Should I wait for Zeiss LARA in the US or get Symfony?

When was Symfony first available in non-US regions?

There was one case study done by Dr Pascal Rozot of Marseille and sponsored by Zeiss, that came through as balanced and unbiased. A clinical trial currently on in the US since May 24, 2017, comparing EDoF IOLs with a Monofocal Intraocular Lens, sponsored by Zeiss. Estimated primary completion date will be September 2018; and estimated study completion date will be December 2018.

 

You can read about it at the website clinicaltrials(dot)gov/ct2/show/NCT03172351 - it has this disclaimer. "The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government."

Just google Dr Pascal Rozot and you should pull out his case study on an 82yo cataract patient - interesting conclusion.

Although no lens manufacturers' names given, these 2 Cataract Surgeons in Lyon & Marseille work with "les implants à champs de vision étendue" (Implants with extended field of vision).

eng version pdf

Zeiss_atLARA_Pascal Rozot_case study

vasselon(dot)fr/archives/ZEISS_CASE_STUDY_ADVERTORIAL(dot)pdf

I read the case study.  Thanks for sharing but why are they not submitting the lens for FDA approval.  What's the point of comparing without FDA approval? 

Don't know soks. Are you aware that for the past years Americans have been crossing the border to get their eyes lasered here in Vancouver, because some (?) Excimer Laser Platforms not approved by FDA can be found here. Unfortunately those specialists are not bistros, or else one could have phoned in for quotes and specifications without having to go through a medical consultation.

I emailed Zeiss about LARA availability. Will report back when I hear from them. 

Dr Florian Kretz (Rheine Germany) discusses his experince with the AT LARA extended depth of focus IOL

Questions include:

1.You have been implanting the new ZEISS extended depth of focus (EDOF) intraocular lens (IOL), AT LARA, in the VIP/KOL/Early Access program. What have been your experiences so far? 0:05

2.For which type of patients do you think AT LARA is the right type of IOL? 0:46

3.How does AT LARA compare to other EDOF IOLs you have used? 1:25

4.How satisfied are your patients? 2:06

5.Will AT LARA become part of your IOL portfolio? 3:02

6.What impact do you expect AT LARA to have on your premium procedures? 3:51

Moderator comment: I have removed the link(s) directing to site(s) unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

Great research jantje. Can you direct message me the link for Florian Kertz video. 

Zeiss replied to me saying the email is not yet available in US. It is available in other countries. I will ask them again if they will submit it for FDA. 

Thanks for posting - going to try and find that.  Am always interested in what is new.   

Go to YouTube and search "ESCRS 2017 - Florian Kretz Interview". The video was published by Touch Medical Media on Oct 11, 2017.

Zeiss' website has a "cataract community".

 

Hi soks, if you go to "EYETUBE net" and search "Zeiss atLARA" (officially launched October 2017), you can find a case study by Dr Florian Krtez (Germany).

I know that you are not interested in atLISA, but I want to point out that even experts are confused with the two names. Dr Alberto Bellone (Milan Italy) published a 1:27-minute YouTube video published on 2017-05-25, "Firsts Zeiss Trifocal Edof LARA implants Cataract and Presbyopia". LOL

 

I decided to look at Beijing private eye hospitals that handle large patient volume, (Indian and Lebanese surgeons have been implanting atLARA IOLs). And found out from "Zeiss com cn" that atLISA was launched in China on 20151110. A research article on "IES IJO CN" (2017 May) at #3.5.2 stated that patients implanted with atLISA lenses have a higher rate of PCO; and on another study group a higher rate of capsular rupture. Assuming all their patients have black hair with smaller pupils, these results may not be the same for the blonds with larger pupils.

Given the above findings, it may be a year or two before the consumers' feedback on atLARA starts coming in.

You are a solid researcher. I saw the videos. I am interested in night time halos. You can also check Daniel Gore PDF on AT LARA he is offering them in England. 

Also in the research case of the 77 year old he is not reporting spider webs classified as H2. He is reporting minor H1 halos. 

Capsule rupture is scary.  The edges of the Zeiss lenses are much broader than the Technis arms. I think trifocals may have had just 2 rings and as they increased the rings on the lens it became EDoF.  

It will be very interesting to see if any of the atLARA recipients post here.  There will be lots of questions for them.

I know in USA and Canada there is more strict criteria to have anything FDA approved- often a good thing but frustrating if it is in the pipeline and wait time long.  

I wonder if European consumers post anywhere. 

If LISA never got to US, LARA wouldn't make it here. 

It seems the Zeiss lenses are larger so lesser chance of seeing the edge but risk of capsule rupture. 

There are many that post here from UK.  When I first found this forum I initially thought it originated there.

