Symfony lens halos

I had and have the same issues as you with the Symfony in my right eye.  I had a monofocal distance lens put in my left eye.  Much better than Symfony regarding light issues.  My good left eye does help my brain avoid the light issues with my Symfony eye but the glare is always there.  I would NOT recommend putting another Symfony in your left eye!

I had my right eye done 6 weeks ago with a Symfony multifocal toric IOL lens and another put in my left eye 4 weeks ago.  My vision is excellent in normal lighting, tv, computer and especially during the day.  The outside world is a whole new place   However, night driving is a real challenge and I notice immediate change during dusk.  Almost like you blink your eyes and now see concentric circles and burts.  I still have two more days to go with the eye drops and when I called my doctor's office last week to tell them of the night time driving difficulty and the blur I still have in my left eye (distance)  they said to give it time and let's see what happens after the drops are done.  In three more days I see the doc and have a feeling he will say like he did before "well, you have 20/20."  I want to tell them that they should be around to test me during those very poor lighting conditions!   I'd bet it's not 20/20 during those times.  The lighting in the doctor's office is not the same as night driving!  Let's be patient and see what happens.

Hi Maria - it is unfortunate your doctor doesn’t acknowledge the night time visuals.   the starbursts will subside in time but the concentric circles will not.  They do appear at dusk and night.  I too have Symfony lenses for 7 months now and night driving is something that was very difficult in the beginning, but has gotten easier.  The glare and starbursts are minimal - except those white/blue new headlights cars have but even those without cataracts or IOLs have difficulties with those at night.   The concentric circles I have learned to cope and adapt to.  They bother me less now.  I was informed of these prior to surgery and still made the decision to go with Symfony lenses. I work full time and am young for a cataract patient.  Perhaps if I were older and retired I would have opted for standard lenses.  But I really appreciate not having to deal with glasses at work (or anything).  Due to my migraines and vertigo issues I would never adapt to monovision or mini monovision so likely I would need glasses for computer and reading if I opted for standard lenses.  Although I understand they provide better night time vision.

There is no perfect lens yet so having to compromise on something is a must.  With aging there are more of those to come I know.  The only thing that bothers me is the amount of cover up and sometimes outright lies to patients.  We should be the ones to decide on the compromise but to do that we need to know the good and the bad of lens options.

if you have excellent vision Maria during the day I would suggest you not get an IOL exchange.  Just my opinion but the next compromise you may have to make is what if that exchange makes daytime vision worse.  My own surgeon told me straight up he doesn’t do exchanges.  Even though he is an excellent surgeon it would take someone with considerable more experience to perform an exchange.

I am not trying to discourage you from that but would like you to think long and hard about it.  I would discourage you from any YAG procedure if you develop PCO if an exchange is something you are considering.  Once the capsule is removed it renders an exchange near impossible.

When the surgeon looks into your eye during the examination, he/she can easily see the same 10 or so circles on the lens. Thus, it should be no surprise to a thinking surgeon to know that you see the same no of multiple circles around lights at night. (my surgeon was not surprised by that at all).

By the way, one can have a 20/20 vision at night and yet clearly see thee multiple circles around lights at night. After all, for example, looking through a spider web does not mean that one can't see clearly the various things through it. it is just very annoying that one sees things which are not even there.

Sue.An (or anybody) ... When you see a halo, do you see a bright fine-lined ring around the outer-most diameter? What I'm seeing are actually 2 fine-lined rings that are jaggedly intertwined to make it look like one ring. This puzzles me. I asked 2 different surgeons about this (on different occasions) and they both had a look on their face like they weren't sure what I was talking about. I tried finding pictures of what I'm seeing on the internet, but didn't have any luck. I've mentioned before that I think I'm seeing the outer edge of the Symfony lens itself ... as if my pupil is dilating to a wider diameter than the lens, thus I'm seeing the edge reflection. (So hard to explain). When I brought the theory of seeing the lens's outer edge to my surgeon, he replied that he didn't think that's what I was seeing. So I'm just curious if anybody else knows or sees what I'm trying to explain. Thanks.

Will have to wait till dusk to have a closer look at the rings and report back.

I do think it is possible for people’s pupils to dialate beyond IOL and that does make additional artifacts for people.  The younger you are the more your pupil would dialate.  Night Hawk has a post stating how much a pupil dilated at certain ages.  Of course there is variations within that.   Good news is that artifact should disappear in time.    Bad news is if that’s what you are seeing exchanging a lens won’t help.  Most IOLs are 6mm in diameter.  A few are only 5.

While I see 8-10 distinct circles or rings around lights at night, I don't find the outer ones to be much brighter than the others.

