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

Sorry - new to the forum, I should have started a new topic. Apologies.

Hi awcUK - sorry these will just be general comments. The Zeiss lenses ate not available in USA or Canada. There ate a couple pf posts from those that have these lenses on the forums.

I myself have 2 Symfony lenses due to cataracts that couldn't be corrected with glasses or cataracts. I would no longer be able to drive without the surgeries. I gather from your remarks that your doctor thinks you are a good candidate for clear lens exchange (which is cataract surgery but you don't have cataracts)? Most of us aren't fans of doctors pushing people to correct prresbyopia through clear lens exchange but recognize for some the idea of switching on and off glasses is burdensome.

Please do lots of research as this is not an exact science. Power calculations cannot be 100% guaranteed nor are you guaranteed to be glasses free despite whatever lenses you go with. Be prepared that there will be a loss of up to 20% of contrast sensitivity - making good lighting for reading necessary. Also with any premium lenses there is a compromise of your night vision. From the little I know about Zeiss lenses you will experience night time glare and halos.

It is good to weigh all those compromises so that you aren't blindsided afterwards. Doctors make thousands of dollars off these surgeries - promising the moon and often understate or don't mention the trade-offs at all.

Trading your natural lens for an artificial one cannot be undone and there is no trying them on like glasses or contact lenses.

I do wish you well on this journey of discovery.

That is great advice from Sue-An which I agree with.

Sue,

Many thanks for the comprehensive reply - food for thought, and I will continue to do as much research as possible before I make any decisions.

Best wishes, Andy

Welcome.

PS personally know people who are very happy with results but also know a couple who are extremely unhappy. Although stats are on your side for a successful outcome if you end up not pleased the stats really won't matter.

I would be interested in knowing if the UK doctors are more upfront about the compromises than they are in NA.

Best of luck.

Both I and my wife had the same Zeiss lens here in the UK. Surgeons could not have been clearer about the positives and the negatives. For me text book perfect results. Great mid/long vision and better close up than before I needed glasses in my 40s. No post op complications, halos I dont even notice them 9 months down the line. First spring post op and the Greens are beautiful. My wife had inflammation of the eye and has to have many more appointments. Her long distance vision isn't as great as she had hoped but reading fine. She will need a top up laser apparently. Risks are there for sure as I said before I would do it all again in a heartbeat. Total freedom from glasses and perfect eyesight again is amazing. But it is never as good as the real lens. Its a trade off the individual has to assess simple as that.

Hi Gordon

That sounds very encouraging - just to confirm, did you and your wife have the LARA lens??

If you now have perfect eyesight, why is it not as good as a real lens?

May I ask which organisation / surgeon you used?

(Apologies for the inquisition!)

Many thanks,

Andy

Yes agree with you. As long as the individual has all the information ( pros and cons ) to make the decision. Some people are more risk adverse than others so it comes down to what that individual wants to do with that information. You are fortunate to have found an ethical surgeon because many are not.

When things go well it is 100 times easier to say you'd do it again a heartbeat. I have same experience as my surgeries went well (except I had no choice due to cataracts). But reading some stories here and from personal experiences of people I know I would not have taken the chance and been happy continuing with glasses (which till now I had since I was 12).

Not a judgment on others that decide differently. My only concern is that people are made aware of trade-offs so they can make an intelligent decision.

Glad it has worked for you Gordon. Did you go with atLISA or atLARA? We don't have those options in Canada. What is the night vision like?

Sorry your wife's didn't go as well and hopefully with a bit of laser tweaking it will. Dis she get the same lenses as you?

Hi Sue.An

Even though you have had great results with Symfony, you gave a very objective feedback to the OP and I applaud you for it.

Thanks for your contributions.

Thanks soks.

I truly am very sorry your results weren't as good. It really speaks to this not only being a lens issue but how unique our eyes are and each case is different. Likely a part (how much I don't know) is the age factor and how eyes react to light. Being diagnosed young with cataracts just doesn't seem fair. Hoping the next surgery turns out much better for you.

