Any experience re: cataract surgery?

In My Humble Opinion (IMHO)
#1

My 55 y.o. wife just saw an ophthalmologist yesterday, and was told she has cataracts. Wondering if any of you had any experience/expertise to share.

For the past year or so, my wife has been feeling a need for increased light when reading, and finding it more difficult to drive at night. Exams by ophth/opt over the past 2 years never revealed anything, but when she went to the ophth yesterday he said no question that she has cataracts, and that she will eventually need surgery. Said it doesn’t need to be done right away, but that they would worsen, and that he expected would be noticeably worse in a year or so. He said if she doesn’t do it now, she might want to get new glasses.

So, I guess question # 1 is surgery now vs later?

Second, he spoke about the different types of lenses available. Said our insurance covered some “basic” lenses, but that getting better lenses could cost up to $9k in out of pocket expenses. Seems to be consistent with what I turned up via Google. At yesterday’s appt, he did not give her detailed information as to the different types of lenses involved, and the costs associated with the various options. I’m not sure if he was discussing multifocal or anything else. We could spend the $9k, and we certainly do not wish to cheap out on her eyesight. But I tend to be a tad suspicious when it comes to the business of providing health care.

So, question 2, covered lenses vs how much for better lenses?

And, I guess question 3, do you seek a 2d opinion? If so, for what purposes? I think it would be appropriate, and should cost no more than our copay. I’d like to know if a 2d guy thinks the existence of cataracts and need for surgery is a no-brainer, and hear what he has to say about which hospitals have the best facilities, and the costs of upgrades.

Any other questions we ought to be asking?

#2

I have had a cataract for over 10 years. It hasn’t gotten worse.

One ophthalmologist said you have insurance, lets operate.

Another ophthalmologist said, it may never get worse. And asked, “Why risk the surgery”?

I listened to the second one.

#3

I’ve had the surgery and know a lot of people who also have had it. The consensus is, and my eye guy agrees, the regular lenses are probably best, as people have a lot of problems with the special lenses and they’re not worth the extra cost.

Most surgeries go without a hitch, but there are always outlier horror stories of infections and other problems. She should not go looking for those stories as it will only heighten the natural fear of having someone cutting on your eyes.

My prescription was being changed every few months, which is why I finally decided to get the surgery done. Glasses get very expensive at that frequency, and night driving was a no-no by that point because of the corona effect of any lights coming at me.

The prep time for the surgery takes longer than the actual procedure, as they ask all sorts of questions, give you a lot of drops to start numbing the eye, etc. Some places will give you an IV, but mine didn’t. Most will offer a mild sedative for nerves. The surgery only took about 5-10 minutes. I felt nothing and could see nothing, as the optic nerve was completely deadened. The following day, my eye was 20/20, and after both surgeries, my vision settled in at 20/25 because of a slight astigmatism. An eye drop regimen is required for about a month after surgery.

I still wear a mild prescription, but don’t really need it, and like most people I need reading glasses, as the artificial lens doesn’t flex like your natural lenses do. But the really cool thing was the brightness and vividness of color after the clouded lenses were gone. Spring was, and continues to be, a glory.

#4

I have no answers, but I am in the same position as your wife.

Do I want the basic? The Toric for my astigmatism? The deluxe? Do I want to get the lens that corrects my near vision or my far vision? For 55 years I haven’t needed glasses for reading, just for distance. If I get the distance lenses, I will need reading glasses for most of what I do, including identifying the food on my plate as I eat, if I understand the doctor correctly.

Do I really want to spend $9000 out of pocket when wearing glasses doesn’t reallybother me?

So, I’m interested, too.

#5

My mother had cataract surgery maybe 20 years ago, in her 60s, and she’s never had a problem since. I can ask her for more details.

#6

It’s not the glasses that are the problem; it’s the gradual dimming of your vision to where night driving is nearly impossible and you’re seeing the world as a sepia-toned environment. Almost everyone I know that has gotten the ‘special’ lenses has told me that it was not worth it in the least, and most people who have had issues with the surgery aftermath had special lenses put in.

#7

I had cataract surgery on both eyes in February 2015. I’m 58, which is a bit early to be developing cataracts, according to my doctor, but I take prednisone for another condition and predisone is know for increasing the growth of cataracts.

