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Synergy Experience - One normal eye, one Synergy eye

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none95038
none95038

Seemingly not much people has used Synergy so far both on this forum and on the Internet in general. I have just implanted by Synergy yesterday. Hopefully my experience would help you make your decision, especially as I have a healthy vision in one eye, I can give you the perspective of how Synergy does vs normal vision.

Background

Late 30s male, having Cataract only in my right eye but my left eye has 20/20 eyesight. It is highly unusual to develop Cataract in such a young age, particularly only in one eye. My guess is probably due to use of steroid ointment for my Eczema problem, or I dropped my phone on corner onto my eye.

Lens Choice

I have done quite a bit of research before seeing my surgeon and have narrowed my target to PanOptix vs Synergy. I am living in a non-US country so I have access to Synergy earlier. When I done my research and seeing my surgeon, the FDA approval data was not out yet, so my research is mainly based on marketing data from JnJ vs a lot of 3rd party published data from PanOptix. My general thoughts:

Defocus curve: The marketing data from JnJ showed a very good defocus curve, with good intermediate without any soft points. PanOptix defocus curve is still good at intermediate, but probably have some soft points. The biggest advantage from Synergy is better near vision. Synergy offer vision close to 33cm, vs PanOptix of around 40cm. After FDA approval data released, I tried to compare the two but actually it is quite difficult because a lot of experimental data is not directly comparable. Some look better for PanOptic and some look better for Synergy. Also the trial patient age is a bit different with Synergy at 70yrs average while PanOptix is 65.8yrs on average. My key takeaway is probably the defocus curve of Synergy is not much better than PanOptix, probably with less intermediate soft spots and stronger near, but the difference is not dramatic.

Contrast: Synergy put contrast sensitivity as its main selling point. Its material has a lower reflective index than that of PanOptix, result in less chromatic aberration that reduce contrast. The FDA trial results actually appeared to favor PanOptix, with the higher value for contrast sensitive for most cases. However, I am not sure whether the numbers are actually comparable because PanOptix reported "(Best-Case Analysis Set)". I am not sure what that means and how significant is it. Also I am not sure the test methodology used are 100% the same.

Nighttime Vision: In Synergy marketing material, JnJ said the UV filter can help improve night time visual disturbance. However, the FDA data showed PanOptix and Synergy has very similar % of patients bothered with Starburst and Halos. But Synergy seemingly has more cases of double vision than PanOptix.

Material Durability: Because of my young age, I have a stronger focus on material durability. PanOptix is reported to have Glistening problems, but not for Synergy. While Glistening seems to be rare for PanOptix so far, I am still a bit concerned about long term glistening problems because seemingly no one has used PanOptix for 10yrs+ yet.

** Seeing the Surgeon**

I have chose one of the best ophthalmologist in my country for refractive errors. He initially suggested a "tri-focal lens" because I have a fully functional left eye and I am not wearing spectacles. When I asked whether it mean PanOptix or Synergy, he said he mean PanOptix. I further asked on Pros and Cons of Synergy vs PanOptix, he said Synergy has better near vision but slightly worse intermediate. I asked about the wonderful defocus curve shown by JnJ, he said don't trust the marketing materials. He further said Synergy is very bad for patient with Astigmatism, but my Astigmatism is very mild so that will not be a problem. Both are reported to have good performance with Halo and Starburst and do not need to be concerned. Likely because I asked, he eventually recommended Synergy for me.

He then said I have a higher risk of anterior capsule rupture, so he recommend me to use the Femtosecond laser.

After he has done some measurements, he said the lens come in steps of 0.5D, and my eye is in the middle of two steps. I will either have 0.25D shortsightedness or 0.25D farsightedness. PanOptix is likely facing similar problem, probably only slightly better. He recommended 0.25D shortsightedness because I have stronger computer use needs than driving needs, which I accepted.

The Surgery

Femtosecond Laser: There is a tube to put eye under suction, with running water inside the tube. I can feel a bit of pressure on eye ball but it's not too bad. First there's a very uncomfortable strong light for around a minute. Then there's a scanning phase in which the scanner, which is quite far above my head, moved slowly for about 2 minutes to take measurement at different angle. My surgeon said my eyeball has moved I have to go through the whole thing (strong light+scanning). After scanning comes the actual laser. I can only see a small green beam making circles and lasted for probably only 15-30 seconds, much faster than my expectation. The hardest thing is to keep your eye fixed and focused on a single location

Cataract Surgery: I can only feel a small needle and some strange pressure. The overall feel is not too bad, but the strong light and operational room setting is still scary anyway.

