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

I had both eyes done roughly 1 week apart on 14th Jan and 23rd Jan 2017.. so now at the 1month stage. Night time driving still very difficult, uncomfortable and in my view unsafe. So I'm still mot driving at night. However the glare and halos although still significant are reduced.

I got perfect vision from my glasses and post iol implant with symfony i am much more aware of the limitations of this technology. They have suggested that they will do some laser top up at the 3month stage which will improve residual astigmatism that i am left with. The general advice seems to be to let your vision settle over the first 1 to 3 months. The general advice also seems to be to get both eyes done as they work better together although i truly understand your hesitation.

My advice is see where you get to just before the op and then decide. If necessary delay by another week or two. You can always elect for the op but you can never go back.

Mutlifocal iols do not give perfect near, perfect intermediate and perfect distance vision. This is the limitation of the technology. They cannot and don't replace the vision we had in our youth.

After my laser top up im hoping to be glasses free for most things particularly sport which was my aim.

Thanks for the response.  I did decide to delay for 2+ months to determine which of sevreal options I would choose for my other (left) eye.  My choices were 1) get the same symphony len, 2) go with a multifocal lens by another mfg lens, 3) go with a monofocal lens, 4) go with a clear lens & use a multifocal contact lens.  I suppose there was a 5th choice in having the right lens removed as well and then select options 1-4 for that eye, but that would be a last resort.

So I had a consult with my surgeon yesterday and decided on option 1 - use the symphony lens for my 2nd surgery.  I don't want to introduce yet another potential for conflict in my vision (I tried mono-focal contacts and hated them) by having a symphony in one eye and something else in the other eye.  Over the last 2+ months I have paid close attention to how my right eye vision has changed and my brain adapted to the new lens and here are my personal results. 

NEAR VISION: one week out from surgery to implant into the right eye, I had almost no near vision with the symphony lens, unable to read my cell phone, computer screen or pretty much anything in print.  I relied on my left eye to be able to read, closing my right .  Over the past few months I tried using a patch over the left  eye or simply removing my contact lens in an effort to "force'" my right eye to see better (I do have perfect vision mid & long range).  I'm not sure that worked, but I did become much more comfortable using the right eye over time. I now find that I can see fairly well with the symphony lens starting at about 12-15" out - not perfect and not great, but I am able to read words in print that I could not initially.  Computer screen and cell phone vision have improved as well.  I suspect that once I have both eyes done (the surgeon recommended a -0.25 adjustment) my brain will adapt to having both eyes with nearly equal vision and my reading will improve slightly more.  So the first hurdle I experienced of near vision loss seems to be improving to at least an acceptable level.  Use of magnifiers as needed for small print or low light is also acceptable.

NIGHT VISION: I initially had "stop in my tracks" night glare, spiderwebs and halo's that made it tough to even go for a walk after sunset.  Driving was initially not viable.  Over time, I still notice the bright light artifacts, but I have adapted to them to the point where I can drive with fear.  However, I realize that is in part due to still having a clear left eye (using a multi-focal contact).  Having a second surgery to replace that left lens with another symphony is a concern and a risk, as the night light issues could be intensified, again making it impossible for me to drive after sunset.  That is why it has taken me 3 months to make a decision. I have decided to take the risk of getting the 2nd symphony lens in order to have a consistent vision experience in both eyes, in the hope that my brain will continue to adapt and overcome the halo's & spiderwebs so that I'll be able to drive, in time, after both eyes have fully recovered.  My surgery is not scheduled until June, but I will write up two follow-ups on how the two symphony lenses work together; one a week or so after surgery and another a few months out.

For all on this thread, I want to thank you for your patience and understanding of how difficult the decision are as to what solutions to choose and for help during the recovery phase following the procedures.  It's clear that cataract surgery, the choices we make and how our eyes respond is far from an exact science. 

 

It  is not easy to know what to do.   I have decided to use a multifocal lens for my second eye rather than the symphoni in hopes of getting better near vision.  Dr. told me today there was a 60%  chance I  may need small laser correction  afterward.   I find typing  on this  program very difficult.

