Symfony already implanted (dominant eye). Which one to choose for the other eye, Synergy or Panoptix

Thank you very much for your reply. So, I was already convinced that the best option would be Synergy instead of Panoptix, until I saw Dr Wong's last video, in which he changes his previous opinion, choosing Panoptix as his favorite. As I don't have any vision problems, other than presbyopia followed by cataracts, I was kind of fooled by the advertising and existing studies of the Symfony lens that I had access to (I hadn't searched the forums at the time), which preached a certain independence from glasses or, as they call it, functional near vision and, I believed that I would be able to perform my usual tasks without the use of glasses, and that I would only need them for very small letters (which is what the advertisement said...), but I noticed not be my case. I work 8 to 10 hours in front of the computer and at the same time I use my cell phone a lot. I don't complain about the Symfony lens that I implanted in my left eye, on the contrary, I found it excellent, but unfortunately I need more near vision and I'm trying to compensate in the other eye. I mentioned the Synergy or Panoptix lenses, because I would not, worried about improving my near vision, end up degrading the distance vision for this other eye. Other than that, my ophthalmologist and surgeon who implanted the first lens and should implant this other, doesn't like to calculate the power of the lenses outside their expected target, I don't know what the reason is, but at least it looks like he got it right with Symfony. ..

I kind of consider PanOptix and Synergy as a Coke and Pepsi comparison. More similar than different. However, I have noticed from comments posted here that people report better close vision with the Synergy. I also have a friend that has PanOptix (both eyes) and she needs +1.75 readers to read. However depending on personal experiences is not always the best guide. A more rigorous way of comparing these MF lenses would be to look at the defocus curves. You can see a comparison that includes the Symfony, PanOptix, and Synergy if you google the article below. Both lenses provide better vision closer than -1.5 D, and for a while PanOptix is slightly better but Synergy is better at -3.0 D. You can covert these defocus position to distance by dividing 1 meter by the defocus number. -1.5 D = .66 meters, and -3 D = .33 meters, or two feet and 1 foot respectively.

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Optometry Times A guide to the latest presbyopia-correcting IOLs October 27, 2021 Tracy Schroeder Swartz, OD, MS, FAAO

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On setting lenses for myopia, there are certain formulas that tend to work better, like Barrett and Hill. See this article for a comparison.

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OPTIMIZING OUTCOMES WHEN THE TARGET IS LOW MYOPIA BY ANDREW M.J. TURNBULL, BM, PGDIPCRS, FRCOPHTH; WARREN E. HILL, MD; AND GRAHAM D. BARRETT, MB BCH SAF, FRACO, FRACS PDF

Interesting your comparison between Synergy and Panptix with Coke and Pepsi! Which would be which? I prefer Pepsi! I'm kidding, it's been a few years since I abandoned sodas and all kinds of industrialized liquids, I just drink plain water, and sometimes a good red wine, lol. Thanks for the information, I've already located the links to the articles you mentioned (great tips!), as soon as I read (and understand...), I'll comment...

Thank you, very kind of you.

Thank you for your time in responding to my post. Ok, you're half Brazilian, who would have thought it would be possible to find someone so close here, lol. In my current condition, with only Symfony in the right eye, I have 20/20 distance and intermediate, but it only gives me J6. Now, along with my right phakic eye, even with a severe cataract that made it myopic, I have J1, thanks to that, I haven't worn glasses since surgery, so I wouldn't want to wear them again. My eye doctor assured me that I don't have any eye problems. Astigmatism in both eyes is minimal and would "automatically cancel" (his words I don't know what he means...). I remember asking him if my eye was long, because I even thought about micromonovision using another Symfony lens for the right eye, and I had read something that was not recommended for those with long eyes, but he assured that my eyes are within normal length. In fact, he doesn't like to do micromonovision or minimonovision. In his opinion, the lens gives its best result, and with the least possibility of problems, when calculated for emmetropia. I'm doing all the exams, follow-up, I even had the first surgery, in a large hospital specializing in eyes, so I trust they are well equipped. As for halos, at Synergy are they a big problem? In my experience with Symfony, there are very few, starbursts predominate, but I tolerate them.

...correcting...Symfony in the left eye...

As for halos or dysphotoposia in general everyone results are different. The halos from my Synergy are slightly worse than from my Tecnis MF.And I would add, diffractive IOLs are just darker at night. For me the tradeoff is worth it, but 90% plus of my driving is during the day and most of the time when driving at night it is relatively short distance on roads I familiar with.

