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

I think if you are OK with the optical effects, especially at night, of the Synergy then this should be a good lens for you. It should give good reading vision if the power chosen is correct. The normal target of -0.25 D myopia should be ideal. The only bit of an issue with being your surgeon's first patient is that he/she will have no personal experience to draw on to choose the Lens Constant (A-constant, Surgeon Factor, etc). They will have to depend on the factors supplied by J&J or from other surgeons. I would hope that your surgeon has a network to tap into to determine what factors would be most appropriate for the formula used. Surgeons doing a lot of surgeries will track their outcomes with each lens type and determine their own personal factors to use to get the most accurate outcomes. See this article for a big more information on this aspect.

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CRSToday April 2021 The Lens Constant

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So if you have an opportunity to discuss with your surgeon I would ask what formula they will use, and where they will get the best A-constant, or other factors needed for the formula. If they use the Hill RBF-2 formula for example I believe Dr. Hill provides doctors with their best current values for the factors for each lens. I see that J&J provides A Constants, and Surgeon Factor in their specifications for the Synergy which vary depending on the method used to measure the biometry (ultrasound or optical). But, that is just a starting point, and most surgeons modify those factors based on their personal experience.

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Regardless it is best to have a discussion with your surgeon on what lens power is indicated and what the predicted outcome for refraction is. It is highly unlikely to be an exact -0.25 D outcome, and a decision between two powers will be necessary. You may want to be part of that decision, now that you know what the implications of going positive are.

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In any case, good luck with it all. I believe @rwbil has looked into this aspect of IOL power calculation and may have some comments on what factors were used and what the outcome was for his surgery with the Synergy.

The optical problems at night with Symfony are already worse than I imagined. With Synergy I hope they are even worse. However, I realized that my daily activities require a lot more of close vision than I imagined, and if Synergy can give me that, I believe the trade-off is valid. On a day-to-day basis, I drive very little at night, and if I need to drive more, I'll try to program for daylight.

You and everyone on this forum taught me enough to be able to have a better conversation with my doctor. I believe I've talked to him all I need to about my concerns and expectations. As I've said before, he says that not only am I lucky enough to have no eye problems, my biometrics are pretty much standard and that makes things easy for him. He told me that at Symfony he used the default values ​​provided by J&J (A Constant, Surgeon Factor, etc.), and he did the calculations using Hill, Barrett and also the manufacturer's calculator, however, the final result depended a lot on his experience. with the results obtained by the machines and his own surgical experience, he has had good results. I will need to trust him.

"CRSToday April 2021 The Lens Constant"

Thanks for another good read and information tip.

Thank you so much for wishing me luck, however, there are 22 days to go and anything can happen until then...

Glad to hear you finally decided. That was the hard part. Keep us informed and your results.

One final thought. Remember what I said Halo size are proportional to close-add and Synergy has the strongest Close-add of any IOL. So If I had to choose I would shoot for Plano or closest hyperopia number and not shoot to go in the myopia direction (typically for other IOLs), due to the close-add being pushed even closer.

Thank you!

Yes, I read a lot about this and, I wasn't very sure about this issue (with Synergy you have to aim for the Plano or slight hyperopia), that's what I talked to my doctor the most. He said he will do everything in his power to achieve the Plano. I'll keep my fingers crossed...

I would have to think about that one for a while. Seems to me that targeting a Synergy to +0.5 D would negatively impact distance vision while reducing the reading vision to about that of a PanOptix. The high add is still there and I would think would still generate flare and halos.

I honestly believe I don't have much else to do, other than what I've already done. As you yourself told me in a previous post, "I think I got lucky with my AcrySof IQ. The surgeon was aiming at -0.35D but actually came out in the 0.0D sphere". Likewise, my surgeon might aim for -0.25D but actually come out +0.10D, or aim for +0.25D and end up coming out -0.10D. Who can guarantee the final result for sure?! The more information I have, the more I am convinced that, even taking all the precautions, a portion of success comes from the luck factor (as you said yourself)...

I would not target +.5D either.

I will use my real-world numbers for an example.

For my Tecnis MF Low-Add IOL the goal was to target Plano or first myopia option. Lens Power of 10.5D targeted -0.15D and Lens Power of 10.0D targeted 0.14, so we went with 10.5D targeting -0.15D or slightly myopia.

But for Synergy Lens Power of 12.0D targeted 0.05D and lens power of 12.5 targeted -0.25D. So for Synergy we went with 12.0D targeting 0.05D or slightly hyperpia.

I perfectly understood your previous recommendation.

Sorry to ask, but do you have the final result of where one and the other lens ended up?

According to doctor I am Plano in both eyes or at least too small to correct.

Wow!

That's what I call a straight shot! And twice...

Yes, luck is part of it. The sad part is that only 70% of surgeries have an outcome within +/- 0.5 D of the target, and 90% are within +/- 1.0 D of the target. That suggests 20% with bad misses, and 10% with really bad misses. So far the surgeon my wife and I went to has overshot by about 0.3 D on two eyes. I will have to wait another month or so to find out how he did on the last eye.

My surgeon has reminded me on several occasions now that it is easy to come up with these precise targets, but he does not have total control in achieving them. So far he has hit about 0.3 D over the targets. Will be a month or so until I see how he did on the last one. I am starting to understand that is one of the issues with monovision. You need more precision than is actually achievable on the close eye. You can get lucky or not...

Sadly luck does seem to be part of it. But can part of it be that most cataract patients are older and might have additional eye issues. I guess I am relatively young at 60 and don't have other eye issues. I cannot help but think to consistently miss the mark by +- 1.0 D something is not right. This is why I say; and people think I am crazy; to make sure the doctor is using the latest IOL Master machine and get more than 1 measurement on different days and preferable on different machines to make sure the results are consistent.

clareon panoptix is now available.

Yes, but I live in Brazil and, if Synergy was only approved here in November 2021, Clareon PanOptixs should only be approved here at the end of 2023...