Hello, I an curious about the success of your two symfony lenses. It has been several months since your second surgery, I think. Are you able to drive at night? can you read without glasses? book? computer? Any other observations? I have to decide next week if my second eye will get a  symfony ( like the first) or a toric monovision. I'm very conflicted. I am not able to read a book with my first symfony. I can't even find a suitable reader to use. Different strenghths at different times of day work somewhat but none allow me to read with pleasure. I rely on my unoperated eye with my progressive lens for much of my reading and near work. 

thanks

 

Hi msailing - I had 2 Symfony lenses implanted July 19 and Aug 21 (regular not toric lenses).  Even after 1st implant I could read at 18 inches.  However to begin with my eyes were -3.25 right eye and -2.75 left (not sure if that plays into how well one sees after one surgery. ) I was able to cope by poking a lens out of a pair of glasses.

After 2nd surgery reading improved a lot and I haven’t worn glasses at all since surgery.  First eye is 20/20 and second eye wind up 20/30.    

So after your first implant you are not able to read at computer distance? how is your distance vision - is that clear?   Did you have a check up since that surgery to find out where you wind up?  Sometimes with the toric lens the lens rotated so that may account for vision not being clear as well.

My very experienced surgeon (has done thousands of symfony implants)  examined me last week and he was very pleased with the results.  I don't think rotation is the issue. However I am finding it difficult to read with the symfony eye and continue to rely on my old progressives in the unoperated eye for extended reading. This includes computer (laptop) and books and magazines. I can read on my smartphone if I place it very close to my eye. Not comfortably however and sometimes I misread numbers. Perhaps the second symfony would help this close reading?

My distance and intermediate vision is really great now.   But I am apprehensive of having the second eye also with a symfony lens and giving up the option of improving either the reading issue or the starburst issue. 

Did your surgeon test your vision?  What did you wind up with?  My first Symfony Lens was targeted at 0D and at first testing vision for distance was 20/20.  I could read clearly from 18 inches and beyond with that one eye.  My 2nd Symfony Lens didn’t hit 0D target.  Ended up with .50 diopter nearsighted.  But that has actually worked out better for me as I can now read at 11 inches outwards.  That eye tested at 20/30.  With both eyes open I see distance and read small fine print.  Haven’t worn glasses for anything for 2 1/2 months.  Going for a check up to my optometrist Dec 1st. 

Wish you all the best for your decision.  It really is a personal choice.  For myself I like the daytime vision I get with Symfony.  I knew ahead of time trade off would be night vision.  First 6 weeks it was difficult but must say the starbursts and glare have settled down a lot.  Still see the concentric circles around certain light sources but these aren’t as troublesome as the glare and starbursts.  I have no issues driving at night.  Prior to cataract surgery for years had trouble with glare and oncoming headlights.  Not sure any lens for me would fix that. Thanks 

Yes he tested my vision- distance was 20/20. He said he was quite happy with the results and that I had the best vision results from the symfony including  reading. I think I'm insecure about giving up my natural lens to something that is not 100%, ie starbursts at night and difficulty reading a book.  I feel there may be a better option in having a monovision implanted in my left eye. I'm seeing the surgeon next week, a week before my surgery to go over my questions. It is a questions of choice- what I will give up in each case.

thanks

thanks.

Feel for you.  I struggled with this decision over the summer.  I am young for cataract surgery.  My surgeon took the time to inform me that anyone younger (particularly those who still had good near vision like I did) struggle the most with the compromise.  There is no perfect lens - which is why I fail to understand anyone wanting clear lens exchange (basically cataract surgery for someone without cataracts just to rid themselves of glasses).   

My cataracts affected my vision to 20/70 and 20/60 so really no choice.  Was having trouble seeing roadsigns but could still read well.  If you have time you may want to experiment with contact lenses to see what’s better for you.

Are you thinking mini monovision with another Symfony Lens?  

I’m not sure what minimonovision is. Can you explain it? 

I have had monovision for many years, with one eye set for distance and the other eye set for reading, with a resulting difference of about 2.25D between the 2 eyes. I adjusted to that in less than 5 minutes, but many people do have a problem dealing with that much difference in the 2 eyes. The mini-monovision tries to have a smaller difference in the 2 eyes (about 1.0D to 1.5D), which makes it much easier for most people to adjust to. Thus, for example, one can have one eye set for far distance (with IOL, or contact lens) while the other eye is set for intermediate distance. That work well for most of the distance range, but will require use of glasses for reading. Depending on the type of activities and what one is used to, one can also opt to work with intermediate and reading vision without glasses and use glasses for distance.

