Cataract Surgery

Miscellaneous and Personal Stuff I Must Share
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I’m glad you are happy with the outcome, but Wow, my friend who had weight loss surgery had a co-pay that was less than half of what you paid for your glasses. And her insurance isn’t the greatest.

I’m glad for you that you could afford the glasses. I wonder what someone who couldn’t would do? would the Lions Club help out with something like that? I know The Lions Club is a general service organization, but the have a special mission of helping people with visual disabilities that started when Helen Keller approached them about 9 years after they formed, and asked them to be “Knights of the blind.” Since then, they’ve evolved to provide glasses to children, and not just children who otherwise wouldn’t be able to see at all, but any child with a prescription, whose parents couldn’t afford to fill it.

I also know that sometimes when a Deaf person needed an interpreter, and was stuck for a way to justify it to an interpreting service, and get it paid for-- it somehow didn’t fall under community living services, vocational services, medical or legal services, but wasn’t something like church, that you would expect the church to pick up the tab for, The Lions Club stepped in. When I interpreted at children’s afterschool programs that had educational content, but weren’t officially part of the school curriculum, the Lion’s Club sometimes picked up the tab.

That just seems like a real jam to be in-- to have a correctable problem, and have insurance that will pay for the medical end, but not for the glasses you need afterwards.

When my mother had her surgery done, she had primary insurance through her former employer, and secondary insurance through Medicare. Her primary insurance paid for the whole surgery, but not the glasses. Medicare paid for the lenses, but not the frames. She had to buy the frames. She picked middle-of-the-road ones, for about $98. She could have gone anywhere from $12 to $300. If she wanted scratch resistance or tinting, or bifocals, she would have had to pay extra, but she didn’t want those things.

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That cost wasn’t for glasses. That was for an upgrade to the lens and having them use a special laser to do an extra refining measurement. Insurance would have covered a normal lens and no extra measurement (besides the deductible). With a normal lens, I would still need reading glasses, which wouldn’t be that big of a deal. Anyway, I sure as heck wasn’t going to skimp, and glad I didn’t. :slight_smile:

I’m writing this now without reading glasses, something that would have been near impossible a month ago.

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You know,** enipla**, your sig ("I don’t live in the middle of nowhere, but I can see it from here. ") is unexpectedly funny given the topic! I can’t believe I just noticed it :D. I think you should change it to “I can see it much more clearly from here”!

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  1. Did he use a sonic screwdriver to do the deed?

  2. He should go into business with a doc I met yesterday, Dr. Huh (gastro, a friend was having a look-see down there).

“I’d like to leave a message for Doctor Hu”
“Who?”
“Huh?”
“No, Hu”

Hey, if business is going to be looking up, you might as well be able to see it clearly :D.

Back to topic: enipla, how are things several weeks out? I’m especially curious about your nighttime and driving vision.

65

Hi all, sorry to have dropped this for a few weeks.

I think I’ve always had halos, starbursts etc. I’ve been wearing glasses since I was in 2nd grade.

I did just go back to my regular optometrist to get a contact lens for the eye that DID NOT have the cataract surgery. It’s a multi-focal contact. Almost as good as the new eye. I’m doing this to ‘balance’ the eyes. The eye that has the new IOL (cataract replacement lens) is great. And now, I’m writing this on a net book without any reading glasses at the regular 100% screen zoom level. I don’t need reading glasses anymore.

The contact lens is a daily disposable. About a dollar a day.

I can see. And see well enough with my new eye to not need the contact lens in my OEM eye. But for a buck a day for a few months or years (until that lens gets replaced by an IOL. I’m gonna do it.)

Do it would be my advice.

66

I see my eye doc next Friday. Here’s hoping the change in eye drops has reduced the eye pressure enough that she’s comfortable doing the surgery!

She did not specifically mention the Symfony but I definitely plan to ask about it. I’m not one who jumps on the newest technology, but this sounds like enough of an improvement over the existing multifocals that it’s worth it.

Doc said that they just don’t use the “accommodating” lenses at all since they work so poorly.

How are you doing with driving and nighttime vision?

Interesting idea on using the contact lens. I gave up on them 20+ years ago because they never felt all that comfy to me, even the best soft lenses, but maybe they’ve improved since then…

67

Welp, I saw the doc this morning. Eye pressure is much lower, so the new drops are working well.

At one point she looked at the eye through some gadget and said “Yeah, you have a cataract”. I looked affronted and said “really? And you’re just NOW telling me this???”. We both laughed.

Unfortunately it went downhill from there and I think I need to find a new doctor because I am PISSED.

