Cataract Caution
On the verge of retiring and transitioning to Medicare, I decided to see if I needed a new prescription and new eyeglasses. I realized I hadn't had my eyeglasses renewed in about nine years. They were bi-focals providing mild distant vision correction and reading, near vision, correction. Since my insurance deductible was pretty well paid up (this was early November) and I'd noticed a little bit of fuzziness in my distance vision, why not get some new glasses?
I checked and found that the optical shop I drove past every day on my way to work was "in network" for my insurance. So, I stopped in there to get an exam and, maybe, new glasses. The place was pleasant enough and the two attendants were friendly. I told the one who greeted me what I was wanting to do and she said they had an opening next week or right away, if I was available. So, I went into the exam room and started down the battery of machines that test your eyes for all the various things for which eyes need to be tested. After about 30 minutes I found myself in the chair in an exam room waiting for the doctor to come see me and discuss the results.
Fairly alarmingly, the doctor told me my sight was much deteriorated as a result of the presents of cataracts in both eyes. According to the results of his testing, without my current prescription glasses I was not seeing well enough to get a driver's licenses. My glasses corrected me to where I would be able to drive, but just barely. At one point he mentioned that I had “stage 4” cataracts. Also, my night vision was dangerous and I should not be driving at night. The good news, however, was that cataract surgery would correct this and I could be glasses free after the surgery.
He began to further explain there were a number of options for the types of cataract correction available. The fact is that cataract surgery amounts to the removal of the eye’s natural lens, which has become fogged (known as a cataract) and the replacement of that natural lens with an artificial lens implant. The options have to do with the types of implanted artificial lenses that are available. Medicare and most insurance policies pay for the surgery itself. It’s the lens options that cause the complicated choices. The options go something like this:
Mono-focal artificial lenses- These are paid for by medicare and most insurance policies (you can choose the have your eyes see far without glasses (the choice of most people) or near without glasses).
“Life-style” or multi-focal artificial lenses- These provide both far and near sightedness and are not covered by medicare or insurance.
“Life-style” accommodative artificial lenses- These are flexible lens that are reshaped by the eye, in a similar fashion to how the natural eye lens works, to accommodate far and near sightedness. These lens are not covered by medicare or insurance.
Mono-vision surgery- This involves two different mono-focal lens - a far-sighted lens in your dominant eye and a near-sighted lens in the other. I haven't been able to discover for sure, but I believe Medicare and most insurance policies cover this choice, since it involves two mono-focal lenses and no “life-style” lenses.
The doctor’s description of the options barely mentioned the normal mono-focal lenses and moved quickly to the Life-style choices. He said they would cost $3,500-3,800 per eye (The surgery is covered by Medicare or insurance, but the lenses themselves cost that much and are not covered). He immediately pointed out that, though that sounded like a lot of money, it was actually less than you’d pay for a used car that would only last a few years before needing replaced. Financing is available. He didn't mention the mono-vision option. Since I’d heard of the one-far/one-near option, I asked him about it. He said that was called “mono-vision” and was not recommended for folks who had never used mono-vision type contact lenses. He said it actually makes you “one-eyed” and takes away your depth perception. He then proceeded to narrow down the options as to who would be the best ophthalmologist to see to have the surgery done. Bottomline, he recommended a large highly advertised ophthalmology center nearby. I’d heard of it because of their advertising. He said Texas had recently made this process easier by allowing “Shared Care.” With this benefit, I would be able to get the surgery done by the ophthalmologist and then see him (the optometrist) for my aftercare. He gave me the number for the ophthalmology center. He also gave me some material to take home and read about the lens choice options. I called and made the appointment for a couple of days in the future.
Since we live in the age of the internet, I, of course, spent a few hours researching and reading and educating myself about cataracts, cataract surgery, and the various options. You know medical conditions become VERY interesting with they are YOUR medical condition. The fruit of my research yielded the following interesting facts:
There are various manufacturers of the “Life-style” lenses. They have varying names and varying features, but none will guarantee that they can eliminant your dependence on glasses, entirely. The varying features include choices between those that provide for far/near sightedness vs. far/medium/near sightedness. They all amount to multi-focal lenses that - were they glasses - they would be either bi-focals or tri-focals.