As I understand it, there are mono-focal lens and multi-focal lens. The mono-focal lens were what my insurance would pay for. They give me very good distance vision and I wear glasses to correct my near and middle distance vision. The multi-focal lens would have cost me an additional $1,900 per eye and, because I have severe astigmatism, I would still have to wear glasses, even with the multi-focals. I opted to save the $3,800.

I don’t know what to tell you about doing the surgery now versus later. I did mine when my cataracts were “ripe” and the insurance agreed to pay for it. I had hoped that the new lens would make a bigger difference in my vision than they actually did. My distance vision is great, but my near and middle vision are just okay. The glasses correct it as much as possible, but it’s not 20/20. The biggest difference I noticed immediately after the surgery was how much brighter colors were. Cataracts are like have dingy clouds in front of your eyes all the time. White is now truly white again. I also need less light to read.

My doctor said that the surgery would most likely improve my night vision. It did not. It made it worse. But that might just be me; YMMV.

The procedure itself is almost completely painless. The only discomfort I had was that drops they used to dilate my eyes stung a bit. Considering they are slicing your eyeball and inserting a new lens, that’s a small bit of discomfort.

The aftercare is a bit of pain. There are a series of three various drops you have to put in your eye at different times throughout the day. That goes on for about two weeks.

Hope this helps.

#8

Thanks all - please keep the posts coming.

Are there any increased risks associated with the surgery if done later as opposed to sooner? As suggested, it might be worth waiting to see if they stay the same. She might wish to just go with new glasses, and putting off the surg if her scrip doesn’t change. Maybe install brighter lightbulbs! :wink:

Obviously need another apt/more info to hear what they have to say about the pricier lenses. What the supposed benefits/costs/risks are. My wife went to the appt alone, and I think she was a little taken aback by the recommendation of surg, such that she wasn’t in position to ask more questions about options. I’d imagine a prudent course might be to see a 2d doc for dx and to and ask for more info re: the various lenses, and then go back to the first guy to ask similar questions.

She had lasik some 20 years ago. For a long time has used reading glasses, and has other glasses she uses for driving - especially at night.

Crazy familial coincidence - my son just had PRK yesterday, and my youngest daughter is having Lasik next month. So far, I’m fine w/ my bifocals.

Aside - this kind of thing is so frustrating and confusing. Really makes me laugh when folk suggest that individuals ought to be better comparison consumers of medical care. My wife and I are both lawyers, and I deal with medical records in my job. Yet we find this an huge task - with imperfect information as well as emotional stress. While not rich, we have the $ to spend to get the job done right. It really is ridiculous to assume that someone who is uneducated and poor would be able to make a sensible decision. Yet, if one has no “skin in the game”, it could be easier to simply choose the more expensive option.

Heck, it is tough to even choose doctors to see for exams, and to compare them. You look on line, and every doctor will have at least some dissatisfied client. Do you go with the older doc who has been doing the procedure for years, or the younger doc who might be more up on new technology/procedures?

Thanks again. Your responses are really helpful in framing the issues.

#9

I had cataract surgery last month with no problems. The drops for the next 30 days were the only ‘pain’ I endured. Sight was fine afterward. Wish I had opted for the $4000 lenses as I don’t like having to mess around putting on the glasses for reading. Yeah, it’s a lot of money not to have to put on glasses to read, but next year at this time I’ll wish I’d have have done it.

Phu Cat

#10

Far as I know there is no increased risk over time, except as her vision deteriorates she may be at increased risk of the kind of accidents that visually impaired people have. I had what is called rapid-onset cataracts, and within six months I could no longer drive or even safely walk across a street. I really don’t know of any reason to wait. The surgery schedule was so crowded that I had to wait nearly two months anyway, and I wish it was done sooner.

Personally I suggest that she do it as soon as possible, because the change will seem miraculous. I’ve been nearsighted since 3rd or 4th grade, and by the time I was an adult my vision was 20-300. When they took the bandage off my eye after the surgery, I was seeing 20-20 and I no longer need glasses to drive.

They will normally do one eye at a time with a few weeks in between the two surgeries, I think just as a precautionary thing. If something goes wrong during one procedure, the other eye will not be affected.

I have no idea how a prior lasik procedure might affect a cataract.

As to adaptive lenses, my ophthalmologist wouldn’t do them. He considered them too new and untested. But that was back in 2007. He offered to refer me to someone else who would implant the new type lenses, but I decided not to go that route.

#11

I am one of those “outliers” who had problems after cataract surgery. My corneas developed something called “map-dot-fingerprint” and did not heal up for a couple of months with the help of various different eyedrops. Also I got the super multi-focal lens. The goal was that after having both eyes done I would be able to forego glasses for the first time in over 50 years.

