AN APPROACH TO CHOOSING PRESBYOPIA CORRECTING IMPLANTS IN THE CONTEXT OF RESTOR 2.5 VS SYMFONY.
With reference to Presbyopia Correcting Implants, it is an accepted fact amongst ophthalmologists that extended depth of focus lenses have actually increased interest in presbyopia-correcting lenses for surgeons as well as patients. As this topic relates, these implants provide an extended focal range rather than 2 unique focal points as in a multifocal lens. Although optically the Tecnis Symfony uses a unique system, functionally the Tecnis Symfony works likewise to a low add multifocal in offering patients distance as well as intermediate vision.
However like any type of lens that prolongs beyond a single focal point, the EDOF Symfony does have its constraints. Despite an ideal emmetropic result, a couple of patients complained about “spiderweb” glare, specifically while driving at night. These complaints become much more common when there is residual refractive error. These implants are certainly much more flexible of residual refractive error than conventional high add multi-focals, however, Doctors have actually learned to avoid doing mini-monovision with them due to these undesirable visual phenomena.
Around 60% of cataract patients choose presbyopia-correcting lenses, and here’s an approach the eye surgeons actually found to be extremely rational based on data from several research studies they have actually performed on patient satisfaction.
Initially, we’ll just talk about patients who are good prospects for a multifocal or EDOF lens. They have healthy and balanced maculas, controllable completely dry eye as well as fairly aberration-free corneas.
If a patient has astigmatism more than 0.5 D and also desires distance and intermediate vision, the Symfony toric is a an option.
For patients who prefer distance, intermediate as well as near, I do not recommend targeting a mini-mono-vision with an EDOF Symfony lens. A lot of these patients do not tolerate the spider-webs in the non-dominant, near eye. With low astigmatism, it likewise makes sense to do this with a Tecnis multifocal 2.5/3.25 also.
Now lets look at Restor active focus. It is yellow in color. It also provides ability to correct astigmatism.Again we do not recommend monovision with these. We have tried mini monovision in patients who were aleready employing that strategy with contact lenses. Those pateints did well. A better option, these patients will certainly do well with a ReSTOR ActiveFocus 2.5 in the leading as well as a +3.0 ReSTOR in the non-dominant eye. Therefore, we can achieve goal of reducing spectacle dependence for activities like Driving and Dashboard viewing, Playing or watching live sports & attending theatre or performance events. While Tecnis SYMFONY IOL lessens the effects of presbyopia and enable the patients to see clearly.
|SYMFONY Tecnis Symfony is an extended depth of field lens. It works a low add multifocal in offering patients distance as well as intermediate vision. Patient’s complaints about “spiderweb” around lights, specifically while driving at night. Tecnis Symfony is certainly much more flexible of residual refractive error than conventional high add multifocals for patients who prefer distance and also intermediate (but not near) vision and if they have low astigmatism. Appropriate for patients who prefer distance, intermediate as well as some near vision. It has high refractive accuracy but can rotate.||ReSTOR ActiveFocus 2.5 While ReStOR works on those patients who have astigmatism more than 0.5 D With ReSTOR, patients have complaints of glare and also halos. They do not face “spiderweb” glare problems. They do well with a ReSTOR ActiveFocus 2.5 in the leading as well as a +3.0 ReSTOR in the non-dominant eye. ReSTOR one may have desire more opportunity for a range of vision versus monofocal. For patients who are not willing to compromise distance vision for a full range, ReSTOR is an appropriate answer. ResTOR is having more rotational stability for both eyes, again targeting emmetropia. This is important with toric lenses|
In the present scenario, multifocal intraocular lenses (MF IOLs) are the most stable,reliable and dependable method for the surgical correction of presbyopia. While looking at the facts, residual astigmatism is one of the leading causes of dissatisfaction after the implantation of a MF IOL.
These IOLs require emmetropia for the attainment of the best visual results, and small amounts of astigmatism that may limit visual performance significantly. Thus, astigmatism has to be completely corrected in order to obtain the maximum efficiency of a MF IOL. Hence, we like to correct astigmatism by various methods. If it is astigmatism with spherical equivalent of zero, we perform limbal relaxing incisions at the time of cataract surgery or during follow-up period. When there is associated myopia or hyperopia we deploy advanced wavefront idesign laser vision correction achieve emmetropia.
Today our topic of discussion will be Symfony or Tecnis Multifocal lens for Presbyopia Treatment.
Hi. I am Doctor Khanna, here with some models of intraocular lens implants when we do cataract surgery or we want to get rid of glasses and you are not a candidate for Lasik surgery. For example, if you are 56 years old and you want to be able to see far, middle and near, then you are up for presbyopic implants. There are different types of presbyopic implants. Today, we are going to talk about the differences between ‘Tecnis’ and ‘symfony’, which are both from Johnson and Johnson.
This is how the lenses look like. This is a clear lens and this is ‘Tecnis’ and ‘symfony’. ‘Symfony’ has less rings than ‘Tecnis’ and it is considered an EDOF (extended depth of field) lens. Whereas, ‘Tecnis’ has certain ridges, which splits the incoming light into distant and near. You can see distant and near and the bimodal curve, lets you see middle. ‘Symfony’ acts like a pin hole camera where you can see middle, distance and somewhat near.