If the issue is starbursts and not halos, then that might not be due to the IOL choice. Wrinkles in the capsular bag behind the IOL are one cause I've seem listed for starbursts. Those complaining about night vision artifacts with the Symfony are in a minority, but they are usually talking about halos, from light scatter off the rings. Most studies of IOLs in general only report results at the 3 or 6 month mark for night vision artifacts to see what happens after the initial healing and adaptation period where some people temporarily have issues that go away, even with monofocal IOLs issues are more common during that period. 1 month is still in the initial healing period and too early to have any sense of what the eventual night vision issues will be like.

Do you know what your refraction is, your prescription? It may be that you have residual refractive error, e.g. that you were left farsighted which cuts down on your near vision (with any lens). That can be corrected via laser. I get 20/25 at near due to my good eye that was on target, but the one left +0.5D hyperopic has noticeably less near, though I hadn't tested it by itself. It wouldn't be very usable for near by itself. I may get a laser tweak to target -0.5D but I hadn't bothered because I have good near from the other eye.

You may also have residual astigmatism reducing visual quality and reducing near. The results I'd seen for toric lenses in general (of any model) suggest perhaps 29% are left with > 0.5D of residual astigmatism which may need to be corrected which may be impacting near vision.

Do you know what your near vision acuity is, to get a sense of what "poorer than expected" is? People have different standards for that, and different ideas for near. I'd also be curious if you had presbyopia before this (most cataract patients did, but uncommonly some folks get cataracts, e.g. perhaps from medication side effects, even in their 20s and are used to a far greater range of near than someone with presbyopia is and have greater expectations).

As I keep mentioning on this site, its mostly people with problems who choose to post (and some of us who researched online beforehand, and post afte to give balance and "give back" since we know what its stressful to sort through options). The vast majority of people have good results, e.g. an article going over results from studies can be found (since they moderate links here) by googling:

"High rates of spectacle independence, patient satisfaction seen with Symfony IOL"

which noted (high compared to results with other IOLs):

"In the European studies, subjects were asked if they would recommend the lens to a friend. Nearly all (97.9% in the Europe-1 study and 93.7% in the Europe-2 study) said yes. A high percentage of patients across studies said they would choose to have the same IOL implanted again (Figure 2). "

There is a risk of night vision artifacts even with a monofocal, though the Symfony is perhaps comparable risk to some monofocals, its not as low risk as the best like the control Tecnis monofocal usually used in its studies.There is a minuscule risk that anyone getting a multifocal will be bothered enough to wish a lens exchange, and the risk is lower with the Symfony.  Everyone has their own risk preferences though, for some even a small risk of problem is too much, I tend to be more of a risk taker, but others aren't.  The first few months some people have more night vision issues, even with a  monofocal. 

In my case since I'm much younger and expect another few decades of use of the IOLs, I figured having better vision for a few decades was worth the slight risk of a lens exchange. I'd been highly myopic all my life and liked the idea of perhaps never needing correction the rest of my life, being willing to risk a low risk of needing readers at times, but a bit more risk than with a multifocal  (though I wound up 20/25 at near). 

Studies do show in the elderly where falls are more problematic that monovision correction or progressive glasses increase the risk of falls compared to good vision without them, and the same is true of reaction time in driving simulation tests. I'm not old enough to be concerned about falls being more damaging, but I still appreciate jogging/hiking on rocky trails and havnig crisp vision with both eyes at that distance since a fall can still cause injury.  

Even many people who wear contacts or glasses for night driving have issues with halos or glare.

With toric lenses there is a decent chance  (pehaps 29% some studies show) you may wish   a LASIK or PRK touchup afterwards for residual astigmatism. 

Thanks for quick and helpful response, I went to the link with the European results, hadn't seen that. I'll post my initial results once I have the surgery...thanks again.

Thank you for your thoughtful reply.   Just came from the eye Dr. and he is recommending a multi-focal w/out astigmatic correction in an effort to get me close up vision.   He tells me I may need a small lasik touch-up to correct the astigmatism after the eye heals.   