I am Canadian by Birth but moved here in 87! Back then I was 20/20

We both have AT LARA. At the start night vision was starbursts and halos but I guess my brain has compensated? They are still there its just most of the time I dont see them now, strange. I do alot of night driving and that is not impaired for me luckily. For my wife? Same firm, same Surgeon (I insisted given my results), same lens. I think there are variables that mean there is no guarantee all is perfect. I think for her it may be when they are going through the 'which looks clearer' bit of figuring out the prescription, that part seems problematic to me... She is fine now and actually they warned me I may need a top up lens before I had the procedure done. I am lucky I guess and agree there are risks.

I have read that atLARA provided a bit more range of focus than Symfony lenses but they aren't available here and I am not sure they will be given I haven't seen any of the Zeiss lenses on the market.

My father's from England so I have plenty of family there - heading over this summer for a visit. Been dealing with Air Canada and flight changes after grounding of 737 max. I can't get a direct flight as those were all canceled till further notice.

Aside from changes the lens shifts during healing process (why power calculations cannot be guaranteed even if properly measured). You can wind up .25 diopter off and be more near or far sighted than planned target.

Good luck with the flights. I may haven risks with the Lens I defintely wouldnt fly the MAX 😭

Prof Jan Venter at Optical Express. South African Surgeon apparently has done over 75K eye procedures. He was outstanding, honest about the risks but I really did feel based on his experience and talent to be in safe hands. I am both fortunate and grateful.

Good luck on the journey and I do hope it goes very well for you whatever the choice.

Air Transat isnt bad? Not AC but decent prices as a family of 5 traveling back we have used them many times.

Gordon:

It seems like you've had great results. I know that you no longer notice the halos at night (your brain is doing a good job), but can you comment at all about how large the halos that you see are? For example, if you see a halo around a headlight, how much larger is the halo than the headlight itself?

Thanks.

Street lights are more star burst than halo. Shards going out in all directions around the light, the closer I am to the source the smaller they are, but typically they would seem to go out in all directions around about 5-7 feet in all directions at a guess if I am paying attention, so not insignificant but I can sort of see through them if that makes sense. Concentric circles on brake lights (when on) and turning indicators. They are still there and I probably notice more if I am tired but mostly my brain seems to have decided to ignore them.

Unfortunately flights booked prior to grounding of MAX with AC. Westjet only fly into Gatwick and I wanted Heathrow. At least AC waiving all change fees. Routing through Toronto now. Me too -not getting on MAX flight. Let Boeing execs take next flight!

Good you had a great surgeon. I am in Atlantic Canada so much fewer options but I did have a good reputable surgeon here who did warn me about the night vision issues of Symfony but I had more of what they were like visiting here on forums.

How far back was your surgery? I used to have that with streetlights but now they have slight fuzziness to them - not really extending much beyond streetlight.Oncoming headlights - especially new blue-white ones are blinding but my husband who wears glasses (no cataracts) says these blind him too so I wonder if what I see is normal. I do see well defined light concentric circles that extend depending on how far away I am from light source quite aways. Red stop lights all the way to the ground a d then get smaller as I approach them. Same with car brakes (see circles only when applied) - if on don't see anything abnormal with those.

The concentric circles are odd/unique and although I am used to them and ignore they haven't disappeared or lessened even after 18 months. It's more like they ate normal to my view now.

i had them done in September it would amazing if they actually went away!

Love the east coast worked 5 summers in Chester NS!

Hello All,

Your posts are most interesting. Does anyone have experience with one Symfony lens and one monofocal lens? I would appreciate any feedback. I have one Symfony lens, great daytime visions but a lot of night vision issues, and halos or glows around all light sources, even inside a house or store or TV. I am afraid to put the symfony in my 2nd eye if it will double the intensity. I delayed surgery on my 2nd eye for a few more weeks to decide.

Any feedback would be appreciated.

Hi Mady301

How long ago was first surgery? I have 2 Symfony lenses and halos and glare for me got better with time (took several months - about 6). I still see concentric circles around light sources though like red stop lights and don't think those will go away with more time. They are something I accepted as a trade off for seeing well at all distances. That too was a bonus as I was expecting to still need readers. Unless lighting is dim or very tiny where I do need readers - it's very occasional. I also have no glare around inside lights (TV, iPhone, tablet or movie theater) and I understand some people do have issues with that. I wonder if it depends on how well lens is centered or if there is residual astigmatism or other eye issues going on.

Having both eyes implanted with Symfony has given me seamless clear vision during the day.

