CATARACT SURGERY FOR THE NON-GLAUCOMA PATIENT
We perform cataract surgery for the glaucoma and non-glaucoma patient. It can be an excellent opportunity for the patient to see better in their daily functioning. Cataract surgery creates an opportunity for the patient not only to see better, but also offers the chance that the patient’s reliance on glasses may be significantly less. Special measurements of the length and shape of the patient’s eye are made to determine the best/appropriate power of the intraocular lens used to replace one’s cloudy natural lens (cataract) to allow the patient to focus the light correctly on the retina. It is not a guarantee that the patient will not need glasses, but instead it may decrease the patient’s reliance on glasses. They may function well without glasses in many activities, but when push comes to shove and they need to see the finer details they may still need a pair of glasses. Doing this does not in and of itself require extra expenses on the part of the patient. This is part of the standard cataract surgery covered by all insurances. This procedure has been almost perfected over the years with excellent results limited risks.
In a quest to require less or no glasses by the doctors and the public, there are other “premium” lenses and/or refractive services associated with cataract surgery that are not covered by insurance. There is no guarantee that these services mean that the patient will not need glasses. The attempt is just to try to decrease even further the chance that the patient will need a glass. In fact, some of these other options, although they may allow the patient to see better without glasses (instead of see better maybe say require less of a need for glasses), may provide poor contrast sensitivity or chronic glare and halos as a result and a lesser overall quality of vision. Though these options are available, we do not believe that a patient’s need for better vision, which requires cataract surgery should automatically become a discussion encouraging them to have these additional surgeries and costs, especially when not requested by the patient. These are all reasonable options and should be considered in each case, especially with the patient’s own thoughts and circumstances taken into consideration. Unfortunately, patients are “sold” on options they do not always understand, and some patients who have very little financial resources have even been known to be persuaded to finance options for these procedures.
Cataract surgery is a wonderful, exciting, and innovative way to help patients see better in their daily functioning. There are many options available with excellent results no matter which option is chosen. The patient needs to offered all the options and their risks and benefits both ocularly and financially so the patient can make the best decision for themselves.
Stephen M. Wahl, M.D.
Comments by Dr. Hurvitz:
We see a constant trickle of patients who have had multifocal IOL implantation and are unhappy. We have helped these patients deal with these problems. Some have needed IOL exchange.
Below are some peer reviewed journal articles addressing these issues:
An article on the technical reasons why visual field is significantly affected by multi-focal IOL’s and should not be used with glaucoma or macular degeneration
http://dx.doi.org/10.1016/j.ajo.2014.04.017
An article about why multi-focal IOL’s were removed in a series of 50 cases
http://dx.doi.org/10.1016/j.ajo.2014.04.010
An article about the indications and contraindications for use of multi-focal IOL’s
http://dx.doi.org/10.1016/j.jcrs.2013.12.011
Below are some non-peer review references:
An article about what is part of the “custom IOL packages” that some doctors offer at extra cost
http://www.reviewofophthalmology.com/content/d/cover_focus/i/1220/c/22982/
A major consumer advocate magazine says to be wary of premium lenses.
Contact us if you would like to see the article in our waiting room.