This first week of my blog I am summarizing some of the exciting new technologies presented at the joint meeting of the American Society of Cataract and Refractive Surgery (ASCRS) / University of California, Los Angeles (UCLA) Jules Stein Institute in Century City.
Yesterday I discussed the most exciting new IOL technology on the horizon for monofocal (single-distance) IOLs. Today, I’m going to talk about what I think is the most exciting technology in the “presbyopia-correcting” IOLs.
Synchrony IOL
First, a word about presbyopia. When we are young, our eyes are able to focus over a wide range from distance to near. As we age we lose this ability to change focus. Eventually, we need to help our eyes with the near portion of this range with reading glasses, or “cheaters.”
Currently, the only options available to return that range of vision involve removing the natural lens (or cataract) and replacing it with a multifocal IOL (more on these in a future post) or accommodating IOL. The problem with current multifocal IOLs is that they result in little rings around lights at night. The problem with the currently available accommodating IOL (the Crystalens®) is that is doesn’t work for everyone. So, what’s on the horizon…
This lens was presented by David Chang, M.D. (UCSF) who is one of the most impressive cataract surgeons alive today. It uses a unique two-lens approach to providing a range of vision (distance and near) after cataract surgery. Once inserted into the eye these two lenses would move relative to each other resulting in a variable range of vision.
Unlike most presently available presbyopia-correcting IOLs this lens does not result in halos or glare after surgery. The initial results are very impressive and I am looking forward to offering this IOL to my patients as soon as it becomes available in the US.
As it is such an unusual type of IOL (two lenses instead of one) many surgeons will not be comfortable implanting this IOL when it first becomes available. Nevertheless, this may be worth searching out as the initial results are quite impressive. I’ll keep this blog posted when new results are available as I’m very bullish on this IOL.
© 2009 David Richardson, MD
I hope you will keep updating on this IOL, as it indeed sounds very interesting. But how much can we hope for? It looks like it will be the best IOL by far, when it becomes available, but it seems it isn’t being discussed much, at least in public. And it looks like it doesn’t provide much accomodation (diopters) as the normal eye, so how will that affect vision, will you still need spectacles at near sometimes, and how about medium and distance view ? What will determine the end result, as it seems it could provide between 1-4 diopters,… Read more »
You can be certain I will have updates on this IOL by April as I will be attending the American Society of Cataract and Refractive Surgery annual meeting in San Francisco. I also agree that it has the potential to leapfrog into the #1 presbyopia correcting IOL once it is released (as did the Crystalens 5-0 when it was approved). However, it will likely share the same challenge that the Crystalens presents to surgeons: figuring out the effective lens position. This could be a topic for an entire post (and I may just do that). In short, it is difficult… Read more »
Thanks. I’m really looking forward to this.
So this means, that surgeon don’t know exactly the position the IOL will end up with, and that is the main factor how the result will be ?
The leaked results for Synchrony indicates results from 20/20 – 20/40 for most people. I don’t know how bad 20/40 is, but it doesn’t seem so bad, compared to that other semi-accomodating lens you mentioned in another post. I looked at that lens a month ago, and the results seemed quite bad, from 20/20 to 20/200.
Yes, these initial results are impressive. To give you an idea, someone with 20/40 uncorrected distance vision would be able to obtain a driver’s license in California without spectacles. The issue with effective lens position (at least for the Synchrony) is that it is a dual optic system with the lenses moving relative to each other. As such, it is difficult to calculate where the lens actually sits in the eye (from the perspective of a ray of light). If the effective lens position (ELP) is more toward the front of the eye (anterior) than anticipated the eye will be… Read more »
I wasn’t able to see real well the next day either but the flwooling day was really a lot better and I drove to work. You will probably notice a big difference tomorrow. I also go the anti-anxiety in my IV. When the anesthesiologist came in she could see how nervous I was and asked if I wanted her to give me a little something to calm me down. They gave me more after I got back into the room. Didn’t put me out but it did relax me.
Hi. Do you have any updates on the Synchrony or other new IOL’s that has made progress in the last year ?
Unfortunately, the initial excitement of the Synchrony has met with less than stellar initial clinical results. That being said, the game is not over yet. If the refractive outcome is more reliable than the Crystalens and it provides even an extra line of near vision then it will have a place in my practice, at least. At the moment, the only “advanced” IOLs that I am recommending for my patients are the Alcon Toric, Alcon ReSTOR +3, and the Crystalens AO. This could change, however, based on updates to the latest clinical research.
