Concerned about Recent Surgeon visit

All l know about my surgeon whose going to my surgery is his done thousands of cataract surgeries over 15 years and my GP and optomerist say his good, Should l do more research into him or is that enough

RonAKA,

Yes, I agree. It really made me feel uneasy. Although this is all routine for the surgeons, they still need to keep in mind that this is our eyes we're talking about here, and the decisions made off the consultation are going to be ...well...permanent. It's a process that must go right the first time through. In my case, as I said, my goal is really to be as spectacles-free as possible and my prospective surgeon didn't address any strategy at all for this during the consultation. Very disappointed. Thanks for your comment.

IG

I would target -1.5 D in your near vision eye with a monofocal lens. I don't think -1.0 D is enough to get good close vision.

I agree that they are not all the same or offer the same services. But, it is not that easy to "shop around" for a cataract surgeon, especially in areas where insurance companies and public health care are thrown into the mix. Unless one invests a lot of time into researching what state of the art services look like and doing some checking of availability of the more specialized services it is hard to make an informed choice. I suspect most, at least in Canada, depend on their optometrist to refer them to a suitable surgeon. It is kind of a closed shop operation and the patient is kind of kept out of the loop. I suspect the optometrists are only somewhat aware of what is going on in the surgery world. My optometrist was not aware that the surgeon I was referred to was doing some surgeries in a private clinic as well as in a public hospital.

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After getting involved in this for two years now, I am only starting to understand what is really available and how to navigate the maze in my province of Canada. Here is a quick summary of what I have learned.

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The basics needed to select a lens are the axial length of the eye, the shape of the cornea (K factor), and the position the lens will be in at the front of the eye. There are different ways this can be done. The older method of measuring the axial length is with ultrasound (A-Scan), while the newer more accurate method is to use a laser. The newer methods of measuring the shape of the cornea deliver not just the simple K factor number(s), but produce a computer topographical 3D map of the shape of the cornea. This will determine how much optical power the cornea will contribute plus determine if there is astigmatism and if it is regular or irregular astigmatism. My understanding is that the latest version of the IOLMaster 700 from ZEISS does all this with one instrument and uses the laser method. The older IOLMaster 500 only does the eye measurements and a separate instrument is needed to do the topical map, at least as I understand it. The surgeon has to take the readings and feed them into a separate computer program to select the lens power needed. The IOLMaster 700 on the other hand has the power calculation formulas built into them and can display the powers needed based on a range of different formulas. The surgeon selects the formula to be used based on their personal experience and considering factors such as the axial length of the eye and previous Lasik procedures done to the eye, etc...

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From this my conclusion is that ideally you want a surgeon that uses the IOLMaster 700 and has the experience to choose the appropriate formula for your eye and what the target will be. I am not convinced from the research I have done that there is any proven benefit from using a laser to do the incision rather than the conventional diamond blade method. Skilled surgeons can get the same outcome with either method. This real skill is in measuring the eye properly and translating that into an IOL power.

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My current situation is an example of the funk you can get into. When I had the first eye done, he was operating out of a local hospital that has an eye specialist department. My eyes were measured 2 years ago now at this hospital with what I suspect was an IOLMaster 700, but I don't know for sure. Now, this surgeon has switched part of his practice to a private delivery method. Both of my wife's eyes were done at a private clinic that I think mainly does Lasik procedures. He operates there one or two days a week, as well as at the hospital, which goes in fits and starts due to COVID. I went to see him at another private office which I believe he inherited from his father who was also a surgeon, and passed about a year ago. Apparently he practiced right up until he passed from cancer. They measured my eyes again at this office with an IOLMaster 500, and an other instrument. On a second appointment at which I thought I would be able to select a lens type and get a surgery date (at the other private clinic), I ended up going away essentially empty handed. He was trying to convince me that I should consider a toric IOL (based on my eyeglass prescription). I told him that when he saw me two years ago he said my astigmatism was irregular and not suitable for correction with a toric lens. I got a big OH! He then stated that he did not have the needed data to continue the conversation and he had to call me back from the hospital where my data from 2 years ago was located on their computer system. He obviously does not have the topographical data to display at his new inherited office. I knew that he did not have an IOLMaster 700 as my readings in this office were taken with an IOLMaster 500. So now I wait for the call so a lens type and power selection can be confirmed. I have to say I am not impressed. It makes me wonder what he would have done if I had not told him of the diagnosis of irregular astigmatism? Would he have simply put in a toric lens with the data he had which was obviously not complete? Don't know. But the point is that if you do not know what is required to do the lens selection properly it might not happen!

