cataract surgery, astigmatism, blended vision

[riccja]

I have been diagnosed with cataracts in both eyes. The surgeon recommends removal of both cataracts. The insurance pays the full cost of the procedure with the same strength iol placed in both eyes.

I have an astigmatism in both eyes which he recommends I have fixed for 1,000 and eye. And in addition he recommends a premium iol with my dominant eye set for distance and my left eye for computer work....which is supposed to be a newer technique then mono vision....he calls it blended vision. He says he does not have any complaints with this technique as opposed to some people not adjusting to Mono Vision. The cost of this is 750 per eye.

He is also the only surgeon that offers a laser alternative as opposed to standard removal of cataracts. The cost of this is an additional 750.00 per eye. I have so far elected not to do the laser upgrade.

Any thoughts or comments on the above would be appreciated.

In addition I can function well with glasses. The only problem I am experiencing now is halos...around lights at night.

A few of the questions I have are....is the additional 3500 worth it as opposed to just the removal with standard iol. The thought is I most likely will need glasses anyway for reading close to my face.

thanks

Rick

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

This is the last comment I will make and it presumes you live in the USA.  Standard, one focus IOLs do not command a premium above what insurance companies and Medicare allow.  Note that deductibles and co-pays apply.

There is no extra charge for the surgeon using different one focus IOLs to try and correct for post op variables like: both eyes set for distance, or near, or mono-vision, or mini-monofocal blended vision.

Extra charges apply when "Premium" IOLS are used that are multfocal, toric, accommodating, or when refractive surgery is done at the same time.

That's all I have to say.  Take your time. Understand the procedure, option and costs. consider a second opinion.
JCH MD

[riccja]

Actually the IOSs are not toric and he is not using a laser...just the traditional cataract replacement.

The 2 IOLs that he is considering are the Nanoflex or the softec. Both based upon my research are standard IOLs that if he were putting both in at the same correction all would be covered by the insurance company?

Help!

Rick

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

that's a question for the surgeon. Likely reasons  the monofocal IOLs may be toric IOLs which are extra cost;  using the femtosecond laser for incision, corneal reshaping, cataract fracture and capsulorhexis is an extra cost. (bear in mind the cost to the surgeon of a femtosecond laser is over a half million dollars)

JCH MD

[riccja]

After giving this some thought I have the following question. I mentioned above that the cost of blended vision or mini monovision was going to be 750 per eye.

But if all the physician is doing is using 2 standard iols' with different strength why the additional cost?

Thanks

Rick

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

Many people have shared their thoughts and the posts such as luvtoski above are very helpful.  Most important thing is there is no correct answer for everyone but know what your getting into and especially be sure you understand the risks.  It is much easier to go into surgery thinking that it is "routine" and "risk free"   nothing in life and Medicine/Surgery is risk free. Think about it like driving a car. We do it every day. Every day we read in the newspaper that someone or two or three was killed in car crash in your area. You still drive because we think it will happen to someone else.  

EVERYONE CONSIDER THIS ANOLOGY:  Think about taking a car trip.  One vacation spot is quite nice and is 100 miles away and the roads are good; a second vacation spot is 1000 miles away, its a fabulous 'destination' vacation like Disney World, or Yellowstone National Forest or Branson MO. However some of the roads are 2 lane and curvy.  The rewards are higher with the longer trip but so are the risks/costs.  Each person must decide how much risk they want to take and how much money they want to spend and how much they think the longer trip will be worth.  That's the bottom line and everyone should be able to understand the concept.

JCH MD

[Luvtoski]

I agree with Dr. Hagan...slow down, do much more research, and try to make an informed decision so that you don't have dreaded regrets.

It is NOT all about the money...if there were mostly happy patients with the upgraded "premium IOL's" I would say spend the money and go for it.  However, once you read all of the unhappy/repeated feedback with patients that were extremely disappointed with their premium lenses, I think you might not want to take the risk.  

Many many patients (including me) are happy with the standard IOL's.

Also, how much astigmatism to you have ?  Mine was .75, which isn't considered much but my Cataract surgeon tried to "sell me" on the toric lens also.  I didn't do the toric lens, and my astigmatism still actually changed to a .25 after cataract surgery somehow.  I honestly didn't know that was possible, but it happened.  Perhaps Dr. Hagan can comment on how astigmatism can change from standard Cataract surgery.

Finally, I have "mini-monovision" now after cataract surgery on only one of my eyes (was due to ERM/Vitrectomy surgery).  I am +1 in good eye and -.50 in the eye with the IOL.  I do like it and will have my second eye set for 0 (distance) in the future when needed.  I can see pretty clearly from about 4' to distance with the IOL eye alone and after approx. 5 months my two eyes have adapted to working together pretty well.

Lots of information...sorry if I gave you too much.  Take some time and read the previous posts as Dr. Hagan suggested.  Also, get at least one more opinion from a reputable Cataract surgeon.  I went to 6 before I found the one I trusted.

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

You need to put in some time reading all the previous discussions of these options and understand the risks vs. benefits   taking increased risks to get glasses independence.

You can access the many detailed conversations by the archives and search feature.  Key words include mini-monovision, multifocal IOLs, toric IOLs,

There is not right answer for everyone.

It cannot be contested though that the lowest risk, lowest cost procedure is to have a monofical IOL put in your eye and wear glasses post op.

I suggest you at least get a second opinion.

JCH MD