You say that Synchrony has underwhelming performance but the only generally available (on the web) studies indicate that they or relatively free of glare, have superior contrast, low capsule opacification rates, generally consistent accomodation over several years and accomodation that averages about 3 diopters and does not seem vary much from individual to individual. Reading rates are about the same as the Technis which considered superior in this category. Are your observations based on results developed in the fda clinical trials that have not yet been published or are they available somewhere to be read? Do they suggest that the… Read more »
All good points. There is no question that compared to the only other available pseudo-accommodating IOL on the US market (the Crystalens), that the Synchrony has promise. That being said, the goal is moving. You compare the Synchrony results to the AMO Tecnis multifocal IOL which is a fine piece of engineering. Nevertheless, from the Surgeon’s perspective, the Syncrony is going to have to prove itself to be a significantly better performer than either the Tecnis multifocal IOL or the Alcon ReSTOR +3 aspheric IOL. Both of these are significant improvements over earlier multifocal IOLs such as the ReZoom or… Read more »
First, Dr. Richardson, thank you for taking the time to reply to my lengthy question. Is the necessary centering of the multifocal type lens more critical than in dual 0ptic or single optic psuedo-accomodating lens. Thus, does relocation of the lens within the capsule become a less likely and/or less important event for the different types of lens. Has the frequency of Yag laser capsulectomies lessened with the latest generation of ReStor or ReZoom or CrystaLens and how do these rates compare to the Synchrony results so far? I believe the early CrystaLens models had trouble with this and I… Read more »
Michael, You are correct that centering is critical when implanting the multifocal IOLs. Additionally, aspheric IOLs (both mono-focal and multifocal) quickly lose their advantage as the IOL decenters. Fortunately, the modern single-piece acrylic IOLs center very well with minimal manipulation. The surface of either the AMO Tecnis multifocal or Alcon ReSTOR is a bit “tacky” resulting in good stability after surgery. With proper intraoperative cortical clean-up combined with the acrylic IOL edges designed to minimize posterior capsular opacification, an aggressive capsule contraction can usually be avoided. Although one could argue that centration may be less critical with the pseudo-accommodating IOLs,… Read more »
Could the 3 dimensional nature of the dual optic design help prevent collapse of the lens capsule? At least one study has found it to have stable accommodation over the course of a 5 year study implying that the mechanism of accommodation continued to have space within the capsule to adjust the lens positions along the z-axis. Does it depend on a certain amount of capsule contraction in the x,y plane to stabilize the lens structure within the capsule or does it experience drift within the capsule? Would a capsule filling design, dual optic or gel, justify its “bulk” in… Read more »
Your logic is sound. Indeed, it is widely believed among ophthalmologists that the “ideal” IOL will be a “smart” gel-like substance which can be injected through a 1mm or smaller incision and fill the capsular bag just as the natural lens does in a young, healthy eye. To date the technical limitations have been the need to create a 5-6mm capsulorrhexis and the lack of a “smart” material. However, the Femtosecond laser may be the technology that allows the creation of a sub-1mm opening in the capsule and there are already companies researching acrylic designs that are rod shaped at… Read more »
Hi I have followed the conversation about IOL’s with interest and it seems the perfect solution is still a way off. My question is simple. I am 56 years old and long sighted to a degree that makes laser surgery impossible and means I must wear contact lenses + reading glasses or varifocal glasses at all times. That said, I do both with a reasonable degree of success aside from the usual inconveniences of having multiple pairs of spectacles and some aversion to bright light when wearing contacts. Would you recommend surgery to fit IOL’s at this time or would… Read more »
I would say that based on the currently available technology you have answered your own question with the statement: “That said, I do both with a reasonable degree of success aside from the usual inconveniences of having multiple pairs of spectacles…” Although I have been impressed with the currently available multifocal IOLs, it is difficult for me to recommend them to anyone without cataracts at this time simply because they do result in small circles around lights at night. Now, for someone who is used to the glare associated with cataracts, this residual halo is often an acceptable price to… Read more »
Hi Dr Richardson,
Do you have any idea when the Synchrony IOL might get approved by the FDA? Is it correct that that this lens requires a very precise Capsulorhexis which might be more easily done with the new femtosecond lasers?
