Symfony Optiblue

Posted , 7 users are following.

About two months ago I had cataract surgery and had a Symfony Optiblue lens inserted into my right eye. Two weeks later I had the same lens put into my left eye. My near and intermediate distance is perfect and much better than I could have ever imagined (I can read clearly on my phone at about 6 inches). My distance vision is okay but not perfect with the left eye being a bit better than the right. With the left I can read most of the letters on the 20-25 line and with the right I can read one or two letters. For example, while watching TV, I can definitely read the subtitles but they are not crisp. Also, my vision gets a little worse throughout the day, but I assume that is because my eyes get tired from all the reading I am doing during the day? In fact, if I take a 15 minute nap late in the day, when I awake my distance vision is improved. Also, at night I do see moderate halos when driving but I can still drive without much of a problem. Anyway, I'm hoping some of you can help with a few questions:

  1. Would you consider this a very good result or do you think I should talk to my doctor about a lens replacement? While I assume my doctor could insert another lens that would improve my distance, I would expect that that would cause my near and/or intermediate vision to worsen. Is that right?
  2. My doctor has scheduled me for a quick laser adjustment for about a month from now. She'll be starting with my right eye and said by "cleaning it up" it will improve my distance vision. I know that once I do this, a replacement lens will not be an option so my second question is whether I should expect the laser to make a real difference?

Any help is appreciated!

0 likes, 22 replies

22 Replies

  • Posted

    My first thought would be that you were left a little too myopic. Do you have the eyeglass prescription for your eyes? That is the most accurate way of determining where you actually ended up for sphere and cylinder (astigmatism) and most helpful in deciding what to do about it. Also think about whether this shortfall in distance vision progressed over time since the surgery vs being there from the start and never improving to get good 20/20 distance vision. I say that because PCO (Posterior Capsule Opacification) develops over time.

    1. I would suggest this is an OK result and not so bad as to justify a lens exchange. There can be complications from that procedure, and you don't want to go backwards in visual acuity. Yes, you could have a piggyback lens inserted that would improve your distance depending on where you ended up for refraction. They can correct sphere and cylinder errors in refraction. And yes you could expect it to reduce your near vision. If you consider it, I would do the eye that is closest to plano and just leave the more myopic eye where it is to keep your nearer vision.
    2. Get more detail on what that "quick laser adjustment" really is. If it is a YAG laser which is cutting a hole in the capsule that holds the IOL then I would not do it, unless you have a clouding of your vision (PCO), rather than just not seeing well. YAG does not correct refraction errors. Your comment that this procedure will nullify the option to do a lens replacement suggests it is YAG, not Lasik. I would get a second opinion before getting a YAG. If your problem is refraction and you can tell that from the eyeglass prescription, then YAG is not going to help. If it is Lasik or PRK then it could be a solution to the myopic refraction if that is the root cause. However, like the piggyback lens solution I would only do it in the eye that is closest to plano, and leave the other more myopic eye to keep your near vision.


      If you can post your current eyeglass prescription I can make some more specific comments.

    • Edited

      Thank you so much, this is really helpful! I have my prescription from about a year ago, but this was before my cataracts started getting really bad. Here's that prescription:

      OD: 1.25 sphere; 1.25 cylinder and 180 axis

      OS: 1.00 sphere; 1.25 cylinder and 075 axis (I think that's the axis, it's a bit hard to read)

      +2.50 add in each eye

      In terms of whether this progressed since my surgery, for my left eye there hasn't been any change. My right eye seems to have gotten a tiny bit worse in the two months since the surgery. My doctor was planning on doing the laser in my right eye. I'll ask her what it is but I'm pretty sure it's YAG (she said it would only take a minute and would be done in her office). For whatever it's worth, my doctor has a great reputation in NYC.

      EDIT: I just realized that you are asking for my current prescription and not the one for before my surgery. I don't have that, all I know is that on an eye chart I'm 20/25 with both eyes but the left eye is a little closer to 20/20 than the right eye. I would need to get a new exam, which I can easily do but it will take a few days.

    • Posted

      What is your prescription NOW?

      To understand where you sit, you might go to an optometrist and pay $65 or whatever. Do not get dilated.

      Or maybe your surgeon has the numbers for you already if you ask.