​I am willing to wait and see how my brain adapts to the the halos and starbursts as I know there is healing that can take place for a few months as your brain becomes more accustomed.   It took one of my friends four months before she could read a restaurant menu, but now she can and she is thrilled.   She use the Symfony lenses in both eyes.    I am not quite as patient as I work full time, use a computer, and cell phone all day as well as drive quite a bit so I need to switch visual fields frequently during the day.   

Is there a correlation between the level of astigmatism one has and the approximae 29% chance of a need for Lasik or PRK touchup?

You could consider temporarily using computer distance readers at work which would likely  leave your near vision good enough for your phone, though that may slow neuroadaptation since trying to see near without correction helps the brain adapt to doing so. I don't know what you are using if your other eye needs correction or how bad the cataract is, if its not too bad you could consider wearing a contact lens in the unoperated eye set for nearer in for monovision, or a multifocal contact.

Your comment is a ambiguous in that I don't know if you mean the lasik touch-up is for the current eye or for the next eye where he isn't recommending a toric.

If it wasn't for the first eye, again I'd find out what your refraction is, your prescription, in the first eye. It may be that a lasik touch-up may be needed to give you better near in that eye since the average results are fairly decent near. Unfortunately I haven't seen any data on how long it takes to neuroadapt to get that, and neuroadaptation can vary greatly between people. One surgeon did make say the Symfony took longer to neuroadapt to than the AT Lisa Trifocal, but didn't respond to a followup email asking to quantify that, likely since there isn't study data yet.  I don't know if I may be atypical then since after near vision fluctuating in and out for a couple of days, its seemed to be consistently decent by the 3rd and could use my smartphone without problems,  and at the 1 week postop was measured at best near to be 20/25. I didn't know if perhaps the fact that I'd worn multifocal contacts before this, from a couple of different brands with different optics, if my brain had gotten used to needing to neuroadapt to new optics and adapted faster, or if its just good luck. 

 

How near is the near vision you need? A bit of micro-monovision may give enough with the Symfony, with reduced risk of night vision artifacts compared to a multifocal. Is it a trifocal being suggested or a bifocal? (I don't know where you live, unfortunately there isn't a trifocal approved yet in the US, even though they've been approved elsewhere for a few years, there are a couple in clinical trials for approval but no idea how long that'll take).

re: the 29% chance of need for a touchup with a toric lens, since they moderate links, you can find the article on it by googling this line:

IOL Surgery Astigmatism Elimination Dr. Rick Wolfe FRACS FRANZCO | 24 March 2016

 It refers to a meta study  of studies on toric IOLS (of varied models) and says:

"Visser31 considered 22 publications to 2012 that published toric IOL outcomes. The pooled estimate of the 22 studies was quite disappointing with only 43 per cent of eyes =6/9 uncorrected and 71 per cent =0.50 D of astigmatism"

That leaves 29% with > 0.5D of astigmatism, which usually people with a premium lens wish a touchup for.  I just saved the data point out of curiosity but hadn't looked into it further to see if they have a breakout.  btw, the level of astigmatism to be corrected isn't determined by your prescription since although most astigmatism is on the cornea, some of it  can be in the lens which goes away when the natural lens is removed. Lower levels of astigmatism are sometimes treated with an incision (often called an LRI, Limbal Relaxing Incision, but it can be located on other parts of the eye) which causes the eye to reshape. Oddly that article I reference cites a study skeptical of LRIs, but other sources I'd seen suggest the outcome of LRIs leaves about the same needing a touchup as toric IOLs around 29% or so (though I can't seen to find the reference offhand).

Studies show the Symfony is more tolerant than other lenses (monofocal and multifocal) of more astigmatism, I was at least 20/20 at early postops with an eye on target at 0 sphere but -0.5D of astigmatism. The most recent check (2 years postop) it had shifted a little so there was less astigmatism, perhaps measurement error , -0.25 sph -0.25 cyl, but it was still at least 20/15 (they didn't have a lower line and that line was easy to read) .

 Also I should mention regarding the issue of night vision artifacts, most of the comments I've seen regarding people having issues seem to be from people much younger than the typical cataract patient, you are more typical. The retina becomes less sensitive as we age so I suspect it may be that younger retinas may be more sensitive to the stray light scattered off rings on the IOL. Unfortunately when I checked I didn't see a study on the issue of age vs. night vision artifacts. 

