Eyesight good after Implants

[Nearsited]

This is not so much a question but a happy result.  I posted a few discouraged queries to this forum.  After my first implant, non-dominant eye, on September 13th, my vision was very poor.  I couldn't see with my old glasses and couldn't see without them.  I wondered if a big mistake had been made.  After my second implant, on September 27th, I had a few days of strange vision.  I didn't realize it at the time, but my eyes were learning to work together.

I believe I must have monovision implants - Acrysof IQ.  Altogether my fully competent doctor spoke less than two minutes with me.  If I had questions, it was difficult to ask, as he was bolting towards the door with my closed file!  My non-dominate eye is near vision, the other is far vision.  Now that they are working together I can see pretty good - near, intermediate and far.  I can read, thread a needle, do my nails, etc. and I can drive (after two days).  Still haven't tried night driving.  I was quite near sighted before the implants, -8.75 and -5.75 with astigmatism in the -3 range.

I am posting this note to thank JodieJ and JCH for responding to my questions when I was feeling very stressed and anxious.  I read so much about Restor and Rezoom, but I can see just fine with the monovision.  I don't have any pain, or flickering, or dry eyes (still on medication drops of course).  So I also want to let people know that monovision can work.  I don't have any problem with depth perception either.  I am actually thrilled with the results, but did not find any of this a "piece of cake" which is what I keep hearing from other patients.

I am also thankful for learning on this sight that one must have patience with the healing process.  I heard that people could see great right after their surgery, but also read many times that one should wait a week to three before things start to settle down.

[JodieJ]

I have to admit that I was shocked at how little my cataract surgeon was compensated for his time and skills.  And the strabismus surgeon who eliminated my double vision (thereby saving my sanity) was paid even less!  In both cases, though, the surgery center received a nice payment.  Like many things in life, it struck me as very unfair.

I do think that good doctor-patient communication can have a lot to do with patient satisfaction (or lack thereof.)

[Nearsited]

I sincerely regret my choice of words and honestly did not mean any offense to you.  I realize that you are spending your own time answering questions in this forum and it is truly appreciated.  When I wrote those words "why should I be surprised at that" I suppose I was trying to be funny.  Making jokes at other's expense is not funny and very bad manners.  I have great respect for doctors, and tried to give my eye surgeon some benefit of the doubt by acknowledging his competence and skill.  However I remain disappointed with his "bedside manner" and concluded that his great rush was in order to see as many patients as possible.  I could look at this in another way - he is helping as many patients as possible.  Thank you for enlightening me on the state of medicare reimbursement.  My ignorance about all aspects of eye surgery has been incredible.

[John C Hagan III, MD, FACS, FAAO]

Hello Nearsited:  I can't you let take a pot shot at physicians without a response. First of all none of the physicians on this Eye Care Forum and other eye forums on the web are paid a penny for our time and expertise. If I were working for a lawyer in the lawsuit industry I would be paid about $500/hr for my expertise.  By that metric I'm giving away about $1000/day of free advice for people that I believe are appreciative and need it. If you think all doctors are greedy and out for the money, I'm sorry I took the time to answer your questions.

The government does not pay for premium implants and barely pays for cataract surgery. In the 1980s Medicare paid $1700 for a cataract surgery and insertion of an implant and 3 months care. In September 2007, Medicare pays $680 for the same procedure and 3 months care.  For contrast dentists in Kansas City charge $1000 for a tooth crown and that's maybe 3 visits.

Out of necessity anyone that wants to make a living doing cataract surgery has to do a lot of them for the huge reduction in Medicare reimbursement. In the meantime out malpractice insurance is about 10 times more expensive (about $80,000/year). If these reductions continue it may be more economical not to do cataract surgery and just see patients in the office. If that happens surgeons will move to different types of surgery and who will do the surgery then? Of ALL medical specialties Ophthalmology and eye surgery have had the largest reductions in payments from Medicare and private insurance companies. Fewer medical students find Ophthalmology attractive with this type of reimbursement.

There's little wonder with figures like this and attitudes like yours that Medicine is becoming much less attractive to talented and intelligent your people.

JHC III MD Eye Physician and Surgeon
(and not raking in the government money)

[Nearsited]

Yes, my docotor's attitude is disappointing and puzzling.  However I'm amazed at my own nonchalance and ignorance about lens implant surgery.  I had only heard others say how wonderful it all was, but I wasn't even aware of the different type of IOLs available.  After much research (after the surgery) I believe I was simply an assembly line patient, treated with the lens my government insurance pays for.  I also think that limbal relaxing incisions are not included in the plan, but would have improved my vision even more.  If I have laser tweaks for astigmatism later, I'm sure it will not be covered under insurance.  In a way, perhaps I was fortunate not to have to deal with what kind of implant to choose and to have all the costs covered by insurance.  Despite my doctor's complete lack of sharing information, I think he was very competent and I have had no post surgery problems at all.  I do have the feeling that he is just raking in the government money, probably doing up to thirty or more implants a week. Why should I be surprised at that!

I still will need glases - appointment is in November - and I am having problems with night vision - extreme glare from oncoming headlights.  I think this is because the one eye (near vision) is not focussing as sharply as the other, and therefore causing the starburst.  I'm certain that glasses will correct that.

[JodieJ]

I'm very glad to hear that you're happy with your results.  It's hard for me to believe that any surgeon would do a monovision correction without first discussing this with his patient.  (In your place, I'd be tempted to tell him how much anxiety I experienced as a result of his lack of communication.)

You may notice an improvement in your night vision over what it was before you developed cataracts.  The manufacturers of both the AcrySof IQ and the Tecnis IOL claim that their lenses provide improved contrast sensitivity/night vision.  I don't know whether this claim is valid, but I'd still recommend either of these aspheric monofocal lenses for problem-free vision after cataract surgery..

[John C Hagan III, MD, FACS, FAAO]

Hi Nearsited. Thanks for sharing your good result. These forum's tend to attract patients with problems as opposed to happy patients with excellent results. Thanks for the follow-up and restoring some balance to these discussions.

JCH III MD