This is an interesting discussion between patients and interested parties from a popular US blog-site Medhelp
He gave me a quick rundown about what can be chosen but it was brief and he said he would go into it at the full consultation. Also, I didn’t know anything about the IOL choices or procedures then. Since Monday though I have read *a lot* about it (especially on this site) and feel I now have a very good idea about this entire topic.
I even went to see my optician whose judgement and experience I trust to ask him what he sees “after the fact” in terms of success, glasses, etc. He said if he had to give an overall impression it would be that most people that were used to wearing glasses for many years…and I am in that category…could not get used to going eyeglass-less for some of the time and needing reading glasses for some of the time. They just found it easier to keep glasses on their head…just like they always have done. For example, he himself is a -2 with good intermediate and close vision. He would opt to get an IOL that would essentially keep that the same and simply wear his progressive glasses always on…just as he has done for many years.
I believe I am a -4 with a +2 for near vision but am not positive (I don’t even profess to know what the numbers all mean anyway). I know I have some astigmatism but I have no idea how much or in what eye.
I think that covers the introduction of my question. What I am looking for is some advice as to whether or not monofocals or Symphony would be the best choice. I know the Symfony was approved by the FDA last month and from everything I’ve read, they are a really great alternative to monofocals. As far as I’m concerned, I would not choose multifocals at all due to the glare, halos, aberrations, and bad low light contrast. I also don’t think I could handle monovision, or at least to any great extent.
I should mention that I am currently out of work and really do not want to spend the money for premium IOLs but will do so if the Symfony IOLs really do offer so much more…and I am believing that they do.
I am NOT averse to wearing glasses after surgery so please keep that in mind. That means that if I need them to correct astigmatism or reading…then I’ll get progressive glasses.
I would like to have great distance vision (for day and night driving) and especially intermediate to watch TV (about 10 to 12 feet away). I use my cellphone a lot so I would hate to lose that close vision I have now (6 or 7 inches away) but again, if I need glasses…so be it. But all that being said, if I could go glass-less some of the time as an option, that would be great.
So I am wondering if getting Technis monofocals would be “OK” or if I should go all out and get the Symfony. Again I’ve read that the Symfony IOLs are the greatest thing since sliced bread for far and intermediate vision…and maybe even for near vision.
I am sure all your comments will be helpful. I would especially also like to hear any long-term ramifications from the Diabetes and how it might affect things down the line. Same for the astigmatism.
Thank you in advance for all your help!
Also, what are the ramifications of Diabetes? Now and for the long-term? With either monofocals or Symfony?
And finally, why aren’t the Symfony IOLs the greatest thing since sliced bread…as compared to monofocals?
In terms of undercorrecting, I suspect it depends on whether you ever find it useful or convenient to take off your glasses to take advantage of your nearer vision the way some low myopes do. Some of them like that ability and so they wish to retain some myopia after surgery. In my case I was highly myopic so I wore contacts/glasses every waking moment and so I had no desire to remain myopic afterwards.
That said it depends on your visual needs, when you’d prefer to wear glasses if needed. If most of your visual needs are intermediate and near, and you don’t mind wearing glasses for distance, it may be convenient to set your eyes for intermediate. If you use a lot of really close near vision, even if you went with the Symfony you might benefit from setting it at intermediate to get more near.
Although a premium lens costs extra, if your insurance doesn’t cover progressive eyeglasses, you might wish to factor in the savings from potentially not needing progressive glasses in the future (though after surgery you wouldn’t likely need new ones often since the add wouldn’t be changing), vs. the cost of over the counter readers (or even prescription readers that aren’t progressive are going to be cheaper than good progressives).
No IOL is perfect, there are always tradeoffs. You mention wishing good vision at everything from 6 inches to distance, and unfortunately there isn’t an IOL yet that will give that full range of vision without tradeoffs. There are trifocals only available outside the US that may come the closest to providing that full range, but which have the risk of halos and where intermediate vision may not be quite as good as distance&near.
