near vision poor after getting Symfony...seeking others' experience

Everything being equal symfony give you closest thing to natural vision. There are trade offs. When it works it works well. I have them. First eye last September second eye lasto month. One eye set at closer foer near vision and 20 25 distance. 2nd eye set to 20 20 distance and is not as good near but both eyes working together give me full vision close near and far. Typing this on my. mobile. if you have issues it is not the lense but something else. Perhaps wrong sizing etc.

Primeland, yes, I had my surgery in the U.S., and I also waited, sort of, to get the Symfony. I was originally on track to get the Tecnis low-add (2.75), though I'd been most interested in Symfony all along, but just felt my vision had deteriorated so much I could no longer wait until some uncertain future date for it to become available. And then...it became available! So I rescheduled with a new surgeon who I was told would be among the first to get access to the new lens.

As for targeting different ranges (distance, near, etc.) I believe that's more of a strategy with monofocal lenses, where the drop in acuity is more pronounced outside of the target focal distance. It's certainly possible to do with the Symfony, and is done to a lesser extent (e.g. with monovision), but its extended depth of focus means it isn't as necessary.

But I do intend to request some monovision, given how poor my monocular near vision has turned out--assuming, that is, that I can find no explanation and adjustment of some sort that would improve my near vision directly.

Hi WebDev,

Do you have the same amount of astigmatism in both eyes? I also share a similar experience since i waited almost a year for the Symfony to come out in the U.S. I am myopic and have astigmatism which needs to be corrected in one eye (1diopter) while the other doesn't need astigmatism correction (.5diopter) so I am considering a Symfony non-toric and a Symfony toric for one eye. But I haven't heard much info on the Symfony toric version but I'm assuming people still have good results despite the complications of a lens rotation. I was wondering if you ever considered an LRI to correct your astigmatism rather than the torics than you could have just got the non-toric version Symfony? I am also considering a bit of micro-monovision but I'm not sure if I'll be able to adapt to all the differences with one eye having a toric and one with non-toric and on top of that with the micro-monovision. I can't think about not being able to see well near since I've been myopic all my life!

Sorry for the multiple posts. Also did you ever consider having your surgery via laser-assisted and not by standard cataract surgery? Thanks.

Jason,

According to my opthalmologist, I have astigmatism in both eyes: .94 in my right (already implanted) eye, and .72 in my left eye, which is scheduled for surgery in 9 days. Those numbers are the average of three measurements (from an IOLMaster, a Pentacam, and a hand-held topographer, I believe).

Interestingly, this astigmatism has over the years been corrected differently or not at all, and always has been slight--i.e. looking at my past prescriptions, some have slight cylinger correction for left but not right, some for right but not left, and some for neither. From this I assume that the biometry numbers above are correct and measure actual astigmatism, and my prescription history just indicates my perception of it hasn't been so severe as to suggest correction during manual refraction.

The lens I have in my right eye is the ZXT150, which has a 1.50 cylinder correction and is the lowest toric correction available for Symfony (for Tecnis Toric lenses [non-Symfony, but I suspect these numbers still would apply], nominal, IOL plane cylinder numbers are about 1.45 of cylinder at the corneal plane, so this would mean I'm getting about 1.03 CYL actual correction). For my other eye, at .72, I'll be farther away from the lowest possible correction of 1.03, so, given my suboptimal experience with my current eye, I plan to question at my next pre-op visit. Perhaps no cylinder correction for this eye would be better than what the least cylinder Symfony Toric provides.

Jason, 

Sorry, I forgot to add: yes, I had this done laser-assisted, with the Catalys laser made by Abbott. This was included in the standard premium cost for the Symfony, and my ophthalmologist's preferred method.

Thanks for the reply WebDev,

I'll be getting mine done without laser as suggested by my opthamologist. You mentioned you read a lot of information regarding the Symfony torics, do you think the Symfony torics have overall more problems than the non-toric Symfony? I'm only assuming because the possibility of lens rotation that exists with any toric IOL. I'm asking because since the Symfony iteself is more tolerant of astigmatism I was wondering if it might be worth it to avoid the toric version and stick to the non-toric version in hopes that it adjusts with my astigmatism. Then again I've only read about the non-toric version and have not heard much about the toric version.

I had first eye done with laser and second without.  Both my experience and results were much better without the last\er.  Had symfony toric inplanted in both. 

I'm afraid I don't know, and I wonder myself, as my second eye has less astigmatism than my first (only .72, where the first eye had .94).

I don't know if the tolerance of residual refractive error applies to astigmatism in addition to spherical error, so I'm not sure whether it'd be wise to not attempt to correct it at all. My instinct is that it's better to try to correct it than do nothing, as a little improvement is better than none, and you may get it fully corrected. I'd imagine they'd have to be way off axis to add astigmatism. (Then again, I know it's tricky: each degree off means a ~3% reduction in correction, so if rotation is off by just 30 degrees--one clock hour--all correction is lost.)

