What to expect in first cataract appointment?
Posted , 6 users are following.
I would be interested to know what happens in the first appointment in preparation for cataract surgery. I am in Alberta, Canada, and with our health care system have waited nearly 10 months for this first consultation appointment. My appointment is for Feb 3, and I had a short discussion with the surgeon's secretary. She said it was a vision test and complete eye exam that would last about 90 minutes. Must be more than just a routine eye exam, based on time alone. I also asked how long it would be until the surgery. I was told it would be about 6 months! So I have waited 10 months to be put on another waiting list of 6 months. Still I find it hard to complain, as I am sure there are many others on the list that have issues with both eyes and have more vision loss than I do. I see very clearly with my currently non cataract eye, but not too good with my bad eye.
So for those who have been through this, what can I expect? I'm sure I have to make the decision as to whether or not I go ahead with the surgery, and that is a definite yes for me. Not hard to make that one. But, is it likely I will have to commit to a specific lens at this point, or does that come later? I am thinking that if I opt for a premium lens, like I intend to, there will be more measurements to be taken much closer to the actual surgery time? And, I also wonder if I can use this 6 month waiting period to change my mind?
Any thoughts appreciated. I would like to be well prepared for this first consult.
0 likes, 26 replies
JBR RonAKA
Posted
Firstly, I should point out that I am in the UK and things will no doubt be different between Canada and the UK.
As for waiting times, I seem to remember not having to wait for such a long period, once it was determined that my vision was sufficiently compromised to make a cataract operation necessary.
My pre-op included, among other things, a blood test as I am diabetic.
Another matter which you have not mentioned was that I was offered the choice between a general anaesthetic and a local anaesthetic. I chose the latter, but I expect that some people would prefer not to be aware of what is going on during the operation. I can honestly say that I never felt a thing during the operation other than, perhaps, a slight feeling of pushing of the eye.
Unlike you, as most of us here are treated under the NHS, I was not offered a 'premium' lens which I assume would include the option of specifying an exact (as near as they can) corrective level and/or (I think?) some sort of multi-focal lens as in the case of varifocal spectacles, although I could have asked for a private consultation and treatment (at cost) in which case I would have been given a greater choice of the lens implanted. The choice of lens and corrective level was, therefore, determined by the surgeon. Although I would have liked a corrective level to give me perfect (or as near as possible) vision in that eye, the surgeon explained that, as I am really quite short-sighted in both eyes, a correction to perfect vision in the one eye would be difficult or even impossible for me to handle. Naturally, I accepted his verdict: he knows better than I!
Finally, of course you can use the waiting time to make a final decision as to whether or not to proceed.
RonAKA JBR
Posted
Thank you for the comments. Good thing you mentioned the blood test as I am diabetic too. I use two types of insulin, and can pretty much control what my BG will be. I will be sure to ensure it is spot on. I have wondered about that aspect as I recall when I was first diagnosed with diabetes (BG way out of control), I was put on a drug that brought it down quite rapidly. I believe due to osmosis pressures the shape of my eye must have changed. All of a sudden I could see to drive without glasses! It of course was temporary and my vision returned to what it was before diagnosis - blind again! It does make me think BG can impact the shape of the eye, and I wonder how they ensure it is stable when they take the critical measurements.
I don't like the risk of general anesthetic so will opt for a local, assuming I am given the choice. I think if my wife could tolerate getting both her legs sawed off for hip replacement while under an epidural only, I should manage with my eyes!
Our provincial health care in Canada is probably not a lot different than NHS. Our health care pays for a standard monofocal lens and the cost to have it implanted. Providing we go to a surgeon that does premium IOLs we do get that option if we pay the additional costs.
I have a question in another thread about the imbalance of correction between the eyes. If I go for pure distance lens I will have to go on with being short sighted in my opposite eye for some time - possibly years. My strategy was to just get the eyeglass lens changed in my IOL corrected eye to a plano upper and reading glasses lower. This assumes it does not matter how each eye is corrected (IOL or eyeglasses) as long as they are both correct. Am I missing something there?
JBR RonAKA
Posted
No, I did the same. My spectacles were quite strong in both lenses before the lens implant. Afterwards, my left lens was reduced in strength (as my prescription reduced from about -6 to -2) quite considerably and I am happy with the result. I have varifocal glasses.
chen78740 RonAKA
Posted
Hi Ron,
I am in Toronto and could share what I have gone through so far. It may not be the same as that in AB.
If AB has the similar process, you may want to prepare all your questions in the first appointment to ask the doctor.
Hope this helps.
chen78740 RonAKA
Posted
Forgot to mention: you could choose not to proceed before 2nd appointment (actually before paying the fee:))
If there are private clinics in your city, you could ask for a free consultation to gather more information and opinions from different sources.
RonAKA chen78740
Posted
Thank you chen that is helpful. I don't think there is any chance I will not go through with this. I would be in bad shape (especially after another 6 months) if both eyes were as bad as this one eye. I wouldn't be safe to drive.
