This is an interesting and very informative patient’s opinion (SoftwareDeveloper) of his own outcome back in 2015.

“I’d posted before asking for information about lens options before surgery,  but thought I’d start a new thread now that I’ve gotten the lens where perhaps others can add their results as well with the Symfony lens. It is a  new type of “extended depth of focus” lens that uses a different design than   multifocal and accommodating lenses.

I had Symfony lenses implanted in both eyes the first week of December.  By 1 week postop my uncorrected vision at distance was between 20/15 and 20/20. At near my vision was already about 20/25 (but fluctuating a bit it had seemed better earlier that day). Given its improvement since then I’d guess its likely 20/20 or so, I can read the small print on my eye drop bottles for instance.  Not everyone achieves this level of near vision with the lens so people shouldn’t expect to necessarily get quite as good a result, and should be prepared for the possibility for needing reading glasses at near. I suspect the fact that I’m comparatively young for cataract surgery, 52, might have  something to do with the results.

I had originally only planned on having 1 eye done (since the other was 20/20 correctible still), but when the patch came off the next day I discovered it might be hard to adapt to the difference in vision between the two eyes even with a contact lens in the other eye. I might have quickly adapted if I’d taken the time, but I decided I didn’t want to risk it,  so I had the 2nd eye operated on a few hours later.

My intermediate vision hasn’t been tested explicitly but I suspect is at least 20/20. That is  based on my subjective sense of it being better than near and because of the design of this lens where visual acuity drops off in a continuous curve from far to near, so intermediate should be around the same as far, definitely better then near. That is one of the differences between this lens and for instance a bifocal IOL where vision may be worse at intermediate than it is at near or far. I spend a large number of hours at a computer and was willing to risk needing reading glasses occasionally for near in order to get better intermediate vision. Most household tasks and social interactions occur at intermediate distance as well.

Unfortunately the lens isn’t yet available in the US yet, they are starting a clinical trial here which is randomized with a monofocal lens (there is a 50% chance you would get a monofocal) so I went to Europe for my surgery.  I figured that at my age I hopefully may be using these lenses for a few decades so it was worth a bit of effort to get a better lens. This industry publication suggests it might be  generally available in the US in a couple of years, and that some US surgeons find it interesting:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/us-surgeons-anticipate-new-iols?page=0,1
“the Symfony IOL might be available in the US by late 2016 or early 2017…
Of the IOLs discussed at the ESCRS Congress, Dr. Olson and Dr. Packer concurred that the brand new Tecnis Symfony Extended Range of Vision IOL was the most interesting as it represents a new concept for addressing presbyopia that seems to overcome the limitations of multifocal IOLs….

from what I’ve heard so far from respected and trusted surgeons, patients implanted with this IOL are seeing 20/20 at distance and intermediate with very usable, J2 or J3 near vision and are not experiencing any loss of contrast or perceptible problems with glare, halos or other dysphotopsias. So, it looks like they are having their cake and eating it too.”

I had considered the option of getting a trifocal lens which targets far, intermediate, and near (also unfortunately not yet available in the US), or even a bifocal with a small add so its focused more at intermediate than near.  However the studies so far seem to indicate that the Symfony provides better quality intermediate vision. In addition multifocal lenses reduce contrast sensitivity which is useful for night vision, while reports indicate the Symfony is at least as good as a monofocal lens. The other thing the Symfony does is to correct for “chromatic aberration”, an issue which is discussed in this industry publication which quotes one prominent surgeon noting:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
” Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. ”

Although the Symfony uses a high Abbe material (I’m assuming its the same Tecnis material that article lists as having a 55 Abbe), it also has other features to to correct for CA to improve image quality. It seemed like a good bet the image quality for distance would be comparable, and perhaps even better, than a monofocal lens, or an accommodating lens.

