Cataract Surgery

[modeltrains]

They had an IV hooked up so the IV must have put me under

Hey there! Glad you have resurfaced and returned!

As anxious as I get when people are messing near or with my eyes they would definitely have to put me fully under.

 

[Simon Auty]

Bobby if you could see a light then you didn’t have a General Anaesthetic (“going under”) you would of had some sedation, usually Propofol (White liquid looks like milk) same drug that was implicated in the death of Michael Jackson ( don’t worry it’s very safe when used properly). The other most common sedative is Midazolam (hypnovel) related to Rohypnol the date rape drug (again very safe when used properly).
If you have these we would use local anaesthetic or Topical/Intracameral so you don’t feel any pain.
If you have a general anaesthetic usually we would use Propofol to put you under (and maybe maintain the anaesthesia-that’s called TIVA) or use a gas to maintain the anaesthesia (called inhalation anaesthesia-usually using a gas like Sevoflurane).
Under a GA we wouldn’t use local anaesthetic we would just put maybe a drop of an anaesthetic on your eye and give you IV paracetamol.

 

[Simon Auty]

Cataract is the leading cause of preventable blindness in the Western world.
The procedure to fix it is simple, relatively inexpensive, and one of the safest and most effective surgeries there is.
In terms of patient satisfaction pretty much only Caesarean section beats it (when baby is wanted!).
There are lots of lens options so ask around.
Often your local Optometrist will be able to refer you to someone who is prepared to use a variety of lenses to get the result that suits you.
They will certainly know who is the best surgeons in your area!

 

[Simon Auty]

Don’t go to a surgeon who gives the Optometrist a kick back!
It’s unethical (and in some countries illegal).

 

[barn]

I got the very expensive multi focal lens with astigmatism correction and I don't need readers. Insurance would only pay the cost up to the price of a mono lens but I had money saved up in a health care expense account. The first thing I noticed was the brightness of everything, I needed to wear sunglasses outside when before I almost never wore sunglasses. The colors were amazing. I couldn't believe how grey and dingy everything was before. After a few months I came accustomed to the brighter light. The halo effect was annoying and very distracting at first. I didn't like driving at night because of the halos around car headlights. It was also disappointing to look at stars and planets because I saw halos around the bright ones. Over time it got better. I still see halos but they are not as predominant and I hardly notice them anymore. I got Propofol for anesthesia which gave me a euphoric feeling. I felt like I had the best sleep of my life. My doctor told me that's why Michael Jackson was taking it. It slows down your heart rate and blood pressure, you could just stop breathing and it can be very dangerous if someone is not monitoring you. For the second surgery for the other eye I didn't get the same effect. Overall I'm very pleased with the results.

 

[jqavins]

If you have these we would use local anesthetic or Topical/Intracameral so you don’t feel any pain.

Am I right in expecting than an intracameral paralytic would also be used, regardless of the type of anesthetic? One can't have the eyeball squirming around in there while one is cutting.

 

[Simon Auty]

Joseph we don’t use any paralysing agent when doing Topical or Topical-Intracameral.
We ask you to “look into the light” and that will keep your eye still enough for the surgery.
The really fast surgeons prefer a sub-tenon block as that means you can’t move your eye around.

 

[bobby_hamill]

I will ask the Dr tomorrow what all I was given in or
as I have my first follow up tomorrow

Before I went into or I was given a small val of fluid to drink
cant remember what color it was

 

[tsmith1315]

Don’t go to a surgeon who gives the Optometrist a kick back!
It’s unethical (and in some countries illegal).

But please be aware that the surgeon may send you back to the referring optometrist to manage the follow-up care.
In that case, the O.D. will be entitled to a percentage (20% here) of the total fee and will provide as many follow-up
visits as are needed for 90 days after the surgery date.

This is patient co-management, and can be confusing if not communicated well.

 

[Simon Auty]

But please be aware that the surgeon may send you back to the referring optometrist to manage the follow-up care.
In that case, the O.D. will be entitled to a percentage (20% here) of the total fee and will provide as many follow-up
visits as are needed for 90 days after the surgery date.

This is patient co-management, and can be confusing if not communicated well.

Here that would be illegal. The Optometrist would need to charge you separately.
But your right, as long as communicated properly it can be a good way of managing aftercare

 

[Simon Auty]

By the way if any of you can and feel the urge to donate then Orbis https://www.orbis.org/en is a Worldwide charity that supports Vision care projects around the World including a Flying Eye Hospital.
Another that is from my neck of the woods is the Fred Hollows Foundation
https://www.hollows.org.nz/

 

[augendoc]

...They will certainly know who is the best surgeons in your area!