How are you going to choose between the two? If you have long hands, then choose ‘Symfony’ but if you want to real closely then choose ‘Tecnis’. If you have had previous surgery like radial keratotomy then ‘symfony’ might be a better choice. In terms of side effects, ‘Tecnis’ has glare initially which faded away and ‘Symfony’ you can see a spider web. The best option is to discuss these various choices with your surgeon and to make sure that the surgeon is comfortable with the choices.
If you have more questions about Symfony or Tecnis Multifocal lens for Presbyopia Treatment call (310) 482 1240. You can always read my book on amazon ‘The Miracle of PI in Eye’.
Have a wonderful day.
While bidding adeu you may say Good riddance to contact lenses too.
Imagine getting up in the morning and looking at the alarm clock with your naked eyes. You then grab your smart phone to check on your email and the latest from your friends on face book. While eating breakfast you skim through the newspaper. Continuing the trend, you drive with no glasses to work and then go on to play golf. After playing the best golf of your life, you get a quick swim in which is a pleasure without glasses or contact. On way home you pick up groceries without squinting. Then you cut some organic veggies for a nice dinner. Catching up on bedtime reading, you wonder why you did not get this unbelievable rejuvenating therapy before.
How is that possible? But first why not talk about why you even need glasses for reading. or I think I may have presbyopia.
Presbyopia is medical jargon for ageing eyes.
What causes presbyopia?
There is increasing stiffening of natural lens and decreasing strength of eye muscles. The zoom mechanism of the natural lens undergoes deterioration.
Old is difficult to define. This condition is present in mid forties. It may appear a little earlier in farsighted people. People with smaller pupils may display a delay in onset of presbyopia.
We have a few choices to overcome this natural malady.
Pie is the creme de le creme of methods to rejuvenate ageing eyes. Let us explore how it is superior to other methods which combat effects of taking too many revolutions around the sun.
PIE is more advantageous than Glasses
Heck yeah. You agree with this or you would not be reading this page.
It’s safe to say PIE overcomes all these nuisances.
Pie gives binoucularity which is better than Monovision
This is a process of setting the focus of one eye on close-up objects and the focus for your other eye on far-away objects. In doing this, your brain combines the two images to create a clear picture. This is a relic from the twentieth century. Primary disadvantage is one looses binocular vision.
PIE allows you to preserve binocular depth of field vision.
Brain prefers PIE to multifocal contact lenses
Multifocal contacts move with every blink. The image presented to the brain fluctuates confusing it. That is why many people are not able to adapt to multifocal contact lenses.
PIE are stable and do not move. Brain neuroadapts improving vision.
Contact can lead to sight threatening cornea infections for as long as you wear them.
PIE is not exposed to the elements or bugs.
Types of PIE
Multifocal PIE let you see far and near
These include the ReZoom, ReSTOR, Symfony and Tecnis lenses. Multifocal IOLs are lenses that have concentric rings of varying focal power, like a bullseye. Some rings provide focus for near objects, others for mid-range objects, and some for seeing objects at a distance.
The Tecnis Multifocal Foldable IOL also has concentric rings for different distances. It received FDA approval in January, 2009 for use in cataract surgery, where the natural lens is replaced. In the clinical trials most participants achieved 20/25 distance vision or better and 20/32 or better for near vision. It is designed using Wavefront data – the same precise level of information that is gathered when you are having Wavefront LASIK.
Accommodating PIE implants mimic natural lens
These lenses are designed to change focus. An accommodating IOL allows you to see distant objects, and then is can change focus and allow you to see objects that are close up. The only accommodating IOL approved in the United States is the Crystalens. This was true in 2005 and is still true in 2014. We even have toric crystalens called trulign.
Wherever you live you will want to enjoy good vision. If you want to see near and far , please contact our
office today. Los Angeles ophthalmologist Dr. Khanna and his staff can help you find the new technology PIE that is best for your lifestyle and needs. Please call today to schedule your free vision screening so that you can see far and near and your computer too.
By Rajesh Khanna MD
Hi, it’s Dr Rajesh Khanna, and if you were born before 1965, you should not miss this episode, because now we’re going to discuss about presbyopia with a flurry of questions. Oh my God, I didn’t even realize that a lot of people would be interested. But the number of questions are even more than what came for lasik. We’ll start with the first question and it is actually related to the same word “start”.
“When does presbyopia start, or when does presbyopia occur?” So presbyopia means ageing eyes in simple terms. Around 40 to 50, between that age group, our lens has hardened, the muscles… they’re called ‘Zonules’ , they’re very thin fibrous but they act like muscles that pull against the shape of the lens, they begin to weaken. So in that age group, it’s almost mathematical how the weakness occurs. Usually at age 40, you need zero diopters of reading add, but by the time you hit sixty, you need plus three reading add. In between for every four – five years, it increases by half a diopter. “When does presbyopia stabilize?” So it begins to stabilize towards the end of 50’s and early 60’s, because the maximum limit is reached, which is 3 diopters.
