. Don't know exactly what it was other than a chilling feeling going up my arm when they administered it. My wife just had one eye done in a clinic instead of a hospital and they used oral Adivan - a half pill under her tongue. She seems to recall much more than I did, but said it was not uncomfortable, but felt pressure. It looks like I will be going to this clinic for my second eye, and have to admit I would prefer the IV method. But, she survived, so I should too!

I actual preferred being awake, but I don't get Novocaine when getting fillings. If they are numbing the eyes, I don't even see the point of the anesthetic. They hooked up an IV, but I really don't think it went in properly or something.

Yes your wife's surgery sounds like my own. I did have it at the hospital though. A bit of pressure was a I felt.

glad to hear your near vision is coming in. you had me scared there for a while.

how is your distance?

i was exchanging messages with Safran this morning and he will not exchange my Symfony with PanOptix as he despises the material. He even likes Symfony more than Synergy. he says Synergy has better near but worse vision quality.

good luck and thanks for posting.

That's depressing. I would have thought the Synergy and Symfony would be very similar in distance vision. How does Dr. Safron feel about Eyhance or Vivity. If you are having problems with your Symfony maybe the best option is switch to one of those lens. That way you should get pretty good vision down to about 2 feet and then you can decide on the other eye. Vivity can have some Contrast Loss, but I would imagine it is less than diffractive IOLs have.

I actually just woke up from a nap and my close vision is starting to shine. I have different items I have been looking. Some of the items are crazy, but one of them is an unwrapped Lever bar of soap in the bathroom and on operation day I could not make out any of the letters. I just checked it out again and I can not see the lettering on the bar better with my Synergy IOL. That bar is 4 feet away.

I also just looked at my Jaeger Card again and my Synergy IOL is now blowing away my MF eye. I have not tested my close vision reading by trying to do any long term book reading yet. The other thing I notice on close vision is that the Synergy eye has darker letters. Not sure what causes that. But what really shines is my cell phone with a lighted background. I measured it and I can see from 12" out to arm length crystal clear. I can see it closer than 12", but vision starts to degrade at that point. I am blown away by how good I can now see my cell phone, so that is the Synergy's strongest strength so far.

So I have to agree with Dr. Saffron on the close vision.

On the disappointing side I have not seen where I see any better when it is dim, which was a big selling feature. Now in fairness I have not tested it much and night time driving will be the biggest test and I have done very little of that.

I also have not been back out in the dark to see if the Dysphotopsias are getting any better or not.

As for distance it is now dark outside where I do a lot of my testing. I like to look at far away tree limbs and leaves and street signs. Last time I looked my MF outperformed the Synergy for outside distance. But I can clearly see the 20/32 line now and I am able to start to be able to guess at the 20/25 line, but it is still pretty blurry and mostly guessing at the letters.

I am hoping I eventually get to at least the 20/25 line being clear.

I think people's happyness really depends somewhat on where there starting point was. Remember my cataract was so bad I could not even see out of left eye. And the only thing I can compare my vision to is my MF eye.

I remember Dr. Safran saying he thought all diffractive IOLs had bad vision quality compared to a monofocal. In fact his exact words were:

"It's hard for doctors who implant multifocals to accept just how poor the optics of these lenses are relative to monofocals "

So if I had a monofocal I might think my MF distance vision is blury.

Dr. Wong also stated that people who missed the refractive mark by more than +/- 0.5 (D) had more problems with the Synergy. Now that is a scary as that is not a whole lot of a refractive miss.

So bottom line is so far my close to at least 4 foot vision is better with Synergy and my distance is better with my MF. Tomorrow I need to measure more objects at various distance to see exactly where the cross over happens.

Should have read entire thread - so happy things are improving for you. Give it time. Yes for those that see great right away but that isn't everyone's story and is no indication of final outcome.

**Distance Vision:

My distance vision is still improving. One thing I have noticed; now that I have a distance chart up and check my distance Vision Acuity throughout the day; is my vision quality varies throughout the day. This is probably true for everyone, but I never paid attention to it before. Another factor is the fact that there is a window in that room and the way the light hits at different times of the day can also be affecting my results.

So during the best part of the day, my Synergy eye is 20/25 and I can guess at a few of the 20/20 line characters. Going outside, my right Synergy distance has improved, but my left MF eye’s vision is still sharper.

But with both eyes open my brain is picking the left image so bilaterally my distance vision is good. The funny thing is I thought with my right eye being so bad for so long the brain just switched to make my left eye the dominant eye and that is why it picks the left MF image, but I did the eye dominance test and from the best, I can figure my right eye is still dominating.