Yes, they will probably know who the “best“ surgeons are, but in the USA they’re going to refer you to the surgeon with whom they have a kickback arrangement, often in rotation if they have arrangements with more than one. It’s called “comamagement” and the surgeon will do the surgery but send you back to the optometrist for all the postoperative visits except perhaps the first one, and those will usually consist of a couple of “You’re doing great” quickie visits with reinforcement of the instructions you were given by the surgeon on how to use your eyedrop medications and then a charge for a refraction and a new pair of glasses in most cases.

During the pre-surgical process you may get all the explanation you need to make an informed choice, but you may also get talked into something you don't need because the surgical fees may be higher as will the kickback fee. You need to be very careful, do your homework, and ask a lot of questions. Regardless of comanagement or not, if you really have a visually significant cataract and your vision problem was due solely to the cataract and not something in addition like macular degeneration, an epiretinal membrane, or a corneal problem (for example) the results will astound you.

 

[tsmith1315]

Here that would be illegal. The Optometrist would need to charge you separately.
But your right, as long as communicated properly it can be a good way of managing aftercare

Yes, that's how it's done. 80% is paid to directly to the MD, and 20% is paid directly to the OD.

Insurance is filed in the same proportion, with the same DOS and Dx, Sx codes.

The total fee to the patient is exactly the same whether you receive post op care from the surgeon's office
or from the the optometrist who diagnosed the condition. This is where poor communication causes
confusion.

Yes, they will probably know who the “best“ surgeons are, but in the USA they’re going to refer you to the surgeon with whom they have a kickback arrangement, often in rotation if they have arrangements with more than one.

There is no arrangement. OD's want to be confident their patients are going to come back happy and with good results. No one wants less than great results for their patient, or an unhappy patient in the chair. Think about it- the time involved working with them is much higher- and time is money. We want to see people who have had a great outcome.

All surgeons send the patient back to the referring OD and the post-op care (at 20% fee) typically takes significantly more chair time than the surgery. I've worked with OD's who didn't do post-op care because of the time involved.

 

[ksaves2]

I got the very expensive multi focal lens with astigmatism correction and I don't need readers. Insurance would only pay the cost up to the price of a mono lens but I had money saved up in a health care expense account. The first thing I noticed was the brightness of everything, I needed to wear sunglasses outside when before I almost never wore sunglasses. The colors were amazing. I couldn't believe how grey and dingy everything was before. After a few months I came accustomed to the brighter light. The halo effect was annoying and very distracting at first. I didn't like driving at night because of the halos around car headlights. It was also disappointing to look at stars and planets because I saw halos around the bright ones. Over time it got better. I still see halos but they are not as predominant and I hardly notice them anymore. I got Propofol for anesthesia which gave me a euphoric feeling. I felt like I had the best sleep of my life. My doctor told me that's why Michael Jackson was taking it. It slows down your heart rate and blood pressure, you could just stop breathing and it can be very dangerous if someone is not monitoring you. For the second surgery for the other eye I didn't get the same effect. Overall I'm very pleased with the results.

One thing to remember is not all folks are candidates for multifocal implants. I sorta had to beg the surgeon to do the procedure. I couldn’t read a laptop screen without a head magnifier and forget about street signs, I couldn’t read them. He may have been gun shy as I have an amblyopic right eye. Am very far sighted and he did have the discussion about the multifocal lenses and mentioned due to my severe far sightedness, they probably wouldn’t help me. So I got single vision implants.
Funny thing is I used to M.D. for a living (retired just this July 1st) and was really looking forward to the procedure. I was only 54 at the time almost 64 now. For some reason cataracts ran in the family at an early age and we weren’t diabetics or worked outdoors either. I wore glass lensed glasses for years that should have provided some UV protection but hey, it’s probably a genetic thing.
Anesthetist asked me if I wanted “anything”. I said I was good. They used drops that were fine for the local. I didn’t feel a thing. Surgeon came in and asked them to slip me a little Versed. I was o.k. with that. It bungs up the memory. When he turned on the ultrasound probe to liquify the cataract I deadpanned, “Don’t turn the blender up too high!” There were some giggles and I heard, “Don’t worry about it doctor.”
Then one of the nurses asked me if I knew one of his classmates and I said, “I sure do, she’s the nurse practitioner I collaborate with. What’s your name?” I heard a shuffling of papers and he replied, “You had Versed. You won’t remember.” I said, “I’ll try.” He gave me his name and when my wife got me to the car, I’ll be danged I completely forgot his name!
Cataract surgery is a piece o’ cake. The prep takes longer than the surgery and if the optho says one is a good candidate for the multifocal implants, I’d try to pay extra to get them. I had an older nurse who got them and she was really, really happy with them. Kurt Savegnago