Unfortunately, we will probably not see this IOL being used in the USA until 2012 (though we can hope for late 2011). Also unfortunate is that you are correct about the capsulorrhexis. Like the Crystalens, the Synchrony appears to be sensitive to the size and shape of the capsulorrhexis. As the femtosecond laser is VERY expensive (and used by only a handful of surgeons), most people choosing either of these IOLs should opt to have their surgery performed by experienced surgeons (who have better control over the size and shape of the capsulorrhexis).
On May 22, 2010 you stated that Synchrony has met with less than stellar initial clinical results. What exactly are they encountering?
On July 6, 2010, you stated that the Synchrony is a bulky lens that requires a larger incision than the Tecnis multifocal which requires less than 2.8 mm.
Synchrony comes in a pre-loaded injector designed to be implanted through a 3.8 mm incision. Visiogen, Inc. is actively working on an injector system that will allow the lens to be delivered through a significantly smaller incision.
Do you have any information on what Visiogen, Inc. might achieve?
Is capsular contraction and/or lens decentration more common in young patients with PSC cataracts?
In general younger patients tend to have a more aggressive healing response. Also important is how well ones surgeon “cleans up” the capsular bag. As the bag is so delicate, not all surgeons polish it as I do with each case. However, I have noted a significant decrease in capsular contraction since I have been routinely polishing the capsule.
Is this not the age of biotechnology??? Are new “living” human lenses being grown in test tubes or petri plates or something to be implanted within the cleaned capsules rather than “none living” IOLs?? Afterall, new organs such as bladders are grown up and transplanted in humans, just where are the human lenses???? Human lenses should be easy compared to human bladders. Why are you MDs holding up progress with these weirdo IOLs when mother nature made the original lenses that we all know and love??? We just want to replace mother nature’s foggy and stiff lenses with flexible and… Read more »
You’re funny. Clearly, you have no real understanding of what is going on with lens replacement research. Fist of all, it is not doctors who are holding up progress in researching human tissue IOLs, as most of the research is being done by MDs. The hold up is that the most promising tissue for replacement is human embryonic tissue which has severe restrictions on its use in research (at least in the USA). Regarding the current IOL materials, they are nothing short of amazing when one considers the progress that has been made in the last 50 years. Take a… Read more »
Almost a year ago, you suggested to Ms. Blackburn that she may want to wait until the next generation of IOLs arrive in 2011 or 2012 before replacing her lenses…. my eyes/age are also similar to hers… 55 years old, farsighted, no cataracts (but one eye much worse than the other… we are considering just doing this eye). Any progress worth noting in the next generation? My eye doc is suggesting the ReSTORE….but I’m willing to wait a bit to guard against halo risks. Glasses are working fine, I just don’t like the thick lens and awful sight in one… Read more »
Unfortunately, the AMO Synchrony is probably not going to be approved for use in the USA until 2012 at the earliest. The only new pseudo-accommodating IOL likely to be approved in the US anytime soon is the Tetraflex IOL which, in my opinion, warrants little more than a “yawn.” Of interest is that many surgeons are having success using IOLs such as the Staar Nanoflex with “mini-monovision” or “blended vision” to achieve an impressive level of spectacle independence without the halos noted with multifocal IOLs.
I had a cataract evaluation recently where the surgeon recommended an aspheric tecnis IOL. This is a non-accomodating lens. I asked about the crystalens, and he said in his experience they don’t work that well. My question is, on a non-accommodating lens, how much near focus is lost? I know distance vision is usually good, but what about near vision? Is it blurry at arms length? Less? More? And what is your opinion of this IOL? Thanks.
The simple answer is that one should not expect any significant near vision from a non-accommodating IOL. That being said some people do achieve a level of intermediate vision (though this should not be expected). How much achieved is quite variable and unpredictable. Some non-accommodating IOLs, however, do seem to provide a better range of vision than others. Both the Staar Nanoflex and LensTec SofTec HD provide a larger range of uncorrected vision in my experience. To achieve that range, however, any pre-existing corneal astigmatism must be corrected either at the time of surgery or at a later date. Bottom… Read more »
What is holding up the FDA approval of the Synchrony IOL? Is it the manufacturer not pushing it for marketing reasons or because there are issues with the product. Or is it just the FDA being slow. The Synchrony IOL has gained European CE mark of approval years ago and is being implanted there. Should I consider a trip to Europe to get it implanted? If so, can you recommend a competent surgeon in Europe that I should consider?
