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Cataract Surgery: Two experiences

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posted on Jul, 21 2018 @ 05:12 PM
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Cataract surgery: Two perspectives

Life is different now. I can see without glasses. Everything is brighter. My wife and I both had cataract surgery the same week. I thought some of you might be interested in our experiences, which were very different. It might help you know what to expect should you be facing this in your own future. I was 69 in May; my wife is 71. It just so happens that our optometrist recommended us for surgery at the same time, but at two different clinics. The reason for that is that I have had controllable glaucoma for a number of years, so the “fix” is different for me.

What is a Cataract?

Cataracts happen, and the reason they do is that dead cells have nowhere to go. Your dead skin cells slough off every day, every time you take a shower. They are replaced by new cells and you don’t even know it. Cells on the inside of your eye have nowhere to go, so they build up, and seventy years later they affect your vision. Their overall color is yellow, and over time everything you see has a yellow tint to it. You may not know this because it happens so slowly and your mind adjusts, but once you have one eye done, it’s obvious. I have a yellow lamp in my house. Makes sense since the light bulb is yellow, right? No, it’s actually white. After my first eye was done I could blink left, right, left and get white, yellow, white back and forth. Same with my “white” countertops. This is why you see some “old ladies” with purple or blue hair. They see it through their yellow cataracts as white. To themselves, their hair is white.

The solution is to take the existing lens out and pop a new plastic (acrylic) one in. At the same time, the lens can correct your vision. As a kid my vision was 20/15, I was a bit far sighted. Before the procedure my left eye was 20/60 and my right about 20/40. Both were foggy, but especially my left. My right eye has always been my “good eye.” My left eye was bad enough that I could not drive with it. I could not drive at night at all because of the glare of oncoming headlights. I’ve had reading glasses for years. My wife started out with bad eyes, off the charts. She has worn glasses since she was 9 years old and contacts since she was a teenager. Her (corrected) vision was better than mine when we started this procedure. Over the years the contacts had changed the shape of her eyeballs, so she had to revert to glasses for a few weeks so her eyeballs would return to normal shape. After all the scheduling I had my right eye done on Tuesday and she had hers done on Thursday.

We now both have 20/20 vision in both eyes (All four!!) The difference is simply astonishing. I can read the little tiny LEDs on the stove from 20 feet away. I can read the clock in the cable box from across the room. I can read a book without glasses for the first time in several decades, though it is difficult. My vision has been set to 20/20 for FAR vision, not near vision, so I’ll need reading glasses. Her astigmatism is gone. My glaucoma is within limits, though that is still sorting out. We’re not completely healed yet. It will take awhile for these new lenses to settle in and be completely incorporated. But like they say, the difference is like night and day, literally. It’s really nice to have something go right and improve for a change, because at our age, we just wait for the next thing to go wrong.

My experience

As I stated above, my surgery involved glaucoma mitigation where my wife’s did not. There are a couple of ways to do this these days. One way is to install a new lens that has a valve in it that drains off pressure. I thought this was a dandy idea, but my doctor, Dr. Nakamoto, said she did not want to do this and that I would be better served if she used the “Kahook” method. This is a blade that allows her to remove a mesh network that interferes with drainage because it does not allow fluid to drain fast enough. This is called the “trabecular meshwork.” Nakamoto basically removed this mesh and allowed the eye to drain. It’s called a “Goniotomy.” Well, I kind of have to go with her expertise here, so that’s what we did. It looks to me like a valve would drain only where the valve is, but a Goniotomy permanently removes the barrier around 360 degrees of the lens so rather than have a single point of egress for excess fluid from the valve, the entire perimeter of the eye allows egress. The result is a reduction of interocular pressure.

Wanna see it work?


At the “Surgery Center” they made me take off all my clothes, dress in hospital garb, stuck me with an IV, and bundled me on a gurney with all kinds of heart monitors, blood pressure cuffs, oxygen tubes, etc. My pre-op nurse, Bobbie, was as sweet as could be. Turned out we went to the same high school. I had to laugh when she tried to find “bare spots” to stick the heart monitors on. I don’t have any because I’m unusually hairy. Lots of Neanderthal genes, I guess. She looked at my back and said, “That’s worse.” I said, “No. That’s better!” For women who like smooth guys, I’m definitely not their man.