      My right eye seems to have gotten a tiny bit worse in the two months since the surgery. My doctor was planning on doing the laser in my right eye. I'll ask her what it is but I'm pretty sure it's YAG

      Maybe it is LASIK.

      The term "a minute" is often corrupted by some people, so as to be meaningless.

    • Edited

      It is the refraction post cataract surgery that is important. I would get an eyeglass refraction done by an optometrist independent of the surgeon's clinic. If it shows refraction error that explains your less than 20/20 distance visual acuity, then it is a bad decision to do YAG. It is not going to correct refraction error at all. And although risks are quite low there is a 1 in 200 chance of retinal detachment. Also, the lens can be pitted by the YAG laser, and the flaps created by cutting the hole can get in the way of your vision and cause starburst effects in addition to your halos.


      When you get an eyeglass refraction done with the phoropter you will immediately see if you can be corrected to 20/20 vision. Ask to see the eye chart with and without the prescribed correction.


      Do not go down the YAG road unless you really have PCO that is impacting your vision.


      If you get an eyeglass refraction it is normal practice for optometrists to report cylinder as a negative value. It is also normal to calculate the spherical equivalent to combine the effect of sphere and cylinder error into one value. The concept is to add 50% of the cylinder to the sphere number. For example:


      -0.5 D sphere, and -0.5 D cylinder combine to give aspherical equivalent of -0.75 D. That is in the range you may expect to see from your refraction results based on your reported visual acuity of the 20/25 line in the eye test.

  • Posted

    I agree with RonAKA that this sounds like a pretty decent result, and a touch-up with LASIK or PRK on one eye only could get you to a very good result. I am especially impressed by your reading vision at six inches!


    Just one additional thought: It might be worth considering making the adjustment to the eye furthest from plano, rather than the one closest to plano. The reason being some ophthalmologists, including mine, have said that nearsightedness worsens the halos of the Symfony OptiBlue lens. So maybe your halos could be reduced by touching up your more nearsighted eye. It sounds like the vision in your two eyes is pretty similar, so it may not matter a whole lot which one you touch up.

  • Posted

    1. for a myope like me it would be a great result. fixing distance will make near worse. symfony can address only distance-intermediate or intermediate-near.

    2. sounds like she wants to do yag for your pco. if you needed yag your near vision would be affected. when i had symfony, pco first affected my near vision. so be 100% sure before you get the YAG laser.

  • Posted

    My doctor’s office confirmed that my doctor is planning on a YAG procedure and so I’m planning on talking to her to ask why she made the decision to do that. I’m also going to get an eye exam tomorrow. I have two questions:

    1. If my doctor had used Symfony lenses that corrected more for distance is it likely that my near and intermediate vision would have suffered. Right now that near and intermediate vision is amazing and given how much I read, that means a lot to me.

    2. If during my eye exam it is clear that my vision can be made perfect with a prescription is that pretty indicative that the YAG won’t help (my reading of some of the above posts seems to say that but I just want to make sure)? I’ll post my new prescription when I get it tomorrow.

    You guys have all been awesome!

    • Posted

      1. Yes, that is generally correct. The normal target for a Symfony type lens is very slight myopia, something like -0.25 D. The reason for that is that if they go in the positive zone, that is hyperopia or far sighted. Being hyperopic hurts both distance vision and near vision. So as a factor of safety against doing that, it is normal to target -0.25 D. That said some surgeons who are promising better intermediate/near vision may target more myopia than that so they can deliver on their promise. This sacrifices distance vision to gain more near vision. They may target -0.50 D or even -0.75 D. Or, the other possibility is that they have simply missed the target. Targeting an exact diopter target is not a perfect science. Hitting +/- 0.25 D is in the 50% probability range, while hitting +/- 0.50 D is up to 90% with careful eye measurements and using the best IOL power calculation formulas. As @soks has mentioned if you have excellent near and intermediate vision it is highly unlikely that you have PCO. PCO is like looking through a frosted glass. It reduces visual acuity at all distances, as it is not a focus problem.
      2. Yes, you are correct. If the phoropter (Which is better? One or Two) corrects you to get 20/20 vision or better, then that further confirms you do not have a PCO issue. Ask them to show you the prescribed correction vs no correction and see how much the correction improves your vision. Pay attention to how much cylinder (astigmatism) there is in the prescription. Astigmatism may improve near vision somewhat, but at a cost of overall visual acuity. Astigmatism cannot be corrected with a YAG procedure.