There are s couple of people with setup you are pondering a201 (haven't seen posts from him in awhile) but his posts are still all here. He had a monofocal implanted first many years ago and when Symfony came out and his other eye developed a cataract he opted for that.

I would suggest posting a new post to ask people who have that set up weigh in on their experience.

Just yesterday on Review of Opthamology Today I came across something written in 2019 on Symfony lenses. Surgeon weighs in on his use of these lenses and recently had them implanted in hos own eyes. Long read - 12 pages but very interesting.

I think lost my original ID here of Sue.An due to posting links so i will message you the link in case you want to read it. ANYONE else that wants the link just let me know and I will message it to you.

Best of luck Mady in your decision - I know not easy and everyone is so different in their perspective on halos and glare and I wish there was a way we could all compare to see if we actually see the same thing or if there is something about our own eyes and the way surgery was done that beings about a different outcome.

Thanks Sue

its been 2 1/2 months since my symfony lens implant in right eye. Night vision improved a lot around 6 weeks and has been about the same every since. I accept this trade off for my excellent range of vision, but still really scared to use the symfony for 2nd eye. Dr. said it would double the starburst intensity with both eyes.

I didn't find night vision worse with both Symfony lenses implanted. My cataracts made night driving much worse than driving with Symfony. Contrast and glare were quite bad living with cataracts. Perhaps your cataract isn't affecting your night vision as much as mine so your non symfony eye sees better at night.

I did find overall vision - especially for reading much better once 2nd eye was implanted with Symfony. Yes it is a trade-off. Some do find opting for a monofocal in the other eye best course of action.

how have you managed 2 1/2 months with just one surgery completed? I had 6 weeks and that was long enough.

Hi there

I can give you advice through my own experience with Zeiss AT Lisa trifocal iol's.

In 2017 I decided that after having to keep swapping glasses for close up and middle distance (seeing street signs when driving), to have lens replacement surgery. I did NOT have cataracts and I had healthy eyes. My close up required +1.75 but not sure what my other prescription was.

I went to Prague to have this done. I was advised to have trifocals as "this would enable me to see at all distances".

I can write a whole book about my experience, but I will cut it shorter...

I have had to take antidepressants, due to the visual outcome. There is NO such thing as neuro adaptation. With any multifocal or trifcoal, you will NOT have clear vision. You WILL see huge halo's and ghosting around all lights. Some are worse than others. I have been unable to hold down my job, working in an office, at a computer, due to the "vaseline" effect.

I STILL required reading glasses, only this time they were +2 ??? So worse than before I had the IOL implanted. I required them because of the "vaseline" effect.

I was uncomfortable driving at night. The halos around car headlights were gigantic and looked like huge spiders webs. I couldn't judge the road because of it.

I had 18 months of emails back and forth with the surgeon, plus other eye surgeons, paying for private consultations in UK, and researching all I could.

In January 2019 I had 1 of the trifocal lenses EXPLANTED and a monofocal (ALCON CLAREON)implanted in my dominant eye. It has been set for distance.

The monofocal lens is unbelievably crystal clear and the colours so vibrant! I can see better than 20/20 for distance.

With BOTH eyes, I can see at all distances, from 3 foot, BUT require + 1.75 for reading. The trifocal, as it is not the dominant eye, only causes diminished acuity in dim light, or when the sun goes in.

The trifocal eye ALONE is so bad, that I would not pass a driving eye test exam if I still had both trifocal lenses still in.

I will be having the other trifocal lens explanted this year. I am deciding whether to have this one set for distance (like the other), OR risk having it set for close up, in the hope that I will maintain some form of near vision (they call this monovision).

IF you DON'tT have cataracts and love outdoors, gardening, sport, star gazing, golf, driving... DO NOT have multifocals or trifocals. You will see at all distances, but your life is like looking through cling film and you have to live with halos and ghosting.

thanks for sharing and sorry you had to go through this.

setting it for close is risky as more diopters are needed for close vision so the range for close vision is small.

Your experience brought tears to my eyes. I am so sorry - sounds like this was a living nightmare for you.

I am so against clear lens exchange and have said so many times on the forums here. It doesn't sound like the surgeon in Prague said anything to give you the impression that this could come with trade-offs or worse not work out at all. I had cataracts both eyes and went into the surgeries with a lot of fear of the outcomes but also knowing I had no other options (except lens selection).