**Intermittent and Close Vision:

My Synergy eye is still outperforming at close and intermittent distance.

Using both eyes, I read a fine print article out of a magazine. My sweet spot was 16” and vision degraded as I brought the magazine closer. I could read the article, but I would not be able to speed-read it for sure. I tried on some readers and that made the letters crystal clear.

So I would say I would not need readers unless I am in bed trying to read a book or something along those lines.

Even though it is not possible, if I could I would switch the left and right eye, so my dominant eye is the one that sees best at distance and my non-dominate eye is the one that sees the best close.

**Dim Light Vision:

I have only done limited testing, but I can tell you Real-World, unlike the perfect office setup, sets up its own test that I would never think of. What do I mean by that? At night I have to walk in the dark around the bed to get to my side of the bed. My bed has 2 high posts I must walk around. Before I could not see those posts until I almost bang into them. Bilaterally I can now see the post, not great as it is dark, but I can make them out way before I smash into them. So bilaterally I can see better in the dark and that was one of my goals.

**Night-Time Dysphotopsias and Driving:

I have not done a whole lot of night-time driving. I drove a short distance in the dark yesterday and tried the one-eye thing (yes yes I know not a great idea while driving). Dysphotopsias vary depending on the light source, color, intensity of the light, and distance. In general, the Synergy Dysphotopsias are worst, but bilaterally it is the same as my MF eye.

The only thing I can say at this point is I can drive a short distance on roads I know at dark without issue as that is what I have done so far. The real challenge will be highway driving, as before I could not tolerate more than 1 hour of that as it was too stressful.

**Thoughts On My Distance Vision & Correcting If Possible:

I am not sure if my distance vision will improve with more healing or not. I am also not sure, before seeing the doctor, how to tell if my vision quality is degraded by a refractive miss or an Astigmatism miss. If it is an Astigmatism miss, from what I read they can still rotate the Toric IOL after surgery though the more time that passes the harder that becomes. Also, even though the doctor said my Astigmatism is regular maybe it is not 100% symmetrical and this is the best vision I can get out of my right eye. And finally, Toric IOL comes in large power steps and maybe my residual astigmatism is what it is.

But let’s say the doctor said I had a refractive miss and it could be corrected to an amazing 20/15 with glasses, contact, or Lasik. I am not sure I would do it as it would mean my near vision would be degraded and I am happy with my near vision. Again it is all about tradeoffs. I would get the contacts in case there was an event like skeet shooting where I needed superior distance vision.

**Thoughts On My Overall Vision Quality So Far:

What can I say Dr. Wong’s Optometrists nailed it. They said the PanOptics patients were blown away and the Synergy patients were happy. That is me to the tee.

I am not blown away, but happy because when my eyes work bilaterally I obtain good distance and close vision. As I said I am not sure I would sacrifice close vision to even get better distance vision. Plus I now see better in the dark; a Big Plus for me.

One thing I should add in case anyone else experiences it, I have had a mild headache at the end of the day. That is too strong and misleading, not sure how to describe it. More noticeable at the beginning. I guess it is caused by a couple of things. The 2 eyes at first provided different images to the brain and 2nd the fact with the bad cataract removed light is getting to that eye.

I suspect it will be some time until the swelling and pressure in the eye stabilizes, and you see the true outcome. I recall back around 2000 I was diagnosed with diabetes and my BG's were sky high. I started a drug that rapidly brought my BG down to normal. Then my vision went brutally bad, and I thought I was going blind! I was in the -3.0 to -4.0 D range and was wearing glasses. I found I could drive and see road signs all of a sudden without my glasses on. It was like my eyes were "fixed". I went to see the optometrist and told him what was going on, expecting to get a new prescription. He said it was normal, and to wait a couple of weeks and my eyes would most likely return to normal and my current prescription would be fine. He was bang on. Apparently the pressure in the eye is upset by osmotic pressure caused by the differential in BG levels when BG is changed rapidly.

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You are likely experiencing the same thing. As my surgeon put it more graphically, the eye does not like to have sharp objects poked into it and it takes some time to recover from it!

thanks for the update. how about watching videos on the phone at near? how is the video quality?

i think the edof component is unnecessary. i remember danish viking who got lara and then was blown away by lisa.

Cell phone Vision, videos and all are crystal clear. This is where the Synergy shines.

