I have cataracts in both eyes. Saw the eye surgeon yesterday. Turns out I have a really big one in one eye. Both eyes will be done. The Doc impressed me greatly, great staff, 1st class, etc.

I'm on Medicare with a very good supplement.

I have my choice of 3 possible treatments. There is the very basic one with a monocular lens implant that will leave me still needing to have glasses. It is not a laser surgery, uses the old fashioned knife. Not anywhere near as precise as the laser. I don't want this one. Cost to me should be Zero $$$ but it's not anywhere near satisfactory.

The other 2 options: The next step up is laser surgery for the cataract, and a much better lens that will give me excellent vision from fingertip length to infinity. The laser is something Femtosecond thing. The Near vision, from fingertips to my eye (reading, computer usage, food menus and other tasks, etc, may require reading glasses. Not a big deal. Cost to me out of pocket would be around $3,200 for both eyes. Astigmatism would be corrected with this procedure.

The best option should give me excellent vision, from infinity to fingertip, and from fingertips to my eye, and should be without any need to any more glasses. Much better and effective lens implants. Cost of this one is quite a bit more, almost $7,300 for both eyes. Astigmatism would also be corrected.

For those of you who have gone through this, or going through it, or if you are an eye care professional, what are your thoughts, recommendations, ideas etc.? Thanks
.

This message has been edited. Last edited by: OKCGene,

quote:

Originally posted by OKCGene:
I have cataracts in both eyes.

I have my choice of 3 possible treatments. There is the very basic one with a monocular lens implant that will leave me still needing to have glasses. It is not a laser surgery, uses the old fashioned knife. Not anywhere near as precise as the laser. I don't want this one.

The other 2 options: The next step up is laser surgery for the cataract, Astigmatism would be corrected with this procedure.


Does anyone have any comments or advice? Thanks
.

I would opt, and advised all my patients when I was still practicing, to have option 1. Using a femtosecond laser for the incisions does not improve outcomes, only increases costs. The lens inside the eye (cataract) is emulsified by a small probe that is vibrated ultrasonically either by a piezoelectric crystal or a pulsed laser at ~30-40,000 hertz. It doesn't matter which method is used to cause the vibration, the result is the same. Conclusion: "Laser" cataract surgery is a marketing ploy and not better than the alternative, and is used to justify higher fees to the patient that Medicare will not pay.

The different lens types are another matter. If you have significant CORNEAL astigmatism the toric implants are worth the extra cost. The important point here is it must be corneal (surface of the eye) astigmatism, not that due to the lens in the eye (cataract) which is corrected automatically by removing it.

Presbyopia correcting IOL's are, again, a different matter. Personally, I wouldn't opt for it. They all compromise distant vision to varying degrees, cause glare and haloes around point light sources, especially at night, and "waste" a fraction of the light entering the eye. Roughly half of the implant is focused at near so when looking at distance half the light isn't brought to focus and the reverse at near.

Don't pay extra for "laser". The results are the same as conventional. Do pay for the toric IOL if you have significant (.75 diopter or more) corneal astigmatism. The presbyopia IOL's are a personal preference, but I'd avoid them due to the optical defects they have. Of note is all these items are a la carte: you can get astigmatic lenses and/or presbyopia correcting IOL's with either laser or diamond incision tools. There is no need to package laser with the premium IOL's other than marketing and fee increases.

i was outsourced from va 2 years ago. i had to choose near or distant vision unless i wanted to pay for the other.
i opted for distant, bought $1 readers. i wear sunglasses for driving but close to 20/20 both eyes.

oh yeah, they had a package that would've done a better assessment, more bells/whistles to the tune of $5k/eye.

Re: “The next step up is laser surgery for the cataract, and a much better lens that will give me excellent vision from fingertip length to infinity.”

That’s an accommodating IOL? I have to say that I’m skeptical about the “from fingertip length to infinity” part.

^^^^^^^^^^^^
Eye doc should be in sales and marketing.

