Post Op Cataract Surgery

[JoKelly]

Now on day 4 post operation.  Great distance vision in new eye needing glasses just for close work.  However when I add in the other eye, there is distortion on that side, plus different colour perception.  The new eye is like someone switched on a bluish neon light and the other eye sees a yellowish tint!  If I put on my old glasses, I can see just about okay for both distance and close work.

My question is, what are the options to cope with the poorer vision in the remaining eye?  Add this eye in and I have an awareness of a shadow on the edge of my new eye and also lights at night are like big circles with black interiors.  I feel like begging them to do the other eye which does not have a cataract just to even them up.   Is it likely they can do that?  Maybe a contact lens on one eye only?  Or just corrective glasses to be worn all the time.  That would be a shame as if I cover up the remaining eye, I can see sharply and clearly for distance.  

I just need to know what is possible.  Many thanks.

[JoKelly]

Just now to update this thread.  I was 'fortunate' enough to consequently develop a cataract in the other eye some six months later.  I had since returned to live in the UK permanently.  The same surgeon said she could see it was dead centre vision and I got the operation within six weeks.  Now I can see without specs at least to find them when mislaid!  Actually because I need just a bit of help on distance and certainly on close work, I have opted to wear my specs permanently again as I just can't put up with forever putting them on and off... My slightly aided vision is just great, so are colours and night vision so I have greatly improved vision overall and will be content with this.  I would say the second eye did not have the amazing improvement the first eye did, but it is much better.

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

Well see what the physicians in Cyprus say, perhaps you can get it done there. Otherwise your daughter can arrange a consult in the US. 3 months would be time enough to have the surgery done and recouperate.

JCH III MD

[JoKelly]

I went to a private hospital here in UK and enquired.  They asked me if I was on the NHS waiting list and I said no, that I had now been discharged.  They replied that they would not consider doing an eye that  obviously 'was not ready' and that the well regarded surgeon who had done my cataract eye, would not do it either even if she was into private practice (which she isn't).  So there appears to be a major attitude difference between US and UK and I am wondering when I get back to my Cyprus home again, what would be their attitude (should I decide to risk it),  I return there in February with my new specs, having by then waited the requested six weeks post op before an eye test for them.   My daughter is in Dallas incidentally and I will be making a three month visit in June.  The cost here in UK per eye is £1800.

[John C Hagan]

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[JodieJ]

Probably the cost varies significantly by geographic location.  Total cost for cataract surgery at a downtown Chicago surgery center using a monofocal IOL was $5000 per eye (without insurance coverage) in 2006.  I doubt the rates have gone down over the past year; probably they are even higher today.  Fortunately, my Blue Cross paid the entire bill.

[John C Hagan]

If the cataract does not bother you don't operate on it. Surgery should be done only when you think it a moderate or large problems and you understand the option of no surgery and the risks of surgery.

Ask your daughter to investigate "private pay (cash)" costs of surgery. The entire package of surgeon fee, initial evaluation, tests to determine the power of the IOL, use of the OR, staff, medication, cost of IOL and 3 months post operative care will probably be $3000-4000 (US). With the weak US dollar this will help you a great deal.  It will be much less expensive to operate in the surgeons surgicenter than at a hospital. Additional costs will include eyedrops. Matching the IOL you have exactly is not important. They're all pretty much posterior chamber IOLs.

JCH III  MD

[JoKelly]

I spend months at a time in USA with my married daughter and she works in a private hospital.  I shall ask her about the costs involved, but in your experience, what would be the average cost of doing one eye and would I have to ask my surgeon what implant she used so that they both could be the same?  In view of what advice I got (which I realise is given out by the cost conscious NHS here in England) is operating on a very slight cataract eye worth the risk?

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

Keep the private option open. There are many Canadaians that come to the US for cataract surgery because of problems with their national health system.