Hi soks & Sue.An,

Dr Marc Timsit (Paris) has a forum "ophtalmologie fr", mostly from his patients. No one asked about atLARA yet. I found only one 45yo unhappy recipients of atLISA lenses with both eyes implanted on the same day. Dr Timsit replied all her questions (not his patient), posted on Day 15, Day 17 and Day 68 after her operation. It seems France has other types of multifocals unknown in NA, one which is "Lights" (implants à profondeur de champ étendue, or implants with extended depth of field).

On 2017 September, Swiss Advanced Vision (SAV-IOL SA) announced two new innovative EDOF IOLs, namely  LUCIDIS and EDEN.

So many options in Europe.  But not always a good thing.  A few from UK posted here on these forums about Oculentis Mplus lenses.  SEVERAL years after implanted the patients experienced cloudy vision - both misdiagnosed as PCO.  YAG done and upon further examination it was not the capsule that was cloudy - it was the lens itself.  If you google this lens with word lawsuit you will read all about it.  But what a shame - lots of people now wondering what to do after several years of having lens implanted with a YAG performed!   

I know we have fewer options but we likely have fewer cases of faulty lenses on the market.

That 45 year old - sounds like a case of clear lens exchange.  The reason lasik procedures done both eyesvsMe time is do people cannot compare operated eye with unoperated eye.   Very risky and playing with people’s vision all to make more money.   There should be consumer protection laws in place disallowing CLE in same day.  There should be minimum wait time.  No cataract surgery performed on national health care dime is performed same day.

I know people are motivated to see better and get rid of glasses but these surgeons take advantage of that.  

Found that site!   Reading now - thankfully grew up in Quebec and read French!

One of the poster is a 20yo with "crappy" eyesight -20D, seeking Dr Timsit's advice.

Yes, the 45yo has had CLE at another surgery (not at Dr Timsit's) to correct her "très forte hypermétropie"; it is her choice her life 'je m'en fou'.  Credit to Nizza594:  For patients fitted with Carl Zeiss Toric Trifocal lenses, it took a good 2 to 4 months, maybe even up to 6 before things felt "normal".

Ideal candidates for Phakic IOLs/ICLs are said to be between 21 and 45 years of age. Read the site where eye-surgeons from Beijing private eye hospitals confabulate with the prospective clients, patients, ex-patients. Came across one 14yo and one 19yo, who have had ICL done for > 4 years and very happy with the results.   WOW

I admit to not being a fan of procedures gone on eyes to be glasses free.  Maybe it is just me - always avoided lasik too even though a few friends and colleagues had it done at work.   Could never justify the risk.  And pretty much all of them now notice more glare and halos at night.

Too late here on east coast - meant not a fan of any procedures for sole purpose of being glasses free.   Time for bed!   

I understand where your heart is. Huge hugs for you. Say from the point of a 33yo struggling to see neither a thing at distance any better nor near without glasses due to hyperopia and astigmatism, or that 45yo with very strong hyperopia and astigmatism, few can relate to their predicament. A family friend was in that predicament when CLE did not exist then, her glasses were taken away by her captor and she was locked away for a long time.

People often say it lightly "getting rid of the specs" or "ditching the glasses", it is their way of playing it down (une façon de parler). We don't really know their true feeling, or if they are trying to hide it.

je te comprends et oui chaque situation est unique.  Each person makes there own decision but unfortunately I wish they had all the information to make an informed decision.  This procedure is hard enough when you have cataracts and no option but to go blind - and still many doctors don’t spend the time for a varied reasons to explain pros and cons and lens selections to cataract patients and forums are full of sad stories of trusting surgeons and didn’t know trade-offs and clinical trials are often funded by companies manufacture the lenses - so have a vested interest in outcomes.  Often the cons are downplayed or not mentioned at all.   Although I have a good result with Symfony and because of my research and stumbling upon this forum I had prior knowledge about the concentric circles there is still ZERO acknowledgment from the medical community or manufacturer about these.   If the surgeon doesn’t nail the measurements or surgeon the side effects and visual outcomes during the day make the patient’s trade-off if night vision that much more worse.

When it comes to CLE those surgeons are often much more inclined to oversell premium lenses as that’s where their profit is.  A couple here who have had it done have said as much as 50% of their clients are CLE/lasik/PRK.   And for CLE this isn’t a repeat customer so you can imagine the market share you need to go after to fund the business and make a profit.

Yes there may be some individuals whose eyesight is so poor with their natural lens that this might be an option but the majority are those who have likely had lasik to correct for distance and now along comes presbyopia and surgeons now say we can fix that too!  The lenses aren’t perfect - neither are the calculations or the fact that during healing IOL moves.  Plus there is a loss of 15 to 20% in contrast sensitivity with a multifocal and slightly better with an EDOF.  Better with a monofocal  but let’s face it CLE patients aren’t going to be interested in a lens that can’t promise glasses free.  The younger a patient is the more they will notice these differences (hence reason why both eyes done same day or close together) and their pupils dilate more so greater chance of visual artifacts.