The tl/dr version is “she couldn’t / wouln’t take the time to answer questions, and booted me without scheduling anything”.

Lens discussion: she does more work with Restor than Symfony (which I specifically asked about because of Enipla’s experience). She has done Symfony - and basically said “I’ll put in whatever you want me to”. I kept asking “Are there reasons why one would be better for me than the other?”. The most she would say was that with any “accommodating” IOL (where all the websits say “multifocal”) there’s a loss in sharpness / contrast, and halos. Fair enough (though she didn’t comment on the Symfony having a reputation for less of that). She made the point that if she had it done, she would NOT be able to use a multifocal for that reason. Valid point. I’m not a surgeon, I work with computers, and ultra-sharp vision is not an issue for me.

I tried getting her to say why one type was better or worse than another (not multifocal vs monovision, I’ve got a good handle on that - but the two brands) and she wouldn’t give me an answer.

The exam was worse than usual. I had to be dilated (OK), and then the bright light torture started. Worse than I remember from other visits - looking longer at various places than usual, and she kept snapping at me because I’d jerk my head away in pain. “You can’t do that when you’re in surgery!”. Well duh. But guess what: I’m very sensitive to bright lights -always have been, and this was unusually painful. I reminded her that I’d need to be sedated anyway.

Then she said I might not be a good candidate for multifocals since I had a hard time getting used to progressives. I pointed out that the ones I had issues with were the full on “correct everything” sort, likely because my prescriptions were so different, and I did fine with room distance progressives. It’s a valid concern, though.

And when I kept trying to get a feel for what the options were to get the best overall vision, she wouldn’t even let me try to explain what I was hoping for = maybe good distance and intermediate, and reading glasses for computer / closeup. I didn’t want to have a setting so rigid that I couldn’t, say, go to the bathroom at night without finding my glasses.

She wouldn’t hear me out and spend another 5 minutes answering questions (she did say “You’ve had some great questions”… then why not ANSWER the last few!!). She basically said “I want you to get a second opinion. You want better refraction. Here’s a guy who does cataracts and Lasik. Go see him. You may have him do the Lasik and the cataract, or have him do the Lasik and me the cataract”, When I tried pointing out that I didn’t have the budget for Lasik she basically blew me off “might as well get everything just right while you’re at it”.

And she refused to answer any more questions, just sent me on my way with notes to take to the other doctor.

Whom I called… and he’s in Washington DC and the Maryland suburbs (we’re in Virginia), an hour or more drive unless traffic is insanely good (i.e. at 2 AM)… and they can’t see me for another month.

I’d hoped to have the surgery DONE by then.

Bear in mind, I’ve known about the cataract for over a year. I met the criteria for surgery even then but she kept putting it off because at that point, she could get me to 20-20 ( the criteria are: can’t get to 20-20, or 2+ diopters part in the two eyes). I lost another diopter in 4 months, and she STILL wouldn’t push on with it.

So it’s been going on for over a year, I’m losing function (I won’t drive unfamiliar roads at night), and I’d hoped to have a surgery date.

So - I’m going to find someone new. I won’t go to my husband’s ophthalmologist because HE’s the one who refused to answer questions about something he saw when my daughter visited him.

I can’t ask my internist for a referral because a) she sent my daughter to a neurologist who turned out to not even be board-certified, and b) she’s moved out of state anyway.

I guess I’ll ask the optometrists’s office for some names; they ought to know who’s good.

Oooh - and when I asked where my doc would do the surgery - thinking “the hospital 2 blocks away from your office”, she said “such and such location”… across the street from the hospital where my son was born… where I had a nightmarishly bad time and 24 years later get the shakes just driving past the place. Ugh.

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Ach, Mama Zappa. Yes, definitely do find someone else, and best of luck on getting things done fast. I’m feeling sorely indignant on your behalf just reading that.

That aside, this thread is giving me some good ideas of what I ought to bring up when I inevitably (eye doc says it’s not a “might” get cataracts, it’s definitely a “will”, and I’m probably going to get them at a fairly early age) have to have cataract surgery myself. My thanks to y’all.

69

Another question (though Enipla seems to have given up on the thread):

I’m severely sensitive to bright lights. As noted, the exam was excruciating. How does that work with the surgery? Are they going to be shining 5-megawatt Klieg lights at me like she was doing the other day?

70

I’m still around.

I definitely saw light during the operation, but I didn’t find it overly bright. Just kind of dancing lights of different colors. I was sedated but for the most part awake. They called it twilight sedation. It was an IV.