As a side note, while I see those circles around lights mostly at night more than 100 feet or so away, I can occasionally see them distinctly inside a room during the day around some bright small LED lights (for example, those on a radio indicating that it is On)

How big are the circles?  Do they the circles from 2 light sources intersect each other?

My affected eye currently converts a light source into a circle around the actual light source.  It looks funny and eerily symmetrical circles looking at city lights from a hill.

Thanks Sue.An ... I wouldn't be as concerned if I knew the outermost ring would go away in time. But if it's reflection off of the lens's diameter, then that would be a physical thing and I have doubts that it would ever go away (like the concentric rings). And yes, I'm aware that a lens exchange might not help in that regard. In any case, it would help if I knew what the cause was.

Thank you for the response at201 ... You would think that after 6 months, I would know without a doubt, but I think the outermost ring that I'm seeing and talking about might be brighter than the inside rings. It's very distinct.

I also see the rings distinctly around the small LED lights inside a room, like you mentioned. I see them every night as my laptop is close by when I go to sleep. (I see the spiderweb pattern around the battery life indicator light on the laptop).

I will check for you tonight.  I haven’t yet noticed any circles around inside lights at home but perhaps it is type of lights I have.  When I am out walking in the evenings I notice concentric circles around certain porch lights but not others - even though same colour of light.  But it appears to be the new very bright LED lights that bring on the circles.   

Another possibility is your pupil could be dilating beyond the IOL itself causing that outer rim.  Good news as we age our pupils dilate less so that artifact could go away in time.

Yep if my right eye dilates larger than the 6mm diameter of the IOL I can see a jagged half circle above certain lights at night.  If I reduce the pupil size just a bit looking at a light up close, the artifact disappears. Also when my eye was super dilated after a dilated eye exam it produced full circles around lights even during the day until the dilation wore off.

If I am looking at a headlight from a car about 50 yards away, the outermost circle from that is wider than the width of the car.

Yes. The outermost circles from the 2 headlights do cross each other, but I normally look away quickly in that situaion.

Actually, the circles around some of the car brake lights (when lighted) are sometimes easier to see because one can look at those longer than the headlights.

Hallelujah! It's so nice to know that somebody knows what I'm talking about. Now why does it seem to be a puzzle to the doctors/surgeons? (Maybe I'm just misinterpreting them.) I see half circles most of the time, but full circles far too often (mostly at night, but also in darkened rooms, like a theater).

So ..... is there a term for those outermost circles? Is that considered a halo or something else? I want to know what to tell the surgeon to make it clearer, since they don't seem to understand what I try to say.

And ... would you expect to see that outermost ring no matter if you have a multi or mono-focal lens implanted (... if it truly is directly connected to the outer edge of the lens itself).

Hi RPK0925

I did go out for a walk and now staring at my neighbor’s amber LED porch light where I notice the rings.  Don’t see anything other perfectly concentric circles bit unlike at201 my outer ri gas are less visible (fainter) than the rings closer to the light source.  I would say at201’s description of how big they are is accurate for me too.

Just read your replies questions to Night Hawk.   I recall reading about those rims (IOL edge) on another site some months back - I think prior to my surgeries.  Going to see if I can’t find those.   But I suspect you would see them regardless of lens type as it’s due to pupil dilation beyond the size of IOL. Night Hawk has a toric monofocal lens.   

Hi again RPK - I think what you have is known as negative dysphotopsia.  I cannot post links but if you look that up that may be what you are experiencing. If it is that should be a term your opthamologist is familiar with.

Yeah I have a monofocal toric IOL in my right eye.

I think since I see the artifact only when my pupil is large in a dark environment or artifically super-dilated after an eye exam, it must be due to a reflection off the edge of the lens only noticeable if your pupil is larger than the diameter of the IOL.

And since the IOL is probably slightly off center relative to the center of the pupil, a half circle would be expected if the pupil just barely gets large enough so say the top edge of the IOL becomes in play. A full circle/ring appears if the pupil is big enough to uncover the edge of the IOL all the way around.

For most people over age 60, their pupils don't normally dilate beyond that 6mm IOLdiameter, but for younger people and a few older folks like me still dilate to larger than that size.  But in the past 6 months since my cataract surgery I've noticed the artifact much less so my pupil is probably gradually not dilating quite as much as I expect will continue.

Sue.An ... Thanks for all of your help. When I looked up "negative dysphotopsia", the definition I found is described as an arc-shaped shadow, usually in the temporal field of vision. I don't think that's what I'm seeing. I'm not seeing any shadows ... what I'm seeing is a bright fine-lined ring ... like a thin, lit up wire or something. I think Night Hawk understands.