If patients were fully informed and aware might be more of a fan but I don’t think they will be fully informed unless they do own research.

One day there will be better lenses but until such time how can this be in patient’s best interest?

LOL guess that is my rant for the day.

Even during Lasik younger people must be advised that this is a solution until presbyopia kicks in.  They should also be informed that if they get cataracts in the future then lens measurement will need advanced techniques.

Totally agree Soks - and I wonder if even that is explained to lasik patients.  Again why aren’t doctors more forthcoming with info at consultation?

I have been on steroids for previous medical conditions and creams for eczema - not till I had cataract diagnosis was I informed by a doctor that use of those can cause early rapid cataracts.  If I knew I would have thought differently about using them. Winter of 2016 my eczema really flared up and those creams didn’t even help - made it worse.  Got skin infection twice and had to take antibiotics.   I researched other ways to deal with eczema and now have a better way of managing it with natural remedies.   

Again maybe I would have used the steroids anyways but but there was no info given to me about the side effects. 

Sue An,

It is concerning that Tecnis hasn't added anything to the Symfony literature or website regarding the concentric ring issue. I don't think I've read a single post on here from a Symfony patient who says that the don't seem them under certain conditions. Several had said it doesn't bother them but that's not the same thing as them not occurring. It would be pretty easy to create a simulation for prospective patients showing faint rings under various conditions. 

I actually think that Alcon does a pretty decent job of explaining the side effects of their multifocal IOL's. They've created a simulator and prominently show an image with the typical halo visible through this IOL next to a monofocal IOL. The close "reading" samples they show are also not perfect either, showing some fuzziness around relatively readable characters (which is accurate). 

I couldn’t agree with you more Derek.  By now Technis should be fully aware that these rings are due to lens design and at least have photos of them around light sources for patients to see.  The degree to which they bother people may vary as you say but doesn’t negate the fact they are visible to each patient getting a Symfony Lens.  In the 11 months I have had them I noticed a marked difference in glare and starbursts and in fact these hid the concentric circles from me for weeks.  But as those got better I started to see the rings.   With today’s choices I would likely opt for them still as I am pleased with overall daytime vision and I don’t spend huge amounts of time driving at night compared to my daytime requirements.   Nor do I have a job that requires me to drive at night.   However if my results were any less than I have - meaning ability to read and enjoy seamless vision from near to far not sure I would accept the trade-off.

PS if Technis doesn’t publish this at least surgeons should describe multiple concentric circles that extend rather largely out from light source at certain distances rather than tiny (making one thing it is one small ring).

Agree with both Sue.An & soks wrt younger people.  Came across a 2-month old thread in "reddit", an Edmontonian looking into RLE says King Lasik will operate on someone with -11. SupraHLE chipped in that he went to Gimble Center to have ICL but instead got the (? RLE), he forgot what it's called but remembered he paid C$8400. LOL

Hi derek40125, There is a 3-part video interview with top US eye surgeons in which they mostly tauted Technis Symphony.  I only watched part 2 briefly. I shall msg the link to you, to pass it on to whoever wants it.

Sue.An,  With today's choices would you go with Symfony or wait for AT LARA?

BTW I have seen four ophthalmologists so far and two of them talked about the concentric rings.  Actually one of them also pulled up the famous picture on the net for the rings around street lamp. 

I just saw a video posted on May 29 with a panel of US doctors talking about EDoF which is only Symfony for them and they mention that. 

It was about what wavefront do you use for Symfony.  They all talked about how forgiving Symfony is but no mention of the rings.

Dr. Por Ming had asked Dr.  Shannon Wong (Doctor who got Symfony himself) on his youtube video about the rings in the comments and as Wong did not talk about them in his video.  He replied saying it is not a big deal.

Would be interested in Sue.An's opinion. Her pre-catarct prescription was Sphere -2.50 / -1.75. Hubby's was around -5 to -6 (> -4 is considered high) plus astigmatism. She is working full time counting bullion He is retired. He used to procure equipment and is familiar with airport instrumentation and airfield lighting system. I believe him when he says he is aware of the concentric rings against a dark background (night), but is not bothered. Had he not retired, I can't answer that.