If someone has to do a lot of night driving like a truck driver then I would say think twice about getting any diffractive IOL

As for Astigmatism, I would suggest you get a printout of your results. It should show you the Cyl. and degrees of rotation. There will also be some small surgery induced astigmatism. I am reading more and more doctors saying even slight astigmatism should be correct for especially with the newer diffractive IOLs. You can read about this from an article on Healio titled, VIDEO: Technologies available to automate astigmatism management.

Thanks for the answer! I also drive a little at night, just to get home from work, and I was already driving the day after the surgery. I haven't tested the steering on a wreck with high beams coming in the opposite direction yet. As for astigmatism, thank you for your concern and for the video indication, all information is welcome, but I don't know if I should be concerned, because, in addition to the information from my ophthalmologist that it is minimal, I remember that, in no prescription for glasses what I did in the past it was considered in none of my eyes and, considering the result of Symfony, I believe I don't have this problem. Unfortunately, I don't have access to my exam results, I believe that since it's all part of an agreement that allowed me reduced prices, they are not provided. Plus, following his guidance, at the next appointment I can ask what the CYL and degrees of rotation of my eyes is (I hope I don't embarrass my doctor, with him thinking I don't trust his ability)...

I think it is a fair question to ask how much astigmatism you should expect after surgery. The astigmatism you see in your eyeglass prescription is an indicator but will not be the same as what you have after cataract surgery. Your refractive eye exam for eyeglasses AFTER the surgery will give you an accurate number on what the final astigmatism is. This is because the astigmatism overall is a sum of the that in the cornea plus that in the lens. In surgery the lens and the astigmatism in the lens is gone. They can be additive or subtractive. In some cases if the astigmatism was offsetting the astigmatism can increase once the lens is removed and replaces with a neutral IOL. Your eyeglass prescription for your Symfony eye would be a good indicator of your potential outcome because in most cases left and right eyes are similar. But of course they are not identical.

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But as @rwbil says the surgeon should be able to predict reasonably well what astigmatism you will have. And after surgery when you get your eyeglasses test you will see how accurate the surgeon was. In general more than 0.75 D of cylinder (astigmatism) can be corrected with a IOL providing it is regular astigmatism.

I think you just clarified a doubt for me! I replied to @rwbil that the ophthalmologist told me that my astigmatism was minimal in both eyes, and that it would "automatically cancel". Reading your post, everything became clear to me. He actually commented something (which at the time of the consultation I didn't understand), about the astigmatism between one and the other being SUBTRACTED and, with that, it would cancel itself in his calculations. It seems he got it right on Symfony, because I have perfect vision from 60cm to infinity, my problem is the near vision that is missing and I try to compensate in the other eye.

I am not sure what the surgeon means by saying it would automatically cancel. When you implant a non toric lens there will be no astigmatism in the lens. The only astigmatism will be what is in the cornea. That astigmatism is measurable with the proper instruments. He should be able to tell you what it is. The only little bit of a caution would be that a "minor" amount of astigmatism may be as much as 1.0 D or more in the subjective opinion of some surgeons. As technology has advanced that has become quite a lot and should not be ignored if you are looking for the best eyeglass free vision.

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I have one eye with an IOL and am now less than 2 weeks from having the second eye done. I got kind of blind sided when I asked the surgeon how much astigmatism I would have after surgery. My first eye had a lot (2.5 D) of astigmatism, but he told me my post surgery would be 0-0.4 D. It turned out to be 0.75 D. Now on this second eye my pre surgery astimatism is 1.25 D, and I was expecting much less post surgery. I was shocked to hear he was predicting -1.0 D, and he was not confident it could be corrected with a toric. Now I am trying to reconcile that I may likely have to have laser surgery after the cataract surgery to correct the astigmatism.

On the records access issue, I am not sure the deal you have with your doctor. I can only tell you my situation. If you have read my past post, one of the most important things I tell people is not only find a top doctor, but find a doctor that has your best interest at heart and you have a rapport with. I went to many doctors before I choice the doctor I used. The doctor I used I had already emailed back and forth many times before I even saw him. He knew I had an engineering background and had research the IOL options and that I was familiar with the advantages and disadvantages of the IOL even including material issues. And he knew I wanted to be involved in all critical aspects of my IOL selection and procedure. So when he did my toric calculation he not only sent it to me, but even asked what I thought.