Yes that what I see a bright fine half ring around some bright light sources in a dark environment when my pupil size is larger. It might be classified as a "positive" dysphotopsia, "negative" is the shadow dark artifacts.

It’s good to know what it is.  Surprising your surgeon wouldn’t have heard this complaint from other patients to know what it is.   Seems like it can happen with any IOL since they are all same size.  A few come in 5mm size whichbeould be worse.

There are drops you can use to constrict pupil but don’t know how long they last or if you want to go that route of more drops

Hi at201 - was reading an article published Jan 2018 on the site reviewofopthomology .com entitled “Surgeons Share Their Views on IOLs” 

This has been first article I have seen where a surgeon notes the spider web artifact of Symfony.  It was a good read.

“Cherry Hill’s Dr. Yasgur says that, in his experience, “Any minus correction left in the the Symfony causes spiderweb haloes, and all Alcon lenses cause ‘diamond-eye’ light reflexes that patients’ family members do not like to look at.”

This outer ring that I'm seeing is one of the biggest issues I see with my implant. I'm still considering a lens exchange, but if I'm going to see these outer rings no matter which lens I choose, I need to give it some serious thought. Going into this surgery, who would have known it would get so complicated.

I'm aware of the drops, but ideally I'd like to stay away from taking drugs of any kind, if possible. (For what it's worth, one of the surgeons I talked said the drops last 3 or 4 hours).

Not an easy decision for sure.  If it is the pupil causing the issue it could very well disappear on it’s own in time.   I wonder if you could test that out by using the drops to constrict the pupils one evening to see if that annoyance goes away.  Just a suggestion.   

From articles I've found via internet searches, the ring seen around some lights in a dark environment seem to be an issue more with the newer IOLs that have square edges.  These reduce the chance of PCO however, so going with a different IOL design that doesn't have square edges may have a different issue.

Fortunately as your eye ages, the pupil should naturally not get as large and should eventually make the rings disappear - thats happening for my eye now after 6months since my surgery.

Hi Sue.Ann,

Thanks for pointing out the article on the IOL survey by emails. It does provide some general trends, but I think that one should keep in mind that these are general thoughts of 57 responders (out of 7605 to which the survey was sent).

Regarding the comment from Dr. Yasgur that "Any minus correction left in the the Symfony causes spiderweb haloes...", implying that the halos don't exist for a plano or a positive correction, seems to be False at least for me. I have a zero or +0.25 D correction, but see the multiple circles or the halos vividly.

while th from a surgeon during an email survey

"while th from a surgeon during an email survey" words in my response above were just some words left over while was editing. Sorry about that!

Surely wish that we could see and edit our response.

Yes some editing and also putting replies in chronological order would be helpful for this site.

I too noted the implication that spider web visuals are more of target of plano achieved.  I have plano both eyes and see them.

Oh and oddly enough yesterday I commented about never seeing them on inside lights but had that experience yesterday .  We travelled for an away soccer game with my daughter and the wShrooms there were those ones that are motion sensored and there is a tiny red light that comes on when activated. To my amazement I saw the spider web lights around that little light at a distance of 3 feet away!   So guess it depends on type of lighting!

I have exactly the same issues.

After 11 months it's exactly the same as it was from the beginning. Neoroadaption is grossly overrated...as are the Symfony IOL.

Is your monofocal in your dominant eye?  Did you consider explanting the Symfony first?  I am in the same predicament--unhappy with a Symfony in non-dominant eye and delaying YAG for worsening PCO.  I have heard that Symfonys work better in pairs and that when your brain sees the same in both eyes it is somehow easier to neuroadapt.  Others have said don't double down on a bad outcome like you--what did your doctor recommend?  I assume that what you have is like monovision so was it hard to adapt at first?  Is the quality of your distance vision much better with the monofocal than the Symfony?

I have symfony in both eyes.  I no longer need glasses for distance and can read without glasses but am more comfortable with slight magnification.  I did have astigmatism in both eyes and the lenses corrected my non dominant eye but I have a little left in my dominant eye.  At night I see the halos and glare from simple household lamps.  I use to enjoy the moon and stars but they are fuzzy now.  The doctor said there was a huge risk in trying to correct this and I would basically have to live with it.  My eyes feel irritated and raw most days plus I have these weird shadows on the sides of both eyes. I am hoping I will adjust in 6 months.  At that time I will probably try to get a third opinion. I'm so afraid things will get worse if more is done to my eyes.  I do think my eyes have remained diailated to a larger degree compared to before the cataract surgeries.