I forget if I mentioned on this page that in my case I actually have less disability glare than I can recall having before (i.e. a bright headlight is less distracting, its brightness doesn't cause me to have trouble seeing nearby objects), but I don't know if that would have been the case with any IOL or if its related to the Symfony's optics. Thats part of why I feel my night vision is better with the Symfony than I can recall it being before, even before cataracts, even though I'm in the minority that do see halos, but they aren't a problem for me since they are so mild/translucent I see through them. (though oddly at 2 years postop the halos have finally disappeared from some lights where I always saw them, while still being there but faded around others. It may be that I've been working a lot at home at night and out less so I've not been using my night vision as much which may have slowed neuroadaptation, less practice for my brain tuning things out).

Thanks again, very detailed informative article. I see from your earlier post that your "good" eye was able to overcome any issue with the 0.5D astigmatation in your other eye, so you were comfortable with the result. Assume you must have had your Symfony Toric lens operation oversees or in Canada, is that right? Is the 1.0 Toric lens he mentioned now available in the USA, I have a left eye reading of 2.25 astigmatism ( high to me)  although I don't know how much might be corrected just with the new lens, as you mention above. Are there surgeons that specialize in IOL Toric lens only or mostly where some of the Verion and Alcon measurng equiptment he mentions in the arcicle might be more likely found within their practice? Again if these questions are beyond the scope of this site, simply ignor them, I'm very happy with what you have already shared.

The Symfony toric is available in the US, a quick check shows they have models with astigmatism corrections at the corneal plane of:

1.03 D 1.54 D 2.06 D 2.57 D

Its not clear from a quick check of the US vs. European websites if they have the models above and below that which are on the European website. Unfortunately part of the reason for residual astigmatism with a toric lens can be that the step sizes of the lenses don't allow an exact correction, they usually go in steps of +0.5D at the IOL plane (which is a bit less power when converted to the spectacle plane, a lenses power depends on how far out from the eye it is). So sometimes they may need to do an LRI or other incision as well.

The level of astigmatism you need corrected won't be determined until they do the scans just prior to surgery since most diagnostic scans only check the front surface of the cornea, but they've discovered for accurate results  they need to check for posterior corneal astigmatism as well to get total corneal astigmatism. The level of astigmatism for the IOL to correct may be higher or lower than your prescription. Astigmatism can be from your cornea, but also from your natural lens (though that is usually, not always, less). When they remove the natural lens, any lenticular astigmatism goes away so its only the corneal astigmatism that matters. The lenticular astigmatism can actually be in the opposite direction from the cornea, and balance it out, so the astigmatism correction needed might be larger than your prescription, or smaller.

There isn't much difference in how they insert Alcon vs. Tecnis lensess, most surgeons can deal with whatever lens. Some surgeons tend to stick to particular IOL brands out of personal preference, or less fortunately due to their clinic's deals with suppliers. 

I should have noted before when you asked: "Is there a correlation between the level of astigmatism one has and the approximae 29% chance of a need for Lasik or PRK touchup?" that although there may not be data on the issue,  that logically it should make a difference. 

One of the reasons for residual astigmatism is if a toric IOL isn't properly oriented so the lens power over a particular spot is off. If the lens rotates a certain amount, the lens power will be off by some X% of the cylinder power, and so the same rotation of a lens leads to a larger error with a toric lens with a high cylinder power. As I noted btw, although that article I mentioned critiques LRIs, I seem to recall that the source I'd seen on them was a meta-study suggesting that it was about the same % who are off > 0.5D  cylinder with an LRI. 

re: "your "good" eye was able to overcome any issue with the 0.5D astigmatation in your other eye, "

I'll note btw that both my IOLs are spherical, I didn't have enough astigmatism pre-op to need a toric IOL.

Perhaps the context was confusing, my good eye is actually the one with the very slight astigmatism :-). My "bad" eye wound up slightly hyperopic, +0.5D sphere consistently at postops (one outlier test early on was +0.25D, but your vision varies slightly through the day, and there is measurement error), though with 0D astigmatism. It has good distance, but that is enough to  noticeably reduce my near vison for e.g. using my smartphone. Fortunately my "good" eye makes up for it so my binocular near is 20/25, they hadn't tested each eye seperately. My "good" eye was initially at 0D sphere, -0.5D astigmatism in early postops consistently, but still had almost 20/15 distance vision. The most recent check, 2+ years postop, it shifted a bit (perhaps measurement error) to -0.25D sph -0.25D cylinder, and is at least 20/15 distance (they didn't have a line below that to check, and that line was easy). 

