Health & Wellness

Cataract Surgery - pros and cons of options

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  • Oct 8th, 2018 4:42 pm
[OP]
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Mar 28, 2005
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Cataract Surgery - pros and cons of options

I wonder if someone who has gone through this, or possibly an eye professional, can comment on this.

My oophthalmologist is suggesting that I have cataract surgery to improve my vision.

I currently have glaucoma in one eye which is controlled with drops, but a portion of the optic nerve was damaged so my vision towards the centre is compromised.
In the other eye I have Macular Degeneration caused by severe nearsightedness.
Seems I need to get stronger glasses every year or so.

I received a questionaire from my eye surgeon with 5 options to chose from.
The options really don't make much sense to me since they are purely dollar related.
My consultation with the doctor is Monday next week and I wanted to be a bit prepared, so I'm looking for a bit more "terchnical" input on them

The options are:
1. Wear glasses all the time; OHIP pays for everything
2. Wear glasses all the time with improved quality of vision - approx. $500.-
3 Wear glasses for near vision (within arms reach) - approx. $2400
4. Mainly no glasses - $4700.-
5. Glasses mainly for distance vision; usually removed for near vision - $500 to $2400.-

I thought the options were basically:
a. Fixed focus spherical IOLs where OHIP covers the cost. Choice of lens power for distance or near vision; wear glasses for whatever the implant does not correct
b. Fixed focus aspherical IOLs where I pay a premium (option 2 above?). Choice of lens power for distance or near vision; wear glasses for whatever the implant does not correct
c. Toric IOLs to correct for astigmatism at extra cost. I do have mild astigmatism but from what I read not worth trying to address with implants
d. Accomodating IOLs - asperic design with some capability to adjust the power of the lens.
e. Multifocal IOLs - asperic design with some capability to adjust the power of the lens.

My current prescription is around -10 diopters, so I doubt options d or e above will allow adjustment to eliminate glasses, although....
the doctor suggested that I have a very stron prescription partially because of the cataracts
Last edited by krs on Sep 25th, 2017 6:04 pm, edited 1 time in total.
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Oct 6, 2015
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krs wrote:
Sep 25th, 2017 6:04 pm
I thought the options were basically:
Is there not a monovision option amongst those? With your other eye issues, the multifocals are likely an especially bad idea.

Do you hope to achieve spectacle independence or not? I'd be personally inclined to go with the fixed focal length aspheric lenses, in a monovision configuration if you can tolerate such (ie: your dominant eye corrected to plano, the non-dominant eye corrected to a -1-1.5 or something).

The 'problem' is that if they get it wrong, you'll either need glasses, or you'll need topography guided PRK to fix it.

Can you tolerate soft contact lenses at the moment? You might want to see if you can do a monovision trial to see if you can tolerate the imbalance. Some people do very well, some people don't.
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Nov 1, 2006
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I haven't had cataract surgery yet but a misdiagnosis by a Toronto ophthalmologist sent me down that path a couple of years ago. Anyway, I consulted with an extended family member who works in another country and his advice was unambiguous: go with the simplest lens and and use "external" correction for any other issues. In this case, that is the OHIP provided procedure.
[OP]
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Thanks for the comments.
l prefer not to have to wear any glasses for day-to-day activities but don't mind them for reading or computer work.
So basically have the IOL's adjusted for far vision.

I read about having a different prescription for each eye - one for far and one for near vision; not sure if one of the options covers that - maybe option 4

The OHIP version I think provides spherical lenses whereas aspherical lenses are closer to what the natural lens is, so that sounds like a better option.
But I'm not sure how much difference this makes in practice; maybe the $500.- is a good investment

For option 3 I have difficulty understanding what I'm paying $2400 for compared to options 1 or 2
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krs wrote:
Sep 27th, 2017 5:46 pm
I read about having a different prescription for each eye - one for far and one for near vision; not sure if one of the options covers that - maybe option 4
Ummm, no, monovision shouldn't cost any more than normal spherical or aspheric lenses. They just select a different power for one of the lenses versus the other. Pretty much any competent cataract surgeon can do the calculations and get you pretty close to a target refraction with IOLs.

