Probable Exchange, Considering Symfony
Posted , 7 users are following.
In my last post, I mentioned that I was left with some refractive error and had to make some decisions about what to do.
So, here's the update. I went for a second opinion about my situation with a very experienced doctor. I'm not going to write every detail about the evaluation for the sake of time, but here's the important stuff:
The doctor says I was given a 13.5 when he would have given be me a 15. He also says the astigmatism power of my current IOL is weak. He has no idea why my measurements with the original doctor were off. I am in the process of trying to get more info from that doctor.
He says I have three options. He does not think Lasik/corneal surgery is the best option. He thinks I should either wear a contact lens to correct the error OR exchange the IOL for the correct monofocal IOL OR exchange for the Symfony if I would like better intermediate vision.
He is not pushing me in any direction, but I think he has concerns that the contact lens is not a long-term solution because I only had surgery in one eye -- my original plan was to have a Monofocal lens in my RE and continue to wear a contact in the LE for the time being (possibly having that vision surgically corrected down the line). Also, I am young. I can wear a contact lens now, but what if down the line my eyes are dry and it becomes difficult. I cannot wear glasses with the IOL in only one eye and the other eye being myopic.
He seems to think an IOL exchange is the better long-term choice. We talked about continuing with the Monofocal vs changing to the Symfony.
Okay, so that brings me to my real question:
I'm young. 33. I am not presbyopic in my LE and I am concerned that continuing with the Monofocal route will be hard given my work with computers. I might find the sweet spot for intermediate vision by making my RE more myopic, but would the Symfony be a better choice for my situation? I understand the drawbacks. I am looking for input from Symfony users, especially people who have one in one eye only. Do you find this works well? Are you generally happy with your intermediate vision?
I also would like to hear from unilateral IOL people with Monofocal lenses. Were you able to get by with readers for computer use with one eye able to see near/intermediate better than the other?
I am facing a trade-off either way. I think I would prefer to have night vision issues and be able to do computers more easily, but I don't know for certain. I need to make my decision over the next few weeks, during the window for easier exchange surgery. I am awaiting a contact lens for my RE to correct the error and that will tell me more. In the meantime, I'm just looking for input. Thank you.
0 likes, 13 replies
Sue.An2 mary1985
Posted
Hi Mary - i have 2 Symfony lenses and lived 6 weeks between surgeries with just the one IOL. Both eyes had cararacts yhat had to be dine (failed vision test at DMV).
At 33 did you have an early cataract that necessitated cataract surgery or did your original doc talk you into a clear lens exchange? Regardless of reasons the younger you are for this surgery brings another challenge as your pupils dilate much more than someone of normal cataract age. IOLs are 6mm in diameter so your pupil may dilate beyond the edge of the IOL causing a ring of light or shadow to appear. And that could be the case no matter which IOL you choose.
Hopefully the new doctor explained that although Symfony will provide you great distance and intermediate vision (and I also have near vision with mine) Symfony also produces halos at night - i see 8 concentric circles around certain light sources at night. For me as I was aware of that accepted the trade-off but many aren't very happy about the compromise. It's crucial when opting for a premium lens like symfony that the power calculation is accurate. making a compromise of night vision is one thing but it is 100% worse if the day vision doesn't meet your expectations.
Is your plan to get a toric lens to correct the astigmatism whether you opt for symfony or monofocal? If not you will need glasses or contacts to correct that anyways.
Most people do not opt to exchange for a symfony lens (heard more stories of opting to exchange symfony for a monifocal lens).
You'll get many opinions on this but it really comes down to your preference and confidence you have in your surgeon's advice and skill. we can support and suggest but we are all patients like you with only our own experience to rely on.
Personally I would try a contact lens to see of that would correct your issue. If as 2nd doc says the power for vision and astigmatism is off you should be able to verify that with a contact lens. if it doesn't there could be something else contributing to your poor vision at present.
Hope things go well. It must be frustrating to try and figure out best route to take.
mary1985 Sue.An2
Posted
Yes, I had a cataract in my right eye. I lived with it for 5 years, until my vision was too effected and it was time to have surgery. I probably got it due to steroid use, but I don't know for sure. There is no sign of a cataract in the LE.
The doctor I am currently with is exceptional. And yes, I am going to wear the contact lens for a few weeks and see what I think about the combination of monofocal IOL in RE and my Natural Lens in the LE. But if that works for me, I will still probably opt to exchange my current IOL for the correct power IOL, because I don't like the idea of having my distance vision off in the RE while there is a natural lens in the LE.
May I ask, what was your neuroadaptation period like when you started with the Symfony. Was it difficult during those 6 weeks to have a nartual lens in the other eye--even though you still had a cataract--or did you think it wasn't too drastically different. Night vision issues don't really worry me as much as the idea of the eyes not working well together.