With mono-focal lenses, the type covered by Medicare and most insurance policies, you choose between being permanently far-sighted or permanently near sighted. Most people opt for permanently far-sighted. Thus, they only need glasses for reading - available at Wal Mart or Walgreens.
Some doctors offer “laser cataract surgery.” This procedure involves the doctor using a specialized laser for removal of the clouded natural eye lens (the cataract). Without the laser, he has to break up the cataract with a knife or ultrasound and then remove it. The laser procedure does nothing for the patient, but makes the surgeons work easier. Thus, it is illegal for the surgeon to charge extra for this procedure. However, if the surgery also involves correction for stigmatism, then the doctor can charge extra for the laser surgery. [This is an important point to remember when I discuss the findings of the my visit to the Ophthalmology Center.]
The average cost of cataract surgery involving “Life-style” lenses is about $3,000. However, doctors can charge whatever they want. There’s no price restrictions other than whatever the market will bear.
Adjustment to the mono-vision (one far-sighted and one near-sighted lens) can be a bit difficult. The brain does a pretty good job of deciding which eye to use, when one eye sees what you want to see more clearly than the other eye. It can have an impact of depth perception, but usually only a mild impact. This is a practice that is very common in contact lenses. The difficulty with implants is, if you have trouble adjusting, the choice is PERMANENT. The risk exists, but it is a low risk. Also, you can experiment to test your ability to adjust by wearing mono-vision contact lenses for a while.
Ophthalmological Surgeon #1
Armed with about three days worth of internet research and education, I bravely walked in the ophthalmology center to undergo further testing and, possibly, make a $7,000 to $9,000 decision. The place was large, nice, busy and very professional. Paperwork was brief and I was called back to begin my exams on time. I suppose they were checking for the same things the Optometrist had checked. They use some similar and some different instruments. The lady who attended to me seemed to be a bit new, since she had to get consultation from another lady a couple of times. Nevertheless, the testing was accomplished. Then, is youngish woman came in who introduced herself as a doctor and said she was going to look inside my eyes to see if there any obvious problems. My eyes had been mildly dilated earlier and were now ready for gazing into. At that point these are the results I was told:
I do have cataracts. They are “stage 4” (as the Optometrist had said), but they were only affecting my vision as if they were “stage 1 or 2.”
No problems with my retina or macula.
My optic nerves were fine, but the left eye was slightly engaged, though not beyond what could be considered normal. Before any cataract surgery, it would probably be good to have a more thorough test for glaucoma. The optometrist could do that.
My eye pressure was normal.
I have a very low amount of stigmatism (less than one). EVERYONE has some level of stigmatism, mine was negligible.
Basically, my eyes were healthy but cataract surgery was in order and I would be seeing a “counselor” to discuss the options. First, however, I would need to talk with the surgeon.
I was moved to another chair and waited there until the surgeon arrived. He came and reviewed the information I had already been told and wanted to know if I had any questions. No one had mentioned the mono-vision option, so I brought it up with the surgeon. He acknowledged it was an option and that it had some adjustments risks. He said that could be overcome by trying mono-vision contacts for a while to see how I did with them. He also mentioned an option I had not heard before. It was called a “rain drop” inlay. He described this as doing standard mono-focal surgery in both eyes to be followed by the insertion of bottom-half lens under the cornea of the non-dominant eye for reading purposes. He had no idea what it cost to do that, but the counselor would be able to help me with that.