“Who gets presbyopia?” Everybody gets presbyopia. Whether you are a man, woman, whichever ethnicity, but not 100%, so you know that everything that is a bell-shaped curve, some people will get it in their 30’s, and some people will not get it until 70’s, but the rule of thumb, everybody gets presbyopia around 45 years of age, which affects the near end reading activities.
“Who discovered presbyopia?” I think even as early as Benjamin Franklin, or even if you go back to the 13th century, there are pictures where people have invented some sort of glasses to be able to read. So I think presbyopia had been there for a long time with us. And it might have started when men and women started living longer. Because as you know, people who follow the Paleolithic diet etc, in those times, human age was around 30-32 years, so people did not live long to experience presbyopia. But I think that around the time of our millennia, about 2000 years ago, when human life began to increase, we experienced presbyopia.
“What does it mean presbyopia?” Presbyopia means ageing eyes. “What age does presbyopia start?” We again discussed that, around 40 to 45. “What to do when you get presbyopia?” There are a couple of things you can do. You can push your hands a bit further and try to read. You can get glasses, or you can put a contact lens in one eye and not the other and make it for reading, or there are surgical procedures which we will discuss in following questions and answer.
“What is presbyopia contact lens?” So I was just hinting at that. So if you wear contact lens in one eye, that will help you read with one eye, whereas the other eye will see far. There are also multifocal contact lenses, but they don’t work very well because with each blink, the lenses move. And most of the people are not able to tolerate that fluctuation in image. “What does presbyopia mean in medical terms?” So in medical terms, it’s the failure of the lens to change its power, by changing its shape.
“What is presbyopia and myopia?” So that’s important because presbyopia occurs in everybody. Whether you are farsighted, you’re plano, or myopic. So in farsighted people, it occurs maturely in their 30’s, myopia people who are nearsighted can read fairly longer into their 40’s and sometimes 50’s until it begins to affect them too.
“Why is presbyopia not a refractory error?” This is a very good question, because the refractory errors we say are myopia, hyperopia and astigmatism because they are static. Presbyopia is a failure of the dynamic part. So just to repeat that, nearsightedness, farsightedness and astigmatism are static problems, so they occur under 40, whereas presbyopia is a dynamic problem.
“Are hyperopia and presbyopia the same?” No, hyperopia just now as we mentioned, is a static problem with the eye being small or the cornea being flat, whereas presbyopia is an ageing issue.
And now, we are going to come to some questions which will be tackled in our next episode, ‘How to kill or treat presbyopia’, so stay tuned for the next episode. Thank you and have a wonderful day.
Everyone will experience presbyopia as they grow older. If you are currently using reading glasses or bifocals, you may be interested in some of the more permanent presbyopia treatment options that are now available. Our experienced Beverly Hills ophthalmologist Rajesh Khanna, MD offers three main forms of presbyopia treatment:
There is no reason you should resign yourself to using reading glasses or bifocals for the rest of your life. Today’s presbyopia treatment options make it possible to enjoy clear vision at all distances again, freeing you to do and enjoy more on a daily basis.
To discuss presbyopia treatment in more detail, please contact The Khanna Institute today or call (888) 339-8143 to schedule a consultation with our experienced Beverly Hills eye doctor. We serve patients in Beverly Hills, Westlake Village, and surrounding areas of Los Angeles, California.
Symfony toric is a new premium intraocular lens to correct astigmatism. It is manufactured by Johnson and Johnson, the same company which also makes Band Aids.
There are about 4 million cataracts surgeries that are performed every year and more than half of Americans have undergone cataracts surgery by the time that they are 80 years old. It is not only a condition that treats older people, but it can occur in the eyes of any human being. Similar surgeries are done in people who suffer from presbyopia, astigmatism, and other problems people may experience with their vision. These surgeries are not necessarily painful, but they do cause some discomfort. However, there is a new way in which patients can look forward to crisp vision after the surgery.
The Symfony Toric contact lens has been approved by the FDA recently and shows that it can help with any of the above problems. Doctors have recommended it to their patients following their cataract surgery in order to help them enhance their recovery and vision. It is especially helpful for those who suffer from presbyopia. The lens returns the sense of freedom and independence to the patients and allows them to continue with an active lifestyle without having to wear glasses.
During a cataract or presbyopia surgery, the lens of the eye is removed and an artificial lens, or IOL, is inserted into the eye. The IOL is usually a monofocal lens which only allows patients to see objects at a distance. The result is then that objects that are closer are out of focus. The Symfony lens is developed in such a way that both the objects at a far distance and those at a closer distance can be seen perfectly. It improves the range as well as the quality of vision in patients. Those who have had the Symfony implanted in their eyes have proven to have more successful results than those who have the IOL implanted in their eyes.
The Symfony lens has been approved by over 50 different countries worldwide and is also available in the United States of America. It has been clinically tested on over 2,000 eyes and these are the results that have been returned:
Would you like tolerant more about symfony toric or presbyopic implants. You should read this informative book on Presbyopic Implants.