"Seriously??"

Yes, seriously. I would imagine there are people out there (like your wife) that would indeed put their trust in the surgeon to do the right thing. Apparently this clinic has done members of royalty, famous celebrities, etc., but that hasn't convinced me... yet. What bothered me isn't that this surgeon isn't experienced or capable...it's that he quickly defaulted to wanting to put in a mono-focal lens set to distance in my remaining eye without any discussion whatsoever with regards to mini-mono-vision or mono-vision options to achieve my goal of spectacle independence. It was only AFTER I said, "But wait... you need to understand something... I want to be more or less glasses free as much as possible" that he said, "Oh okay, Yes, we can do that." There was no pre-talk of any sort to get a sense of what my objectives were. I'm quite disappointed really as I'd had high hopes for this place, but this experience has really turned me off.

IG

I apparently did a bad job of expressing my opinion as the statement below was my point.

"I would imagine there are people out there (like your wife) that would indeed put their trust in the surgeon to do the right thing"

Too many people IMHO think every surgeon is the same or put full trust in some surgeon their neighbor recommends.

My 2nd point was after doing the research to make sure you have a highly qualified surgeon that is only the 1st step. Just because a surgeon is highly qualified on paper does not mean he has your best interest at heart. So the 2nd point I tried to make was shop around and find a surgeon that you have a good rapport with and has your best interest at heart. I am from the US and as Ron pointed out this might be more difficult to do in other countries.

And the 3rd thing I would recommend is doing exactly what you are doing and that is research and become knowledgeable about the options. Again too many people just rely on the surgeon. I cannot begin to tell you how many people come here and say they are so upset their doctor did not even explain to them the advantage and disadvantages of a particular IOL.

And I have a true story. When I got my first cataract and was looking at MF IOLs, I knew a co-worker that had just got a monofocal IOL and I asked him, "Why did you pick a monofocal over a MF" And he just gave me a blank stare. He did not even know there were MF IOls. He got the IOL his doctor told him to get. I guess that is great for some people, but my brain does not work that way. I want to know all the options and the advantages and risk of each option. And Sadly that means you have to do your own research.

That is my 2 cents worth.

RWBIL,

I agree with you 100% on all points. I venture to say that the majority of people in our circumstance don't come to a site like this one in order to get informed. They just go in and accept whatever their doctor/surgeon tells them. While it might work out for them much of the time, there are those times it doesn't in part because they weren't aware of the array of options/strategies. I'm much like you -- I want to know as much as I possibly can when it comes to a procedure like cataract surgery.I want to at least try to maximise my chances of a good outcome.

This is what was so frustrating about my consultation recently. The surgeon just defaulted, with minimal thought and no discussion, to a mono-focal set for distance in my remaining un-operated right eye. It was ME who brought up my objectives after that (i.e. to be spectacle free as much as possible). It was ME who suggested a mono-vision or mini mono-vision strategy.I was hoping for some discussion of lens selection (Vivity? Eyhance? Neither?), the pros and cons of each, and his assessment of how likely we might be able to meet my objectives. I feel I'm actually low hanging fruit for a decent outcome, but none of the aforementioned things were addressed.

I wrote an email to the clinic expressing my dissatisfaction with the consultation. I've yet to hear back. By the way, I am an American but live in Europe. Thanks for your reply. Again, I agree with you 100%.

Regards,

IG

Based on my experience here are some detailed questions I would ask.

1. Does the surgeon have a IOLMaster 700 and can show you the true condition of your eye, and what lenses would be suitable for you? Would you benefit from a toric lens or not?
2. Is the surgeon willing to spend the time with you to explain all the options based on your specific eye measurements, including the pros and cons of each lens?
3. Is the surgeon willing to offer monovision, and spend the necessary time to ensure the accuracy of IOL power selection for each eye to ensure a good monovison outcome.
4. Does the surgeon offer a wide selection of IOLs or just one particular brand like J&J or Alcon?