I'm 3 weeks post op on one eye and 4 weeks on the other. No laser involved in mine and I went with multifocal Panoptix lens in both. The surgeion also did limbal relaxation incisions on both eyes to correct minor astigmatism. I asked about the astigmatism because no other eye doctor ever mentioned it and he told me mine wasn't bad enough to clinically be diagnosed as astigmatism. The incisions basically nudge things into a better place for a better outcome with the lenses.

The upcharge after insurance was $2500 per eye for the Panoptix lenses and it was money well spent. I couldn't be happier with the outcome and can see clearly near and far. The day after the first eye I was 20/30 distance and a week later, a day after the second eye I was 20/20 distance and near in both. They say it can take 3 months to reach full potential but I really don't see need for improvement today.

I do have halo's off headlights, they're mildly annoying and supposedly may dissipate with time. I've read that your brain learns to disregard the useless information in time but each person can be different. I watched so many videos and read so many studies that I'm almost ready to apply for my surgical residency. The entire process fascinates me and I have new respect for the marvel that is the human brain.

I have commented on this subject many times, I will give a brief answer to this complicated question.

I went in to have my cataracts fixed. I did not see the up-sell train coming and got rolled over by it. I was talked into having the multi lens installed for a $3000 up sell. I was also told at that time that I needed to have my eyes resurfaced first. I agreed and had the eye resurfacing done prior to the cataract surgery. It was VERY painful after the surgery, and the liberal use of Vicodin was mandatory for a couple days along with laying flat on my back. I did not know at the time that it was all so they could sell me the upgrade. I also was told in the beginning that I could opt for the multi lens in one eye (dominate eye) and a standard contact lens in the other. After the multi lens was installed in one eye I was then told I would have to have that lens in both eyes.

I struggled with the eye I had the multi installed in for a year and put off the operation in the other eye until the problem was solved. I complained to the surgeon multiple times about a constant halo, driving at night was almost impossible, I was told multiple times by the surgeon that I was just too picky.
I finally decided to go to the Cole Eye Institute at the Cleveland Clinic.
They ran a bunch of tests and then sent me to see the eye surgeon.
He immediately told me he knew what was wrong. He said the first surgeon took too much material off my eye during the re-surfacing, and that eye, my dominant eye, would never be the same. He was also puzzled by the need to resurface the eye.
He then explained in detail the problems with the multi lenses that were NEVER told to me by the first surgeon.
He explained all the problems I was having and said that is the way a multi works. He said the halo I see is very visible by a percentage of patients who opt for the multi. He also said that the multi lens permits less light to pass through, about 10% less. If both these problems were told to me upfront in the beginning I would never had opted for the multi.
He told me that I would only be happy if the multi lens was removed and a standard lens installed. He was worried that the multi lens was installed over a year earlier but thought he could remove it but needed me to be awake during the surgery so he could advise me about the surgery while he was doing it in case he ran into a big problem removing the multi lens. He did not.
I went back to him a month later and had the other eye done with the standard lens.
Much better but my dominant eye will never be great.

Don't believe all the crap some Dr. feed you, its a money maker and they get on you like a used car salesman.

My wife and I, as well as every cataract patient I personally know, have all opted for your first option -- the basic procedure that is fully covered by MediCare.

Every one of us is fine in terms of walking around, driving, and in my case, passing the vision portion of the Commercial Pilot medical exam, all without glasses.

All of us do use glasses for desk work and reading. I can read or do desk work without glasses, but it is an effort, whereas it is very easy with glasses.

I would strongly suggest that you follow GJG's suggestion (he is an eye doc), and stick with the basic, simplest, lowest cost, procedure. It's really not a burden to use glasses for desk work and reading.

If you're a CostCo member, the optical department offers "workspace" progressives at very reasonable cost -- less than one tenth the cost of the two "upgraded" procedures that you mention, and none of the complications that can arise from them.

Best of luck to you, whatever you choose.

I had the top of the line deal 10 or so years ago and I consider the results to be miraculous. I wore very thick glasses for many years.

If you have to sell some guns or borrow the money, got with the 3rd option, you will not regret it.

Use a Dr that does a lot of these surgeries.