        Good luck with your test...

  • Edited

    Hi Rsko. i had Symfony lenses inserted in 2017. Personally I would not get that YAG procedure done yet. I would wait till it is affecting your vision more.

    Have you considered getting glasses to improve your distance vision? Most of the time near and intermediate vision is what's needed for reading computer TV viewing - anything around the house.. Perhaps the glasses only needed for driving or out on walks?

    I would consider your results good and not consider a lens exchange or tweaking it with laser treatment.

    The more messing about could bring on another condition you wouldn't want to deal with.

    best of luck to you - i really like having near vision and if i had to choose between near or distance I would choose near.

  • Edited

    I just had my eye exam and here are the results:

    Right eye: -050 -075 x101

    Left eye: -050 -025 x140

    He also confined that my near vision is perfect.

    In terms of the YAG, he said I had a tiny bit of PCO in each eye. He said in the left eye it was more of a film and in the right eye it was more spotty, but he emphasized that it was very little. The vision in both eyes was about the same right after the surgeries, but the vision in my right eye has gotten a little worse since then - maybe due to the PCO?

    Since there is some PCO, I'm leaning toward getting the YAG, especially since the vision in my right eye did degrade a little since the surgery. I also may consider LASIC in my right eye, but need to talk to my doctor about how much that may impact my near/intermediate vision. I think it would be crazy to replace the lens, right? what do you all think?

    • Posted

      if u got great intermediate n near with just -0.5 myopia thats a great result. dont do anything. get glasses to sharpen distance n get yag when necessary.

    • Posted

      Your spherical equivalents which are the sphere plus 50% of the cylinder would be:


      Right: -0.875 D

      Left: -0.625 D


      You should have better distance vision in the left and better near in the right. If you want to retain your near and improve your distance I would do the Lasik on the left eye to correct the myopia and cylinder. There is no rush to do the YAG and based on what you report there would be no improvement in visual acuity. Hold off on the YAG until it becomes visible, if it ever does.

    • Posted

      Thanks! You are right, I do have better distance in the left and (very slightly) better near in the right. The same lens was put in each eye but I guess each eye is not exactly the same and that's why the results are different? What's strange is that my right eye has seemed to get a little worse since the surgery.

      In terms of my spherical equivalent, is this a more or less an expected result with the Symfony Optiblue lens or is it more myopic than one would expect? Would this be viewed as very minor nearsightedness?

    • Posted

      Yes, each eye is not exactly the same, and the IOLs come in steps of 0.5 D, so not unusual at all that each eye has a different outcome. In fact it is unusual to have the eyes so close that the same power of IOL was used in each eye. Keep in mind that it is not necessary to perfectly match the vision in both eyes. There are advantages to the overall range of focus to having one eye at plano or near it, and the other somewhat myopic.


      In a perfect world it may be best to be -0.25 D in the distance eye, and -0.75 D or so in the other eye. You could come close to that by doing Lasik on the Left eye. Lasik should be able to reduce both the cylinder and sphere to get you near plano. Your right eye is probably fine where it is now for better near vision. But, if you are satisfied with the near vision of the left eye, you could do the other way around, and try to get the right eye close to plano with Lasik. I would not do both eyes with Lasik, as it will reduce your overall near vision.


      I have indications of PCO in both eyes which are not impacting my vision. The laser specialist recommended waiting until it does before proceeding. There is no rush to do it, and you may never need it. Some reports show that YAG is really only necessary to deal with PCO in 8% of cataract surgeries. However, stats show 30-50% of eyes are being done, which suggest an unnecessary over treatment with YAG. It seems to be used as a cure all, when it really only resolves PCO.

    • Posted

      This is very helpful. One silly question: If I had the YAG, would the PCO potentially continue requiring another YAG down the road anyway?

    • Posted

      BTW - When you say the best would be to have -.025 D in the distance eye and -0.75 D in the other eye, are you referring to the spherical equivalents?

    • Posted

      The YAG blows a hole in the capsule which accumulates the PCO so a second one should not be necessary. However, if the edges of the hole, or the flap depending on the pattern used get in the way of your vision or cause glare, it can be necessary to enlarge the hole in the capsule.


      Yes, -0.25 D in the distance eye and -0.75 D in the near eye would be spherical equivalents.

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.