There is little marketing or financial benefit to be had by delaying the approval of any medical device. In the case of the Synchrony the company (AMO) has purchased the technology and is unable to see any financial benefit in the US until the FDA approves it. In general, the FDA is to blame for delays in US patients benefiting from new technology. In the FDA’s defense, however, there simply is not enough funding for them to move very fast. They are responsible for the safety of the American public with regard to medical devices and medications and have, to… Read more »
Greetings again Dr. David, it has been a while. I have abandoned contacts and now get by with glasses corrected for distance and various over the counter reading glasses to kind of handle near vision. The examining optometrist I visited last week tells me that my cataracts show signs that they will worsen rapidly in the near future and he can do little to improve my glasses (I believe he said the cataracts showed signs of sugar crystals and water blisters, if that makes any sense). He recommends that I go ahead with mono-fit Technis lens corrected slightly toward the… Read more »
Hopefully the FDA will approve the Synchrony in 2012 (that’s at least the expectation). As I’ve mentioned on other posts the Staar Nanoflex and Softec HD can provide some range of vision for those who cannot wait and are either not interested or are poor candidates for the Crystalens or multifocal IOLs.
These posts are great!! I am 53 and have a mature cataract in my right eye that formed over the last 14 months. My left eye is just begining to get a cataract. I have been near sighted all my life with astigmatism. The doctor said my right eye has 0.8 and my left has 1.1 – 1.2 astigmatism. I have been studing up on my options and think that the Staar Nanoflex and possibly blended vision is what I would like to try if possible. I discounted the multifocals because of the night halos and glare. I considered the… Read more »
Chris, Glad you like the posts. With regard to your questions: 1) The Nanoflex IOL is made from a pretty soft material so (in that sense) it would be easier to remove from the eye than a harder acrylic material (such as that used in the AMO Sensar). However, I would not recommend choosing an IOL with the idea that it can be easily replaced at a later date when technology improves. Lens exchange surgery is significantly more challenging than is cataract surgery. In general, I recommend choosing an IOL with the anticipation that it will be “for life.” That… Read more »
Thank you for the quick reply! I just saw a second eye surgeon (I decided to get 2 opinions before surgery rather then after) and he indicated that I could esentially have any IOL I wanted since my eyes are healthy, normal and the corneal astigmatism is fairly low. This practice does use the Nanoflex and I asked him about them. He said that the Crystalens has better optics and since I am willing to pay for a premium lens, I should go for the best since I will be using them for the next 30 years or more. I… Read more »
You’re welcome Chris, Getting a second opinion is often a good idea prior to making a decision about surgery. You are fortunate to have healthy eyes that allow for many options. The downside, of course, is that with many options comes much confusion. I will try to address your questions below: First, you need to separate the idea of the lens technology and the “refractive package” being provided by the surgeon. The two are really separate (though interdependent). Think about it as you would modifying your car: there is both the cost of the part as well as the payment… Read more »
After having thought it through, I have decided to either have a regular monofocal or a Nanoflex lens installed. I could not find a surgeon in my area with experience with the Softec HD lens. Once my right eye is operated on, I will get several powers of contacts for my left eye to see if or how much of monovision I would like or can stand. I wish I could wait 10 years for the next generation of IOL technology. I am uncomfortable with the state of premium lenses at this time. Not enough history behind them, they have… Read more »
All good questions Chris, I’ve reposted your questions with my answers immediately following: Question: I have read the the Crystalens can “slip” out of position. In your experience, has the Nanoflex shifted position and cause problems since it has the same general shape as the Crystalens? Answer: All lenses can “slip” out of position with time. How much they slip and how bothersome this can be depends on the surgical IOL material, surgical technique, and refractive type of IOL. – IOL Material can result in more aggressive scarring of the capsule which can then result in movement or distortion of… Read more »
I have had a non-correctable with prescription glasses cataract in my left eye for the last 2 years. Since I have been very fortunate (and spoiled by) not wearing glasses for more than 64 years, I have been interested in the accommodating IOL as my eventual solution. The Synchrony looked the most promising, but I have not been able to get a “read” on when it will be approved by the FDA. I’d also be interested in your thoughts on the viability of Synchrony technology and what other advances are on the near horizon. Enjoy your posts and responses to… Read more »