The question becomes, can you tolerate monovision or not. Some people can't because it can induce migraine headaches.

I'm not sure that the slight bit of additional counselling, etc., costs $4700. They might be fitting an "accommodating" IOL in such case, or a multifocal.
For option 3 I have difficulty understanding what I'm paying $2400 for compared to options 1 or 2
Yeah doesn't make a lot of sense to me.
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My dad had the surgery a few months ago and chose Option 3 and paid out of pocket $2000.

Essentially my understanding is that Option 1 fixes the cataract but doesn't fix the vision - so you'd still need glasses as you do normally for all your near-sightedness. Option 2 does fix the vision but does not fix astigmatism which means you'll still need glasses if you have that. Option 3 will fix astigmatism also, you may still need glasses for reading etc.

Months after the surgery, my dad doesn't need glasses anymore but is considering getting a pair for reading and using computer.
[OP]
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kmarcie wrote:
Sep 29th, 2017 2:46 pm
Months after the surgery, my dad doesn't need glasses anymore but is considering getting a pair for reading and using computer.
That's essentially where I want to get to.

I have some astigmatism but very light.
I have to figure out which entry on my spectacle prescription describes that to see how severe that is.

I also spoke to another person who had this surgery done.
Their choice was simply hard or soft lenses, hard covered by OHIP, soft were $320.- per eye.
Now I'm not sure where hard vs soft even gets into the picture.
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Aug 29, 2006
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Not a directly personal experience but many senior members in the family had done it and I believe the problem with options 1-3 & 5 is you just don't know what you will end up with. Sometimes, one didn't have near visions problem before ended up need glasses for it after or astigmatism and vice versa, etc...

Seems to be the luck of draw with the cheaper options and more chances of not needing glasses with the more expensive.

I am guessing the most expensive is basically one of the other options but with a correction procedure after.
krs wrote:
Sep 29th, 2017 4:08 pm
That's essentially where I want to get to.

I have some astigmatism but very light.
I have to figure out which entry on my spectacle prescription describes that to see how severe that is.

I also spoke to another person who had this surgery done.
Their choice was simply hard or soft lenses, hard covered by OHIP, soft were $320.- per eye.
Now I'm not sure where hard vs soft even gets into the picture.
The Devil made me buy it - RFD. :twisted:
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Yeah good point, paying the extra over and above aspheric or monofocal lenses (not to be confused with the expensive multifocals) could very well be purchasing a commitment by the surgeon to do an exchange, or to do PRK if the implant doesn't correct the vision to glasses-free status. Hence, the fee.

The el-cheapo OHIP surgery will replace the clouded lenses, but they could miss their target for the implants, and accordingly, glasses could be required.

This is one thing that people who undergo LASIK/PRK need to be especially aware of, that there is a higher chance that it might be harder to hit the target for prescription with a lens implant. These patients might need their lenses changed, or another PRK procedure performed. If they had LASIK previously, this could present more technical challenges. Moral of the story, don't get LASIK.
[OP]
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Thanks for all the comments.

My consultation is on Monday - hopefully that will clarify a lot of things.

My guess is that not all of the 5 options that were listed are actually options in my case with the vision problesm I have in addition to nearsightedness.
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I just came across my old thread lokking in this section about a thread on generic vs brand-name medication.

On the cataract surgery - in the end it turned out that in my specific case there were only two options - either the OHIP version where OHIP pays for everything or an option to get a more accurate measurement of the eye (using lasers rather than ultrasound) and an option to get IOLs that are closer to the shape of your natural lenses rather than the one OHIP provides.

Suggestion was that the upgrade options would in the end provide slightly better vision.

I opted for the better option in both cases considering it would affect my vision for many years to come so I might as well make it the best it can possibly be.
Maybe the OHIP option would have been OK and given me the same vision, but if it hadn't I would kicked my self for years after to save a few bucks.

