Tecnis Synergy
Posted , 73 users are following.
Hello all - if anyone has any experience using the Tecnis Synergy IOLs, please share your views. Thanks!
7 likes, 262 replies
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Notes on Tecnis Synergy
andyhp el2020
Edited
The bottom line appears to be that if you get his lens, at night time, you will have halos, probably starbursts, but you will most likely, have clear vision from 30cm to infinity day and night - literally the next day after surgery - improving rapidly over time.
The question might be, is it worth it to have almost perfect vision again, & deal with light artifacts at night time as a side effect? For me, its a no brainer, I don't want to wear glasses - they give me headaches, major pain in the butt to carry around, and less fun for mountain biking and some outdoor activities, and I am a computer scientist, thus need to be able to read screens for a good 8 hours a day. The trade off so far, is 200% worth it, and the halos / starbursts are decreasing - only at day 7 and I have not been this functional in life overall for 2 years. I don't quite understand those who have this lens removed after install - attaining 20/20 vision, only to downgrade to a monofocal that absolutely requires the use of glasses and has zero near vision. I ponder if some people just really want to wear glasses? For me, this lens is literally changing my life for the better every second. Its like being young again. I have not seen this well since I was in my 30's.
The odd person is going to have a bad experience - its statistics... maybe its the choice of doctor, a bad diagnosis, bad lens, or bad lens install - or maybe you twitched too badly during the surgery - I almost did. I do know that the placement of this particular lens is UBER important, to get it perfectly centered- to have the least chance of halos and starbursts....but that just makes sense. I read that it can be re-centered if this is the case.
Please pass on any questions to me. I feel there is a lot of negative press out there regarding this lens, and I am not sure why, as clearly, I have had an amazing experience so far. Going from 1 working eye to 2, is purely epic.
RonAKA andyhp
Edited
"downgrade to a monofocal that absolutely requires the use of glasses and has zero near vision"
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I am not sure I can agree that a monofocal is a downgrade in vision quality, or that a monofocal has zero near vision. Within the range it is designed to work, they offer the highest vision quality. The term "premium lens" in the case of a multifocal, does not refer to vision quality. It refers to the additional features of a multifocal lens and the price. These features come at a price in dollars and vision quality, and whether or not the patient thinks the net outcome is a gain or a loss, is probably a matter of personal priorities.
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I think that sometimes people get the impression that if you get a monofocal set for distance the vision drops off the cliff if you look at anything closer. Not true of course. With my monofocal IOL with a 0.00 D outcome lets me see down to 24" quite easily and some things like black text on a bright white computer screen down to about 18". No, it is not good enough for computer work unless you have a big screen monitor that is 24" or more away.
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And it seems very few consider the option of monovision, which is two plane Jane monofocals with one leaving you about -1.25 D myopic. This is ideally the non-dominant eye, and the dominant eye is fully corrected for distance. I simulate this with a contact currently and I can read the No. 1 paragraph on a Jaeger eye chart at 14", and surprisingly more easily when I keep both eyes open including the distance set IOL. The bottom line is that with my simulated monovision I do not carry readers around. I drive day and night in the city, but I do switch to my progressives for night driving out of the city. We have issues with deer and moose in my area at night. Not good for anybody to hit one.
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I think it is unfortunate that not all surgeons offer and explain the option of monovision to patients. But, they are under a lot of pressure to get people through the cataract process as efficiently as possible. I think optometrists could do more as well by explaining how it works and setting up patients with trial contacts to simulate it.
grich andyhp
Edited
You just seem happy to be able to see, which I understand since you were stuck with a bum eye for so long. I am surprised you are able to read the computer screen properly with the Synergy. Are you able to read spreadsheet numbers from 70 cm away at normal font size without relying on your unoperated eye? If you cant then there is already a problem if you have to do both eyes with the same lens.
On another note, Im not even sure why some are happy with the severe downgrade in visual quality of the Synergy. Seeing 20/20 is only a small portion of the equation - you are meant to see 20/20 for all types of lenses. Enjoying the colors in the world as your eye was meant to see it, instead of stunted colors of the Synergy is a major concern for some of us. Dont tell me you havent closed one eye and compared it to the Synergy and found no difference in colors.
Monovision lenses gives you the absolute highest quality vision comparable to your natural lens you were born with. Still has issues, outside of losing near vision and part of intermediate vision, but it is as good as technology gets us at this point. But we cant grow back our natural lens.
With a multifocal lens you're sacrificing visual quality to get near and a bit more intermediate vision. You will see graphs that show exactly what you're losing in visual quality compared to a monovision lens. A monovision lens is still held as a the gold standard by surgeons today. There is no free lunch here with multifocal lenses.
Do you know what percentage of lenses put in are monovision lenses? The multifocal lenses are a tiny portion of the market of cataract surgeries because of the price and because of the visual artifacts. Quite frankly, if multifocal lenses were such a miracle it would be covered by health insurance.
Personally if i had another lifetime to repeat I would have picked the Panoptix instead of the Synergy because one of them has been in the market way longer and is very trusted by surgeons and has fewer night problems.