Thank you David, I’m glad to hear that you feel my posts and responses are objective and clearly written for those who do not have a medical background – those are my goals and it is not always easy to “translate” the medical jargon. You have, indeed, been fortunate if you have not had to wear glasses for over 64 years! It would be great if that continued to be the case for the rest of your life. It may be possible with the currently available IOL options (given the caveats I’ve mentioned in other posts and comments). With regard… Read more »
re: “With regard to the AMO Synchrony, however, you are in good company in your inability to get a “read” on the FDA approval horizon.” The company told me the FDA wants more data so they are just now starting to plan a new clinical trial which likely won’t even start for a few months so the lens won’t be approved anytime soon. Unfortunately with a rapidly developing cataract I won’t be able to wait for the FDA to approve anything new. The current trial plan is for the Synchrony to be randomized with a monofocal so those who join… Read more »
Comment Dr. Richardson, I learned a year ago from my optometrist that I could no longer be corrected better than 20/25 with glasses (-6.50 -.50 x 180 and a -7.00 Sph. w/ 2.50 Add) due to cataracts but after going to an ophthalmologist I was told the cataracts weren’t bad enough for insurance to pay for surgery; he did however recommend a multifocal IOL for 6 to 12 months later when they worsened. My vision is now worse and I’m doing some research. I’ve found your site to be the most informative; however I am a bit confused with all… Read more »
Dennis, Although I cannot give a specific recommendation as this requires having far more knowledge about your eyes than I have available (or even could have available without an exam), I can state that most people who have done well with monovision also tend to do well with “blended vision” using the Staar Nanoflex or LensTec SofTec HD IOLs. Blended Vision tends to be more forgiving than true monovision in terms of one’s ability to tolerate the difference between eyes. However, the near focus point of Blended Vision is not as close as that of traditional monovision so “readers” may… Read more »
Thank you doctor for your prompt reply; I certainly understand your point regarding the necessity of a thorough exam in order to give a professional opinion. I believe the “blended term” you mention signifies something much like monovision with contact lenses. Are the Nanoflex and SofTec HD monofocal or multifocal lenses? If they are multifocal, do they have the side affect of some glare and halos around lights? Also I believe I’ve read the SofTec HD utilizes a somewhat controversial blue light blocking material. Can you shed any light on that issue? My dilemma centers around finding the best compromise… Read more »
I’m afraid you’ve got more questions than I can adequately answer in a single comment post. Let me work on creating a separate post to address each of these as I believe others share your concerns.
I am a 65 year old male with bilateral -8 myopia and mild -1 astigmatism in my right eye. I have recently developed cataracts that manifest in double vision or ghosting in both eyes. The first opthamologists that I consulted recommended the Acysof aspheric for left and Acrysof aspheric Toric for the right eye. I was initially hoping for an accommodating lenses like Crystalens, but he said he had stopped using them because “they don’t work”. In doing research on the internet I had become impressed with the nanoflex lens. It offers some accommodation without significant added cost. He had… Read more »
Dear Michael, Although I cannot state with certainty that the Staar Nanoflex would be an appropriate IOL for you, most patients who choose this IOL do very well with at least some pseudoaccommodation. In my hands it provides almost as much range of vision as the Crystalens IOL with a more predictable refractive outcome (and no chance of a “Z-syndrome”). That being said, not everyone is a candidate for the Staar Nanoflex as it is a “plate haptic” IOL. Unlike “3-piece” IOLs, a plate-haptic IOL requires a perfectly intact capsular bag. Additionally, in high-myopes the appropriate IOL power may not… Read more »
What are your thoughts on the toric NanoFlex? I understand it’s been available in Europe for some time now. Alternatively, what are your thoughts on combining the Visian ICL with an IOL to correct astigmatism?
As the Colamer Toric has not been FDA approved in the USA I have no personal experience with it. Most likely it will not be available in the USA until 2014. It is approved in Europe but not yet widely available.
With regard to the Visian ICL it would be unusual to combine that with an IOL. Most surgeons would either do a clear lens exchange with an Alcon Toric or place a Staar ICL and address residual astigmatism with corneal refractive surgery (LRIs, PRK, or LASIK).
