Symfony 8 week follow up appointment with surgeon, Inflammation

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Had an appointment with my surgeon today. Scheduling had messed up and didn't have me down as having an appointment because of the cancellation of my right eye surgery. This was supposed to be a follow up on my left Symfony eye which I have been experiencing positive dysphotopsia (halos, starbursts, ghosting and glare). My surgeon and I decided to hold off on the right eye at my 1 week follow up to see how symptoms resolved themselves. I also had complaints of blurry distance vision.

Testing results: I'm still experiencing glare but it is reduced and not bothering me as much. With glare testing I was able to see the letters this time. My reading vision in my Symfony eye is 20/20 and distance is 20/25. With a 0.5 diopter correction distance is 20/20. IOP is 7 in left eye and 8 in right eye.

Consult with surgeon: I'm a little frustrated that he did not have my chart because of the appointment screw up. I had to remind him of our last appointment discussion. At that time I was experiencing bad glare, and night vision issues (halos, starbursts) and daytime ghosting on reflective images. I'm still experiencing daytime ghosting but it's not as noticeable and I seem to be able to tune it out (neural adaptation?) for the most part. I still get halos & starbursts and yes spiderweb effect from lights. I think they are subsiding somewhat also but still very present. At my last appt. he said I had a posterior capsular fold which could be contributing to these aberations. He went to do the slit lamp exam and said I have inflammation and could see cells. He didn't even look to see if the fold had resolved (My optometrist said it was mostly resolved a few weeks ago). He instructed me to start using the anti-inflammatory drops again for the next two weeks and return for another exam.

He did target my left non-dominate eye to be slightly myopic (near sighted) for better near vison. He said he was targeting for -.25 and with healing it usually changes +.5, he didn't want to overshoot it because that would leave me hyperopic (far sighted) which would not be a good outcome. Now I fully undersand why my distance vision with my Symfony eye is slightly off. We did discuss surgery on my right eye and he thinks (like my optometrist) that once both eyes are done I will notice less night vision issues over time. We discussed targeting the right for plano. He did tell me he has only had one patient that he put in a monofocal lens with a Symfony because of night vision issues, and only one other patient that found night vision issues extremely bothersome. He said this woman wagged her finger at him she was so upset, but when he asked if she wanted to exchange the lenses she refused because she didn't want to give up the great near & intermediate vision. He asked if I was going to wag my finger at him. Told him, not yet!

So now my questions are is inflammation 2 months post surgery common? Is this a real serious issue? Why don't I have symptoms (ie: pain, redness, blurriness, scratchy feeling etc.) I'm to use the Ilevro drops twice a day for a week then once a day for a week. I go back to see him in 2 weeks. Sigh. In the mean time his office should be calling me to schedule surgery on my right eye.

Joanne

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  • Posted

    Hi Komiko:)

    Re the drops & inflammation - my friend who referred me to my (2nd) surgeon had some blurriness several months after he got Crystalens IOLs. This surgeon told him to use anti-inflammatory drops (don't know which ones) and in a few weeks his problem was gone! Some cataract surgeons seem to have gained more expertise on which drops to use in which situation. Maybe they are more experienced or simply more interested in this approach, avoiding unnecessary surgeries.

    This surgeon just did my Right eye on Monday. Thanks to reading a post here by "at201", and many other posts regarding the night time driving artifacts with Symfony IOLs, I had opted for a standard monofocal IOL in my Left (Dominant) eye and a Symfony Toric IOL in my Right eye. Because of life long extreme myopia, I preferred to have a little myopia (-0.5) in the Left eye and slightly more myopia (about -1.0) in my Right eye, in order to have better near vision overall.

    I'm thrilled to say that this approach appears to have worked VERY well! I can easily read my phone and small print at 10 inches, and tested better than 20/20 for near in both eyes. I test at 20/20 or 20/25 for the Left eye, even with only the monfocal lens. In the Right eye with Symfony Toric, I tested 20/30 the day after surgery, even tho there was still inflammation. It has improved since then.

    I have virtually no night time driving artifacts in the Left eye, just barely noticeable halos due to remaining astigmatism. (Because I didn't get the toric monofocal, I knew I would have this.)

    So far - on day4 after Right eye surgery - I definitely see starbursts when I use only the Right eye. I find it quite beautiful when looking at the moon.:) But while driving just after dusk tonight, I found that the dominant Left eye did it's job well, taking over at distance and minimizing the Right eye starburst effect from oncoming headlights. Since some people here said the starbursts greatly diminished after a few months, I expect this to get even better.

    Wishing you the best!