JCH III MD

[JoKelly]

Well I have been back for my appointment and asked for the other eye to be done,even privately.  They said that my corrected vision in the remaining eye was too good to operate on.  Apparently here they run a crosses system, and 8 crosses equals an operation.  They said I only have one cross against the remaining eye.  So in a month's time it is glasses again all the time.  They asked me to consider that if the operation was not such a success a second time,. I might actually suffer loss of vision!   I am resigned to it now and longing for better glasses to wear which will even up the two eyes.  I am really grateful for the better vision, even if it is only one eye, as I can at least start driving again.  Probably in a few years time, I shall qualify for the other eye.....

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

You are welcome.

JCH III MD

[h2oskier]

Thanks for the insurance suggestions.  I will see what I can do.  I am really feeling the same way that JoKelly feels in that I am ready to start begging for them to do the second eye.  Depth perception is a big factor.  My vision is pretty good in the new eye in all vision fields.  I know that everything would be clearer if I had both eyes working as a team.  Thanks again for your knowledge.

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

We often quote a study from the British National Health Insurance. At one time they just wanted to do one cataract surgery per patient and just make them live with the cataract on the other eye while it slowly went blind. There arguement was that it would half the cost of cataract surgery to the UK and one eye was good enough.

A study was started to see if fixing the second eye really did help a person function better. They hoped it would not. The study showed that fixing both eyes improved depth perception and there were far fewer falls and broken hips, better field of vision and far fewer driving and other accidents, that disease on the back of the second eye could be detected better, that emergency surgery for a too ripe cataract was eliminated.

Their conclusion was that fixing the second eye actually reduced costs to the NHS. Now its just a matter of going to the back of the line for the second eye and reported here i this forum waiting 6 to 12 months for the second eye.

JCH III MD

[JoKelly]

Many thanks for these answers which have been of great reassurance to me.  Fortunately I am under the umbrella of the British National Health Service and all treatment is completely free for us.  I have a daughter living in the States and health insurance looms large over the lives of most Americans I know.  I have another week to my follow up appointment.

Distance vision is good in the new eye but I would need glasses for close work.  The other eye now seems very blurred, yellow colours and produces haloes in artificial light as well as the shadow at the edge of my new eye vision, so I cannot wait to see what solution would be offered.  I feel like begging them to do the other eye to match!    Perhaps they will.  Anyway thanks again.

[John C Hagan]

JoKelly, I can make a few comments. First the change of color is the most common thing that people note in the first few days. The most common type of cataract is yellow-brown and selectively blocks out blue and makes white look yellow. When the cataract is removed and the IOL placed in the eye everything looks "too blue" but you get use to that fast. You can calibrate the color in your new and old eye by looking at something you know is white.It will look white in the new one and yellow in the old one. The blue will seem normal in a month.

You may have some luck with getting insurance coverage for your unoperated eye if: 1. You cannot wear glasses because of the difference in the strength of the old and new eyes. 2. If you have glare and night vision problems and the glare is coming from the eye with the small cataract. Remember if you are over 60 almost everyone has microscopic levels of cataract.

JCH III MD

[h2oskier]

I can also notice the difference between the two eyes post cataract surgery.  I had my left eye done on 11/14/07 with a crystalens IOL.  Insurance denied paying even their part of the claim because it wasn't yet "medically necessary."  My vision was very limited and it was dangerous to be out and driving so I had to get it done.  I am going to have to wait to have the cataract removed on the second eye until I am practically blind for insurance to kick in.  I'm thinking about taking out the lens in an old pair of glasses for the operated eye and leave it in for the other.  On the operated eye my vision is 20/20 in all three vision fields.  It is incredible!

I am now almost 3 weeks post op and the color difference is not as dramatic as it was in the beginning.   Like you, I notice the oncoming lights at night, but that has also been diminishing somewhat over the last week.  I notice a shadow/reflection on the side of my eye.  My dr. said that he thinks that it is the incision that I am seeing, and that as it heals the "reflection" will go away.  Hope that helps some.  

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

We do not give advise on the immediate care post-operatively. You have good questions but you need to ask them of your cataract surgeon.

JCH III MD