A Zeiss sponsored article (promoting atLARA) in the Ophthalmologist (2017 December #48), pages 20-21, #Para 2, has this preamble.    LOL

"Multifocal IOLs – and in particular trifocal IOLs – provide patients with good visual acuity at all distances. But this has come at a cost: the optical compromises inherent  in  such  lens  designs  can  lead  to  visual  side  effects like halo and glare. If patients can’t tolerate them, the alternative is often placing a monofocal lens. These are safe in terms of visual side-effects, but come with a glaring rawback: patients need to wear spectacles for near and intermediate vision. Extended depth-of-focus (EDoF) IOLs provide an excellent compromise of the benefits of both monofocal and multifocal IOLs: more spectacle independence than monofocal IOLs, with fewer visual side effects than multifocal IOLs. If you have a patient who leads an active lifestyle, who wants to be largely spectacle-independent, who may be particularly sensitive  to  visual  side  effects,  and  who  is  happy  to  occasionally wear reading glasses, EDoF lenses could be a great choice. However, such lens designs still involve optical compromises and visual side effects – meaning there’s still room for improvement."

#Para 3:

"It has taken real innovation from ZEISS, including simulations with about 50,000 optical design candidates, to push forward the field of EDoF IOLs: the result is a lens that provides the widest range of focus of any lens of its type on the market today – and simultaneously minimizing visual side effects and contrast loss. That lens is the AT LARA 829MP, with each letter in ‘LARA’ representing an optical innovation by ZEISS:

L –  “Light Bridge” optical design, providing the widest range of focus among EDoF IOLs.

A – Aspheric optics that are biometrically optimized and neutral. The aberration neutral aspheric design supports depth of focus and post-LASIK usage.

R – Reduced visual side effects, thanks to patented Smooth Micro Phase (SMP) technology and an EDoF design that results in fewer visual side effects than multifocal IOLs.

A – Advanced chromatic optics, with a color-optimized optical design for increased contrast sensitivity."

~ msg you the link.

Thank you very much for that info. Very interesting comments. I would have guessed that Lisa and Lara were named after one of the scientists' daughters or significant others. 

atLARA isn’t available here and I know so little about it and haven’t read much in way of patient reviews so it is honestly not a question I could answer.  Theoretically I like better range of focus of atLARA over Symfony.

 But looking at it’s design has me concerned there could be other issues.  

I ask myself how much better would I want to see (daytime) because I am glasses free - play sports - run - golf able to function at my job again.   I am very content with where I wound up. Night vision not as great but I manage to drive - wouldn’t want a long trip night driving - but never enjoyed that anyways.   There are no actual reviews of what halos are like with atLARA- might be same for all we know!

I am cautious/conservative by nature (lol work for a bank) - I think I made a slight move out of my comfort zone with choosing Symfony.  I would only go with a different lens after more info was available.  I knew about the circles (didn’t quite understand it all till I saw them myself) but I talked to people who had great daytime vision (outside of these forums) so I thought I could live with the trade-off.

I wonder if the atLARA will even be approved here.

I believe Dr. Shannon Wong only has one eye with a Symfony IOL, the other eye is a natural lens with good distance vision. So with that combo, the night artifacts like coincentric circles around some lights might be reduced with his other eye's natural lens providing a clear distance image for him.

What age did your husband have cataract surgery?  I had it at 53 so pupils dilate more on dark so perhaps night vision is a little worse for me?   I can’t miss the circles.  After time you get used to seeing them - so learn how to ignore them.  

So at last some opthamologists are acknowledging the circles.  That is a start.

LOL maybe - but I would rather have another daughter Mercedes!!!!

Do you wonder why they aren’t offered in US and Canada?

I was able to chat prior to my surgeries with a lady 62 years old who I was introduced to by a retired employee where I work.   She was one of the recipients of Symfony when first approved in Canada - had them done Dec2016.  Coincidentally she had same surgeon as myself.   She was very impressed with her vision - glasses free but when I questioned her on the concentric rings - she at first conversation said she didn’t notice any just had a bit of glare first 6 weeks.   She called me back a week later and let me know she did see them - red traffic light but confessed she didn’t drive much or go out after dark.  So I do think it depends on lifestyle.   

Right you are and since he was wanting to correct presbyopia he may have targeted Symfony nearer vs plano.  Have to watch video again to see if target was ever mentioned.  If targeted for nearer his natural eye would take over for distance and the concentric circles may not be an issue for him.

Thanks for the information. 

I was going to suggest that you have larger pupil size, but google proves me wrong. ^0^

It costs the manufacturer a lot of money to have a product approved by the FDA.

not found in the US but here in Canada, such as FineVision (Cliniques Michel PoP, Montreal Qc), Corneal Collagen Cross-Linking, Schwind Esiris/Amaris, etc.

I cannot remember who were asking about piggy-back lens, but I found this video to correct astigmatism using a "pin hole' lens and a piggy-back lens.

~ msg you the link for sharing with others