So, from there it was off to see the counselor-
Counselor Consultation:
In her late 20s, the counselor was friendly and jovial. Her immediate opening conversation was to discuss my calendar to see when the surgery could be scheduled. I deflected that discussion in favor of discussing what the options were and what was going to work best for me. She had a form letter that she showed me that listed the various options and left room to fill in the costs She had already written in the cost of Life-style lenses in each eye. She had also written in the cost of a laser stigmatism procedure. She said that would be optional. I asked her about the option the doctor had mentioned of a "rain drop inlay." So, she wrote in the cost of the inlay and said that would require that I get the laser stigmatism procedure as well. The amounts were:
Life-style lenses: $3,500 each (so, x2 = $7,000)
laser stigmatism procedure: $2,000
rain drop inlay: $4,000
She then wanted to return the conversation to getting the surgery on the calendar. I was wanting to ask about mono-vision AND I was wanting to know why the laser procedure was required for the rain drop inlay. I quoted the doctor who had said my stigmatism was very minor and negligible. The counselor could not tell me why it was required, only that it was and that in order to have the rain drop inlay I’d also have to have the laser procedure and “when can we schedule your surgery?”
Knowing that I was leaving town for the Thanksgiving holiday and that then I would be retiring at the beginning of December and making at least two other holiday trips, I wasn’t willing to commit to the surgery until after the new year. I told her I wasn’t in a hurry to get it scheduled and that I would be getting back in touch when I was ready to pin it down. She pointed out that waiting too long would result in the need to reexamine my eyes and that the costs might be changed. I told her I was willing to live with that eventuality. So, our conversation ended with her not being very happy with me. I had already made a decision, in my mind, to get a second opinion. I did commit to going back to my optometrist for a better check on the presence of glaucoma.
In spite of my decision to seek a second opinion on the cataract surgery, I stopped by the Optometrist near my house to do the glaucoma check, as I had committed to do. He happened to be available right away, so I didn’t have to make an appointment. I simply had the test done and then met with the doctor to discuss the results. He wanted to know the result on my visit with the surgery center. I told him they had said I had stage 4 cataracts, but that they weren’t effecting my vision any more than a stage 1 or 2 cataract. He thought that was a ridiculous idea and hinted that needed to get the surgery done before I did much more driving. Also, he advised me that I stop driving at night. I tried to tell him I didn’t think my vision was dangerous at night and certainly not dangerous in the daytime. He would hear nothing of that and said I had only gotten used to seeing badly and didn’t realize how bad my vision was. After we argued about that and I quit arguing, he told me I didn’t have a glaucoma problem but that I might in the future.
Ophthalmological Surgeon #2
Some time after Thanksgiving, I was able to get an appointment to see an Ophthalmologist for a second opinion relative to my cataracts and their effect on my vision and my need for cataract surgery. I’ll skip all the description of the testing and go immediately to my discussion with the surgeon about the results of the testing.
After his greetings to me, the doctor reviewed with me the visual images that had been made of my retina. He said it showed no macula problems, no glaucoma problems and generally healthy eyes. He pointed out that my eye pressure and other tests showed no problems and that I had only slight, but negligible stigmatism. Cataracts! He said had a nice cataract in each eye, but that they were only stage 1 or slightly more. I mentioned the stage 4 diagnosis and he was flabbergasted. He said stage 4 is, essentially, blind. In his thousands of cataract surgeries he’s seen 4 or 5 stage 4 patients. He said my vision, with my glasses, is 20/25. He could correct them to 20/20 with as new prescription, but, as my cataracts progress, my vision will be affected and the new prescription will need to be changed. He went on to explain that in order for him to recommend (or even be willing to DO) cataract surgery three conditions need to exist:
I need to have cataracts - I qualify under that condition.
The cataract need to be effecting my vision - I barely qualify under that condition.
I need to want the surgery - Qualification for this condition was up to me.
He was not recommending that I have cataract surgery at this time. But, I need to come back in a year to re-evaluate or come back if I experience further deterioration in my vision.
This doctor also gave me some further information. When I described what I had experienced with the Optometrist and the other Ophthalmological Center, he apologized for his profession that now contains practitioner who are simply trying to make a lot of money. He laid it all at the feet of the legalization of what he called “kick-backs” but that is officially known as “Shared Care.” This practice puts Optometrists and ophthalmologists in a partnership for doing surgery and after care that is very lucrative for the doctors involved, but not done for the good of the patients.
Conclusion-
Do not get cataract surgery based on the recommendation of one doctor. Get a second opinion. Insist on full and clear explanations of what can and will be done and why what the doctor is saying is needed is needed. Do not be uninformed. Read about what the doctor is saying he/she is recommended. Read online ratings of the doctor you are seeing. Read online ratings of the surgery center or hospital that will be used. Know your options and choose wisely.