Hello dr. David, There is incredible amount of information about nanoFlex lenses here more than any other site and I truly thank you for time and knowledge. I am in my mid fifties, hyperopic, and have “managed” dry eyes. I don not have cataract but my vision is really poor . I am considering NanoFlex monofocal lenses using blended vision. They sound wonderful and wondering why ther are not more acknowledged between surgeons. I read at medhelp a doctor saying that nanoflex have higher incidence of PCO and are prone to pitting when laser is needed in yag. Is that… Read more »
Thank you Mira, I can’t say for certain why the Nanoflex is not embraced by more surgeons, but I have a few thoughts on the subject: 1) It’s a plate haptic IOL. When plate haptic IOLs first came on the scene they were made of silicon which is a slippery, springy material. They could not be easily folded with forceps so required injectors to get them through a small incision. As these IOLs left the injector they did so with significant speed and force. I’ve even seen a video of one that jumped out of the injector through the capsular… Read more »
Hi Dr. Richardson, Hope this comment reaches you as I am not sure I am doing this right. I have a Nanoflex implant, right eye. After 2 wks., PCO set in, now need Yag. Vision has dinished from 20/20 in the beginning, now 20/25. Ques: Do you think 20/20 will return after Yag? I have a Restor lens in the left eye which is off by 1/2 dioters, it fluctuates between 20/30 & 20/40, also needed a Yag after 2 wks. which I didn’t do. I would need Yag and maybe PRK to get better distance, but I will most… Read more »
Norma, You have some very good questions many of which, unfortunately, cannot be answered without actually examining your eyes and taking multiple in-office measurements. The best I can do online is to provide the most detailed general information about the technology that is available. Specific questions about how your eyes might do are beyond what anyone can answer online. Indeed, even with an exam and measurements the real answers to questions such as “How will my intermediate be with Nanoflex?” can only be answered by going ahead with YAG capsulotomy. That being said, if your initial vision was 20/20 prior… Read more »
Hi Dr. David, I believe I read where your practice is in California, I wish you were closer. I’m in Virigina. I read your response to Mira re: PCO, stating that you polish anterior/posterior capsule as well as remove the lens epithelial cells (LECs) during surgery. I don’t know if my doctor did this, but I wish he had. He told me to come back for Yag 3 months after surgery, but it’s been longer. I know, I’m a big baby? My right eye, Nanoflex, is the eye that not only has posterior vitreous separation as does the left, but… Read more »
Norma,
The risk of retinal detachment after YAG capsulotomy is small, but not zero. I encourage my patients to consider the risks but keep them in perspective. For a small visual annoyance, any risk might be too great to consider. Then again, 1,000s of people choose to have LASIK each year (a procedure that has substantial risks) in order to cut out the annoyance of wearing glasses. Risk tolerance ranges greatly from person to person.
Once again, Dr. David, thanks for your speedy reply. Years ago, I was going to have lasik surgery, I was told I was a good candidate even though I had the beginnings of cataracts. ESP kicked in and I went for another opinion. Doctor said don’t do, and so I didn’t. I feel I must do the Yag in Nanoflex eye because I have noticed deterioation in vision. Not only now 20/25, but over-the-counter mangifiers for reading are not working as well anymore, so it must be done. Distance vision is not clear at this point either. Question: My surgeon… Read more »
Norma,
Your surgeon must be very busy indeed if he does not even bother performing YAG laser procedures himself. In general, the YAG capsulotomy procedure is a “low risk” surgery (but as with all procedures there is still some risk). It is also not a technically difficult procedure though some doctors are clearly much better than others at minimizing the creation of pits in the IOL. Fortunately for you and others who have the Staar Nanoflex IOL, all but the largest YAG pits tend to resolve with time (something that is not seen with other IOL materials).
Hi Dr. David, Yes, I guess he is very busy, so busy that it has been 3 weeks and I cannot even get him to respond to my last email, actually he has never responded to any quesitons, except when recently forced to by his secretary. I find this frustrating. I feel as though I am not entitled to getting questions answered. I also feel that I am entitled to know, or least discuss possible solutions with what he may be thinking of doing. I know that I already told you that I really want his expertise, but in all… Read more »
Norma,
I can understand your frustration. Unfortunately, the only way to get the answers to the questions you are asking is one-on-one with a surgeon who implants the Staar Nanoflex IOL. If your surgeon is unwilling or unable to do so then it may be time to seek out a second opinion.
Hi Dr. David, Finally got a reply from my doctor, but only because I emailed his secretary and told her I needed him to answer my question. Why do I feel like the culprit here? He said I could try the contact to see how I would do with monovision, but it may not be to good a scenario because of the Restor lens implant. Also, I think he forgot that this is also my dominant eye, which is usually always set for distance. I emailed him again. This sure is getting crazy. I know of several other doctors who… Read more »
No surgeon I know of likes to explant an IOL (it’s significantly more challenging than cataract surgery).