A good surgeon that you're comfortable with is the most important thing. My surgeon has done over 55,000 cataract surgeries and is a clinical instructor at our local university. He never pushed lenses at all and came right out and told me he didn't want to influence me at all. I could have left things as they were, gotten a new script for glasses or had the cataracts removed. A friend of mine had his done last fall and got the Panoptix and couldn't be happier so I knew going in that's what I wanted.

In contrast, a woman at work had hers done and got monofocals a month before my surgery. She had a different surgeon and is disappointed with her outcome. Her surgeon is my old eye doctor that I liked a lot but didn't know she did eye surgery. I'm glad I didn't know because I probably would have her do mine.

A few years ago I had subcapsular cataracts (inside the lens) and had to have the surgery at about 50 years old.

I opted for Light Adjustable Lenses, and I couldn't be happier. Bigger upcharge though, but I have a lot of working years staring at pc screens and speaking to groups to get through, and I didn't want to be messing with glasses constantly

quote:

Originally posted by mark60:
A good surgeon that you're comfortable with is the most important thing. My surgeon has done over 55,000 cataract surgeries and is a clinical instructor at our local university. He never pushed lenses at all and came right out and told me he didn't want to influence me at all.
<snip>

Ditto. My ophthalmologist is also an eye surgeon, and a teaching professor (at UCSD). At my last visit I asked him about cataract surgery. I wanted better visual contrast and color saturation. But his advice was to wait.

I also asked him about “Crystalens”, an IOL that has flexible haptics that provide a diopter or two of actual accommodation (at considerable extra cost). He wasn’t enthusiastic about those either.

Here’s an article about the Crystalens and Trulign Toric accommodating IOLs (both FDA approved). Just info – I’m not advocating these products. As I mentioned in the previous paragraph, my ophthalmologist wasn’t enthusiastic about them.

https://www.allaboutvision.com...commodating-iols.htm

quote:

Originally posted by mark60:
A good surgeon that you're comfortable with is the most important thing. My surgeon has done over 55,000 cataract surgeries and is a clinical instructor at our local university. He never pushed lenses at all and came right out and told me he didn't want to influence me at all. I could have left things as they were, gotten a new script for glasses or had the cataracts removed. A friend of mine had his done last fall and got the Panoptix and couldn't be happier so I knew going in that's what I wanted.

In contrast, a woman at work had hers done and got monofocals a month before my surgery. She had a different surgeon and is disappointed with her outcome. Her surgeon is my old eye doctor that I liked a lot but didn't know she did eye surgery. I'm glad I didn't know because I probably would have her do mine.

Where did this number come from? That’s like a surgery every day for 150 years or at least 75 years if just counting each eye?

quote:

Originally posted by mark60:
A good surgeon that you're comfortable with is the most important thing.....

I agree.

I had one done May 8 the other May 22 and it was a piece of cake, they really have this down. Their surgery center was efficient, the staff were friendly & competent, and they had me out in just over an hour both times. The actual procedure only took 7-8 minutes.

Like others the doc showed me three options illustrating the different lens' with large models. There was the opt 1 which Medicare pays for and it would have been fine giving me good distance and intermediate vision with readers for close work, computer monitor, reading, etc.

Option 2 was a multi-focal offering distance and "probably" good enough for close up w/o readers unless the print was pretty small. He pointed out on the model the slight ribs delineating the focus rings saying they can amplify glare say at night from oncoming headlights.

When I said I don't want that, he showed the 3rd option which worked similar to opt 2 only more progressive and w/o the ribs. Distance and intermediate will be about the same as opt 1 & 2 with even less likelihood to need readers than opt 2. And w/o the glare you can from lights.

I chose opt 3 which by the time everything was done cost almost $6,000. This included the all in one eyedrops (which Medicare doesn't cover) but easier to keep track of than 3 different drops over 3 weeks for each eye, and the eyes done 2 weeks apart.