I checked and found that the optical shop I drove past every day on my way to work was "in network" for my insurance. So, I stopped in there to get an exam and, maybe, new glasses. The place was pleasant enough and the two attendants were friendly. I told the one who greeted me what I was wanting to do and she said they had an opening next week or right away, if I was available. So, I went into the exam room and started down the battery of machines that test your eyes for all the various things for which eyes need to be tested. After about 30 minutes I found myself in the chair in an exam room waiting for the doctor to come see me and discuss the results.
Fairly alarmingly, the doctor told me my sight was much deteriorated as a result of the presents of cataracts in both eyes. According to the results of his testing, without my current prescription glasses I was not seeing well enough to get a driver's licenses. My glasses corrected me to where I would be able to drive, but just barely. At one point he mentioned that I had “stage 4” cataracts. Also, my night vision was dangerous and I should not be driving at night. The good news, however, was that cataract surgery would correct this and I could be glasses free after the surgery.
He began to further explain there were a number of options for the types of cataract correction available. The fact is that cataract surgery amounts to the removal of the eye’s natural lens, which has become fogged (known as a cataract) and the replacement of that natural lens with an artificial lens implant. The options have to do with the types of implanted artificial lenses that are available. Medicare and most insurance policies pay for the surgery itself. It’s the lens options that cause the complicated choices. The options go something like this:
Mono-focal artificial lenses- These are paid for by medicare and most insurance policies (you can choose the have your eyes see far without glasses (the choice of most people) or near without glasses).
“Life-style” or multi-focal artificial lenses- These provide both far and near sightedness and are not covered by medicare or insurance.
“Life-style” accommodative artificial lenses- These are flexible lens that are reshaped by the eye, in a similar fashion to how the natural eye lens works, to accommodate far and near sightedness. These lens are not covered by medicare or insurance.
Mono-vision surgery- This involves two different mono-focal lens - a far-sighted lens in your dominant eye and a near-sighted lens in the other. I haven't been able to discover for sure, but I believe Medicare and most insurance policies cover this choice, since it involves two mono-focal lenses and no “life-style” lenses.
The doctor’s description of the options barely mentioned the normal mono-focal lenses and moved quickly to the Life-style choices. He said they would cost $3,500-3,800 per eye (The surgery is covered by Medicare or insurance, but the lenses themselves cost that much and are not covered). He immediately pointed out that, though that sounded like a lot of money, it was actually less than you’d pay for a used car that would only last a few years before needing replaced. Financing is available. He didn't mention the mono-vision option. Since I’d heard of the one-far/one-near option, I asked him about it. He said that was called “mono-vision” and was not recommended for folks who had never used mono-vision type contact lenses. He said it actually makes you “one-eyed” and takes away your depth perception. He then proceeded to narrow down the options as to who would be the best ophthalmologist to see to have the surgery done. Bottomline, he recommended a large highly advertised ophthalmology center nearby. I’d heard of it because of their advertising. He said Texas had recently made this process easier by allowing “Shared Care.” With this benefit, I would be able to get the surgery done by the ophthalmologist and then see him (the optometrist) for my aftercare. He gave me the number for the ophthalmology center. He also gave me some material to take home and read about the lens choice options. I called and made the appointment for a couple of days in the future.
Since we live in the age of the internet, I, of course, spent a few hours researching and reading and educating myself about cataracts, cataract surgery, and the various options. You know medical conditions become VERY interesting with they are YOUR medical condition. The fruit of my research yielded the following interesting facts:
There are various manufacturers of the “Life-style” lenses. They have varying names and varying features, but none will guarantee that they can eliminant your dependence on glasses, entirely. The varying features include choices between those that provide for far/near sightedness vs. far/medium/near sightedness. They all amount to multi-focal lenses that - were they glasses - they would be either bi-focals or tri-focals.