Hi Dr. David, I finally made an appointment to get the Yag done on the Nanoflex eye. I am uneasy thinking about it because I know once it is done, I will have to deal with correction for my presbyopia. I think what little near vision I have with the Restor lens has somewhat spoiled me. If only I had faith that a Yag/PRK was the right way to go, I would have probably had the right eye also done by now with a Restor lens and this procrasting that I put myself through would not exist. I just found… Read more »
Norma,
Predicting final uncorrected near vision with either ReSTOR or Staar Nanoflex is a bit art and a bit science. An exam is necessary and a contact lens trial can be beneficial in making the assessment. Ultimately, however, no doctor can be certain of the outcome prior to surgery. This is one of the reasons I tend to err on the conservative side with my treatment recommendations.
Hi Dr. David, Hope all is well with you. RE: Your April 13th answer regrding exam & contact less trial. You said no doctor can be certain of the outcome prior to surgery. Also, this is why you tend to err on the conservative side with your treatment recommendations. You lost me there, would love a little more input. I know that I told you I have bilateral PVS and horseshoe tear right eye retina. Is it possible that I was never a good candidate for the Restor lens in the first place? Left eye (Restor) sometimes has a foreign… Read more »
Norma, All I meant by “no doctor can be certain of the outcome prior to surgery” is that we can’t tell the future and nothing is guaranteed. By “conservative” I am simply stating my general preference for choosing treatments that are more likely to be forgiving (thus my preference for the Staar Nanoflex over the B&L Crystalens). As for prior retinal tears, they seldom play a role in my choice of an IOL. One exception would be if the tear was really a macula-involving retinal detachment in which case I would not recommend a multifocal IOL. Although I cannot comment… Read more »
Hi Dr. David, Thank you for your, as usual, excellent feedback. Saw a dr. here re: dry eyes, he wanted to plug Restor eye, said that multifocal lenses are not as forgiving with dry eye. Must be, because dry eye right eye, nanoflex, gives me no grief at all. I decided to just try eye drops for awhile instead. Dr. said use everyday for 2 wks. every hour, so I will abide. My Nano eye refracted at 20/30, so I have to stop being a big baby & go & get the Yag. My Restor eye refracted at 20/25 (this… Read more »
Norma, I have both happy ReSTOR and Nanoflex patients. I also have a few less than thrilled patients who have had ReSTOR IOLs placed. I find that in general the Staar Nanoflex meets my patients’ expectations. Than again, that may be because I manage those expectations prior to surgery. I specifically state that to experience the fullest possible range of vision both eyes will have to be done with one eye set for distance and the other eye set for intermediate. I am also very clear that even with the Staar Nanoflex blended vision option spectacles may be required for… Read more »
Thank you, Dr. David, for your comments of April 24th. I agree completely. Unfortunately, none of this important info. was relayed to me the day we decided to do Restor lenses. My plan with the 2nd Dr. was somewhat opposite of what we probably should have done. Instead of implanting the Nanoflex R.E for distance., explant the Restor first. This would have given me the opportunity to wear a contact in the R.E. to see if I could handle blended vision. Now I don’t think I will even bother, as I am sure I already stated, Restor Lens plus dominant… Read more »
Hi Dr. David, Have been using eyedrops for dryness (Restor L.E.) for about a week now, everyday, but not quite making it every hour, but I am starting to get some relieft from the “foreign object sensation”, so I think I will hold off on a “plug”. I know I mentioned this to you last week, but one question: Do you think it is possible that once the Restor is explanted and implanted with the Nanoflex, that even though the eye is dry, I will have less of a foreign object sesation? I ask this because the Nanoflex seems to… Read more »
IOL exchange is unlikely to have any significant impact on foreign body sensation.
Hi David, It’s me again! I just called your office and thought I could come to you for consultation/eye surgery. It turns out you are very close to some of my relatives which eliminated the problem of where to stay, but, I also found out that you no longer take Medicare, which I am now on. I asked your receptionist if I could pay you and them get reimburshment from Medicare, but that is not an option. This is when I wish I could win the lottery, except that I never play. I don’t mind traveling. DO YOU KNOW A… Read more »
I’m afraid I do not know any doctors on the east coast who implant the Staar Nanoflex well enough to make a recommendation. Sorry.
