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

Thanks for sharing! This information is really important! Obviously I have no way of knowing the size of the halos on the Tecnis MF that you have, but I can say that on the Symfony I have, the halos don't appear alone. The biggest and most frequent dysphotopsia I see are starbursts, and when the light source is intense and distant, they are huge, and they decrease as the light source approaches. I don't know, but I think it's the same for everyone!? The halos, when they appear, are weaker, and they concentrically connect the beams of the stars, forming exactly the existing rings in the EOF structure of the lens, in some cases they look like spider webs. Comparing it with my phakic right eye with nucleus cataract, I can say that the dysphotopsias in it are much worse! Symfony's, at least, are much sharper and more defined, lol. Today I will be consulting with my ophthalmologist and if he assures me that the measurements of my right eye will guarantee me good vision with Synergy, I will choose it. I got so much information from the users of this forum and I did so much research that, between the pros and cons, it seems to me that Synergy is superior to Panoptix. Undoubtedly it is a lens that needs ideal conditions to work well, but I feel that it is superior in near vision, it has no flaws, it has better use of light and with that a better contrast, it has a good vision from afar. and, I believe it should make a great pair with my already implanted Symfony. Or am I wrong?!

Like you say there are a lot of factors, such as distance to light source, intensity or even the color. The Halos from my Synergy IOL can be 4 to 5 times the size from what I see from my Tecnis MF IOL. As I have read so many times the greater the close-add the bigger the halos.

So I think if you do a lot of night-time driving that maybe this IOL is good in a mix and match situation. I actually like my mix and match IOLs. IMHO I think mix and match is a great option as you can address the weakness of any particular IOL. But for some reason, maybe the fact there are not many mix and match clinical trials, most doctors will not even do it.

hello rwbil

In these 2 weeks, I think I've read all the posts on this forum that related to Synergy or PanOptix lenses, and I've done it more than once. I must also have watched and rewatched all the videos available on the Net. I also read several articles, studies, reports, etc. As I said, my interest is in the best near vision, but without compromising the distance vision or aggravating the dysphotopsias already inherent in the lens (with that I'm ruling out monovision), and trying to match the best possible with my Symfony lens already implanted. All technical information, studies, measured results, etc. indicate, without a shadow of a doubt, that Synergy would be the best choice. But when I look at it from the customer satisfaction side, it seems to me that I should run away from Synergy and stick with PanOptix. One thing that worries me is that even with a lot more PanOptix implanted lenses floating around, I haven't found many people unhappy with it, unlike the huge amount of people unhappy with Synergy. My surgeon has assured me that I am a candidate for whichever one he chooses. My engineering side evaluates technically, and tells me to risk Synergy, after all it has the best results! On the other hand, I can't ignore the amount of people who didn't do well with her. On 03/07/2022, I have a new query to define which IOL I should choose, and I still can't decide. Sorry to ask, but I know you have a lot more experience than I do, besides having a Synergy in your eye, so if you know the answer, I would like you to explain to me why a lens that should be the best, no have you obtained the best result from the patient's point of view?

I think there are a lot of factors.

First, I think the vast majority are happy with PanOptics and with Synergy. My doctor says 90% are happy, but the other 10% are not, which is a big problem for him. In fact he did the clinical trials for Symphony and he not a fan, as he said his patients got dysphotopsias but not close vision.

Second I think a lot of people that get diffractive IOLs should not have gotten them. IMHO these IOLs are for people who have absolutely no other eye condition than cataracts. I am not just talking about the big ones, but even if you have long or short eyes or a large amount of astigmatism it can be a problem.

Third I think Synergy is the riskiest of the IOLs. As I have said the greater the close add the greater the dysphotopias and many surgeons miss the mark. Missing the mark with Synergy can be a big problem. This is why I say make sure to get a few IOL Master (using latest machine) measurements on different days and preferable on different machine and make sure your reading are consistent. In fact best to find a surgeon who also uses the ORA Machine.

Fourth expanding on number 3, Synergy has the worse dysphotopsias. In fact I will make you a steak dinner bet they come out with different Low-Add options. My halos can be 4 times the size from my Synergy IOL in comparison to my Tecnis MF IOL. And I can even see halos in the daytime around certain light source. To be able to see 20/20 at 13” comes with a cost.

This is why I say Synergy is probably best as a mix and match IOL. Remember you see bilaterally and the brain somehow figures this out. I should say; at least it does it for me. Maybe for other people it does not. I can just tell you I can look at a light source and do the cover up one eye at a time thing and see a huge halo from Synergy but then bilaterally I see the Tecnis MF halo size.

I will add, many people also complain about the Symphony IOL, but you are doing good with it, which is why I think you might be a good candidate for a mix and match with Synergy.

Next to last thought, you would probably do fine with PanOptics also and IMHO it will have less dysphotopsias, but also IMHO the close will not be as strong and PanOptics probably not as good in the dim light.

Last thought. Last time I said this my post was modified, even though I cannot imagine why so I will try and word it more general (not mention specific doctor names). And if you are in American, you can PM for additional thoughts on the best way to do this.Find a top doctor that has implanted both IOLs and see what their experience has been with the 2 IOLs.

i am very interested in the response to this post.

In fact, you are largely responsible for my indecision! I'm kidding! You opened my eyes to a fact that I already knew but didn't want to believe. I had practically read all the posts on your compiled list, and others that you didn't even list, but were at different times and couldn't compile as a whole. It's a shame that Synergy isn't the "perfect" lens we were hoping for. I think we are in a similar situation, both with Symfony, not knowing what to do for the other eye... you even think about explanting Symfony... I don't think I would have the courage to do that...

trust me i am as confused as you are. and panoptix isnt perfect either. safran will not even exchange to a panoptix due to glistenings.