I am glad that the lens exchange has provided good distance vision with a monofocal. If you do decide to target the other eye to get more near vision I personally wouldn't target it for much less (half a diopter) for mini monovision. If there is too much of a difference and eyes not working well together you could end up with double vision and the greater the difference it also affects your depth perception. As you've come to realize through this experience there are worse things than glasses/contacts.

Tweetypie would you put your story in a separate post - title it my clear lens experience or something of that nature? More and more there are people that visit these forums looking for advice for lenses as they want to correct presbyopia (no cataracts). I would like them to read your story and think think twice. Doctors doing clear lens exchanges make thousands of dollars off this procedure and I know most don't ever let on about the compromises - just promise patient they'll see well all distances and be glasses free. Although that can happen a doc cannot guarantee that outcome. In my opinion they should do everything to discourage this and upfront disclose all that could go wrong. If motivation is to be glasses free I wonder if the patient would decide to proceed if told there is a strong likelihood they'll still need glasses.

Again so very sorry for your experience. I do hope your 2nd surgery goes well and you can get your life back.

I'm really sorry to hear about your problems with the trifocals as well. Thank you for sharing your story here. As Sue said, a lot people end up on this forum researching IOL's purely for presbyopia vs cataracts. You are fortunate in that the explant/implant of a monofocal seems to have worked very well. Not everyone is that fortunate. Like Sue, when I'm discussing my satisfaction level with my IOL it's always "relative to my vision with cataracts" and that make a huge difference in overall satisfaction vs just trying to correct presbyopia.

I'm going to agree with Sue and Soks also on keeping the target distance between your two eyes relatively close. Having testing this with contact lenses, I would not go for more than 0.5D difference, although you might be able to tolerate much more than that and some people are able to handle one eye for reading and the other for distance.

If you have decent distance vision through your trifocal under some lighting conditions than you can test this a bit. If you can tolerate contacts, have an optometrist fit you and give you sample lenses that are +0.5D to +3.0D (several in between) and try them over a period of time. See if you can get used to distance vision with the two eyes like this. If you can't wear contact, then you can do some testing with glasses but the size difference between the eyes will become too great as you get into the +2D range. You can easily get some cheap readers at +0.5D, +1.0D, etc. from Amazon or a store and try this. Try to choose a design with a plastic frame all around the lens as you can easily pop out the lens for you monofocal eye.

If vision is too bad under all conditions with your trifocal, you probably can;t conduct this test though.

I also recommend keeping the 2nd eye close in distance to the first eye. I know several people who are about between 0.75 , and 0.90 with excellent distance and intermediate vision. , you will require reading glasses for close work. Monovision does not work for everyone, and there is always blurring in between the two distances.

Light vision anomalies with cataract left eye are blur, glare and rainbow like halos, with symfony Right eye they are wide starbursts and spiderwebs. So quite the light show when combined. I have a clear lens put in my glasses for right eye, as I am very nearsighted (-4.5) . Not optimal, but at lest I can see enough to work on my PC and drive now.

I am in the same situation. Got the AT LISA in one eye five months ago. I see large halos in the middle of my field of vision in addition to multiple halos around the light source itself (the latter I can live with). I am regretting this SO much but also dreading extra surgery. This is the second AT LISA because power was wrong the first time so they gave me a lens replacement one week after.

I am considering the Alcon Clareon monofocal for the other eye (which is my dominant eye) so I am glad to hear your experience since this is the same iols and sounds like the same category of dysphotopsia.

edited

I just saw it's been four years since you asked. what did you end up doing and are you happy with the result?

..................

Any cataract surgery is a trauma and increases the risk of retinal detachment later in life (according to research and my eye doctor).

If you are very myopic (use more than -3) you already have a thin membrane and increased risk. An average person (without cataract surgery) has about a 1/300 risk of developing retinal detachment. A very myopic person's risk is 1/20 (again with no eye surgery).

there are plenty of people who are happy with trifocal lenses, but I think it's worth extra consideration if it's purely due to reading glasses correctness. especially if you are very myopic.

How did all this turn out for you? Did you change the lens in the other eye to a clareon as well? and are you happy and satisfied with the result? crossed fingers