Options of IOL during cataract surgery
It is commonly known that there are many options while ordering a cup of coffee. But five to ten years ago, the situation was significantly different that only cream or sugar coffee was available. This change in coffee is quite similar to that in cataract surgery. Several years ago, patients only had the option to receive a cataract surgery and all the other things would be arranged by the surgeon. Nowadays, options of coffee include Grande, Venti, Cream, low-fat milk, soy, vanilla, sugar-free vanilla, caramel, mocha or flavor-of-the-week. When it comes to cataract surgery, patients now are always required to choose a specific intraocular lens type among the considerable group including spherical IOL, aspheric IOL, IOL for astigmatism correction, IOL for distance, intermediate or up close vision.
In front of such a wide range of IOL options, patients have no easy job to make an appropriate choice. The first consideration associated with IOL selection is similar to that of coffee. People should often decide an initial issue that either caffeinated or decaf style to choose. In similar, cataracts patients should first ask themselves whether they mind wearing glasses. This is absolutely the first decision that determines which type of IOL to select. Some people want to throw away their glasses after cataract surgery, while some others can tolerate occasional eyeglass use.
The standard type of IOL suits people who do not mind wearing eyeglasses. These patients can save the cost of the surgery because this kind of IOL is covered by insurance. In fact, this group of patients is quite small.
Aspheric or toric IOL suits people who want to get good uncorrected distance vision but can tolerate eyeglass wearing while using a computer. Aspheric IOL can correct higher order aberrations and bring excellent distance vision. Toric IOL is aimed to correct significant astigmatism. These two types of IOLs are not covered by insurance. In a similar case, the Alcon ReSTOR IOL or the AMO Tecnis IOL suits people who want to get clear distance and reading vision without glasses while leaving the job of computer perceiving to glasses. If a patient wants to restore good distance and intermediate vision without the help from eyeglasses, they can choose the ReZoom multifocal IOL or the Crystalens accommodating IOL.
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THE Sydney South West Area Health Service has rejected the NSW Opposition’s claims that patients are waiting too long for eye surgery at Liverpool Hospital.
Opposition health spokeswoman Jillian Skinner said 376 patients were waiting for ophthalmology surgery at the hospital, most of whom need cataract surgery.
She said on average patients waited up to six months for ophthalmic surgery at the hospital.
But a spokeswoman for the health service said patients needing ophthalmic surgery at Liverpool Hospital were receiving it well within benchmark times.
“Patients are prioritised according to need. Those classified as most urgent, or category A, are on average scheduled for surgery within 15 days, well within the 30-day benchmark,” she said.
“Category B patients are seen within 36 days, well within the 90-day benchmark, and category C patients requiring surgery within 12 months, are on average receiving treatment in under nine months.
“Liverpool Hospital recently increased the number of ophthalmic surgery sessions being performed to address the increasing demand and help to further reduce waiting times for patients.”
Mrs Skinner said waiting times would increase due to Federal Government cuts to the Medicare rebates for cataract surgery.
The rebate for common cataract surgery has been reduced by 45 per cent from $623.70 to $340.76.
“(It) means more people will be thrown into an already crowded public system, (and) will wait even longer,” Mrs Skinner said.
In a written statement, Federal Health Minister Nicola Roxon told the Leader advances in technology have meant that cataract surgery is now quicker and cheaper.
“We believe patients and taxpayers, not specialists – earning on average $500,000 a year from Medicare alone – should reap the benefits of these improvements,” she said.
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Few cataract complications and their treatments
A posterior capsule opacity (PCO) is the most common among those few cataract surgery complications, including eye inflammation, infections and a dislocated IOL. The reason for a PCO comes from the lens capsule, which will be maintained during a surgery. About 20% of patients have haziness on their intact posterior capsules, so that even if the lens has been replaced with a successful IOL, the vision is still blurry. A PCO is not a “secondary cataract”. Cataracts will never recur once removed.
A PCO can be treated with a YAG laser capsulotomy, which takes a few minutes and is safe, effective and painless. During the procedure, your doctor will remove the hazy posterior capsule with a laser, eliminating any incision. Patients can resume normal activities immediately after the surgery, with the help of anti-inflammation eye drops. Only 1% of patients may suffer from a detached retina from a YAG laser capsulotomy.
Another complication for a cataract surgery can be mal-positioned IOL, which may lead to double vision or severe visual acuity decrease. There are two underlying reasons that may cause dislocated IOLs: broken capsule bag and dislocated capsule bag. Since the IOL is placed within the extremely thin capsule bag, a broken bag due to accidents may lead to dislocated IOL. The other reason comes from a dislocated capsule bag, which will surely lead to dislocated IOL.
Dislocated IOLs can also result from operational mistakes during the IOL positioning process. Once an IOL dislocation is found, a second procedure to reposition the lens will be taken soon. With proper treatment, dislocated IOLs won’t bring permanent vision problems.
Although the most severe complication may lead to vision loss, complication-free cataract surgeries account for 98% of the total. Other potential complications include minor eye inflammation, retinal detachment, retinal or corneal swelling, eye pressure increase and droopy eyelid. You should always tell your doctor about your floaters, light flashes and curtain-like vision loss, in order to receive immediate treatments.
Kinds of cataract surgeries and their costs
Even though the cost of a cataract surgery varies from procedure types, different IOLs and cost-of-living standards, it can be as high as $4,000 per eye. Currently, single monofocal IOLs are considered to be medically necessary, since the patient always need an alternative lens for normal vision. In this case, both Medicare and most of the insurance companies cover this type of IOLs. However, if the patient chooses a presbyopia-correcting IOL, he needs to pay the discrepancy or the extra expense. Insurance providers keep in mind that these premium lenses are not medically necessary, since they provide additional vision benefits such as perfect near vision. These common vision problems can be corrected simply by eyeglasses or contact lenses.
Since the extra costs of premium IOLs vary significantly between different ECPs, the patient should always ask their exact prices before receiving the surgery. Another part of extra costs comes from the procedure of eliminating astigmatism during the surgery, which is also excluded by insurance plans. Those special IOLs that can correct astigmatism are named toric IOLs. Once implanted, they can offset the vision distortion caused by the lens’ irregular shape. Patients should ask the surgeon’s billing representative about all of these extra costs and the aspects they cover.
For a standard cataract surgery, you can simply get reimbursements covered by your Medicare, while the reimbursements from private insurances are slightly more complex. Under some vision insurance plans, the patient should pay a certain portion of some items that are not parts of the procedure itself, such as an EKG, a comprehensive eye exam, eyeglasses and follow-up procedures. For example, a laser procedure named YAG laser capsulotomy to treat complications is not included in most insurance plans.
The patient should consult the insurance company and Medicare representative carefully to figure out all items that are covered, such as the copayment rate, deductible amount, eyeglasses coverage, surgeon recommendation, prior approval from the company, just to name a few.
Another application of cataract surgery is called refractive lens exchange (RLE), which requires the patient to pay all of its costs. RLE aims to correct potential cataract in advance, which replaces the functioning lens with an IOL. Some people choose RLE to reduce their dependency on eyeglasses. Sometimes, they just want to treat cataracts as early as possible.