I wish I had just gone with the normal single-focus, or avoided the surgery altogether. I now see multiple blurry rings around light sources. Driving at night is problematical. Just to make things even more fun, I developed an astigmatism in the treated eye that had not been there before the surgery. Bottom line is I now see worse out of the treated eye than I do out of the untreated one, even with glasses, which continue to be necessary. When I go for a checkup the doctor asks me when I want the cataract in the other eye done and I say “Never.”

This was done at a highly regarded facility and there is no reason to even suspect they provided anything other than the best care. Just my bad luck to be that one in a thousand.

#12

The time risk is usually disease related. If you develop insulin dependent diabetes, for example, things become more complicated.

#13

I had the surgery about two years ago. The doctor did it in two rounds. First one eye which is covered with a patch until you do followup the next day. Two weeks later the other eye…repeat.

The surgery itself was over in about 15 minutes. The nurses were wheeling us in and out like it was a marathon. The prep for surgery took an hour, so there were multiple prep teams for the different patients.

If you wear glasses you’ll need to make an appointment with your regular eye doctor for a new prescription. I went from 20/90 to 20/30.

No problems to speak of, but in the months before the operation night driving was a holy terror. Every light source seemed to have a foggy rainbow around it.

#14

I has the surgery on both eyes about 30 days apart. I was very nearsighted, about 20/200 or worse. I was about 63 when I had the surgery and had worn glasses since the 5th grade.

Everything went fine and I wear progressive glasses for reading and such as vision closer than about 3’ is not sharp. My lenses do not focus. I had some astigmatism, but it was in the lens rather than in the cornea so no special lines were required. My vision is about 20/30 and I don’t need glasses to drive or shoot my rifles or pistols.

I did develop an issue where the back of the lens capsule gets cloudy, but a few seconds with a YAG laser and it’s fixed.

One thing I love about no glasses? Being able to be in the rain or snow and not having to wipe my glasses.

#15

One thing to consider with regard to waiting is that in many cases they worsen over time. As they worsen it can be difficult for the doctor to correct your eyesight as well as if you’d had it done sooner.

#16

In virtually all cases they worsen over time, but since the entire lens is replaced, I’m unaware that a cloudier lens is any more or less difficult to replace than a less cloudy lens.

#17

It’s not. They liquefy the old lens anyway and suck it out. There can be a secondary clouding in later years, as mentioned above, but it’s easily fixed.

#18

Not sure about the whys but my moms doctor said she let hers go much too long, and they were so thick he would have a hard time making her vision 20/20 or even close to 20/20. Thought it had something to do with the measurements and cuts they have to make.

#19

I had 3 cataracts - the common nuclear sclerotic ones in both eyes and as a bonus, a posterior polar cataract in my right eye. Plus I have retinal degeneration and have had tears repaired several times. Since I’m a high-risk case, my surgery was done under general anesthesia. So much of my specific experience doesn’t apply. But a few things might:

  • I did not have the surgery right away when it was optional. It wasn’t clear that my insurance would pay for it, and by getting the strongest contact lens prescriptions on the market, I was able to get by for a while (I didn’t need to drive at night). By the time I had the surgery, it wasn’t optional; I was so blind I could barely function. (I would have preferred not to wait quite so long, but life got in the way and due to illnesses, prior commitments, and vacations by both me and my doctor I ended up postponing one eye for nearly a year beyond when first planned). My insurer paid for it without a word of complaint.

  • I have monovision lenses; in other words, the basic lenses in each eye, but one is set for distance and one is set for reading. I have no trouble adjusting and don’t need reading glasses. It was a happy day when I went to the DMV with my paperwork showing that the corrective lens restriction could be removed from my drivers’ license. (I do have a very light prescription for distance vision but I don’t really need it and only wear glasses when I want super-sharp vision, like in a movie theatre or on a hike through panoramic scenery.)

#20

I got my cataracts fixed in Feb and March of 2007. I opted for the bifocal implant lenses which cost $1000 per eye, above the cost of single vision lenses. The surgery itself was covered by my insurance. After 50 years of wearing glasses, I don’t need them anymore. I do find it easier to read with a pair of reading glasses from clic.

I don’t remember having any pain, but it took a few months get used to seeing with the new lenses. I found that, without glasses, being in the rain is not nearly as worrisome as it was.