I don't know about those IOLs as we only have Synergy or PanOptics here in the Good old slow to approve FDA (with the except of revolutionary vaccines) . IMHO it is not just about EDOF, but Synergy provides the stronger close and supposedly better dim light vision.

Unfortunately until they come up with a modular base component there is no easy switch and try and see which one is best option.

I will never know if I would have preferred PanOptics. But so far I am Happy with my Synergy results though hoping as my eye heels I get a bit sharper distance. Only time will tell. Also I am just not a fan of the PanOptics material and it is not just about glistening. Dr. Wong said the Tecnis just looks better in the eye and I think that is important, but that is me.

I really wont know the whole picture, until my heeling is complete and I find out if I am off on the refractive mark or astigmatism and obtain my best corrected vision.

I can only say at this point if my current vision is the absolute best I could get out of Synergy, then I would not want 2 eyes done as I need at least one with great distance vision. But bilaterally I am Happy. And it is too early for me to jump to any conclusion yet. I will know more in a week as I will see the doctor and he can check for refractive and astigmatism.

If you can wait as more time goes by and more Doctor's get Real-World results from those 2 IOLs more will be known. Even the studies are usually like only 50 patients or less at this point in time.

what needs to improve for your current distance vision? is it blurry? is there a haze?

maybe it is just some minor residual refraction or surgery induced astigmatism?

For distance, my right Synergy eye is 20/25, whereby my left MF is 20/20.

If I go outside and look at a tree far away and focus on the branches and leaves, the MF is just a sharper image. I can also read street signs from a further distance with my MF eye. But bilaterally I think my vision is pretty sharp.

I will know more as time passes and once I see the doctor and he can test for residual refraction error and astigmatism.

It may be the drops causing the mild headaches or the brighter lights - I had that too and wearing sunglasses helped in those early weeks

how is your intermediate vision where you may have experienced gap with your multifocal. synergy must be doing all the heavy lifting for that zone.

when is your appointment? i m curious to know if you can get sharper distance on synergy by correcting with glasses.

Had my follow up appointment today.

**Distance Vision:

In the doctor’s perfect office setup I am 20/20 for both my MF and Synergy eye. But for my MF the letters were very sharp and for the Synergy I could make out the letters, I was not wild guessing, but they were a bit more blurry; not as sharp.

I could not make out anything on the 20/15 line. If you look at the Synergy defocus curve it shows vision acuity close to 20/16 at Plano.

The assistant started to do the machine switching lens thing; is 1 or 2 better, but gave up. Probably due to healing my left eye it gets dry and when that happens vision can get blurry and I need to blink. So apparently what I said was great before, I later said was blurry so she gave up. She then checked my pressure and said it was good.

In Real World I can tell my distance is getting better, but Synergy still not as sharp as my MF eye. Before I could just cover up 1 eye and instantly tell the MF eye was sharper, but now I have to do the cover up 1 eye thing several times to decide.

Also how the sunlight is shining at me has an effect on my Synergy IOL. Maybe due to healing or all those rings, not sure.

**Close and Intermittent Vision:

In the doctor’s office I was J1 for both the MF and Synergy IOL and J1+ bilaterally.

In the Real World, Synergy is better than my MF for both close and intermittent vision. I can see the computer better, but what I really notice is how clear the cell phone is. I thought my cell phone vision was good before, but now I realize it actually wasn’t as it is as sharp as can be now.

I have not been doing a lot of activities due to the surgery and Covid, so once I do more activities I will have a better idea, as the Real-World conditions vary so much. How will the Synergy do inside watching a basketball game and so forth. Only time will tell.

The doctor was very excited with my outcome. I asked if he could tell if I had residual astigmatism or refractive error and he said I was 20/20 and he would not even attempt that until the 1 month follow up.

So that is basically where I am at this time. Luckily so far I have fallen into the Happy Camp, as the risk is always higher with these diffractive IOLs and I think Synergy might be the highest risk diffractive IOL out there as there is always a risk when getting that great close up vision.

Oh, I did ask the doctor about the other IOLs out there now. He was not a big fan of the Eyhance or Vivity. He said they gave the same distance as the monofocal and just the slightest amount of closer vision for a premium price. He is a terrible salesman for premium IOLs.

I also asked about the PanOptics, he said it did good for distance and intermittent, but not as good as the Synergy for Close. Once again he said 90% of his patients are happy with the diffractive IOLs, but the 10% that are not are a big problem for him. So even though he has done clinical trials on diffractive IOLs he does not seem to be their biggest fan.