Symfony Lens... Laser or Conventional Surgery

Astigmaism can be corrected during conventional surgery either with a toric IOL that corrects the astigmatism,  or with an  incision that causes the eye to reshape as it heals (often called an LRI, a Limbal Relaxing Incision, but sometimes the incision is located elsewhere on the eye cand named something else). LRIs tend to be a bit less predictable, but are simpler since they correct the astigmatism on the cornea where it exists, vs. a toric lens where it needs to be placed in the correct orientation and there is some risk of it rotating after surgery and needing to be rotated afterwards back into place (sometimes that can be done in the office, other times its a minor surgery). 

Each eye heals a bit differently in response to an incision, which is why the results can vary a little bit, but are close enough. Laser incisions to correct astigmatism are more precisely made, but since the response of the eye to the incision varies, its not clear it makes that much difference to the patient. Such things are stil being studied, there is a difference between a theoretical minor average difference in a study, and whether the difference for any particular patient is even large enough for them to notice. 

They can also correct residual astigmatism after surgery, e.g. with an incision or with LASIK/PRK, or other laser variants which alter the surface of the eye directly, rather than using an incision to get the eye to reshape itself. If the lens power is off after surgery, you might wish a laser touchup anyway. The formulas to determine lens power aren't exact, they are a statistical estimate based on past eye measurements. For most people they are good enough, its usually those who had high prescriptions before surgery where there is more of a risk the IOL power will be noticeably off.

The issue of laser cataract surgery unfortunately is still under debate,with some surgeons prefering it but others prefering manual  and viewing the laser as overhyped (for instance so when they make the initial incision, they can an idea of whether the lens capsule is more fragile and know to be more careful than usual). Since they moderate links, I'd suggest for instance googling:

So, You've Got a Cataract? - David Richardson, MD

To find a free PDF of an ebook by a surgeon where he critiques laser cataract surgery. The book isn't from this year, but I haven't seen any indication anything has changed since he wrote it (nor do I see anything on his blog suggesting he has had a change of heart).

 Laser cataract surgery only involves making some incisions via laser rather than blade, and those incisions aren't intended to alter the eye's vision, they aren't like lasik, and so it isn't clear that making more precise cuts matters to the end results.

Overall the studies so far tend to not show it demonstrating any clinically significant  difference for the typical cataract patient, that each method is very safe and they merely have different rates of different rare complications, with some indication there might e.g. be slightly more of some complications with the laser. There may be some data suggesting a benefit, but most don't consider it convincing. The very experienced surgeon I used thought that the major benefit was that it had more consistent results than an inexperienced surgeon (as long as they were past the initial learning curve with the laser at least), but that it didn't make a differene really for an experienced surgeon, he didn't think in my case it would make a difference, so I didn't bother with it. Many surgeons consider the laser essentially marketing hype, people (including surgeons) buying into cool new technology prematurely before its demonstrated a benefit above the existing approach, if it even will. 

It has an advantage for mature hard cataracts, but in modern developed countries those are rarely seen since people get treatment far before the cataract gets that bad, except in rare cases of rapidly developing cataracts. With a hard cataract the laser can soften the lens, and less ultrasound energy is required to break it up, and the reduction in trauma to the eye leads to less complications. With typical cataracts there isn't much effort required to breakup and extract the lens so the laser isn't needed.

That said, the technology advances all the time, and it takes time for large studies to be done. So it could be that some new model laser or updated laser software will lead to a demonstrable improvement over the conventional method, but that the study just hasn't been done yet.  Many studies also include patients that just had "laser cataract surgery" in general, rather than being just for   specific laser models, or software updates (since they update the software that controls lasers to improve things even if they don't buy a new laser), so its possible the benefit of some laser model exists but hasn't been shown. That said, even if they can manage to show a benefit for some new laser (vs. the laser being worse, eg. unintended consequences leading to some unexpected different complication) its likely to be small.

 In my case after being in other areas of high technology for years, I've seen some new technologies that obviously have benefits over the existing approach and are worthy of being adopted quickly, while others are premature hype. In my case I decided the Symfony was a new technology it was worth getting, but that the laser cataract surgery wasn't worth it, despite the price being negligible. The surgeon I used had done 40,000+ surgeries, with almost all of them being conventional surgery, so I figured I'd prefer to go with what he'd spent the most time doing. The cost difference was negligble, I'd already gone to to trouble to travel from the US to Europe to get the Symfony since it wasn't yet approved in the US, but I still decided it wasn't worth the risk going for the laser cataract surgery. 

 

My surgery was with laser.  The laser broke up the cataract, my surgeon then measured for correct IOL and then went in for the second process with yet another machine,  for the lens insertion.  My astigmatism was corrected in my right eye first...  and I have since had more laser to correct a little more in my left eye.  I have never heard of astigmatism being correct by any other method... but tecnology changes daily.  You would be best to ask your choice of surgeons.  I now have good vision... close up, middle and far distant with the Symfony lens.

Thanks... software dev & Sharon... in process of making a decision.

1, My understanding is that Laser Cataract surgery gives better results (on the average) as it depends less on the skill of the surgeon.

2. The problem with correcting astigmatism during cataract surgery (by making special incisions for that) is that it is not precise and that it does not take care of the unpredicted astigmatism introduced during the cataract surgery itself. LASIK enhancement after the cataract surgery is a better option because it addresses the actual astigmatism as well as any error in the spherical prescription of the IOL. Also, most LASIK surgeons will provide another enhancement, if needed, free of charge. if the eye changes a little more.

3. Many surgeons, who install premium lenses such as Symfony, include the LASIK enhancement free of charge as part of the price of installing the lens (my cataract surgeon, who is also a LASIK expert, did that). So, you may want to check that in your area.

4. Just for your information, I have a Symfony Toric lens in my right eye for distance and a monofocal lens in my left eye for close-up. With this combination, I have good day vision at all distances beyond 16 inches. However, I wish that my night vision were better, the main issue being the seeing of multiple concentric circles or halos around lights at night time. Many other people seem to have had the same issue. Rather than repeating the details here, I will encourage you to read my post, “Has Any One Else Had This Very Unusual Vision Issue with Symfony Lens?” on this forum. You should be able to find it by clicking on my name and then looking under “Discussion”.