How to assess a cataract surgeon's experience?

[CathyJM]

Now that I know which IOL to get, I'm wondering if I should ask for a more experienced surgeon. I don't have any complications so the surgery should be routine, with monofocal lenses. By accident I ended up having to see the newest, least experienced ophthamologist at a practice that includes two doctors who have been out of medical school for 20 years or so, have excellent reputations. This newer doctor graduated from medical school in 2001; I haven't asked about later training.

A local optometrist referred me for an emergency checkup after an optical migraine (visual disturbance in one eye that disappeared within half an hour -- my head felt "funny" but didn't develop a real migraine.) The checkup was to make absolutely sure my retina was OK, so I was urged to see this less experienced doctor rather than wait a few days to see one of the more experienced ones. He went ahead and tested my eyes for cataract surgery too, and expects to be the one to do it. I like him, and he acts confident, but I believe I don't know enough about him to be completely confident in his skill.

Maybe cataract surgery is so simple that someone who graduated that recently could still be considered experienced? What questions should I ask about his training and experience? The number of cataract surgeries he's done? Percentage of post-surgery problems? Post-medical school training? (All I can find online is the year he graduated from medical school.)

[Michael J Kutryb, MD]

Good questions and comments.  I personally use topical anesthesia as much as possible (over 90% of the time) and I've done about 4000 cases that way - but before that I did about 2000 with a block without a single block related complication except one case that had to be cancelled because there was some bleeding in the eyelid from the block  (surgery was performed no problem a week later.)  I have, however, seen about 4 cases in the past 12 years from other surgeons, who had complicatons from a block - all were double vision problems due to injection near the inferior rectus muscle.  I still do a necessary block on about 7% of patients for many different reasons.  These are usually incredible difficult cases referred from other doctors and I need the extra stability the block provides.  So in these cases, the block makes the case safer.  In the end ITS ALL ABOUT RESULTS and I've seen several incredibly skilled surgeons here in Florida do all their cases with blocks.  There has been a trend in recent years towards more topical anesthesia, mostly because its not only a  little safer, but also because its more efficient, not having to stop for 10 minutes to give a block, wait 20 minutes for eye to soften, then into OR for surgery.  I think to strictly avoiding a surgeon who does blocks is a bit of a strong statement.  Your not looking at the whole big picture.  Remember its all about results.  I'd rather have surgery by a doc who uses blocks who has a 0.5% complication rate vs a doc who does topical who has a 3% complication rate.  So the best surgeon is the one who listens to the patient, custom tailors surgery to the needs of the patient, and gets the best results with the lowest rate of complicatons.

Finally, as my general rule (others have their own valid opinions), if you're going to use topical anesthesia, you should aim to have surgery over in about 15 minutes or less or patient can get antsy sometimes.  As per your question, you can always add more topical anesthesia and or iv sedation as well.
MJK MD

MJK MD

[olaf]

I heard that topical anaesthesia was only for very experimented surgeons and simple surgery, because the duration of the sedation is very short (ten minutes ?).
By the way, is it possible to put a complement of anaesthetic drops during the surgery, if the initial topic anaesthesia is not enough ??
Thanks in advance.

[JodieJ]

All of the above suggestions are excellent, but there is one more consideration I'd like to add.  Apparently some doctors are still using injectable anesthesia (i.e., retrobulbar and peribulbar "blocks") for cataract surgery.  These "blocks" carry small but very serious risks (e.g., permanent loss of vision, eye muscle damage).  I'd strongly suggest that anyone avoid a surgeon using this type of anesthesia; topical anesthesia (eye drops) is so much safer, and you can go home without an eye patch.

[CathyJM]

Thanks ever so much. That's exactly what I need to know.

[Michael J Kutryb, MD]

One other trick that can be useful.  At the office where you have been going - ask a few employees "Now tell me the truth, because it's really important - who would you have to do YOUR  cataract surgery if you needed it?"

MJK MD

[Michael J Kutryb, MD]

Ask the following - how many surgeries have you performed?  What is your complication rate?  These are some basic questions.  My best advice is to ask one or two optometrists who the best surgeon in town is.  Ask your primary care doctor, ask  your neighbors, your friends, your hair stylist etc.  Eventually you will start to hear the same name or names again and again.  At that point you should be heading in the right direction.  True word of mouth referrals from happy patients may be your best source of true information.  Also - experience counts in this field.

MJK MD