Questions re: Cataract surgery for Wife

We are in Canada, Nova Scotia. This is a quote from a reply I received from the Provincial Health plan provider.

"A "hard" lens is covered by MSI but there are other options, such as "soft" lens and these lenses are not covered through MSI."

A friend had the surgery, says she paid $80 for the lens but can't offer any details. Does that seem like it would be a reasonable cost to upgrade to a soft lens? Also, the Surgeon wants $50 in cash for the visit. Sounds shady...lol, but maybe it's to cover costs/tests not paid for by the health care provider.

It sounds like Nova Scotia runs a very basic coverage system. I sure would spend $80 for a soft lens if it was my eyes. We are in Alberta and many of these additional costs are covered. There are no fees for medical visits. We do have to pay for the post surgery eye drops which cost about $50.

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It sounds like your wife's cataract is very dense. That can make it hard to measure the eye accurately to determine what IOL power is needed. One question you should ask is if an accurate measurement can be taken with the basic A-Scan ultrasound or if an advanced method needs to be used.

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Another extra cost issue you may want to be prepared for is astigmatism and the need for a toric lens. In Alberta a toric lens is not covered and costs an extra $1000 per eye. If the astigmatism is not high (greater than 1.25 D or so) it is not essential for good vision. Astigmatism can be well corrected with eyeglasses after surgery. But, if the astigmatism is high and there is an expectation to go without glasses for distance vision, then a toric lens is the way to go.

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If you google the name of that Queens University brochure that I gave you, and read it, you will see what the extra charges may be. It is best to be well prepared for the surgeon visit, especially if he/she is charging you for each visit.

Ask specifically what model the free lens is. I would bet money it's the Alcon Acrysof Monofocal (which is a great lens) and the "soft" lens is something like the B&L Sofport. I don't know for sure but there's no way the free lens is actually a hard lens.

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As for the $50 I know there is one test that incurs a usage fee so they have to charge if you do it in their office. You might be able to get that test for free at the VG but getting an appointment might take time they feel you don't have.

I tried to reply to you but it has been awaiting moderation for 6 hours. Not sure why.

This site has some "wonky" moderation rules. They do not allow any hot links to outside websites, but you can link to other threads here within this site. And there are some other rules that I just really do not understand. Just make your post again, and make sure to avoid any links, and reference to commercial places that sell things. I suspect they may have some screens to avoid spam posts. That is why I posted the name of that brochure at Queens, and not the link.

It is possible that some provinces in Canada do not cover the cost of foldable lenses. It used to be in some provinces that they only covered the cost of hard lenses. The practical reality may be that you would have to find someone that actually will implant a hard lens if you want it for free. i.e. the fee structure is still based on the hard lens being available, but it may not be in reality.

Thanks for the reply david98963. I'll get her to ask about the lens types at her appointment tomorrow. Given the average wait time posted for the Doctor, I figure she must have been bumped up due the her lack of vision. Out of curiosity, I put her in front of an Essilor online eye test on my laptop. She couldn't make out anything with her right eye.

You were right I think, I had posted a link from CBC, from 2013, about Doctors in Nova Scotia complaining about only hard lenses being covered by MSI. Titled "Additional cataract surgery funding urged for N.S."

Likely why my post was held up.

According to her last vision test, before the cataracts showed up, she didn't have any astigmatism.

OD - Right (SPH) +2.00 (CYL) 0 Axis 0

OS - Left (SPH) +1.75 (CYL) 0 Axis 0

NV-ADD+1.75

I wonder if the $50 is for an advanced test to determine the IOL power needed. I guess we'll find out tomorrow.

I want to thank you for your input. You have provided very helpful info.

That sounds promising for not needing a toric lens. In some cases there can be astigmatism in the lens that offsets astigmatism in the cornea. In cataract surgery the lens is removed so that astigmatism, if there is any, is gone. Then the residual in the cornea may show up. Not likely based on that prescription but is possible. The additional test may be to determine if there is astigmatism to correct or not.

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To get the most help on this site you should find out exactly what lens model is being offered and what the extra cost options are. The most common soft lens used is an AcrySof made by Alcon. The spherical model is the AcrySof Monofocal, while the aspheric model is the AcrySof IQ Aspheric Monofocal. As I mentioned in my first post, it is not essential to get an aspheric lens if cost is a consideration. In the Tecnis line I am not so sure of the exact wording. They may simply be just Tecnis monofocal and Tecnis Aspheric Monofocal.