With mono-focal lenses, the type covered by Medicare and most insurance policies, you choose between being permanently far-sighted or permanently near sighted. Most people opt for permanently far-sighted. Thus, they only need glasses for reading - available at Wal Mart or Walgreens.
Some doctors offer “laser cataract surgery.” This procedure involves the doctor using a specialized laser for removal of the clouded natural eye lens (the cataract). Without the laser, he has to break up the cataract with a knife or ultrasound and then remove it. The laser procedure does nothing for the patient, but makes the surgeons work easier. Thus, it is illegal for the surgeon to charge extra for this procedure. However, if the surgery also involves correction for stigmatism, then the doctor can charge extra for the laser surgery. [This is an important point to remember when I discuss the findings of the my visit to the Ophthalmology Center.]
The average cost of cataract surgery involving “Life-style” lenses is about $3,000. However, doctors can charge whatever they want. There’s no price restrictions other than whatever the market will bear.
Adjustment to the mono-vision (one far-sighted and one near-sighted lens) can be a bit difficult. The brain does a pretty good job of deciding which eye to use, when one eye sees what you want to see more clearly than the other eye. It can have an impact of depth perception, but usually only a mild impact. This is a practice that is very common in contact lenses. The difficulty with implants is, if you have trouble adjusting, the choice is PERMANENT. The risk exists, but it is a low risk. Also, you can experiment to test your ability to adjust by wearing mono-vision contact lenses for a while.
Ophthalmological Surgeon #1
Armed with about three days worth of internet research and education, I bravely walked in the ophthalmology center to undergo further testing and, possibly, make a $7,000 to $9,000 decision. The place was large, nice, busy and very professional. Paperwork was brief and I was called back to begin my exams on time. I suppose they were checking for the same things the Optometrist had checked. They use some similar and some different instruments. The lady who attended to me seemed to be a bit new, since she had to get consultation from another lady a couple of times. Nevertheless, the testing was accomplished. Then, is youngish woman came in who introduced herself as a doctor and said she was going to look inside my eyes to see if there any obvious problems. My eyes had been mildly dilated earlier and were now ready for gazing into. At that point these are the results I was told:
I do have cataracts. They are “stage 4” (as the Optometrist had said), but they were only affecting my vision as if they were “stage 1 or 2.”
No problems with my retina or macula.
My optic nerves were fine, but the left eye was slightly engaged, though not beyond what could be considered normal. Before any cataract surgery, it would probably be good to have a more thorough test for glaucoma. The optometrist could do that.
My eye pressure was normal.
I have a very low amount of stigmatism (less than one). EVERYONE has some level of stigmatism, mine was negligible.
Basically, my eyes were healthy but cataract surgery was in order and I would be seeing a “counselor” to discuss the options. First, however, I would need to talk with the surgeon.
I was moved to another chair and waited there until the surgeon arrived. He came and reviewed the information I had already been told and wanted to know if I had any questions. No one had mentioned the mono-vision option, so I brought it up with the surgeon. He acknowledged it was an option and that it had some adjustments risks. He said that could be overcome by trying mono-vision contacts for a while to see how I did with them. He also mentioned an option I had not heard before. It was called a “rain drop” inlay. He described this as doing standard mono-focal surgery in both eyes to be followed by the insertion of bottom-half lens under the cornea of the non-dominant eye for reading purposes. He had no idea what it cost to do that, but the counselor would be able to help me with that.
So, from there it was off to see the counselor-
Counselor Consultation:
In her late 20s, the counselor was friendly and jovial. Her immediate opening conversation was to discuss my calendar to see when the surgery could be scheduled. I deflected that discussion in favor of discussing what the options were and what was going to work best for me. She had a form letter that she showed me that listed the various options and left room to fill in the costs She had already written in the cost of Life-style lenses in each eye. She had also written in the cost of a laser stigmatism procedure. She said that would be optional. I asked her about the option the doctor had mentioned of a "rain drop inlay." So, she wrote in the cost of the inlay and said that would require that I get the laser stigmatism procedure as well. The amounts were:
Life-style lenses: $3,500 each (so, x2 = $7,000)
laser stigmatism procedure: $2,000
rain drop inlay: $4,000
She then wanted to return the conversation to getting the surgery on the calendar. I was wanting to ask about mono-vision AND I was wanting to know why the laser procedure was required for the rain drop inlay. I quoted the doctor who had said my stigmatism was very minor and negligible. The counselor could not tell me why it was required, only that it was and that in order to have the rain drop inlay I’d also have to have the laser procedure and “when can we schedule your surgery?”