My understanding is that the ZXT150 that I have is the lowest correction available (I see a ZXT100 referenced as available in Europe, but not in the U.S.) The ZXT150 has 1.5 D cylinder, which translates to 1.03 cylinder at the cornea, and is meant for correcting 0.75-1.50 (the numbers are from the Tecnis [non-Symfony] Toric sheets, but I assume the numbers would be the same).  The apparently unavailable ZXT100 is 1.0 D, or 0.69 at the cornea, and targets 0.5 to 0.75, which I would expect would be the best fit for me if available. So I'm not sure what I'll get. I have an appointment coming up with the surgeon pre-op and will check then.

WebDev,

?I've seen several opthamologists and most mentioned that any astigmatism significantly lower than 1.00 was not worth correctling (like for my 0.5 eye). Although from my knowledge I stil see it that correcting any amount of astigmatism is worth than to leave it alone.. It's interesting you mention the ZXT100 though that targets smaller amounts of astigmatism, do you know if this is available in Europe and if it ever will be in the U.S? I've heard there were multiple versions of the torics available and since the ZXT150 might cover the majority I think that may be one of the reasons why the other versions are not available (I heard there were like four of them). Please keep me updated on what information you get from your next visit regarding astigmatism and your monovision choice.

Astigmatism as low as 0.5 they usually correct via incision rather than through a toric lens. Part of that involves merely strategic planning of the incisions they need to do anyway as part of cataract surgery, to locate them where their surgically induced astigmatism will counter existing astigmatism rather than add to it.

Hi Glen,

Is there a reason you got your first eye done for near and then the second one for distance? I figured they usually do distance first. Did the surgeon decide based on your dominant eye or were there other factors? I am assuming you don't have astigmatism as well.

One thing that ive been told about and that has been posted on this forum is that after RLE surgey we need to wait 3 to 6 months for neuro adaptation which will reduce or stop the ghosting/blurring that we get. However I can see perfectly with new prescription glasses as soon as I put these on.during sight tests at the optom. So.....my question is what is this neuro adaptation? It seems to me to be a delaying or holding tactic. .... do things improve after 3 or 6 months unaided?

Neuroadaptation with a premium lens is different than with eyeglasses. Unfortunately they don't understand it well and haven't studied it as much as I'd have hoped for. Most IOL study results tend to be done at the 3 month or 6 month mark so the average results talked about are based on those time points, without indicating how soon before that they are achieved. There can be some minor improvement after that point, but I hadn't looked into what the data says regarding what % of people improve how much after that. I did go from almost-20/15 the first few months, to 20/15 being easy to read (and they didn't check a line below to see how many I read from that).

Your eye is used to adapting to changes in its focal point, like a new pair of glasses provides. For most of our lives our eyes   accommodate, they  change focus to a different distance.  Getting new eye glasses does confuse the brain a bit since the focal point has changed even though your eye muscles didn't do it, and some people do experience some initial adjustment period where things seem odd and they can get headaches, but its very short since the brain can easily adapt to it.

Changes in astigmatism are a little different, since our eyes can't change astigmatism under the control of muscles. However over a lifetime people's astigmatism can change. So our brains need to be able to adapt to that type of change also, though a change in eyeglass correction of astigmatism is more commonly a little hard to adapt to than a change in spherical correction.  In some cases when people have a small amount of astigmatism they are used to, they don't correct it since the person finds their vision worse than what they are used to. 

A multifocal lens is an entirely different sort of issue since it places 2 or 3 different images no the retina at once from different focal points. The brain somehow manages to realize which image it should pay attention to. Its not clear exactly how it does it, but the ease of doing it varies greatly between people. Even if the brain is able to almost right away decide which image to use, it seems to take some time for it to learn how to more precisely filter out the right focal point (or combination of focal points if you are looking at a distance in between 2) to use. 

The Symfony in theory seems like it should be easier since it is merely putting more of a range of things into focus at once. When your pupil size shrinks, that can increase the depth of focus. However oddly I had one surgeon comment via email that neuroadaptation seems to take longer with the Symfony than the AT Lisa Trifocal he was comparing it to in a study, which puzzled me. Unfortunately he didn't respond to a request for more information and to quantify the issue, it may be he hadn't sorted through the data yet, and I hadn't checked on it since. I adapted quickly, but I have to wonder if the fact that I'd used multifocal contacts in the past, with different brands with different optics, had perhaps given my brain exercise adapting to different sorts of optics. 

 In my case my distance vision was fine as soon as the bandage came off at least 20/20, and by  1 week postop almost 20/15. My near vision fluctuated quite a bit the first couple of days, going in and out (requiring readers to see computer&phone at times), I don't know what they measured it at the first day. However  then it settled down after that and got to 20/25 at near at 1 week postop and has been fairly constant since then,perhaps some slight improvement. 

Neuroadaptation varies wildly between people, with some people not requiring much time, and others getting decent vision within a week or two but then taking a longer time to get the best quality vision. Most usually have good distance vision right away and its the near&intermediate that might need to improve, since the lenses tend to be designed so  most  light  is focused from the distance point.

How is your night vision with car headlights?