Although some results for the Crystalens look like it will similarly do well for intermediate while providing some chance at decent near vision, some showed a lower chance of good near, e.g. some of the studies listed for the March 2014 update in this government review:

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/OphthalmicDevicesPanel/UCM346413.pdf

Part of the concern I had with the Crystalens was that in some patients the lens does well, but in some it doesn’t accommodate, which leaves it effectively being  a monofocal lens ( but without things like the correction for chromatic abberation). There is also concern I’d read among some  over whether over decades of aging anything would interfere with the physical movement of the lens, something non-accommodating lenses don’t require. There is no perfect lens, so its partly a matter of placing a bet on which might work out well, and I figured that it was better to bet on something that didn’t require the accommodation to work (in addition to other concerns regarding problems people have with the Crystalens, though those may be fewer in the newest versions). I hadn’t searched to find  the study behind the figure in this presentation, but it notes:

that about half of Crystalens patients require reading correction. That may be in part because as it notes: ‘ “Pushing” does not equal “Sustaining” ‘. This issue is that someone with their natural lens still who is presbyopic for instance may be able to theoretically read a particular print size without glasses, but that the muscle effort to focus may be a strain to do  for an extended period of time, and the Crystalens at least partly seems to require the same sort of accommodative effort.  (though  there is speculation it may be benefit from some extended depth of focus, which is what the Symfony is designed to use to begin with). I’ll continue this in another post in a few minutes.

Jan 04, 2015
Taken from http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258
Another Patient: Jim_in_Italy
First, i want to thank “software developer” for his interest in continuing a dialogue with all users of medhelp.  He was of tremedous help when I began researching IOL options earlier this year. I owe him a huge debt of gratitude

(He is a non-medical expert, IMHO, and well worth listening to.)

I live in Europe, Italy. I was highly myopic (-11D) and with astigmatism of approx 2.75D.  Advanced but not incapacitating cataracts in both eyes. I was “useless” without glasses, perhaps legally blind. I could see if something was a few inches from my face but nothing beyond that

Late in 2014, I had decided on the AT LISA, a tri focal lens, and then I started reading about the AMO Tecnis Symfony Toric.  The more I read, the more I beccame convinced that this was the state of the art.  I emailed with surgeons in Europe and the US and had good responses from all but those in Italy. (The only one who replied in Italy said I was too informed and knew in advance what I wanted; I wasn’t the type of patient he wanted to deal with !!!)

I would say that at least 3 doctors in the US said a/ that they could not wait for the Symfony to be approved in the US and b/ the Symfony was the IOL they would have implanted in their own eyes. That was a great sign I was on the right track

I finally decided on a doctor in Austria, and had the first eye done in late June and the second a week later. I am extremely satisfied, not 100% as I will describe later.  Maybe 8.5 or 9 out of 10

I had the toric Symfony implanted with micromonovision of -.75  in my left, non dominant eye, to improve near reading without glasses. From having worn contact lenses with monovision, I knew I could adapt, which is not the case for everyone.

Exactly what I was told I would experience, I am experiencing, so no surprises:
yes, I have halos and starbursts around certain lights. They are not a problem.  My eyesight for night driving is good to excellent

Without reading glasses, I can read a newspaper easily at 20 inches with both eyes (the right eye is a little blurred) and close up at 10 inches with the left eye only. With 1D reading glasses, which I use when I will be reading a lot, i have no blurred vision

As for distance, the change from before and after is mind-boggling.  The right dominant eye sees extremely clearly (better than 20/20) and the left eye is a little blurred due to the micro monovision I opted for. But with both eyes, I am very happy with distance vision

During dim light situations, beware that near vision accuity decreases, so reading a menu in a darkish restaurant will probably be a problem.  Reading glasses eliminate this problem, but I didnt wish to always carry reading glasses

All the above is well known about the Symfony, most importantly that its near vision is not as good as the AT LISA but in all other aspects, I believe it is better.

If I am not 10 our of 10 satisfied, it is because I stlll see a slight “second image” with teh left eye. I think this is because there is some residual astigmatism, and because of the micro monovision.  And of course, I would like to have better near vision to perhaps 5 inches rather than 10, but I knew this was going to be the case

One thing that i don’t read as much about is this: In a face-to-face conversation, again more in dim light than in bright light,  I find myself “pulling back” to a comfortable distance of 20-25 inches

what would I do differently? perhaps I would have chosen a doctor who used femtoscond laser.  But the rapport with the doctor is critical I feel. and eye surgeons, like most surgeons, have their “peculiarities”.