I had my very own anesthesiologist for the duration, a guy named Dr. Rider. I had not “been under” since I was 20 for an appendectomy, so quite frankly I was frightened, which he could see. He got me through it and I was knocked out before I knew it. Twenty minutes later I was in “recovery” where my wife was bossing the nurses around. All I wanted was a cup of coffee because I had had absolutely nothing since the night before.

Of course, this all happened twice, two weeks apart. When all is said and done my left eye, the “bad eye,” is better than the right eye. Both test out at 20/20, but the left eye is brighter and “crisper” than the right eye. This may even out over time, but the kicker is that I can use my left eye to drive now. I haven’t really used my left eye ever, in my entire life. It’s a big change. My eyes do not work together and never have. This has not really hurt me. I have a pilot’s license and can land just fine.

My wife’s experience

Far different. She went to an “ambulatory” clinic where they do not knock you out. Instead, they give you some valium. She has a problem with “White Coat Syndrome.” If she goes to a doctor’s office, her blood pressure soars. They told her they couldn’t do the surgery unless she could get it down. Naturally, that made it worse, so she was lamenting that she would “never” have the surgery. But she scored some “anti-anxiety” pills, figured out when the best time was to take her blood pressure medicine, put some Grand Marnier in her coffee cup, and took a couple of doses of liquid valium at the clinic. Yup, that oughta do it.

She finally staggered out, said it “took 5 minutes” and was a “piece of cake.” When I finally got her home and seated on the couch she said there were two of me and everything was crooked. It took a couple of hours for those symptoms to abate.

Her new lenses are different than mine. They are “toric” lenses (Think: torus) which can correct for astigmatism. They basically can correct in two directions at once. Her two lenses are also different because she has used “monovision” for years. It’s just that they are now in her eye rather than in her contact lens. Monovision corrects one eye for far vision and the other for near vision. Your brain works out which eye to use for what task. Pretty slick system!

continued below...
edit on 7/21/2018 by schuyler because: (no reason given)




posted on Jul, 21 2018 @ 05:13 PM
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In both our cases you have a preliminary exam or two where they figure out what to do, measure your eyes, etc. on a wide variety of funny blinking machines. Then you have the day of surgery. The very next day you go for an exam to ensure things worked out, and then again a week after that. So during the second week I had surgery on Tuesday, follow my follow up on Wednesday, her surgery on Thursday, her follow up in Friday. The following week it was my week follow up on Wednesday, her other eye on Thursday, her follow up on Friday. So other than the preliminary exams, it took about a month from start to finish.

Interesting point for her: No makeup, including eye shadow, eye liner, or mascara. Why? Potential contamination that could start an infection. This is in effect for a week after her last surgery.

Eyedrops

You become very familiar with these. If you don’t know how to do it, you’ll learn. I hate them, and I have this theory about it: The Caveman theory, which I tell every eye doctor. The idea is that I have a million years of evolution telling me I should never let anything close to my eyes. Science has 200 years. Guess who is going to win? My optometrist of many years has already been trained and makes fun of me, but these new guys need direction. It’s better if I do it myself. What eye drops? Ketorolac Trimethamine (stings like an SOB), Prednisolone Acetate, Polymyxin B Sulfate and Trimethoprin, Ofloxacin. You start these drops prior to your surgery and keep them going up to two weeks after up to four times per day. They are designed to prevent infection, inflammation, itching, allergic reactions, etc. So basically every three to four hours you go through a round of this stuff, five to ten minutes apart. By the time you get to the end of it you ought to be pretty good at it. Cost depends on your plan. For me it’s $4.00 a bottle, which is from 5 to 10 ml each. Tiny little bottles that all look alike. You can tell the difference by the color of the cap because one is a slightly different shade of lavender.

Insurance and Costs

We are both old enough to be on Medicare Advantage plans. This is a bit complicated. As you probably already know, Medicare by itself is not enough insurance to cover you. You need some sort of supplemental plan. Also, even though we’ve been paying into Medicare monthly since the whole things started in the sixties, we also pay a premium taken out of our social security checks. That “covers us” for Medicare. Now, a “Medicare Advantage” plan is a little different. For these plans your monthly Medicare premium that you pay is assigned to your insurance provider. They get that money every month. In addition, they charge you every month, so the insurance company gets some money from the Feds, and some money from you.

Supplemental plans are not all “Advantage” plans. You can get supplemental plans from paces like AARP. Generally speaking, Medicare plus Supplemental is more expensive than “Medicare Advantage.” This is one of those areas where YMMV and depends even on where you live.