I agree with you that there are many factors. I fit the Symfony patient statistic, I expected more near vision and perhaps less dysphotopsia. I also agree when you say that many of the people who were unhappy with Synergy were not even candidates for this lens. And I add to what you saw, the cases in which the replacement of the natural lens occurred simply to get rid of the glasses, without having cataracts. I had perfect vision until I was 44 years old, when presbyopia started, so beyond what my doctor says, I firmly believe that (apart from cataracts) my eyes are normal (average axial length and virtually no astigmatism), proof of this is that Symfony fitted perfectly. Your third reason has already worried me more, as far as dysphotopsias are concerned. My pupils are small, so I've never had any problems with lights, flashes, or seeing the edge of the lens, as some have reported. With Symfony I see halos yes, but they are very small and never bothered me, now the starbursts in some light sources are really big. If Synergy adds huge halos to these starbursts, it might not be something I'm going to like, although I'd still be willing to trade that for excellent near (and far) vision. I have this concern about the surgeon missing the target and, even because of that, I postponed the surgery for the second time, which would be done with Synergy. Plus, before going any further, I had a long talk with my doctor, so he could reassure me what the risks were of something going wrong. He said he would do the math (he uses Barret and Hill) and in this next query we'll see what he says. I don't know which "machines" were used, because I was without glasses and with dilated pupils, I don't even know if the optometrist who took my measurements was beautiful or not. I know there were 5 different "machines" and the results are stored in files that the surgeon accesses on his computer (nothing printed). As I said at the beginning of this post, I'm in São Paulo in Brazil and things here are a little different. More I looked for a hospital group whose specialty is the eyes and the team of surgeons seems to be well regarded. Everything went well with my first surgery, so I trust my surgeon, but I keep my fingers crossed.

Sorry to ask, maybe I'm being invasive?! Would you do it all over again? Would Synergy still be your choice if given the chance to change?

Have you had a refractive check done on your Symfony eye to determine where it landed for sphere and cylinder? Perhaps the reduction of closer vision is due to a miss on the power target? You may have mentioned that earlier, but if so, I have forgotten! The perils of older age go beyond getting cataracts. Good memory, but short.

Would you do it all over again?

After having Synergy my advice would go against 99% plus of doctors, who don't want to do a mix and match. Probably being their is little to no clinical trials of mix and match IOLs.

I think Synergy is a good mix and match IOL. I would worry with 2 Synergy IOLs that the dysphotopsias might be too bothersome.

So, yes I would do my Tecnis low add MF and Synergy IOL combination again.

I think it's a tendency for doctors to only inform us of what they think we should know and, when we want to know more, some can even be more specific, but most just say that everything is ok. When I returned after 15 days for the follow-up appointment, I was initially evaluated on a "machine" that I'm not sure, but I believe it's an autorefractor. In the office, the doctor checked the measurements from his computer screen, and said that everything was as expected. Then he had me read letters in various sizes projected on a distant screen and told me I was reading 20/20. In fact, I had already printed a Snellen chart at home and already knew I could read 20/20 at 13 feet. He also handed me a card with a Jaeger chart, which I could read the J4 and J3 line with difficulty. I had already printed a Jaeger chart at home, but I think that, due to the poor quality of the print, J5 was the closest I could read. Finally, he checked my eye in the slit lamp and then he snubbed it, saying "the guy who implanted this lens is really good, it's perfectly centered...". Besides being able to see well with my Symfony eye, that's all the information I have...

I always ask for an eyeglass prescription when I see an optometrist. The refractory prescription is the best measure there is of the cataract surgery outcome. They may not give you one at a 2-3 week interval as the eye is still recovering from the surgery. At 6 weeks they should give you one. At least here in Canada they have to give you this information as we are free to buy glasses at any location, not just from the optometrist that did the measurements.

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I will be seeing my surgeon at 3 weeks after this last surgery and I suspect he may be guarded with the refraction results if he even does one beyond a simple Snellen eye test. But, at 6 weeks I will see my optometrist whether the surgeon likes it or not and get a full exam with a refraction prescription. A three week and a 6 week exam is covered by our health care system after cataract surgery.

I don't think you know, here in Brazil, the optometrist is not allowed to set up an office to serve clients, perform eye exams, prescribe prescription or contact lenses, choose or advise the use of prescription lenses. Optometrists are allowed ONLY to manipulate the optometer, manufacture prescription lenses, promote the dispensing of optical formulas provided by the ophthalmologist and the replacement of identical prescription lenses to those that are damaged. Here, he is a professional who works under the ophthalmologist. Here, no one says "I'm going to the optometrist", here we always say "I'm going to the ophthalmologist" and, most of the time, he also does the optometrist's duties. Some larger clinics have optometrists hired just to do measurements and follow-ups. It's just a curiosity...

I'm going to take advantage of one more curiosity, the chiropractor profession is also different here, it is not regulated, they have to work as masseurs...

That sounds a little different than in Canada, and it may vary some from province to province in Canada. Typically people get their regular eye checks and prescriptions by an optometrist and never see an ophthalmologist. If a cataract is detected then the optometrist refers you to a cataract surgeon which is an ophthalmologist. An optometrist does the normal eye exam and writes a prescription (if you ask for it) for the glasses. Usually in the same office there will be an optical supply company that sells the glasses (or contacts), but they cannot be legally the same company. What they try to do is walk the prescription to the optical company (usually owned by the same optometrist(s)), where an optician tries to sell you glasses. The whole thing is kind of sleazy as they do make it seem like there is no other choice in where you get your glasses. And they don't give you the prescription in writing unless you ask. I just cut to the chase and tell them that I buy my glasses at Costco, and then I don't get the high pressure sales pitch where they try to sell me glasses at 2-3 times the price they are at Costco.