Knowing that I was leaving town for the Thanksgiving holiday and that then I would be retiring at the beginning of December and making at least two other holiday trips, I wasn’t willing to commit to the surgery until after the new year. I told her I wasn’t in a hurry to get it scheduled and that I would be getting back in touch when I was ready to pin it down. She pointed out that waiting too long would result in the need to reexamine my eyes and that the costs might be changed. I told her I was willing to live with that eventuality. So, our conversation ended with her not being very happy with me. I had already made a decision, in my mind, to get a second opinion. I did commit to going back to my optometrist for a better check on the presence of glaucoma.
In spite of my decision to seek a second opinion on the cataract surgery, I stopped by the Optometrist near my house to do the glaucoma check, as I had committed to do. He happened to be available right away, so I didn’t have to make an appointment. I simply had the test done and then met with the doctor to discuss the results. He wanted to know the result on my visit with the surgery center. I told him they had said I had stage 4 cataracts, but that they weren’t effecting my vision any more than a stage 1 or 2 cataract. He thought that was a ridiculous idea and hinted that needed to get the surgery done before I did much more driving. Also, he advised me that I stop driving at night. I tried to tell him I didn’t think my vision was dangerous at night and certainly not dangerous in the daytime. He would hear nothing of that and said I had only gotten used to seeing badly and didn’t realize how bad my vision was. After we argued about that and I quit arguing, he told me I didn’t have a glaucoma problem but that I might in the future.
Ophthalmological Surgeon #2
Some time after Thanksgiving, I was able to get an appointment to see an Ophthalmologist for a second opinion relative to my cataracts and their effect on my vision and my need for cataract surgery. I’ll skip all the description of the testing and go immediately to my discussion with the surgeon about the results of the testing.
After his greetings to me, the doctor reviewed with me the visual images that had been made of my retina. He said it showed no macula problems, no glaucoma problems and generally healthy eyes. He pointed out that my eye pressure and other tests showed no problems and that I had only slight, but negligible stigmatism. Cataracts! He said had a nice cataract in each eye, but that they were only stage 1 or slightly more. I mentioned the stage 4 diagnosis and he was flabbergasted. He said stage 4 is, essentially, blind. In his thousands of cataract surgeries he’s seen 4 or 5 stage 4 patients. He said my vision, with my glasses, is 20/25. He could correct them to 20/20 with as new prescription, but, as my cataracts progress, my vision will be affected and the new prescription will need to be changed. He went on to explain that in order for him to recommend (or even be willing to DO) cataract surgery three conditions need to exist:
I need to have cataracts - I qualify under that condition.
The cataract need to be effecting my vision - I barely qualify under that condition.
I need to want the surgery - Qualification for this condition was up to me.
He was not recommending that I have cataract surgery at this time. But, I need to come back in a year to re-evaluate or come back if I experience further deterioration in my vision.
This doctor also gave me some further information. When I described what I had experienced with the Optometrist and the other Ophthalmological Center, he apologized for his profession that now contains practitioner who are simply trying to make a lot of money. He laid it all at the feet of the legalization of what he called “kick-backs” but that is officially known as “Shared Care.” This practice puts Optometrists and ophthalmologists in a partnership for doing surgery and after care that is very lucrative for the doctors involved, but not done for the good of the patients.
Conclusion-
Do not get cataract surgery based on the recommendation of one doctor. Get a second opinion. Insist on full and clear explanations of what can and will be done and why what the doctor is saying is needed is needed. Do not be uninformed. Read about what the doctor is saying he/she is recommended. Read online ratings of the doctor you are seeing. Read online ratings of the surgery center or hospital that will be used. Know your options and choose wisely.
posted by Ron and Marilyn @ 9:12 AM
1 comments