The operation is longer than my expectation. After the operation, the surgeon said I have posterior capsular rupture, but the problem is fixed with no loss of vitreous body. This is actually good because I do not have to concern about PCO. What is more problematic is that my my ligament is weak, so he need to use a tension ring to fix the location of the lens. Eventually the lens is in a perfect location and the implications should not cause issues.

** The first day **

Visited the ophthalmologist for checkup about 18 hrs after surgery. My right eye report about 20/38 for 4m vision. I asked about the risk of cystoid macular oedema due to posterior capsular rupture, which he said is minimal because I have no loss in vitreous body, but weakened ligament means I have higher risk of lens displacement, and lens replacement operations will be much more difficult so he won't risk it unless it is absolutely necessary.

Everything, far and close, still seems blurry. Saw a sizable halo for headlamps inside tunnel. Under strong light, I can see a mild light arc in far right of my vision field, but it is not disturbing and do not notice unless I am actually looking for it. At arm length from monitor, I can read font size of 18 (Calibri) relatively easily, and read size 14 if tried hard.

I know I am still early in my recovery. I will keep update my progress, especially as I am lucky enough to have a fully functional normal eye so hopefully my experience will be useful to you.

0 likes, 12 replies

12 Replies

  • RonAKA
    RonAKA none95038

    Posted

    Thank you for the detailed description of your procedure. You obviously have done a lot of research. You made a good choice in selecting -0.25 D near sighted. You do not want to go into the + side or you will lose reading vision. -0.25 should not cost much at all in distance vision. But, of course you will need to get your eye tested at about 6 weeks to see where the correction finally settles. Hopefully you will be just fine with no need for glasses. Your good eye will make up for any shortfall close or at distance.

    • none95038
      none95038 RonAKA

      Posted

      While I am happy with my choice of going 0.25D nearsighted, I am not sure whether losing 0.25D reading vision (seems reducing maybe 3cm of near range) in exchange for a perfect far vision maybe is a good choice too? is my understanding correct?

    • RonAKA
      RonAKA none95038

      Posted

      I believe IOL's come in steps of 0.5 D. You don't know what your really get until after the procedure. However, assuming the outcome is actually -0.25 D then the next power step for a lens would be +0.25 D. There is no in between. Either one gives about the same distance, but -0.25 is the better one for closer up.

  • rwbil
    rwbil none95038

    Posted

    As someone looking to Get Synergy, I am hanging on to every word and wishing you the best and cannot wait to hear as your recovery progresses.

    Getting cataracts so young sucks (technical term). Young people are so use to having such good vision with a nature lens that can still see close and far. Older person like me coming from crappy vision are just happy to be able to see and hardly notice things like contrast sensitivity loss.

    I am sure you will do what all of us have done and cover up one eye and compare, just don't go insane with it.

    • none95038
      none95038 rwbil

      Posted

      Sure! I will keep posting Synergy vs my normal eye comparison as my eye recover. Feel free if you want me to do a particular comparison.

  • Sue.An2
    Sue.An2 none95038

    Edited

    Thank you for posting your experience. Wishing you a good outcome and speedy recovery.

    I was diagnosed at 53 with cataracts - not as young as you but was also told due to my long term use of cortisone cream for atopic eczema and one time was on steriod medication for a condition. Wish I had been told of side effects. My eczema ne er responded well to the the steriod creams. There is a new cream now without steriods called Eucrisa which has been a miracle for me. First time ever seeing a marked improvement.

    Again hope all goes well for you.

    • none95038
      none95038 Sue.An2

      Edited

      If I knew cortisone can cause cataract I would definitely be extra careful on applying that on my eyelid. Now I mainly apply more moisturizers to ease my eczema. I will definitely check out Eucrisa. Thank you!

  • none95038
    none95038

    Posted

    Vision at 9th day

    Visited my ophthalmologist for check up. Far vision measured 20/20, close up vision under bright lamp read 20/30. Ophthalmologist said I am still early in my recovery so there's room for further improvement, especially on halo and glare.