I'm from the US, but I  had my Symfony done in the Czech Republic back in Dec. 2014. I'd gotten a problem  cataract at the atypically young age of 49 and disliked the idea of losing the remainder of my near vision,  but since one eye remained good I was able to stall hoping the US would approve a better lens, like a trifocal.  I'd been a high myope, unable to do much of anything without wearing contacts or glass. So  the idea that as long as I needed surgery anyway, that perhaps  might not need  correction the rest of my life appealed to me. I finally gave up waiting for the FDA to approve something and went abroad, finding a high quality surgeon but in a lower cost country while at it (both eyes done for less than my deductible if I'd done it here). I decided that the Symfony was a better bet than a trifocal for my needs, since it has a bit better intermediate, and lower risk of night vision issues. Even now 2+ years later there are still no trifocals IOLs approved in the US.

 

 

 

It would be very helpful if someone could help me with this decision. I have cataracts and the vision in my OD IS 20/40. I was told that I could get it cataract surgery. My current prescription is as follows:

OD -4.75 -1.50x010 Add 2.50

OS -3.25  -1.50x110 Add 2.50

1 year ago it was :

OD -4.25 -1.75x009 Add 2.50

OS -3.25 -1.00x110 Add 2.50

Now I am 70 and very much enjoy golf but I also do a lot with iPhone and iPad and with my bifocals on I can see the print clearly now. I can also take my glasses off and see the print such as this without to much trouble if I hold the iPad about 12 to 16 inches from my face. Now I have not seen a surgeon but I have phoned a number of their offices and discussed things with them. There is at least one group that will not do Symfony or any other similar lense. There are a couple that will do Symfony Toric if I am qualified. Now I know from the discussions that testing must be done to determine my final numbers. However the ones that will do Symfony are more expensive than the ones who will not do it. 

Now i I saw somewhere that some one did the math to convert these numbers ( which I know will probably change) into what needs to be corrected with a lense but I cannot find it anymore. Can someone do the math based on these numbers and tell me what Symfony I might qualify for?

now my other decision is that my glasses turn darker with sunlight and UV Ray's. I find this to be a great convenience for playing golf and other outdoor activities because I do not have to worry about sunglasses. However I have worn glasses since I was a child and always dreamed of seeing without them. So in the end if the Symfony hurt my near vision I would probably get UV byfocals and wear them all the time. However I do want to be able to drive at night which I am able to do now   With this said what would you recommend. I am trying to make the right decision about a surgeon from the start. 

Thanks for for any help you can provide. 

re: "Can someone do the math based on these numbers and tell me what Symfony I might qualify for?"

I assume by which Symfony you mean whether you need a toric Symfony which corrects for astigmatism, or the regular Symfony which doesn't. (since your prescription is moderate myopia, welll within the range of lens powers that the Symfony comes in, though the actual power is determined by eye measurements rather than that precription).  Small amounts of astigmatism are often corrected in surgery with an incision, often an LRI  (limbal relaxing incision) which causes the eye to reshape itself. Usually larger amounts are corrected with a toric lens. Doctors vary in their preferences for how much they prefer to correct by incision, and how much with a toric lens, and there is a range of astigmatism where it really depends on the doctor which way they prefer. 

Those numbers give the astigmatism for your prescription, which isn't the same as what will be corrected in surgery, which they determine with a device that scans your eye.  Usually they only do that within a few days of surgery to order the IOL, though some scans may be done earlier  that givesome idea of what the corneal astigmatism is.

Astigmatism means your eye isn't shaped like a sphere, more like an American football, so it has different lens powers at different angles. Astigmatism can come from  the cornea of the eye (corneal astigmatism), or from the natural lens ( lenticular astigmatism). When you remove the natural lens, the astigmatism coming from the lens goes away, so the IOL only needs to correct for astigmatism on the cornea. Unfortunately from the prescription we can't tell how much of the astigmatism is from the cornea and how much from the lens. Sometimes the natural lens has astigmatism in the opposite direction from the cornea and it counterbalances it so the corneal astigmatism is less than the prescription, or it could be more.  Often there are small changes in prescriptions merely due to measurement error, or even due to our eye changing slightly throughout the day so it depends  on when the test is done. However the shift in astigmatism of the one eye from -1D to -1.5D suggests its possible that the increase in astigmatism is due to a cataract. 