Don’t want to cause you more questions, but it seems odd to me that they are suggesting LASIK and cataract surgery. They will be replacing your lens, and at least in my case the Symphony IOL is correcting my vision.

I did have LASIK years and years ago though. The correction used in the IOL is not very much.

71

I agree!

And Lasik is something I have never, EVER had an interest in. I was once persuaded to go through an evaluation for it - because I’ve had such difficulty adapting to full-on progressives (I can deal with room-distance ones, which have less distance correction). I’ve got wonderful corneas for the purpose. but the concept of eye surgery… for essentially cosmetic reasons. Ooooooh no.

I definitely want a second opinion. This doc has been pushing it off for a year - a year ago, the cataract was evident and I met one set of criteria or qualifying for surgery. 4 months later, it was worse - and she STILL didn’t want to do it then.

At this point, I honestly get the feeling that she wanted me gone. I don’t know why - I’m not an especially difficult patient, I follow instructions etc. Yeah, I had trouble dealing with the intensely bright lights during that part of the exam, but I was not jumping to be annoying, I was jumping because SHE WAS HURTING ME.

If she couldn’t be arsed to spend 5 more minutes to answer the last few questions I had, then screw that. She doesn’t know it yet, but she is F.I.R.E.D. Fired.

“I’ll put in whatever you tell me to”… ??? Yes, she needs to listen to my needs, but she also needs to guide me as to what would work and what wouldn’t. If I want something that would be awful, she needs to tell me. And finding out what I"m hoping to accomplish is kind of critical to that whole process.

The person she is referring me too is actually very well qualified (though their practice’s web page has bits about what he and his wife like doing for recreation. WTF? I don’t give a rat’s ass about that). But no way in hell will I go there if I can find some place in the same area code.

Been doing some more reading. It looks like the ReSTOR (the multifocal lens the current doc uses most often, vs the Symfony) is not strictly a “bifocal” but is more graded. Different tech than the Symfony, but not quite as sharp a transition.

In any case, what I’m thinking now is going for one of the multifocal / gradual lenses (ReStor or Symfony), with what’s called “low add”. I don’t need something that will let me read close up. That’s what 2.99 disposable readers are for. I want something where I can drive, see the dashboard (something I can’t do well now with distance glasses), maybe brush my teeth without needing glasses (not at the same time as driving… really…), and the like.

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Geez, that’s passive-aggressive. She doesn’t want to do the surgery. You might want to check her ratings and malpractice history. Go get that second opinion.

73

My latest: I called my optometrist’s office for some names and got two.

One is a few miles away, in an office building i happen to know well (our dermatologist is there; in fact I saw the sign for his office when I was there earlier this week).

The second is the former partner of my soon-to-be ex: Docs A, B and C were in practice together about 1.5 miles from my house. My primary care doc sent me to A. My husband wound up going to B. The practice split up - and C remained at that location. C was the one I went to see 2 days ago.

Advantages: Well, he’s very close to home. He does surgery at a very close hospital - same outpatient surgery center I had my wrist surgery at earlier this year. He does laser-assisted surgery - which does not necessarily give better results than traditional, but certainly no worse, and gives the option of doing some astigmatism correction.

I said I thought that a low-add multifocal might be the right choice for me given my past issues with full-on progressives: I can wear “room-distance” progressives that let me read, use the computer, and cook, but not full distance-to-reading ones.
He concurred, especially as I was up-front about saying “I’m not expecting to be completely glasses free. It’d be nice but I have no problem with needing glasses some of the time”.

Ideally. I could get by with cheap drugstore readers, but we’ll see.

He thinks I might not need a toric lens, if he can get sufficient correction with the laser.

So - he wants to do the preop testing which will help determine the best lens for me (e.g. he may decide a multifocal is not a good idea, or toric is / is not required, whatever). He recommends the Restor Active Focus vs the Symfony simply because the material used has been around a lot longer and he has more experience with it, and knows that it will last well. He doesn’t know that the Symfony won’t last well, of course - but because it’s new, he just can’t be sure. it’s a valid argument (and one the soon-to-be ex did NOT explain).

Posterior opacification is something I’m fairly likely to develop: higher chance than average because a) Type 2 diabetes (though well-controlled), and b) my relative youth (I’m 59). I said “because I have longer for it to develop?” and he said “No, because the way a younger person’s healing process goes, it’s likelier”. Non-issue, of course - gotta have the surgery, and it’s quite easily dealt with.

I was very up front about wanting sedation. He said “basically, we use it for everybody”. And he assured me that they’d get enough on board to let me tolerate the bright lights. He seemed amused at the idea of doing surgery while chasing me down the hall.

