Scared Perfectionist Has Cataracts

Hello,

My dad is 65 years old (retired), and is easily mistaken for 45 years old since he is in excellent health, and does not need any medications.

About 20 years ago, he was prescribed mild eyeglasses for reading fine print, such as stock quotes in the New York Times. As he aged, he gradually needed strong eyeglasses for reading, since he is presbyopic (farsighted).

My dad has developed cataracts on his left eye, for the past 10 years, and for the past couple of years, it has worsened.  From his left cataract eye, he can still see people, but cannot see their facial features. Now, the right eye has also started to develop a mild cataract also. This is high time that he has to undergo Cataract Surgery.

Even though he hates to wear glasses, and is least worried about cost, still he wants the CONSERVATIVE choice of monofocal IOL instead of multifocal, because he is a perfectionist, who wants least complications. Only the problem is he is SCARED. He wants to know what precautions to take before, during, and after the surgery, so that it should be perfectly done. More importantly, he wants an experienced surgeon who should perform or recommend all necessary tests (diabetic retinopathy, macular edema, lipid leakage, etc, etc, etc) prior to cataract surgery. The surgeon himself should make all the PRECISE eye measurements for the perfect power and size of IOL. He wants a surgeon who mostly uses topical anesthesia (as opposed to injection) to perform the cataract surgery with minimum incision, to break, and remove the cataract, without leaving any partical behind. The perfect power IOL implant should be the perfect fit in the capsule. All of this should be completed without any complications at all.

The question is, how do we go about finding that surgeon in New York City?


Thank you, and we appreciate all your help

[JodieJ]

NO doctor can guarantee perfection.  For a list of the local board-certified surgeons whom other doctors would choose for their own cataract surgery, go to www.castleconnolly.com.  For a nominal fee, you can get names, contact information, and details about practice, education and training.  I have had very positive experiences with Castle-Connolly doctors.  Your father may want to consult more than one doctor before making a decision.    

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

Perfection may exist in the here-after but not in this world. Even if there was such a thing as the best cataract surgeon in the world that surgeon would have complications with cataract surgery and at least every 5 to 7 thousand cases complete loss of the eye due to infection or bleeding.

It is normal to be scared. Perhaps he would feel better if he would talk to some of his friends that have had successful cataract surgery. There are over 2 million cataract operations done in the USA each year so there is a huge pool of surgeons that do superb work.

You father takes a risk of loss of life every time he gets in a car, plane, bus, taxi. He takes a chance of a major bleeding problem every time he takes an aspirin. Life is full of risks. Physicians however have to spell out the risks, even those that are very rare--such as loss of the eye----and that makes people nervous. In the past physicians didn't talk about risks  for a variety of reasons mainly that it created great cocern and worry. Now the legal system and consumer rights demands have legally mandated this "informed consent"..

Your father would probably be more comfortable going to see 2 or 3 surgeons to see which he feels more comfortable with.

You can find a list of cataract surgeons that belong to the American Academy of Ophtahlmology at www.aao.org

JCH III MD

[wdt2613]

I had my cataract surgery done on 10-19-07 after consulting 3 doctors.  I find the best ones to be the ones who have done this process many many many times, know the risks, care enough to not view you as a dollar sign, and spend time working on your eye.  My doctor took 1.5 hours to do my single cataract because of complications that developed.  It was very concerning considering I am 30 years old.  Now I have 20-15 visions with a bunch of reflections.  I would think you should see JCH on this board, he seems excellent, just my humble opinion.  If your father is that concerned about finding a doctor, I am sure he could front the bill to JCH's office.

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

-------------------

[ClearEyes]

Good Evening,

We really appreciate all your helpful responses. This forum will ultimately help my dad in finding the cataract surgeon best for him at last!

JCH, we agree with you when you explain that, "Perfection may exist in the here-after but not in this world." We are looking for an experienced cataract surgeon who will take due diligence in minimizing the risks, before, during, and after cataract surgery. Most importantly, a cataract surgeon who has concern for the patient. As for the outcome of cataract surgery, we must leave this on God.

My father wishes he can have you perform the cataract surgery; he's in New York. If you can personally recommend few cataract surgeon within the 5 boroughs of New York City, we will truly appreciate it.

Jodie, is there another site other than Castle Connolly to search for qualified, and experience surgeons? It seems that Castle Connolly lists ALL the cataract surgeons that exist within a given area. We searched Castle Connolly for cataract surgeons in Brooklyn, NY, and were flabbergasted to find the name of this one surgeon who bought on my dad's anxiety to have cataract surgery in the first place!

Two years ago, my dad went to a cataract surgeon, adjacent to Maimonides Hospital. Instead, when he got there, the medical assistant performed the eye
measurements. Finally, when he got to see the surgeon, the total he spent with my dad was not more than 5 minutes (maybe 3 minutes), including  1/2 minute spent examining my dad's eyes. The surgeon told my dad he should get cataract surgery
immediately, without delay. My dad expressed that at last, he will get rid of his eye glasses after surgery. The doctor replied that he mostly performs MONOFOCAL surgery, but if my dad wants, he will perform MULTIFOCAL surgery, but it is very
expensive. Then, my dad asked the surgeon which MULTIFOCAL lens will he use, and the surgeon replied that all lenses are the same, hence it won't make much difference. My father was just shocked! Won't make much difference???