    Here's my experience so far:

    • Far vision: I feel my Synergy eye is very close to a perfect vision and I am very happy with the result. One interesting thing is I can notice there's very very slight distortion in the image. For example, a straight building become very very slightly bent/distorted when my normal eye see a perfectly straight building. I don't think that's a big deal though
    • Computer use: Setting monitor brightness has a very big impact on image quality. When monitor is set to bright, my Synergy eye can see greatly just like my normal eye. I can see even small fonts in grey with great clarity. When monitor is set to dim, my Synergy eye can only see larger text in black, and text seems a little bit blurry. My Synergy eye can see font size 7 (Calibri) while my neutral eye can see font size 6. However I do see glare around text on a dark background
    • Mobile phone use: Same as Computer, the brightness of the screen has big impact on readability of small text in grey. I can achieve quite a good readability when my screen is set to 40-50% brightness. My "sweetspot" distance is about 33cm, text start to become blurry when getting closer. My natural eye can see things up close to say ~10cm
    • Book Reading under room brightness: My normal reading distance is about ~50cm. Text appear to be a bit blurry but still readable. Vision is getting better when the book is bring closer to ~33cm, but it's quite a unnatural reading position.
    • Night time vision: The glare, halo and starburst actually get a bit worst in last few days after my Synergy eye recover more. Understandably, these night time vision problem is more serious when the environment is darker vs a bright light source. To an extreme, in a dark bedroom, a small LED indicator can produce a big halo ring that occupy a big part of vision field. It is very very noticeable, but not really bother me, probably because my normal eye has mild (~0.3D) astigmatism which has a bit natural glare and starburst anyway. I don't think the night vision problem will impact my ability to drive at night, but probably because I have one normal eye and because I am living in a big city where everywhere is well-lit.
    • Color: I don't notice any difference in color between the two eyes, except when looking at screens where my natural eye see slightly more yellowish and my Synergy eye see more blue-ish. Note Synergy come with a blue light filter which will cause image to look yellowish. But natural lens will age and becoming more yellowish over time. I remember the Yellowish-ness of Synergy is similar to natural lens at 40 years old, so maybe my normal eye is aging more than normal.

    Overall definitely my Synergy eye is not as good as my natural eye, but I am happy with the result so far. The book reading clarity is not as good as I hoped, and I have to set my monitor/phone brighter than normal to get better vision. Feel free to ask if you want me to compare Synergy vs normal eye vision.

    • rwbil
      rwbil none95038

      Edited

      Love the update. Sounds like you are doing pretty good and hopefully the near will improve as the eye heals.

      I know everyone is different, but one of my main concerns is how bad are the dysphopsias during night time driving. Can you provide more information on what you are experiencing. It is hard to find perfect simulators. But this first picture is way worse than what I have now, so it will set the baseline.

      image

      The next photo is a bit closer but again not that accurate. For headlights when the car is far away they can be quite large to to the point of reaching over to the car next to it. But it is far away so no big deal. But as the car comes in closer the size of the halo goes down to basically non existent when the car is near me. Traffic light in the photo are close but again vary with distance. Red brake lights are the worse for me. And really bad on highways / expressways as I have trouble judging distance to the car in front of me when they hit there brakes. I am hoping the problem is not due to the halo but due to basically only having 1 good eye.

      So anything you can add about driving at night and what you experience would be greatly appreciated.

      image

    • Sue.An2
      Sue.An2 none95038

      Posted

      Here's my experience so far:

      Far vision: I feel my Synergy eye is very close to a perfect vision and I am very happy with the result. One interesting thing is I can notice there's very very slight distortion in the image. For example, a straight building become very very slightly bent/distorted when my normal eye see a perfectly straight building. I don't think that's a big deal though.

      It may be the IOL however seeing straight lines bent could be Epitetinal Membrane which can occur after cataract surgery. I was diagnosed with that a year after cataract surgery by my optometrist and still waiting to see specialist. Just something you may want to have checked out. I only notice it when left eye is closed - guess brain chooses the better view.

    • none95038
      none95038 rwbil

      Posted

      When I only use my Synergy eye, I think my glare problem is not as serious as the 1st picture. Actual glare is probably similar to slightly worse than my natural eye. But I can see much more fine halo and fine starburst that can be quite large. Also my halo/starburst is semi-circle shaped, i.e. there's more halo/starburst in the upper part of the light source than lower half. I guess that is due to small natural astigmatism in my cornea.

      Just like what you said, when the car is closer, the size of halo become smaller and less relevant. Actual halo can varies quite a lot depend on distance (farther light has more), brightness and viewing angle. Red break light and orange street lamps are more annoying than yellow and white head lamps.

      Overall vision quality should be worse than the first picture, but I think it will not affect my ability to judge distance.

      Note I am using only 1 eye and I am relatively early in neuroadaptation, so your experience maybe different.

  • MikeATX
    MikeATX none95038

    Posted

    @none95038

    Hi, would you please update us on your progress thus far with your Synergy IOL? Any further changes in performance?

    Thank you!

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