I tend to describe the experience I have with Symfony IOLs as like having early presbyopia, it doesn’t provide as much near as a trifocal or higher add bifocal. You do notice some reduction in near vision even if you can get away without readers for most things. A minority of people need readers with the Symfony for reading, though most will need them occasionally for say threading a needle or other really near fine vision tasks. In my case I have no trouble using a smartphone using normal fonts, but I don’t hold it at 6 inches (though its at a comfortable distance, perhaps 15 inches, I don’t recall what I measured before and don’t have ruler handy). A tiny bit of monovision, micro-monovision, will give some more near vision with the Symfony without much impact on distance or stereopsis. (for various reasons I didn’t get that, though I might consider a laser tweak to get there, it hasn’t been something I’ve felt a need to do).
Although the European studies consistently showed that the Symfony was comparable in contrast sensitivity to monofocals, the FDA trials seem to indicate a slight reduction. I hadn’t explored the issue, but the reduction seems to be minor since it wasn’t picked up before in other studies. I don’t know whether its enough for patients to notice even if the tests show it, its not something thats noticeably impacted me as far as I can tell. (but everyone is different). The risk of halos is low and seems to fall within the range of monofocals, perhaps higher than the better monofocals (like the Tecnis) but lower than data I’d seem for other common monofocals like Alcon.
As far as I can tell, my distance vision is better than I can remember it being with contacts or glasses in the past, including night vision overall. That said, I did wear multifocal contacts before I had cataract issues (which reduce contrast sensitivity and have some reduction in low light vision) so my memory may be flawed since it had been a while since I had single vision contacts or wore glasses much. I did find someone else about my age with the Crystalens (which is a single focus lens, even if it supposedly accommodates) who seems to see a reduction in near vision with even a slight reduction in light (e.g. holding something to cast a shadow over the near eye chart), but the same experiment didn’t alter my low light vision at all.
Let me clarify my initial long-winded post.
When I say I am not averse to wearing glasses, I mean that I’ve been wearing glasses for 48 of my 59 years. I am used to always wearing them and therefore never lose them! So if I need some type of glasses afterwards…so be it.
However that being said let me say that I use my progressives when using my cell phone or reading….when the distance is approximately 12 inches.. What I love though, is that I can take off my progressives for distances of 6 inches for either close reading (cell phone, book,detailed work). I would prefer not to lose that ability because it seems comfortable.
Will I definitely lose that 6 inch vision with the Symfony? I know ill lose it with monofocals.
And one more thing, as I mentioned I have some astigmatism. I don’t know how much or in which eyes or both. I would rather fix that with eyeglasses rather than getting the toric Symfonys. The reason…I am too worried that it has to be placed perfectly and that it might move as well.
That actually leads me to a separate question. Can you rub your eyes after surgery heals? I mean everyone rubs their eyes font they? Your eyes tear when you cut onions, allergies, itches.
I thank you in advance for your reply.
re: “definitely lose that 6 inch vision with the Symfony”
You can convert a distance into a lens power diopter measurement by -(100 / distance-in-centimeters) so that 6 inches means a focus at about -6.6 diopters or so. Although the results of lens studies are just averages, some lucky people wind up with better results, the odds are no one would get vision up that close with any lens set for distance, any lens would need to be set to leave you nearsighted to some degree to get that close in. Unfortunately the number of diopters it takes to get just a little bit closer rises rapidly. You would have to get lenses set to leave you very myopic to be able to get distance that close up, perhaps with an eye set to be -4 myopic (focusing best at 25 cm) you might get useable 20/30 vision at 6 inches (based on average results) with the Symfony. (you’d have to be perhaps -5 or so with a monofocal).
With the Symfony you do get a wider range of vision than with a monfocal (regardless of where you target the best focal point), but not as near as you’d want. If halos weren’t a concern for you then I’d suggest a high add bifocal as something to consider, perhaps with some monovision on top of it.
I read my smartphone at a more typical distance I think for those who aren’t nearsighted when reading it.
If you don’t have much astigmatism, they tend to correct that with an incision rather than a toric lens. Surgeons vary on how much astigmatism they prefer to correct with a lens vs. an incision. A small amount of astigmatism doesn’t impact vision too much so glasses might not be required for some distances afterwards. If you needed glasses afterwards for astigmatism and wore progressives, it isn’t clear if the Symfony gives too much benefit. Overall they have good luck with toric lenses, and can reposition them if they do rotate after surgery. I hadn’t checked on the statistics regarding that in detail since I didn’t have much astigmatism and didn’t need a toric lens.