The surgeon then left the room, and my dad thought he would return. Few minutes later, he asked the nursing assistant where was the surgeon, and she replied that the surgeon is in another room, and if he wants to make surgery appointment, go and make it. My dad was happy to walk out of that place!

Total conversation took, including testing, 3 minutes, DEFINITELY not more than 5 minutes.

After seeing this surgeon's name on Castle Connolly list, it seems we are back to square one. Jodie, is there any other list we can search where we can find few surgeons who can fulfill our needs for MONOFOCAL implant, i.e. perform all required tests, make accurate eye measurements, use topical anesthesia, make minimal incision, etc? Most of all, show concern for patient? Or, if you personally know of
any cataract surgeons within 5 boroughs of New York City, we will appreciate.

Because my dad is a "perfectionist", he settled with MONOFOCAL, rather than MULTIFOCAL, even though he does not like wearing eye glasses. Money is not an
issue. As a matter of fact, after everything goes successfully, he will even REWARD.

WDT, yours is a successful story, and hopefully, my dad also will have the same.

Looking forward to your responses, advice, etc.

Happy New Year to All!

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

-----------------------

[JodieJ]

Like the best restaurant guide, no directory is infallible.  I've had four successful eye surgeries with Castle-Connolly doctors.  All their doctors are experienced, board-certified, and well-regarded by their peers.  You might also try the aao.org directory which Dr. Hagan recommended, although the surgeon whom your father disliked is probably listed there, too.  

In my own case, I narrowed my selection to doctors who 1) practiced both cataract and refractive surgery (I wanted to reduce my astigmatism) and 2) were conveniently located.  I consulted three doctors and was very happy with the one I chose.

I suggest that your father set up consultations with 2-3 doctors before making a decision.   Unfortunately, however, this isn't a perfect world, and I suppose that your father might find something wrong with each one if he looked hard enough.  Yes, having cataract surgery can be scary for many people, but I think that your father can look forward to having better vision as a result.  Best wishes.      

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

---------------------------

[ClearEyes]

Hi Jodie,

Thank you for your concern. We really appreciate your interest in our situation. My dad said that he feels we've come to the right place, since there so many helpful people, as yourself, on this forum.

Currently, I am researching several doctors on Castle Connelly and American Academy of Opthalmology websites to find the doctor who is experienced in cataract surgery, and perhaps other areas where my dad may need help as well, even though he doesn't know of any other eye problems (except the cataracts). Most importantly, someone whom my dad will find least fault with.

My dad is absolutely strong willed when it comes to surgery, because he is extremely health conscious, especially for his eyes. His ophthalmologist, whom he visits every couple of years for eye glasses prescription, commented that going for cataract surgery is like getting a haircut; any ophthalmologist can perform it! God forbid, the surgeon doesn't take necessary precautions, and my dad looses his sight!

My dad and I have compiled a list of questions to ask during the consultation. I eventually want to have a list of 5 or 6 powerful, and thought-provoking questions. Please critique the below questions, and tell us if there are any questions to add, modify, or simply delete:


1. What are the necessary tests to perform BEFORE cataract surgery, to ensure there are no diseases of the eye, which may interfere with the surgery, cause complications, etc? Will you perform these tests, or do I need to visit another specialist?

2. Will you perform the eye measurements? How will you ensure these eye measurements are most accurate?

3. How will you calculate the power of the IOL I need, with minimal error?

4. Do you prefer, and use topical anesthesia on  your patients?

5. Do you prefer, and perform Phacomulsification on your patients, i.e. make minimum incision, suction the cataract fragments? How will you ensure that all the cataract fragments are removed from the eye capsule as completely as possible?

6. What mechanism will you use to ensure that the MONOFOCAL IOL is the best fit for my eye capsule?

We absolutely appreciate the support and help from this forum.

Thank you,

[JodieJ]

In both of the directories we mentioned, you can narrow your search to doctors who specialize in cataract/IOL.  I'm not an M.D., so I'm not going to critique your list of concerns.  However, I suspect that your father would prefer a doctor who is very patient and willing to address each of his concerns in detail.  The goal is to find a doctor with whom your father feels comfortable.  I suggest that you set up 2-3 consultations and go from there.  Best of luck, and I really believe that your father can look forward to having better vision.

[ClearEyes]

Good Afternoon everyone, especially Jodie,

My dad recently visited a cataract surgeon for initial consultation for Monofocal cataract surgery. As a patient, my father has many concerns about the surgery, however, the surgeon told him to ask the
question which is bugging him the most. My dad expressed concern for performing due diligence, before, during, and after surgery, rest is up to God. The surgeon said, don't worry about it.

We started to ask about the Cataract ID card, which has been mentioned on this board, but the doctor never heard of it, and asked to give him the literature, or website where he can find out about it. We ourselves searched GOOGLE, but in vain. Is there anyone who can explain what this ID card is?

Best regards

[Occupant]

I think, although I am not absolutely sure since nobody called it that when I got it, you are referring to the plastic card (similar to a credit card) that they hand you after surgery for each eye that lists the manufacturer, the type of lens and the diopter of the IOL that they just put in.

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

That is right "occupant"  the card has the IOL manufacturer, model number, serial number and power. The information is also put in the doctor's chart and the hospital/ASC chart.

JCH III MD