He does suggest doing both eyes, a few weeks apart, in order to get the best effect from the multifocals. That’s similar to what the optometrist recommended.

I left a call for the surgical coordinator - gotta call again, as she didn’t return my call. I really want this done sooner rather than later, though I have to weigh it against some travel plans that involve a lot of driving, in early November and just after Thanksgiving. Also, this year for financial reasons: we hit our out of pocket very early on so the basic stuff is free, and we’ve got enough other expenses that we might be able to deduct the extra cost for the premium lens. I guess I might be getting bionic eyes for Christmas.

74

Sorry to be so late for a return to the thread I started.

I do have an excuse. My Wife and I left on a 4600 mile road trip on September 24th. We are back. Been a bit busy. No way I could have done the trip with out my new eyes.

Mama Zappa, I had the option of going go a place close, only 20 miles from home, or ‘far’, 100 miles from home. My optometrist recommended the place farther away. Mostly because they would do a final laser eye measurement when they got my cataract out and then choose the proper lens. Understand that 100 miles is nothing for my wife and I. So, I chose what my optometrist suggested.

I was also told about Posterior opacification Seems like no big deal.

My results have been nothing less than miraculous. I just gave all of my reading glasses to the library (I had 12 pair scattered around [home, work and car-I keep finding them in the oddest places]). Don’t need them any more.

I’ve watched my brother in law go through Retinitis pigmentosa for 20 years now. He is for all practical purposes now completely blind. My mother has Macular degeneration. It’s a difficult time for her. I thought it best to prevent such difficulties for myself and loved ones.

Mama Zappa, try to consider yourself lucky. I’m 57, a little younger than you, and have had my site restored to that a 10 year old. Surgery is scary, I know, but this is really quite simple and the most common surgery in the USA.

I only had the cataract in one eye. And to balance things out, I wear a multi-focal contact in the other. Works great. I’ll oddly be glad to get a cataract in the eye that I wear a contact in so I can get a IOL put in that so I don’t have to mess with a contact lens. That’s how easy it was.

Surgery recap - Wife drove me to clinic. Was put on a gurney in pre-op. Had to take shoes and shirt off and wear a gown on top. They put lots of diffent drops in my eye to dialate and numb. Had to wait about an hour, and couldn’t read anything. Really, that boredom was the worst part. Had an IV put in. They called it twilight sedation. So I was never really out. Light show in eye, but not bright that I would consider. Then I was wheeled out to rest a bit (maybe 30 minutes). Wife got me and we went to the Cheesecake Factory before the drive home. Don’t order the cheese stuffed burger. Sounds better than it is. Roasted artichoke heart appetizer though, is great.

The patch over the eye was bothersome to sleep with for a few days. Oh and I had to put Rx drops in the eye for 10 days.

Had to do a follow up check up with my local optometrist the next day. I just drove myself. Then two more to get the proper contact lens for the eye that did not have the surgery.

Best of luck. Try not to get too wound up about it. I’ve had worse splinters then that surgery. Absolutely zero pain of any type. Consider it a few days away from normal that you can take it easy, only to return to a better life.

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Trip: nice!!! We did an 8,000 mile trip when we were a bit (30+ years) younger and it was one of the best things we’ve ever done. I want to do it again (except this time, hotel or RV, not camping or friends’ couches).

What does your cataract have to do with the RP or MD? Just referencing vision loss, or does fixing a cataract reduce the risks of those?

I’m actually “looking forward” to having it done. I mean, surgery is no fun but being able to see would be nice.

I don’t think I’d be considered legally blind in the bad eye - 20:200 or worse with glasses… but I have to hold my phone about 4 inches away to see it clearly with that one eye, and computer distance is just a big colorful blur. And I’ve noticed actual double vision in that eye, at least some of the time. It’s time to get it fixed.

I had the pre-op measurements done today. Much faster than at the other opthalmologist - I was in and out in less than an hour. They measured my cornea curviture on 3 different machines - evidently they gave similar-enough results that they were satisfied. I imagine if they got different results from the different machines they’d have to redo everything to figure out what was going on.

I see the doc in a week, at which point we’ll make decisions and hopefully schedule the work. I’m leaning toward the laser-assisted version, as the incisions are more precise and they can do the limbic relaxing incisions to hopefully sort out the astigmatism, though of course I’ll have to discuss that with the doctor.