Oh, and I currently experience no bad side effects with the monofocal IOL as pertains to pupil size or any other issues. It is only a matter of having the wrong power lens in my eye. I am just deciding that since I probably should have the exchange done, which lens should I go with.
Sue.An2 mary1985
Posted
Hi Mary - I didn't find the 6 weeks as bad as I thought it would be. For most part Symfony eye took over for distance and intermediate. I could tead vloser with unoperated eye do that LE took over for reading. I managed with poking the lens out of my glasses for Symfony eye. My prescription wasn't overly strong pre-surgery -3.25 RE and LE was -2.25. Didn't need readers at time of my surgeries.
As I work full time and enjoy traveling and sports i wanted to be as much as possible glasses independent. Thought of losing near vision worried me. Although at time didn't realize monofocals could be set to give me usable reading and intermediate and wear glasses for distance which was what I was accustomed to before cataracts hit.
For me this has worked out and although i do see concentric circles at night everything else is very good. I will say I need good lighting now and in dimly lit situations I either have to turn on more lights or use flashlight feature on my iphone to read (ie menu in restaurant with low lighting).
If you are able to wear a contact lens in the eye that doesn't have a cataract you could adapt much better. (that is if you need correction now).
Symfony vision is very seamless. I don't experience any dip from near to far. with both eyes i can read from 11 inches but I know the info provided says it is more from 18 inches and glasses needed for near vision. Must be there are conditions which make this better for some eyes and worse for others. Some get more range with a monofocal lens than others. wish that was more predictable and surgeons could shed light on that prior to surgery.
I know it isn't an easy decision and I hesitate to influence you one way or another. More so as an exchange is more complicated and requires a much more skilled surgeon. You might want to ask how many your doctor performs.
Best wishes for a successful outcome.
mary1985 Sue.An2
Posted
My doctor performs exchanges several times a month, about 16, so I feel like I'm in good hands.
May I ask you a question about your indoor vision? You work with computers, right? Do you find that you do will in all indoor lighting as well as outdoor lighting? If the room itself is dim, not dark, do you have trouble seeing well? Have you watched TV and used the computer in darker rooms without issue? What about movie theaters?
Night driving is not an issue for me. I hardly drive as it is. My concerns are more about other dim/dark room activities.
Also amusement parks, festivals and and Christmas lighting.
Sue.An2 mary1985
Posted
Hi Mary - living where I do in Canada spend 5 months of the year having to drive to and from work in the dark so it was a concern of mine prior to going for Symfony lenses. Although I knew from my doctor and more so from shared experiences here on the forums about the concentric circles - it is not easy and no one can fully describe it until you see through your own eyes.
IMO inside lights (Christmas tree, lamps etc look all normal to me). In pitch darkness pvr does have slight glow around it as does iphone computer tablet etc. But I have tried that to experiment - I don't normally watch TV or read iphone in total darkness. I would be interested to know if normal eyes see that glow too. Have gone to plays concerts and movies since my surgeries and I am not bothered by that either. I was far from the stage last concert I was at and did see the concentric circles around a couple of the bright LED lights. Been at other concerts closer to stage and didn't see anything off.
The only time ceiling lights have glare is when ceiling is painted black. Our church has that and during worship time they dim lights and just ceiling ones on and I have been bothered by those - I avoid looking up.
I am convinced that power calculation and little to no astigmatism play a big part in how much night time lights bother me.
One of my eyes has no astigmatism and sees 20/15 and can read at 11 inches. That eye compensates for the other. I see at 20/25 with that other one and it has .75 astigmatism. When in these conditions and I close my better eye lights have more glare but with both open I see everything better. One's brain must pick the better view.
Because day vision is so very good and whether my brain has just adapted well to night vision I can't say but I personally have never contemplated changing Symfony or regretted the decision at all.
There is a definite contrast difference. I had a 6 week wait between surgeries and even with cataract still in one eye that eye could see better in dimly lit environments (menu reading - now I have to use flashlight on iphone to read those.).
All that to say if someone ends up very pleased with the day vision at all ranges (and fully aware of the compromises/trade-offs) for night vision one can be satisfied with that.
It would appear that some people experience worse night vision (or vision in dimly lit/dark areas) are very bothered by it and I end up wondering if two people see the same does that image bother some more than others or do they really see differently than I do in those situations.
Sorry Mary I likely am not too much help as you decide on this. I am so hesitant to push these lenses as I know not everyone is as happy about them as me.
martin04519 mary1985
Posted
in reply to your question I am fine in well lit areas though in a darker area e.g. rail station noticeboard, I find vision more difficult. Essential in spite of what surgeon promised to have reading glasses and suffer glare from sun and night time lights
Curious3123 mary1985
Posted
who is your surgeon?
soks mary1985
Posted
I have had Symfony in one eye for about 5 months. I am 43. I have intermediate and distance. I still use glasses to correct -0.5 astigmatism. The astigmatism correction glasses make near vision even more worse which is as expected per optometrist.