Usually (not always) lenticular astigmatism is small so if the corneal astigmatism is about the same as your prescription,    its likely the eye that was -1.75 a year ago and is -1.5 now would usually  be a candidate for a toric lens (though some surgeons would use an incision, likely a minority).The other eye that is -1.5 now but was -1D may have had a change due to the cataract, if its -1D that is in the range where some surgeons would use a toric lens and others an incision. 

re: "Symfony hurt my near vision".

It would increase your near vision compared to a  monofocal, and the visual range should be greater than someone your age has with single focus correction. I tend to describe it as being like early presbyopia when you just start noticing with distance correction that say to read  the fine print on a medicine bottle you need to adjust where you hold it, but at least in my case can still do so without readers (and a bit better if you get micro-monovision to have one eye very slightly nearer in, perhaps -0.5D). A small minority need readers for fine print or extended reading of small print, and to thread a needle for instance I use readers (though thats a rare task for me so I wasn't concerned about very near).

  Those who don't have good near usually have the lens power being off so they are left farsighted, which can be corrected with LASIK or PRK (or glasses/contacts of course).  However you are only a moderate myope, so the odds are good that the IOL power choice will be accurate, the risk the power will be off is higher for those who are high myopes (since the formulas are based on statistics and not exact, there is no guarantee, but for various reasons the odds of an issue are higher for those with high prescriptions). In my case my eye that was perhaps -6D, just in the range of being highly myopic, still wound up on target at 0D (or -0.25D at the last check, most were 0D, close enough). It was my eye that was about -9.5D that was left  a touch farsighted, +0.5D, but the other eye makes up for it.  However even those with perfect vision might have the IOL power off a bit, the odds are just much better they will get it right, even up through moderate myopes the odds are pretty good.

Your near and intermediate vision will be worse with a monofocal. Some very lucky people have some usable near vision with a monofocal, someone on this site posted extremely good results, but its best to expect average results rather than bet on that, and those people would have had even better near with the Symfony. 

Some surgeons are conservative and don't want any patient complaints so they avoid any premium lens. You'll notice that eye surgeons don't personally get involved with selecting the details of the lens material and coatings for  glasses, and usually have someone else (a tech or an optometrist)  test your visual acuity and find the prescription, since they are more concerned with medical issues than with optics. Which IOL to get is a matter of optics and convenience to not need to wear correction. While many surgeons are good about considering other IOL choices,  many other surgeons are just focused on treating the medical condition: getting rid of the cloudy natural lens and putting in an IOL. Most figure that as long as that is done, worst case the person can wear correction, so they don't consider it a medical issue so they are less concerned about convenience. 

Many patients are going to be happier with a premium IOL than they would have been with a monofocal IOL, but a small % complain and some doctors don't like that. A monofocal is the safest choice, there are risks of night vision problems even with a monfocal, but if so there isn't much to be done so they can ignore complaints. Although the vast majority of people with premium IOLs are happy with the choice, some have complaints. There is a minuscule risk that someone may be unhappy enough with the Symfony to wish a lens exchange, but that isn't much different than the initial cataract surgery, even if not quite as simple (since the artificial lens is harder to break up to remove than the natural lens). In my case I figured high odds of having more convenient vision the rest of my life was worth a minuscule risk I'd need a lens exchange. Its necessary to realize that *someone* winds up being the "statistic" and does wish a lens exchange, so someone risk averse needs to be cautious. During the first few months there is a greater chance of things like halos at night while you are still healing and adapting to the IOL.  Unfortunately out of 20million+ cataract surgeries/year and 480,000+ with premium IOLs, even a tiny minority with problems posting online can give a distorted view of how happy most people are with the results.  In terms of night driving, as I posted earlier, google:

"High rates of spectacle independence, patient satisfaction seen with Symfony IOL" 

to see that the odds are low of night vision issues, but some do have them. It just depends on how much risk you wish to take. I had my problem cataract appear at age 49, though I postponed surgery for a while that was when I made my mind up to go for a premium IOL, so my decision was based on the odds of   living with the more convenient vision for some more decades.