Now, when you go to the doctor or have a procedure, the doctor or clinic bills Medicare and Medicare pays a part of that fee. Most of the rest of the fee is covered by your “Advantage” plan, but you usually have a modest “co-pay” for every visit. Except for surgery where the “co-pay” is far larger. More on that below. Both my wife and I have been with our respective clinics and doctors for many years, since the seventies. When we retired neither of us wanted to switch. So I belong to an HMO (Health Maintenance Organization) called “Group Health,” which is local to western Washington. It just got absorbed by Kaiser Permanente. They have all their own clinics and doctors, so you must go TO THEM, unless they can’t do it, which in this case, they could not. So I was referred outside the organization. The upshot: I pay $28.00 per month to belong to Kaiser Permanente. That’s how much I pay per month for health insurance.

My wife has been with a place called Virginia Mason as long as I have been with Group Health. To get her into a Medicare Advantage Plan we had to use an outside insurance provider. You see, Kaiser Permanente is their own insurance. That’s a big difference. For her we use Regence. It works the same way. Regence gets the Medicare premium, and they charge her a monthly fee: $167.00. Way more than for me, right? Couldn’t my wife have joined Kaiser Permanente? Sure. Did she want to change doctors? Not in your life! But look: $167.00 a month for full coverage? Not bad. $28.00 a month for full coverage? Unheard of. Private insurance without an Advantage Plan around here would be $750 per month apiece. I’m just fine with these prices. I’m sure one of these days Kaiser will say they forgot to add a zero.

Surgical Co-Pay

Here’s where it gets weird. Regence, bless their hearts*, considers cataract surgery “elective” surgery. It’s not a heart attack so no emergency, right? You can choose when to do it. And cataract surgery that involves a toric lens to correct astigmatism is REALLY elective surgery. So the Co-Pay is $1,300 per eye. Apparently it is “elective” that you continue to be able to see. I mean, you could correct astigmatism with glasses, right? You don’t need a fancy expensive inter-ocular lens to do that. So we’re out $2600 for her surgery plus some office co-pays. (The figures below show a little less.)

My surgery Co-Pay is $250 per eye. It’s $250 for ANYTHING, no matter what. So my cost is $500 plus a few modest co-pays for these office visits. I’m probably out about $600 altogether. It hasn’t quite settled out yet, but I’m very close. So for a $28 per month premium I pay $600 for cataract surgery. For $167 per month she pays about $2700 for cataract surgery. YMMV.

Full Disclosure. It’s even MORE complicated. Before my wife retired several years ago, her employer (mine, too, a public library) was grappling with how to fund health care for staff. The premiums were out of this world, but they could be significantly reduced if the co-pays were higher. But there is such thing as a HRA/Veba account, a “health maintenance” account, where the IRS allows an employer to set up a tax-free account for every employee. The employee then draws on this account for co-pays using what amounts to a special Visa credit card. You do not have full control of this money and must abide by HRA/Veba rules for expenditures, keep receipts, etc. She had accumulated about $2900 in this account, which has been sitting there for years. Bottom Line is that we were able to use that money to offset the surgical co-pay. Of course, that money is not there any more. We just used it up, but we did not need to take it from our monthly income.

Cost for her: $9,591.00 of which we paid $2,200.00
Cost for me: $7,948.00 of which we paid $615.00
Cost my clinics billed: $27,368.00 (Nobody paid this)

continued below

* "Bless your heart" is a Southern phrase that means, "You're an idiot!"
edit on 7/21/2018 by schuyler because: (no reason given)



posted on Jul, 21 2018 @ 05:13 PM
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You can see from these prices the advantage of insurance. Had I gone into these people with zero insurance, they would have charged $27K. But because I have Medicare and an insurance provider, Kaiser Permanente, they refused to pay that outrageous charge and the providers had to settle for a significantly less amount. These guys, Medicare and Kaiser, basically negotiated for me. And it’s not the doctors who are making out here. The doctor and anesthesiologist for this surgery got a little more than $2000. The rest of the charges are for the “surgery center” which, comparatively, did little but provide a space with a nurse.