Sue.An2 andyhp
Edited
There are a lot of factors involved - not just IOL choice. So happy everything turned out well for you. I made a similar choice in 2017 choosing Symfony an EDOF lens. I am glasses free. Having little to know refractive errors achieves s better result - a monofocal lens is more forgiving than a premium lens I have heard. Also for some people whether it is because pupils are smaller or not they get more range of vision. It has been speculated that I would see as well with a monofocal (nearer vision) as I do with Symfony. Hard to know for sure.
In any case glad things worked out well.
soks grich
Edited
but what if panoptix develops glistening after YAG. and the patient is 40 years old so the lens has to last them for a really long time.
AJ_Canada el2020
Edited
It is now 8 months since my cataract surgery. Both eyes were implanted with Synergy IOLS, with surgeries one week apart. You can read my first weeks experience earlier in this thread. This is an update on my previous postings.
The Good:
My visual acuity is very good from 12" to infinity, especially in bright light. Focus is a little soft at arm's length, but not enough that I need glasses at any distance. In soft light, my focus is poorer especially at near distances but I can still read menus even in dim light.
After surgery, I had significant dry eye in both eyes. This has mostly cleared up. The dry eye would cause my focus to be poor in the morning, improving later in the day. This is no longer the case.
The Bad:
Primary Halo: Because these lenses use diffraction rings, I see halos around bright points of light. The most obvious is the closest halo to the object that I call a "primary halo". I see a significant primary halo around traffic lights at night, and I see small primary halos around shiny reflective objects during the day. In a sense, every point of light creates some form of primary halo, but I don't see the halo unless the background is significantly darker than the foreground. So for example, if I am looking at sun light bouncing off a lake, I see tiny primary halos around every sparkle. I also see these halos around every light on a Xmas tree, especially if they are LED. If I am looking at a metallic object up close, I will see halos around any point of light reflecting from the surface. The intensity of the halo is proportional to the contrast. The more contrast between the point of light and its surrounding, the brighter the halo.
Secondary Halos: These are lighter halos that occur further away from the point source in expanding concentric circles. I tend not to see these halos except at night or when I am looking at LEDs. In a dark setting with bright LEDs, they are obvious and very apparent. That said, Typically I do not see them during the day, or around incandescent or diffuse lighting at night.
Starbursts: Any sort of intense light source creates a starburst, but since the starburst rays are faint, I tend only to see them at night. The higher the intensity of the light and the greater the contrast, the larger the starburst. The starbursts can be quite large but they are relatively faint.
Glare: The glare is similar in intensity to the starbursts and only occurs with high contrast lights or at night. The size of the glare is smaller than the starbursts, perhaps half the diameter. Similar to glare with a slight cataract but less intense and does not impair focus.
Ghosting: Any time I see bright white against black, I will get a slight ghost image of the object. For example, while typing this I can see a slight ghost image of the white letters on my keyboard against the black background of the keys. This also occurs with subtitles while watching movies.
Arc in left eye: I see an arc on the cheek side of my left eye which is typical of a "Negative Dysphotopsia". This occurred right after surgery and has not diminished. It is annoying but I typically don't see it unless there is bright light streaming in from the left.
My opinion:
For what it's worth, here is my opinion. In a sense, the Synergy lens is an amazing piece of technology. It does provide good to very good vision from 12" to infinity. But there is a very real cost that you pay in terms of visual artifacts, most of which do not go away. They may seem less obtrusive over time, but that is because you get used to them, not because your brain magically doesn't see them. NONE of these visual artifacts have disappeared. Some have become less apparent, but they are still there.
Do the visual artifacts bother me? Of course. But for the majority of time I am not aware of them because I am either working in a well lit environment or am focusing on something else. Are the negatives of this lens obvious at night? Absolutely! Definitely. 100%, guaranteed. Let no one tell you differently. They are there and they are obvious. Can I drive at night? Sure, but it's tougher than it was before and I do get concerned that the glare and starbursts from the car and street lights obscure my vision. That's one of the tradeoffs.
Would I do it again? Hard to say. The fact that I am typing this without glasses, and that I basically never need to worry about glasses, and that I rarely drive at night, and that I am on a computer 80% of my awake hours, these lenses pretty much work for me. But that's me. Would I prefer not to have these visual artifacts? Of course. But that type of lens doesn't exist at the moment. Twenty years from now, who knows.
RonAKA AJ_Canada
Edited
Good report on the IOL's. I agree that there is no perfect solution to vision after cataract surgery. I think mini-monovision is the best alternative to MF to being eyeglasses free. They require some pre-planning, and cooperation from the surgeon in getting both good close and distance vision. And there is no extra money in them for the surgeon so many pass over that option.
AJ_Canada RonAKA
Edited
Monovision was not really a viable option in my case. I had amblyopia (lazy eye) in my left eye as a kid, and it was never really fully corrected. I basically have one good eye, my right, and so multifocal was really the best option for full vision range.