Thanks, Dr. David, for letting me know so quickly that you are not familiar with any doctors here on the east coast. The doctor that I presently have is experienced with Nanoflex. He is the one who did my right eye. However, my guess is that he doesn’t polish anterior/posterior capsule, as well as remove (LEC) cells during surgery. If he did, I don’t think I would now have the what seems like a lot of PCO in the Nano eye. It is awful, and thankfully, technology is such now that something can be done about it. Can you imagine… Read more »
Although I do not know him personally, Dr. Ken Lipstock in Richmond, VA was mentioned by my Staar representative.
Hi, I know of Dr. Lipstock. He loves blended vision with Nanoflex lenses. I don’t think he like to do explants, and I would need this to implant the Nanoflex.
I don’t know if I’ve already let too much time go by to explant the Restor anyway. I would assume the sooner explanted, the better. This eye has never been yagged, and I think I read where Restor is one of the easier IOL’s to explant.
What is your opinion on this? Too late – over a year??
Norma
Earlier explantation is always preferred regardless of the IOL. I’m not sure where you would have read that the ReSTOR is “one of the easier IOL’s to explant.” In truth, the single-piece ReSTOR is one of the more difficult IOLs to explant (not true for the 3-piece ReSTOR which is rarely used in the USA). The single-piece ReSTOR haptics have bulbous tips that can be exceedingly difficult to remove once the capsular bag has scarred down around them. Often it is necessary to “amputate” the haptics in order to free the IOL from the bag. It all depends upon how… Read more »
BTW, I’m not aware of any surgeon who “likes to do explants” as they are both more challenging and less predictable than primary cataract surgery. As both expectations and risks tend to be higher with IOL exchanges, it sets up the surgeon for potential failure in the eyes of the patient. What’s to like about that?
Thanks for the info. re: Dr. Safran. And you are so right, IOL exchange is a scarey business. If I can make the two lenses I now have work, Restor, L.E. and Nanflex, R.E., then so be it. I ‘m so over all of this.
Again, thanks for everything.
Norma
Hello Dr. David, I just read on a site last night that a patient is not a good candidate for the Restor lens if used to replace another explanted IOL, in my case, the Nanoflex lens. Is this true? I just realized today, that within 10″ from the microwave, I was able to read fairly well the instructions on the unit with my Nanoflex eye. Do you think this is due to the distant vision loss I have right now because of needed Yag, or is it possible that even though I need Yag for waxey vision, the lens has… Read more »
Norma,
I’m afraid I have answered all questions that I can with regard to your situation. Any further ability to answer would require an in-person exam. I am hopeful that you will find someone near you who has the skills and answers you seek. I am sorry I cannot provide further assistance.
Hi Dr. David, It has been a long time, but I think I am finally coming to the end of my journey. Unfortunaley, before my Restor left eye surgery, I never consulted with a retinal specialist, although I suggested this to my surgeon, and he said it was not necessary. Looking back, I believe it was. I made sure I saw one before doing the Nanoflex right eye surgery. What I know now, is that besides bilateral PVS, and lasered horseshoe tear in the right eye, I also have a mild epiretinal membrane and a druse temporal on the fovea… Read more »
Dr. David, this not a question but a followup on a conversation that we began in 2010 I believe. I do want to thank you for your willingness to share your knowledge with those of us who have struggled with a diminished quality of eyesight. When I originally wrote it was in an effort to learn about what was then viewed as a promising technology, the dual optic Synchrony lens. In the past two years my ever more intrusive cataracts finally left me little choice other than surgery. A little less than two months ago I had cataract surgery performed… Read more »
Michael,
Thank you for sharing your early experience with this new technology IOL. I hope you will continue to provide updates as your brain adapts to this lens.
Warm regards,
David Richardson, MD
I am now 9 weeks post surgery. My local eye clinic checked my vision again after wearing the distance correction for two weeks. My refraction had not changed but the astigmatism had changed a little. With the distance correction in place I now am seeing 20/20 at distance and 20/20 for near vision. The optometrist that did the evaluation expressed the view that a possible problem with this might be that younger people not driven to surgery by a severe problem such as cataract might want to have this lens implanted before the effect of very long term use of… Read more »
While searching for a friend who needs cataract surgery now I discovered this old thread. I am the “michael” in this thread who went to Europe to obtain the Synchrony iol. It is now my sixth year as a recipient of that iol. I have tried, without success, to discover if any surgeons in the world are still implanting these lenses. Although there are at least two similar iols in trials, the FluidVision and the Juvene, both of which use a fluid or gel filled bag and claim results that match or exceed the performance of the Synchrony, but they… Read more »