Conclusions

Yeah, sure, that elective co-pay nonsense for my wife bothers me. But what’s not to like? We both have 20/20 vision at age 70. It’s a gift. We can keep on driving and keep on reading. That’s all I wanted out of this deal, to maintain our independence and our quality of life. For a librarian unable to read would be like death. For a male from the fifties not to be able to drive would be devastating. I drive a Corvette. Catch my drift? We just bought about 20 years of life here and I don’t really care what it cost. I know something else will get us, but not this. Nothing has a yellow tint anymore, and my hair is not purple, which would be kinda cool, if I had hair, I mean. Well, I did ask God for a lot of hair, but I failed to specify where. I have as much hair as anyone. It’s just not on top of my head.

It was very nice and necessary that we had each other. You can’t exactly drive yourself home after one of these surgeries. The day after surgery in my right eye I was so sensitive to light that it hurt with my eyes closed and covered with my hand. We were both very woozy after surgery, me from anesthesia she from valium. The nurses for me suggested she was not up to the task. I’m almost twice her size (105 lbs vs. 180 lbs,) and if I had fallen they would have been right. But she’s tough. This is one of those times that you appreciate having a life partner, especially an intelligent one. I am grateful.

The glaucoma issue is still a bit up in the air. I’m now doing one eye drop, Travatan, instead of two, and my pressure is at 16, which is at the top of the bell-shaped curve for normal eyes. That means the glaucoma is GONE! Ideally I will no longer need to daily eye drop regimen to keep the pressure low, but if I have to do that it’s a small price to pay. My wife is up and running and cruising at top speed as usual. Nothing slows her down.

So onward, but no more fog.



posted on Jul, 21 2018 @ 05:34 PM
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Sighhhhh. I'm facing one in my left eye. Also a hip replacement. The VA will pay, but uggggg..

Did you experience pain afterwards ? Many years ago my Uncle had cataract operations and said it was like eyes full of sand afterwards. Must of been much different then, and now has the coke Bottle glasses. That was in the 80's, and of course great strides and techniques have evolved.



posted on Jul, 21 2018 @ 05:37 PM
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There was pain for the first day, but that was it, just super-sensitive to light. I know what you mean, though. My father had cataract surgery long ago and wound up having to quit driving because he saw two white lines in the road, one going up at an angle. It was a real boondoggle for him. But yeah, life is different these days with advanced techniques. Surgeon told me there are "complications" in about 2% of the surgeries, so now they basically know how to do it.



posted on Jul, 21 2018 @ 05:49 PM
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Surgeon told me there are "complications" in about 2% of the surgeries, so now they basically know how to do it.
LOL, I can see from your Avatar.... lol, just kidding.



a reply to: schuyler



posted on Jul, 21 2018 @ 06:15 PM
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So, are you glad you did it...or not?

I've had it on both, and it was the absolute BEST thing I ever did.

Sure, there were some adjustments, but overall...I CAN SEE!!

So what about you??



posted on Jul, 21 2018 @ 06:37 PM
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a reply to: schuyler

Thank you for sharing your experience. My 17yo Pomeranian goes in for cataract surgery on Tuesday. Her case is pretty severe, at this point she's about 95% blind. I can't wait for her to be able to see again. Your post will give me a little insight about how it will be for her.



posted on Jul, 21 2018 @ 07:01 PM
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originally posted by: Flyingclaydisk
So, are you glad you did it...or not? I've had it on both, and it was the absolute BEST thing I ever did. Sure, there were some adjustments, but overall...I CAN SEE!! So what about you??


Fantastic. I was at the borderline of whether I could drive or not. It was that bad. Now I can see as well as I could when I was 20. I couldn't stand to be in a brightly lit grocery store. All the lights and colors made me nauseous. I couldn't stand the bright lights of oncoming traffic so I could not drive at night. I couldn't go through a tunnel because of the bright light outside that would hit me. Now all that is completely gone. Plus--no more glaucoma. Win/win.



posted on Jul, 22 2018 @ 07:01 PM
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Just saw a new optometrist recently and I will need cataract surgery in maybe two years or so. I only have Medicare and no fancy extras for coverage. Wonder how much it will end up costing me? Yikes!



posted on Jul, 22 2018 @ 07:12 PM
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originally posted by: Night Star
Just saw a new optometrist recently and I will need cataract surgery in maybe two years or so. I only have Medicare and no fancy extras for coverage. Wonder how much it will end up costing me? Yikes!