The tech asked if I had any questions for her and I did have a few. One was “can I drive while adjusting to the first lens”. I have a “CANNOT MISS” trip in late November - family business, and I need to be able to drive. If that would be an issue, I couldn’t schedule anything until December. She thought it would be no issue, since I’d still have the un-operated eye at that point. I asked about pupil size, as that’s an indicator of possible problems with the multifocals. She said mine were “average”. I asked if my right eye would even qualify for surgery for insurance purposes, and her opinion was that there was enough scattering that it would.

Oh yeah: distance: We’re in a major-enough metropolitan area that fortunately there are many, many choices that don’t require driving 100 miles!! I cancelled the consult with the guy that would have required a 20+ mile drive - both because I was pissed at the whole scenario, and because I know what traffic is like getting to that area, and it ain’t pretty. Mine will actually be at the same place where I had my wrist surgery back in March - i.e. practically walking distance.

76

Nice time for this thread to resurface. Optometrist made me an appointment yesterday with an eye surgeon to have a cataract removed; he’s sending me to the doctor who removed his cataract – she does only cataract surgery, so I guess she’s good. Appointment for first visit is next week but it will probably be two or three months before the actual surgery.

The trigger for going now was that I managed to let my driver’s license expire and now have to take the test and I know I can’t pass the eye test.

I’ve gotten pretty used to a soft, blurry world but it bugs me to have had to give up driving at night. Hoping for an improvement there, mostly. Even on familiar roads I can’t read the street signs and often miss turns, even missing my own driveway at night.

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Have also decided that camping is a been there done that thing.

Just a reference. No idea if there is a relation. Good luck, it was very simple for me, I hope you have the same experience.

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Driving and work did it for me. I’m a programmer and was starting to struggle with computer screens. And I got to where I was uncomfortable driving somewhere I was not familiar with. And I had one good eye.

Also, I come into work early in the morning. Twisty dark mountain roads. Luckily, I got it done before it was dark in the morning. I wouldn’t have been able to do it. No way, know how, and I’ve been driving the same road for 26 years.

Good luck to you too. It will really change your life.

79

Good luck!!

I see the eye tnext Tuesday. Hoping to have it scheduled some time before Thanksgiving.

Re the license: Slightly off-topic, but be prepared to have to jump through extra hoops re proving your identity when you do go to renew. A friend had missed her renewal date and had to provide extra documentation including proof of naturalization… which the DMV declined!!! Apparently there was some kind of screwup with a USCIS database and she wasn’t listed. It took a call to her Congressman to get it straightened out. She’d never been asked to produce such documentation before, with any of her renewals - but apparently they raise the bar if the old one has expired. Part of that is that new licenses in our state are RealID-compliant now.

80

Bumpdate: I saw the doc this morning. Evidently I’m a good candidate for a multifocal based on the various measurements they did, including something called angle alpha (well, if you google it, you’ll get the Greek letter instead).

My astigmatism is outside the range where the limbal relaxing incisions would be helpful - I’m at 1.5 diopters in that eye, and the results are not great much over .5 or .75 diopters, so the results would be unpredictable. So, toric it is.

The right eye won’t need a toric - it’s only got about .5 diopters and they’ll zap that while they’re playing laser tag with my right eyeball.

He’s booked up for a bit - so I won’t get either done before Thanksgiving. In fact, the left will be done in early December, and the right will be done in early January. Oh well. The main issue there is financial: we’ve hit our out of pocket limit this year, and we’ll be able to itemize medical deductions, so the extra lens expense would be deductible - dunno if we’ll be able to do so next year.

They gave me choices of several different surgery slots on the first available date. For the one in December, I opted for the “oh gawd, you have got to be kidding me” early slot. For the one in January, I opted for the “you are out of your effin’ MIND” early slot (arrival time at 6:45 and 6:00 AM, respectively). My logic being: while OR-delaying emergencies are less likely with this sort of thing, might as well get 'er done and over with.

I’m seeing a new (to me) primary care doctor tomorrow - already scheduled. The timing is good - I’ll need medical clearance before the eye surgery. Interestingly, they’re stricter than when I had wrist surgery at the same facility - no pre-op labs or anything required for that.

I asked “what if I sneeze or get hiccups during?”. Doc laughed, said he’d only been sneezed on 3 times, but in any case, I should try to give them a second or two notice if I could.

I think the doc appreciated that I’m not expecting perfection out of all this - I’m perfectly happy to wear reading glasses (drugstore or prescription). I’m sure a lot of people go in with insanely high expectations.

Annoyingly, they want to repeat the measurements I had done last week. Not a big deal - it took about 40 minutes total; it’s just a slightly longer drive to get to the office where they do that (the surgery center, and the office I went to today, are 1.5 miles from home).