I couldn't be more pleased, I was up to 2.50 readers and now I can see close up w/o readers better than before with the readers. Distant vision is night and day improved I can actually distinguish textures in pavement such as sand or gravel, I had lost that ability years ago. Colors are so bright now and no haze.

quote:

Originally posted by ridewv:
<snip>
I chose opt 3 which by the time everything was done cost almost $6,000. This included the all in one eyedrops (which Medicare doesn't cover) but easier to keep track of than 3 different drops over 3 weeks for each eye, and the eyes done 2 weeks apart.
<snip>

Was your “option 3” the “Crystalens” product that I mentioned a couple of posts above?

Following with great interest. My wife needs x
Cataract surgery now; I can wait some years.
Question: if you need readers for close-up it’s for the whole field of vision, right? So easier to work with than progressives?

quote:

Originally posted by RR:

quote:

Originally posted by mark60:
A good surgeon that you're comfortable with is the most important thing. My surgeon has done over 55,000 cataract surgeries and is a clinical instructor at our local university. He never pushed lenses at all and came right out and told me he didn't want to influence me at all. I could have left things as they were, gotten a new script for glasses or had the cataracts removed. A friend of mine had his done last fall and got the Panoptix and couldn't be happier so I knew going in that's what I wanted.

In contrast, a woman at work had hers done and got monofocals a month before my surgery. She had a different surgeon and is disappointed with her outcome. Her surgeon is my old eye doctor that I liked a lot but didn't know she did eye surgery. I'm glad I didn't know because I probably would have her do mine.

Where did this number come from? That’s like a surgery every day for 150 years or at least 75 years if just counting each eye?

You wouldn't believe the assembly line process. The procedure is only 10 or 15 minutes with the surgeon and he does them 2 days a week all day. the two times I was in there was a person in the OR, one in pre op and one in the post op chair. The prep room has chairs lined up on both sides of the room, one side waiting for surgery and one side waiting for discharge. Kinda seemed like cattle being led to slaughter.

One thing I wasn't expecting is seeing in a different color temperature is the best way I can describe it. Everyone says things are so much brighter and colors are more vivid and they are. What I didn't expect was a bluish cast, especially in sunlight. My week between eyes I was constantly alternating closing each eye to compare. My old eye saw everything yellowish compared to the new eye seeing more blueish. One eye at maybe 2700-3000K and the other up around 6000k. I asked at my post op if I was seeing the way a young healthy eye would or if it was a byproduct of the procedure, He told me that's what I've been missing. Everything is completeley normal to me now.

I should mention that my cataracts were mild and I didn't "need" them removed right away. My whole reason was to eliminate the need for glasses and thinking I'd need the surgery at some point in the future I'd do it while I was still youngish. I don't mean to seem excited but I couldn't be happier.

I had mine done two years ago. Back story, left eye is amblyopic from birth, 20/400. Right eye is farsighted. Wore glasses since grammar school. In my 40’s went with progressive lenses and never had any issues. When the time came for cataract surgery I went with the standard with distance lenses, looked forward to not wearing glasses. No problem with the surgery, 20/20 in my right eye within two days. I lasted about two weeks before going back to the doc to get my glass prescription changed to progressive with my 2.75 reader on the bottom and no prescription on the top. Over 30 plus years of progressive glasses I found it a pain in the ass to not be able to just look anywhere and have it in focus. About the only time I don’t wear them is watching TV. I guess if you have been using readers for years, you are used to having pairs everywhere for when you need them but I never have. I’ve spoken with many friends who went with the multi function lenses and most are not as happy as they thought they would be. My SIL went with distance in one eye and close in the other and was happy with her decision. It works well for her and didn’t have any up charges or halo effects.

quote:

Originally posted by Pipe Smoker:

quote:

Originally posted by ridewv:
<snip>
I chose opt 3 which by the time everything was done cost almost $6,000. This included the all in one eyedrops (which Medicare doesn't cover) but easier to keep track of than 3 different drops over 3 weeks for each eye, and the eyes done 2 weeks apart.
<snip>

Was your “option 3” the “Crystalens” product that I mentioned a couple of posts above?

No it was not Crystalens, I'm thinking it was an Anchor product.