  

In your reply to BIGDBK you said "However the shift in astigmatism of the one eye from -1D to -1.5D suggests its possible that the increase in astigmatism is due to a cataract."  I didn't realize that some of the astigmatism was related to cataracts in the lens versus the lens themselves. I thought that astigmatism was limited to cornea shape and/or other aspects of the natural lens, not the cataracts in them.  

I was also surprised to read that Premium lens are only about 2-3% of the cadaract surgeries. Is the ratio of premium lens likely to grow in any signifcant way here in the USA  given the early popularity of the Symfony lens?  Any guess as to the likely % of premium lens vs mono for those who would qualify for a toric? 

re: "some of the astigmatism was related to cataracts in the lens versus the lens themselves."

Cataracts can impact both the spherical refraction, how myopic you are, or how astigmatic you are, depending on their shape and location within the lens. Some cataracts have little if any impact, usually only a minor impact, but some can make major changes. 

In my case I had a very atypical cataract, atypically young at 49, but also atypical in how rapidly it impacted vision. In 3.5 months my astigmatism went from like -0.75 to -4D, later it subsided and instead the eye went from -9.5D to -19D or so over a couple of years (while my other eye was 20/20 correctible still so I mostly tuned out the cataract eye, which is how I was able to stall surgery hoping for a better IOL to be approved in the US). It was really weird since in the first few months my optometrist was puzzled since she didn't think the issue was a cataract since even though it impacted vision so much it was barely visible in the lens, she  refered me to an ophthalmologist to diagnose the issue  just describing it as "trace nuclear sclerotic changes", but the eye surgeon diagnosed it, and later it was clearly visible to the optometrist. While my optometrist was puzzled I spent lots of time researching eye issues concerned I might be going blind, personally suspecting it was a cataract even though the optometrist was skeptical, which is when I discovered the US was behind the times in IOLs.

A premium IOL costs money out of pocket extra so many people don't bother with it, partly since some cautious surgeons are just focused on treating the medical issue and aren't concerned about convience of not needing correction. In their mind if the person can see well with correction, they've done their job. Some surgeons had poor experiences with early generation premium IOLs and haven't given the newest ones a chance, which is like judging personal computers or cell phones by what the early ones were like.

I don't have a figure handy on the overall premium IOL market share, but in the US its higher than that, but still small. An article I just saw says:

"Multifocal IOLs have slightly less than 5% of the market in the U.S., which has been constant for the past 5 years. Yet, there are practices that implant in excess of 90% of their cataract surgery patients with multifocal IOLs. How is this disparity possible?". I don't know what share the Crystalens had, which would add to that.

I've seen a number of comments suggesting they expect the premium lens market to grow quite a bit due to the Symfony, partly I suspect since its a new category of IOL so those who swore off multifocals might give it a try. An article by one surgeon noted: "The addition of an EDOF lens to our practice has significantly changed the way I talk with patients about advanced technology IOLs. The lens has more than doubled the share of presbyopia-correcting lenses that I implant–from about 10% of all my cataract procedures to 20% to 25%" but I haven't seen any industry wide statistics on its sales or market share. 

 

Oops, clarification, when I wrote: "astigmatism went from like -0.75 to -4D, later it subsided and instead the eye went from -9.5D to -19D or"

Of course the second figures where the spherical refraction, its myopia increased due to the cataract while the astigmatism went back down.

 

I'm sure you're right about the increase in premiums due to the Symfony, both of the surgeons I saw in Sarasota FL were high on them and wished they had had them two years ago.  Both of them also recommended me for the toric version, so I'm leaning that way but will wait till next year to see more data. Thanks for clarifying the cadaract in the lens questions, helpful.  

Please tell me what you ended up with in each eye and your results so far.  any info about other people or friends would also be appreciated especially 6 months postop.  I thought i was getting a synfony but found out later doc put in a multi focal Tecnis ZLB00.  Very blurey vision first week, then impoved some but still not clear at two weeks and not improving.  Best near vision at about 16 inches, gets worse before or after that.  Canceled surgery on 2nd eye till i get this all sorted out.  Got a 2nd opinion doc said I could still have the synfony in 2nd eye or Tecnis different model that would give better intermediate range (like reading computer).