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I think at this point the most concerning thing I hear is that the cataract is so advanced that it may be difficult to measure the eye to determine the power. You may be best to pay some extra for the more advanced measuring system test if the surgeon feels it is necessary.

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Last if it is possible with all the COVID rules I would go with your wife so you can hear what she is being told first hand. Sometimes they go over a lot of information in a hurry and it is hard to digest. That way one of you can take notes and compare what you heard after the fact if necessary.

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Hope that helps some.

I'm feeling that the Doctor will want to make all the decisions tomorrow. Not bad as long as all the choices are rather simple. If it makes the surgery happen faster I guess that would be a good thing. She's pretty stressed out about the whole thing and worried the left eye may cloud over before the right one gets fixed. She's had a rough go of late. Last August she tripped and fell, broke one ankle in 3 places and dislocated it, sprained the other. After 2 surgeries, some plates and pins installed and tons of physio therapy, she's still hobbling around with a cane and may need more surgeries. Looking back, I think she may have tripped because of the cataract causing a loss in depth perception.

I'll try to go in with her, if I'm allowed.

Yes, try to go with her. You may want to say that she is not seeing well and may be stressed by the decisions to be made.

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These surgeons are doing many surgeries in a day, and I would suggest it is not a big imposition on them to delay the surgery for a week to give you more time to think about the choices if they are not obvious. I also would not be surprised if there is a significant time wait between your consult and the actual surgery time. This gives you some time to change your mind. Once they have taken all the measurements, different lenses can be selected after that without another consult.

From what I've been told and read about, A hard lens, if one is actually still available, requires a larger incision to insert it and therefore has longer recovery time.

It would seem that the province of Nova Scotia will pay the cost of the surgery along with the equivalent cost of a hard lens. The doctor will likely charge the difference between the hard lens vs the soft variety. We'll find out more this afternoon when she meets with the surgeon.

Glad I found this group! Thanks to all for the advice and input.

So a bit more info, turns out the appointment was with the technician today. She took some measurements and did a few tests. That's what the $50 was for. The tech said the Doctor uses the AcrySof lens but she wasn't sure exactly which one, only that there is an $80 fee for the lens and it gets paid to the hospital on the day of the surgery. I guess the plan is to do both of her eyes, a few weeks apart. She sees the specialist on March 15th so things are moving right along. He will do the measurements to determine the lens power on that visit and if there are choices we will find out on that day.

My suggestion would be to space the two eyes about 7 weeks apart. That will give the first eye time to totally recover, and your wife can get an accurate eye test to see where the eye ended up. That information can be useful in refining the target for the second eye.

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The process I have been through is an exam by the surgeon 24 hours after surgery, another exam at 3 weeks, and then a final optometrist eye refraction exam at 6 weeks. It is best to do each eye independently. My surgeon says he almost always learns something specific in the first eye operation that can be used to improve the results in the second eye.

I heard the receptionist talking to a patient that was just getting scheduled for the surgery in the first eye and what I heard her explain to him was pretty much exactly what you suggested.

She had an appointment with the surgeon today. He looked, or tried to, into her eyes, he could see into the left but had to use ultrasound on the right one.

I wasn't able to go in with her this time because we have our grandson visiting for a week and I had to wait in the car with him.

She has an appointment on April 21st to take measurements for the lenses. Surgery on the right eye will likely be on April 30th.

Her appointment for lens measurement was March 21 not April 21.

The measurements took only a few minutes by the technician. She is scheduled for surgery on the right eye on April 6th. No other lens options were discussed or offered. The papers given to her only state to pay $80 to the hospital for the intraocular lens on the day of surgery. That must be the cost difference between the hard lens that Nova Scotia Health covers and the soft lens upgrade.

I would call and confirm with them that the $80 is what it takes to get a soft foldable lens. The latest information I could find on line was that the soft lens was an extra $280 in 2017. Perhaps since then the cost has been reduced.

The free lens is foldable. I'm in NS and I'm aware of what lenses NS Health uses. There are no rigid lenses.