RonAKA AJ_Canada
Posted
My wife has the same issue. With only one good eye, monovision is certainly not an option. In her case we opted for a toric monofocal. She is quite happy with it, other than now she is more dependent on reading glasses than she was before.
AJ_Canada RonAKA
Edited
Understood.
By the way, I had a posterior vitreous detachment (PVD) about 1.5 years ago that left a significant shadowy floater in my right eye. The PVD and resulting floater is benign, but it covers about 1/4 of my vision when it floats up into view. The floater is sort of like having a randomly appearing cataract.
If there was only ONE visual artifact I could get rid of, it would be the floater - hands down. But this requires a more serious surgery that most opthalmologists advise against.
RonAKA AJ_Canada
Edited
I have a PVD as well that is a distraction, but not all that bad. It started out looking like an engagement ring, and now looks more like a spider with legs hanging down. So far my wife has had pretty good results, but definitely needs readers.
grich AJ_Canada
Posted
Are you sure the arc isnt caused by a microfold in lens capsule bag holding the lens? That can be lasered out and is covered by the government or insurance.
AJ_Canada grich
Posted
The arc appears to be a classic sign of a negative dysphotopsia based on the symptoms. That said, I will be seeing my optometrist soon and will ask her to take a close look at the lens to confirm. With my eyes dilated, she should be able to see if there are any distortions in the lens and also test for shadowing from the edge on the IOL on my retina. Also, if I squint I can make out the individual concentric diffraction rings in the IOL and they seem to be well positioned so I don't believe there is a fold.
Jennifer_Guess el2020
Edited
I am having the Symfony on the 3rd of January and the Synergy on the 10th. I'll post after each with my experience.
Sue.An2 Jennifer_Guess
Posted
Jennifer is there a reason why you have the 2nd surgery just 1 week after first? You mat want to have more time between the surgeries to allow for healing and settling of IOL.
Jennifer_Guess Sue.An2
Posted
Hi @Sue.An2 - it's what they recommended. It will be done with laser which they say is less intrusive/less time to heal.
grich Jennifer_Guess
Edited
It is unreasonable to be having 2 surgeries within a week of each other. They are literally doing this to maximize their revenue, and not giving a s**t about their patients.
Your first eye needs 2 weeks for scar tissue to start forming, and you need more than a week to decide whether you can live with the lens or not. The assumption of the surgeon is that you will not do a lens exchange means after getting both eyes done makes it less likely they will do a lens exchange for both eyes if you cannot tolerate the dysphotopsia (visual artifacts like halos, glare, starbursts, weird shadows on fonts against dark backgronds) associated with the Synergy lens. I suggest reading the full 11 pages on here to see if you still want to go through this. Your other options can be the Panoptix (very proven over several years and better tolerated than the Synergy for dysphotopsia) or the enhanced monofocal lenses if you want to avoid the problem all together.
I would push back on them and have the 2nd surgery at least 1-3 months after your first surgery.
Dont worry about the lens if you decide you no longer want the Synergy. The manufacturer J&J will do a full refund on the lens to the clinic even if it is customized and already delivered to the surgeon. It's the cost of doing business for J&J and they are fine with it. You could pick another lens with a different company without issues.
grich Jennifer_Guess
Posted
okay, i misread what you wrote.
Why are they putting in a Symfony (which is a discontinued lens) and then a Synergy in the other eye?
They have different viewing distances. Both lenses overpromised and have major issues with dysphotopsia
What is going on here???? Who is your surgeon and why is he/she recommending wack things like this, and pressuring you to have both eyes done within 2 weeks?
If the surgeon doesnt give you a satisfactory answer why they are putting in 2 different types of lenses then it's time to find another surgeon within the clinic or another clinic.
Jennifer_Guess grich
Edited
@grich - I am not sure, but have found out that these two are used quite a bit to help with the issues such as halos, light, etc. I did not know the Symfony was discontinued....hmmm! Are you a specialist/trained in this area? Also, lots of people I have talked to had their eyes done in this time period - so maybe standard in some parts of the world.
grich Jennifer_Guess
Edited
Nope Im not a surgeon or in the field.
1 week per eye isnt reasonable, not if you need time to know if you can tolerate the lens they give you. 1 month is minimum if you want to know this answer. But it's on you to decide. It's covid season - it's going to be real easy to delay your surgeries without penalty if you really wanted to.
You do understand that both Sympony and Synergy has extreme issues with halos, starbursts, glare etc? Supposedly Synergy which came after Sympony reduces these issues, but you can sort of tell from the people who reported back that the issues are still there. So the questions again is why are they putting in one of each into you when both lenses have the same problems? You can verify that Sympony has the same problems quite easily.
If Synergy is so great why arent they putting that into both eyes? If Sympony is better for night time why arent they putting that into both eyes?
Best wishes on your surgeries. Have low expectations and you will be happier.
Sue.An2 Jennifer_Guess
Edited
Please be careful. It doesn't matter if laser used or not. Eyes take time to heal. I strongly recommend you wait additional weeks between surgeries. I would also seek our a 2nd consult - this surgeon seems to be pushing for this to be done quickly.