Trouble is one never knows - it's not like glasses or contacts - try these and those and a third pair and decide which ones work best.
One essentially gets one kick at the can.

I'm now one the last week of eyedrops in my second eye that was done, eyedrops in the first eye that was operated on were stopped about a week ago.
The whole procedure itself was absolutely painless.

Vision in the first eye that was done ended up at 20/20 (sometimes 20/25) about a week after surgery, the other eye is still blurry due to the drops.
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krs wrote:
Jan 18th, 2018 9:25 pm


Vision in the first eye that was done ended up at 20/20 (sometimes 20/25) about a week after surgery, the other eye is still blurry due to the drops.
Can you elaborate? What kind of surgery were performed for both of your eyes? What type of lenses did you chose? All technical and financial aspects ... if you don't mind.
[OP]
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Somehow email notification doesn't always work on RFD - just saw the question now.

I don't really understand your questions:

What kind of surgery were performed for both of your eyes? - Standard cataract surgery - I didn't know there were any options
What type of lenses did you chose? - When I had my final consultation with my ophthalmologist there were only two options as far as IOLs were concerned - the OHIP standard or the somewhat better version at $175 per eye. I chose the better version.
The only other choice was either the OHIP option to measure your eyes to determine the strength of the IOLs or pay a bit, I think it was $150.- to get the more accurate laser measurement. The OHIP option uses ultra sound and makes one measurement - the laser option takes a few measurements and is more accurate.
I chose the laser option.
In general my thoughts were that these IOLs are good for the rest of my life - many, many years anyway, so unless the costs were really outrageous I would go for the best I could.
Glasses were costing me quite a bit since I needed very strong ones so I paid extra for high index lenses.

I just went back to my regular optometrist two days ago with the expectation to get some normal glasses now.
Bottom line is that on one eye the vision is 20/20, the other eye has optic nerve damage from about 20 years ago and IOLs can't correct that.
I now only need reading glasses and was told by both the ophthalmologist and the optometrist to go to the dollar store and get them there - 1.75 for computer work and 2.50 for regular reading.
Did that - set me back $1.25 each - computer screen is crystal clear.
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krs wrote:
Feb 3rd, 2018 11:25 pm
Somehow email notification doesn't always work on RFD - just saw the question now.

I don't really understand your questions:

What kind of surgery were performed for both of your eyes? - Standard cataract surgery - I didn't know there were any options
What type of lenses did you chose? - When I had my final consultation with my ophthalmologist there were only two options as far as IOLs were concerned - the OHIP standard or the somewhat better version at $175 per eye. I chose the better version.
The only other choice was either the OHIP option to measure your eyes to determine the strength of the IOLs or pay a bit, I think it was $150.- to get the more accurate laser measurement. The OHIP option uses ultra sound and makes one measurement - the laser option takes a few measurements and is more accurate.
I chose the laser option.
In general my thoughts were that these IOLs are good for the rest of my life - many, many years anyway, so unless the costs were really outrageous I would go for the best I could.
Glasses were costing me quite a bit since I needed very strong ones so I paid extra for high index lenses.

I just went back to my regular optometrist two days ago with the expectation to get some normal glasses now.
Bottom line is that on one eye the vision is 20/20, the other eye has optic nerve damage from about 20 years ago and IOLs can't correct that.
I now only need reading glasses and was told by both the ophthalmologist and the optometrist to go to the dollar store and get them there - 1.75 for computer work and 2.50 for regular reading.
Did that - set me back $1.25 each - computer screen is crystal clear.
Could you let me know what clinic/doctor you had?
Was quoted 2300 for each eye! I'm finding prices to be range wildly. Thanks.
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1stRock wrote:
Jun 18th, 2018 7:32 am
In Quebec premium lenses are free.
Are you sure?
A friend of mine on the West Island had cataract surgery not long ago and the only lenses that were free are the very basic ones.

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