My worst side effect is seeing the edge of the IOL at night in dark areas. I believe this is called positive dysphotopsia. This effect is debilitating when happening from multiple light sources. I do not know if this is because of Symfony or if I will also get it with a monofocal.
Non operated eye helps reduce Symfony glare which is different from IOL edge. I wear -2.5 glasses for the other eye and now I am used to it so no anisometric problems.
Sorry you are having to go through this at 33. While IOL exchange is supposed to be straightforward, it is additional trauma to the eye. Good luck for what you decide to do.
mary1985 soks
Posted
So your other eye has a natural lens, then? You find they work well together?
soks mary1985
Posted
other eye has natural lens but has myopia correction of -2.5. i wear glasses. 0 for the cataract eye and -2.5 for the natural lens. it was strange for 2 weeks then it became normal.
martin04519 mary1985
Posted
Just for info, I had cataract ops on both eyes 2 years ago at a private hospital in Darlington UK. One eye gave reasonably good vision with Zeiss multifocal lens although still needed reading glasses. The other eye was badly out of focus even after a second operation 5 weeks later. The Darlington surgeon in July 2017 said he could do nothing for me - having paid several thousand pounds for each eye. I saw 2 separate surgeons in France who showed surprise at the lens location and said the faultily located lens should have been removed soon after the first op as difficult or dangerous to remove much later. As already several months had elapsed and as the French surgeon was fully booked, he very skilfully removed the wrongly placed multifocal lens 18 months after initial operation and fitted a monofocal one. My eyesight after 19 months of life changing circumstances was massively improved and although the UK surgeon was very full of himself and arrogant, I have received an offer of partial recompense from his union. However I have raised a complaint with the General Medical Council to try to stop this UK from treating other patients so badly. Hoping that your treatment goes well
seeherenow49806 mary1985
Posted
Hi Mary:)
I had monofocal IOL placed in LE in June 2018 and Toric Symfony placed in RE in Oct 2018, so about 10 months and 6 months ago. I wore a contact lens in the RE during the intentional 4 month interim. I wanted to be sure I knew where the LE IOL would settle before the monovision prescription for the RE was calculated. This plan worked out very well! I wore a contact lens in the RE while I waited and the only problem I had with the eyes working together at the computer at that time was when the RE cataract got worse.
I had some edge glare on each eye but recently realized that the LE glare (with monofocal IOL) is completely gone at night now and very minimal in daytime, only when sunlight thru a window/door is very perpendicular. The RE (with toric Symfony) still has nighttime edge glare when going from light to dark environment, but it is greatly diminished now and I have no edge glare problems with the RE in daytime.
I found that each eye continued to gradually "settle" into its perfect vision for much longer than the docs said - 6 months each! I went for a long walk by the ocean a few days ago and was amazed at how clearly I was seeing at all distances, both eyes working beautifully together. Really grateful!!
The nighttime driving RE Symfony effects (halo, spiderweb, etc. at ~ 30 feet away) are very minimal now, VERY faint. I actually enjoy them - haha! Kind of a reminder to be grateful for the gift of restored vision. I had been extremely myopic before the cataracts, so this whole experience is a miracle for me.:)
I think it's important to have the Symfony lens in your non-dominant eye and the monofocal in your dominant eye, if you're opting for one of each. That way the night time driving artifacts of the Symfony are mitigated. Not sure if that applies in your case, since you only have the cataract in one eye. If there's a likelihood that you might develop a cataract in the 2nd eye, this might be worth considering. But who knows - there could be much better solutions years from now!
My ultimate result was much better than predicted. I originally opted to go slightly myopic in each eye because I preferred to retain best near & intermediate vision and wear glasses for driving. So I planned on -0.5 diopters in my Dominant LE with the monofocal IOL and the surgeon calculated about -1.0 diopters for my toric Symfony RE. But when I went to my optometrist in January, my LE measured only -0.25 myopia - effectively considered "plano" or nearly perfect distance vision. I didn't correct the astigmatism in that eye by getting a toric monofocal. The Symfony RE measured -0.75 in January, just 3 months after surgery. I think it's gotten even better distance vision by now, but still have awesome near and intermediate vision.
Wishing you a beautiful outcome whichever choice you make! Glad you got a second opinion, too! I did that after my LE surgery and had a different surgeon do the Symfony eye.
Sue.An2 seeherenow49806
Posted
wonderful results! I too noticed that vision has gotten even better with time and since proven by my visit optometrist in Jan. RE is better than plano - see 20/15 and where that eye had slight astigmatism at 6 week check up it has none now. LE astigmatism got slightly worse and is .75Distance is 20/25. All in all happy I too am not noticing the rings or glare as much. Yes there likely will be better lenses down the road but I coukdn't hold off. Vision is so much better than it was with cataracts and I am still amazed to be able to see right from the moment I wake without having to reach for glasses.
Glad things are going well with you.