I would say that the Symfony is definitely worth the price difference and greatly superior to a monofocal in my humble, non expert, opinion. My two sisters have monofocal IOLs, and while it is not possible to compare how they might have fared with the Symfony , or I with a monofocal, I am much happier with teh result than they are

I will “watch” this discussion to answer questions, and I am happy to email to anyone who wants to start an off-line conversation

Another Patient: Marliesje16
Thank you for your information about the Symfony lens. I am now almost two weeks after the surgery in my right eye (Symfony Lens).
The world is much brighter after surgery, I also see the colors as they are. (My left eye will be operated within a few days, also a Symfony Lens).
The results are a good distant vision and intermediate. I can read a computer screen quite well, near needs to improve. Near vision is at armlenght.. I should be prepared for the possibility for needing reading glasses at near.
Flickering sometimes when the sun shines bright. I see some halos around light sources at night but not disturbing. I have quite bad flaring from car headlights and lamppostst at night which is disturbing.
I can read my smartphone at armlenght, unfortunately not near.. I am satisfied with my decision to choose the Symphony lens on advice of my surgeon.
My question is if near vision will improve within a couple of weeks/months and will the flaring at night also be mild.
An answer to a common Question:
Avatar universal
hi,greetings of the day..
I”m 43 year old indian male professional. recently i got right eye catract surgery with mono focal lense, now i am facing reading problem so have to wear 1.5 reading glasses.
now i want to adopt multifocal or symphony to avoid near vision problem while left eye surgery.
which one is better ?? and feasibility ?? cost wise its costing me 67000/- INR  ..if we compare to mono focal its double price ( dat cost me 35000 INR)
please give your valuable suggestions.
rgds.
cp gulati
gulati.***@****

Mar 07
Upvote0
Avatar universal
Avatar universal
In terms of “which one is better”, that depends on your visual needs and how much you are willing to risk issues like halos and reduced contrast sensitivity (reduced vision in low light). The Symfony reportedly has a risk of halos comparable to a good monofocal, and contrast sensitivity comparable to a good monofocal. The newest multifocals have lower risk of halos than older ones, but still higher than a monofocal. Since multifocals split the light coming in to different focal points, some % to near and some % to far (and some % to intermediate for a trifocal) that can reduce vision in lower light (though its not a problem for most people).

I used to wear multifocal contact lenses before I had cataracts, and although I liked them and had no complaints at the time, I can definitely tell that I have better vision in low light (like a dimly lit restaurant) with the Symfony than the multifocal contacts. (though multifocal IOLs are probably better optically than the contacts so they likely do better).

The results reported for lenses are of course averages among patients, each person will be different. On average the Symfony seems to have better intermediate vision than multifocals. The trifocals and high add bifocals have a bit better really near vision. In my case I decided that intermediate distance was more important than near, since thats computer distance (at least for my desktop computer), social distance, many household tasks, finding footing when hiking/running on a trail to see the rocks and ice, shopping, etc. I figured that way for most tasks I wouldn’t need glasses, especially when outside of home&office. If   I needed reading glasses I’d prefer them for really near since that would likely just be when at home or office.

I figured worst case I have a magnifier app on my smartphone if I needed to see something small when out, or they make foldable reading glasses that will fit in your pocket for occasional use (though I’ve never needed the app or glasses when out of the house so far).

I’ve only seen one article on the new Alcon Panoptix trifocal, which might be a slight improvement over the other trifocals, but at least from that data it looks like it doesn’t match the intermediate vision of the Symfony, but I hadn’t seen a direct comparison. It has still has the other problems multifocals have.

I’m not sure what your question “feasibility??” means. If you just mean can you mix a monofocal in one eye with a multifocal or Symfony in another, then the answer is that I’ve seen reports of mixing multifocals and monofocals with good results and the same should be true of the Symfony. It is also possible to exchange the monofocal you already have for another lens if you decide its useful, or if there is some rare problem adapting to 2 different kinds of IOLs.

Mar 07

Dimitri Kazakos is passionate about eye surgery. He is a top cataract, lens and laser eye surgeon, with a proven track record of excellent results. Through a very comprehensive range of refractive procedures and with the use of latest modern technology, Dimitri is able to offer to his patients the most suitable treatment for their eyes.