First, check around. As you can see from our experience, prices vary. Second, check out the Medicare "Advantage" plans in your area. I pay a whopping $28.00 per month for mine for full coverage, and my cataract surgery cost far less than my wife's. I was out a little more than $600 total. There's an "open enrollment" period in the Fall of every year.



posted on Jul, 22 2018 @ 10:43 PM
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originally posted by: Night Star
Just saw a new optometrist recently and I will need cataract surgery in maybe two years or so. I only have Medicare and no fancy extras for coverage. Wonder how much it will end up costing me? Yikes!


Try a vet. Only $2500 for my dog.



posted on Jul, 22 2018 @ 10:59 PM
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a reply to: schuyler
Hi Schuyuler,
I believe I can describe it in just a few words.....

The wow-factor, post-op, is like seeing Star Wars for the first time.
and,
Everything is Hi-Def.



posted on Jul, 22 2018 @ 11:00 PM
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I had this done around 5 years ago, cost at about 800$..for the lenses, the surgery covered by our medical system.
I was in the same boat as the OP's wife..blood pressure too high to be put under, I think though, they do not want to put you under anyway. How did you(OP) manage to get put under?
I wanted to be put under..due to my anxiety..lol, they very reluctantly agreed but my BP made it more difficult. Eventually I just manned up and did it conventionally, it was a breeze as it turned out.

Anyone facing this..have no fear, it is a breeze and so worth it to see again.



posted on Jul, 22 2018 @ 11:03 PM
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a reply to: Adonsa

My 1st stop after leaving to doctor was to the grocery store, everything was so bright and colourful..felt like everything in the store had some kind of new packaging ..unreal how dramatic it was.



posted on Jul, 23 2018 @ 11:09 AM
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originally posted by: vonclod

I was in the same boat as the OP's wife..blood pressure too high to be put under, I think though, they do not want to put you under anyway. How did you(OP) manage to get put under?


I went right under, no problem. My surgery was much more complex, so that's how they do it. My wife had the blood pressure issue. She was given an anti-anxiety drug by her physician, takes blood pressure medicine anyway. She figured out the best time to take both for maximum effect, then put some Grand Marnier in her morning coffee. That got her under the threshold. Then they gave her some Valium for the procedure itself, which she described as very easy. Sounds like a lot of drugs, but there were no ill effects.

For those saying how much brighter it is, I second that. The world is, indeed, a very bright place. Cataracts act as sunglasses, really, though the process of their formation is so slow that you don't notice anything getting dimmer. The days after the surgery will be a very happy time. The pain is minimal and for a short time only.



posted on Jul, 23 2018 @ 11:14 AM
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I had cataract surgery at the end of the last year. My left eye is okay. My right eye is clogged with floaters and I think that my retina is slowly peeling off in spots. I have an appointment to get it checked. But my right eye was always my weakest eye, and if the cataract surgery did anything, it was make it slightly worse a little faster.

But when the floaters clear up, and I get a clear view, I can see forever.



posted on Jul, 23 2018 @ 11:21 AM
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I was always wondering about this procedure although I am not at that stage yet, but perhaps soon. Thanks for detailing what to expect and as for putting eye drops into your eye, do you pull down your lower lid and put the drops there? It does seem like an easier way to do it.

www.healthline.com...



posted on Jul, 23 2018 @ 12:24 PM
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Well, because I have the Cave Man Cringe I just try getting the drops in there and hitting my eye rather than my cheek. The Dr. showed me a new way to do it. She would put the drop in the inner corner and then have me just roll toward the outside, so the drop would fall in at that location. Seemed to work fine when she did it, but me doing it is another thing entirely!

Re: Floaters. I have them, too, and cataract surgery won't do a thing for you there. "Floaters" are in the fluid of the eyeball itself. To me they are just annoying. As I understand it, they are pieces of congealed protein. I heard that in the EU there is an approved procedure to "zap" floaters with a laser that liquefies them. There is also a procedure called vitrectomy that sucks the floaters out and replaces the fluid with salt water, but doctors are reluctant to do this except for extreme cases because of the danger involved.



posted on Jul, 23 2018 @ 12:33 PM
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Had both mine done a couple years ago. After insurance the price was about $600 per eye. The procedure was a piece of cake, 15min each and no pain at all after. However, my vision was soooo bad before the operation, the clinic missed the fact that I also have astigmatism and didn't order the correction into the new lenses so I still have to wear glasses frequently.

That aside, I can see beautifully and I am no longer a danger to myself and others when I drive! This is one "elective" surgery that is a MUST DO.




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