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    • Posted

      Oops! I meant to say that I tested 20/20 or 20/25 ( 2 different days) for Distance in my Left eye. And 20/30 for distance at post op appt for my Right eye.:)

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    • Posted

      seeherenow49806

      Thanks for the reply. Congrats on the outstanding results you have. I have seriously considered going with the monofocal in my right eye but really want the benefits of the Symfony. Guess you could say I'm going on faith that the Symfony will be the right choice for me.

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    • Posted

      Hi Komiko

      I came here looking for your surgery details and would like to mention that both Wills Eye and my surgeon had told me that they did not want me too much myopic as the light effects would be exaggerated with Symfony by leaving me myopic. That was also one of the factors I didn't want to go 0.55D.

      For the other eye I will have them go upto 0.49. Since 0.5D lens is 0.35D refraction I will make a decision between 2 lenses. If ORA plano is upto 0.15D I will have them go to the next lens. If it is 0.15 or greater I will stay with the lens. Ideal will be 0.35D. But IoL master suggests it will be 0.25D .

      Without astigmatism i feel your vision effects will go away with another SYMFONY at plano. You should wear -0.5D glasses and see if that helps with the glare.

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    • Posted

      Hey soks,

      You can see more of my details in my first post - Symfony lens 5 days post surgery, distance vision. I'm a little confused with what you posted, but from what you've posted you're saying that -0.5d myopic gives more night artifacts, which I experience. I don't really understand your calculations and how you figured it out for you next lens. I have an appointment Thursday with my surgeon to check on the inflammation in my Symfony eye. I tried internet search on inflammation post surgery, but most article were related to directly after surgery, not 2 months post, so I don't know why I have inflammation. I would like to go to this appointment armed with questions for the surgeon. Do you have suggestions as to what I should ask?

      I would like to try -0.5 glasses but without the right eye done, don't know if it would be worth it at this point. I really would like to see if it helped eliminate night artifacts at all. The glare has improved and I'm more bothered at night by the halos and starburst. Will give my optometrist a call on Monday, if my eye has cleared of inflammation maybe I could try a contact lens, I have an old pair of glasses maybe he could put a lens in.

      I hope your healing well.

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    • Posted

      My surgeon and another doctor from Wills Eye told me that the night artifacts would be exaggerated if I went with mini monovision. In that discussion the conclusion was I could just wear glasses at night to correct the myopia which will make the artifacts go away. So check the artifacts with -0.5 glasses. If they go away then you can continue to use glasses (my preference) or get lasik.

      The calculations they do for IoL always tells them what you will end up with. For example 16.5 Symfony I end up with -0.2. Symfony 16 I end up with +0.15. So for me plano is -0.2.

      If I had asked for better near he would have put Symfony 17 with which I will end up with -0.55 and more night time artifacts. So for your next eye get as close to 0 as possible so the brain will ignore artifacts from other eye and use it only for reading.

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    • Posted

      Thanks for explaining, I will call my optometrist monday, I have an old pair of glasses that he can put a -0.5 lens in for my left eye and a plano lens for the right for night driving for now. Will see if it eliminates artifacts.

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    • Posted

      I have dial a vision adjustable glasses from Walmart. Tonight I will make my near better in the operated eye and see if it introduces night time artifacts for that eye and report back.

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    • Posted

      I think I can confirm this theory. It's cloudy rainy in NYC. By making near slightly better the first thing impacted are street lights. They become weird shape and distorted even when everything else in distance is still clear..

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    • Posted

      Hey soks,

      Hope you are doing well. Just wanted to update you on the night driving glasses. My optometrist wanted to give me the 0.5 correction for my symfony eye, but my old prescription for my cataract eye. My old prescription from June for my cataract eye is way off now. I popped the lens out and drove with just my left symfony eye correction. It does not eliminate the artifacts, the starbursts and halos are still there, but I can see SO much better, everything is crisp, I can see great distance, headlights from oncoming cars I still see huge starbursts but I can make out the outline of the headlight without the fuzzy glow. Street lights in the distance still have starbursts that reach to the ground, and of course the concentric circles are there behind the starbursts.

      I have an appointment with my optometrist on Wednesday to check on my dry eye? inflammation? issue, and hopefully we can get the correction for my cataract eye right.

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    • Posted

      That's great that with 0.5D you get good distance in the Symfony eye. When I put a +0.5D reader the distance does get blurry. So its the price for your good near vision 😃. Now go plano for the other eye and u wont need to wear glasses. Give few more months for the artifacts and see if they improve. I think they should get better.

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    • Posted

      Yes, plano for the right eye when I can get it done. In the meantime I hope my optometrist can come up with the right prescription for my right eye for driving glasses.

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