After surgery heals then rubbing your eye is no different than beforehand as far as I’m aware, I don’t recall hearing any cautions about that. Rubbing your eyes is more problematic for those wearing contacts, so from decades of wearing them perhaps I don’t tend to ever rub my eyes. (I can vaguely remember doing so when young before contacts, which is why I’m thinking I changed behavior after getting them). Wiping them to clear allergies or sweat or whatever else is different.
So it seems that I can get that with the Symfony but would most likely need reading glasses…or I could get cheaper (and better optics) monofocals, set for distance and then need progressives for intermediate and close vision.
I don’t think I want monovision. And well leave the astigmatism out of the equation for now.
Again, I have my cataract consultation on Thursday so I’ll need to hear what he says.
It’s a lot to consider and I appreciate all your help so far.
Actually most people with the Symfony don’t need reading glasses for typical reading distances, only for really near vision like the 6″ you are talking about which is nearer than most people read at. There is no guarantee though, some people are the unlucky “statistic” that needs readers even at typical distances. It can help to get a tiny bit of micromonovision, like -0.5D, doesn’t have much impact on distance vision since the lens gives decent vision a little bit further out from where it is focused so the -0.5D eye still helps with distance vision The Symfony manufacturer page has information about micro-monovision on the “clinical” tab:
It also doesn’t have much impact on stereopsis since for most of the visual range both eyes are being used, except for very near.
For myself, cost is an issue for me and it will have to play a big part in my decision. That being said, I am willing to raid my retirement funds to pay the additional costs for the Symfony IOLs if I feel they are worth it to me and of course after I hear what my surgeon says on Thursday during the consultation after my dilation and including a discussion about my astigmatism.
Right now, I feel that they may be worth it to me. The website you referenced really shows some great stats. Of course…it’s Tecnis’ site so they are going to spin things their way as much as possible.
I would like to thank you again for all your comments. They, along with Dr. Hagan’s, have been tremendously helpful in what has been a crash course in “Everything Cataract”!
A related article in the current issue of that publication talks about the issue of night vision with multifocals, and the difference with the Symfony:
1) I have a Class 3 cataract in each eye (or is it category?). He certainly can remove it with normal phocoemulsification (sp.) but given that I am diabetic which means there can be healing issues, that the femtolaser is gentler and requires less healing. My take is that it is also less traumatic in general in terms of breakup and suctioning which means it’s better all around for the surrounding tissues.
2) I have astigmatism in both eyes and he recommends a toric. I asked him about the dislodgement and placement issues and he said he has only had one move on him where he had to go in and readjust. If I choose the toric, he said I will only need OTC readers for close work. If I choose the non-toric monofocals, I will definitely need glases.
3) I mentioned the Symfony. He said the rep was actually in his office on Tuesday telling him all about it. He doesn’t care about what is written on the internet about the lenses, he prefers to have his only experience to really know how good they are. He is very obsessive in measurements and results etc. and only will believe what his experience shows. That said, he told me that he would love to put in the Symfonys so that he can see the results for himself. He said that they won’t be available until September sometime.
4) Costs…well here is the problem. I am out of work and would rather not pay but let’s face it. You only do this once and at 69, I don’t want to make a mistake by being cheap. Here are his fees:
a) Non-Laser/Traditional IOLs – $0
b} Laser/Traditional – $1500/eye
c) Non-Laser/Toric – $1700/eye
d) Laser/Toric – $2500/eye
He does not know what the Symfonys would cost but he said to probably add $500 per eye for each of the above and hope that it’s less.
I should mention that he uses the Alcon monofocals and toric lenses. He doesn’t use the Tecnis because the program he needs to use to do the calculations is much harder to use than Alcon’s. I am not sure how I feel about that.
I trust this guy as I have been going to him for years. I know how he is, very thorough and obsessive. He doesn’t do a million procedures a year (like some others where I live). He does about 8 or so on the days he operates which is not everyday. I think it’s once a week or so.
Anyway, this is the story. On Monday I go back for the rest of the measurements and then will schedule the surgery. He does them two weeks apart.
I’ll give him my final decision then.