On the Astigmatism I kept it simple. In addition to getting the astigmatism measurement from the IOL Master machine I would ask to see the image from the Topographic machine to see if it is regular astigmatism. I cannot imagine a doctor getting upset about you asking if your astigmatism is regular v. irregular or how much Astigmatism you have.

Ron already explained corneal and lenticular astigmatism. The only thing I can add is from talking to my doctor and my research want might be considered insignificant astigmatism for eyeglasses is not necessarily the same for the new diffractive IOLs.

In fact I said the exact same thing to my doctor about the fact that I did not wear astigmatism correcting contacts or glasses and at first I was against a toric IOL for that reason. I felt the toric IOL was just adding additional risk of rotation being off. I was also completely clueless about Astigmatism at that time as in had never been an issue so I did not bother researching it. As you might imagine after that I did research the subject before agreeing to get a Toric IOL.

From my research IMHO, Vision Quality with the newest diffractive IOLs are more susceptible to astigmatism error. If your goal is to get the clearest sharpest vision possible then this is an important consideration.

My goal is just to make sure you are aware of this issue and know enough to ask the doctor to make sure it is not an issue.

Sorry to ask, but if you can answer, which lens do you have implanted in your operated eye and which one do you intend to put in the other?

Thank you for your concern and guidance, they are important! I can see from your information and that of @RonAKA that astigmatism is a real concern! As I said before, I got the lenses and the surgery at reduced prices through an agreement, so I couldn't choose the ophthalmologist, more, it's a great hospital specializing only in eyes, very reputable, and its team is well prepared. My ophthalmologist gives me confidence, but I feel that he has an attitude of waiting for me to trust that he knows what he is doing, so he doesn't give me many details. I have an appointment with him now on 02/14/2022, precisely to define which lens will be. I'll take a list of questions I'll ask, I hope he answers me...but I still don't know which lenses to choose... There's a detail, I'm also an engineer.

I have the AcrySof IQ Aspheric in my operated eye. I had considered another one, but toric, as well as a Vivity, but the surgeon was not positive on them, so I am getting the Clareon Monofocal. It is the same as the AcrySof IQ but is made of a newer material. I unfortunately will likely end up with some astigmatism that may need to be addressed with laser.

Thanks for answering! With this configuration you will have vision at all distances, without the need for glasses?

A video of Alex (Ukrainian) just premiered, who has an explanatory channel about eye surgery on Youtube. The name of the video is "Tecnis Synergy IOL - a real world clinical experience" which, more or less, says exactly what you all have been telling me!

Yes my objective is mini-monovision to achieve vision at all distances without glasses. My AcrySoft IQ eye has been corrected for distance and I can see down to about 18" reasonably well. I am attempting to under correct the second eye by about -1.5 D to give me the closer vision. Now, this is becoming more difficult as I did not expect there would be as much residual astigmatism.

First need to tell the doctor to get out of Ukraine Fast.

Second, he is saying exactly what I have said. Synergy has the potential to provide one with the best overall vision acuity, but it is also the highest risk IOL out there. This is not the IOL to get if you have other eye issues other than cataract and everything needs to be nailed pretty close to perfect, including refractive and astigmatism error.

I understand that due to residual astigmatism it is more difficult to calculate and predict a good result for the micro-monovision you are aiming for, I believe this is why my doctor does not advise micro-monovision. Plus, it means that with your eye that has the AcrySoft IQ corrected for distance, you can see up to about 18" reasonably well! That's amazing! With Symfony, my best near vision is at 24", maybe I can reasonably see up to 20". I still couldn't understand this compromise that one lens has in relation to the others, in which one gains, while losing in relation to the other, it is difficult to choose one. What else do you believe that AcrySoft IQ "win" (or maybe "lose"), to Symfony? Dysphotopsias? Intermediate vision? Loss of contrast? Sorry for so many questions...

Well, what can I say? I also agree with you that maybe it would be better for the doctor to get out of ukraine real quick...

I think I just got lucky with my AcrySof IQ. The surgeon was targeting -0.35 D, but it actually came out at 0.0 D sphere. The astigmatism as I said before did not do as well and came out at -0.75 D. I suspect this astigmatism is assisting my near vision. The near vision achievement seems to vary from person to person.