My optometrist recommended this surgeon because he offers the premium lens options. Also I have done enough checking to know that he probably specializes in the Alcon lenses. From what I have determined from research is that they are the most popular lens used, and the most stable in the eye, which is important for a toric lens, which I am most likely to choose. The Tecnis lenses are less stable, although they have the Toric II lens in post approval trials now which is supposed to be better. The glistenings issue is a slight concern, but I don't think a significant one with the Alcon. And potentially the aspheric correction at -.27 is a bit better with the Tecnis compared to the Alcon at -.22. However what I really need may not be either of these.
I don't think there is going to be any surprises in what he offers or recommends but you never know. I am just a bit surprised that it is going to be a 90 minute appointment. I am guessing that there may be at least some measurements taken of the cornea shape to see what type of correction is likely to work. I gather for a toric lens the astigmatism has to be reasonably uniform or it does not work well. But, who knows I guess.
This will be done in the hospital where the specialized eye clinic is located. But that may be just a result of the fact he is a University of Alberta prof and doesn't have a commercial clinic office.
Sue.An2 RonAKA
Posted
Hi I had my surgeries in New Brunswick. Yes long wait time in Canada. First appointment for me was at the hospital where eye mapping was done. 2nd appointment was with surgeon who dilated my eye and did thorough exam and I did bring questions with me and discussed strategies and options. i delayed my surgery as I had additional questions after I looked online and discussed with others. so had a second appointment with surgeon before surgery. I had to have both eyes done and had a 6 week wait between those surgeries.
Sue.An2 RonAKA
Posted
Hi I had my surgeries in New Brunswick. Yes long wait time in Canada. First appointment for me was at the hospital where eye mapping was done. 2nd appointment was with surgeon who dilated my eye and did thorough exam and I did bring questions with me and discussed strategies and options. i delayed my surgery as I had additional questions after I looked online and discussed with others. so had a second appointment with surgeon before surgery. I had to have both eyes done and had a 6 week wait between those surgeries.
RonAKA Sue.An2
Posted
Thanks Sue,
They have told me to expect the dilation drops at this visit. Have not had those for a long time as my current optometrist does the eye exam with a camera and no drops. I have read that you can't do an accurate eye shape measurement after using drops, so that perhaps suggests no measurements at this visit. Time will tell I guess...
Sue.An2 RonAKA
Posted
I believe they dilate your eye to exam it for other issues. I still underwent the other types of eye tests (different visit) Good luck - keep us posted.
chen78740 RonAKA
Posted
The wait time with this surgeon is not long. First appointment in last Dec, 2nd for IOL measurement on Jan 30 and surgery booked in Mar.
I have to use Tecnis Toric in my left eye as I already have ZCB00 in right eye and the surgeon wanted to use the lens from same vendor on both eyes to gain a "balance"
If you go with private clinics, it would be even faster with higher cost ($1000 more as I have asked)
RonAKA chen78740
Posted
I'm not sure a private clinic to jump the queue is even possible in our part of Canada. That seems to be a no-no in our government health care system. In the US I'm sure it is possible though. I am still quite able to see well enough to drive, so find it hard to complain. If my good eye starts to go south it could get interesting though. Long retired, so at least not an issue with working.
Sue.An2 RonAKA
Posted
I think those that want clear lens exchange ;same procedure as cataract surgery) can go to private clinic and pay out of pocket. Makes no sense if you are a canadian and have cataracts as our system pays for the surgery and you have access to all lens types.
mjcg RonAKA
Posted
Hi Ron! Just remember the most important thing for you to do at your appointment is to ask questions (ask, ask, ask).I went for three consultations and each surgeon had a different opinion (I'm here in Michigan if you'd like to take a drive over the Ambassador Bridge to Detroit and visit some surgeons around here (lol). Anyway, just think carefully about the outcome that would best fit your vision expectations and understand clearly what your surgeon is recommending. I went with a monofocal near vision lens (which is a rare choice) because I'd been near sighted most of my life and I'm ok with wearing progressive glasses. I'd read about nearsighted patients who went with a distance lens and then missed their close up vision (being able to thread a needle, pluck an eyebrow, etc.).I also had only one eye done and needed the lens IOL to be "in sync" with my other eye to avoid double vision outcomes. I really trusted the surgeon I went with too. I think if both my eyes were being done, I may have gone with the multi-focus lenses at a higher cost but then you have the people who complain about halos and such. So... ugh, it was and is a tough decision.
My pre-op appointments averaged about 1.5 hours. Paperwork (there's always paperwork), health assessment (blood pressure, weight), financial options discussed, a complete eye exam which includes dilation of eyes, optical measurements, etc. One place had me watch a five minute video about the procedure too.Patient and surgeon schedules get backed up due to emergencies and such, so you should just be prepared for that. You will definitely learn that patience is a good skill to have when it comes to eye surgery (haha).
It is coming up on one year since my cataract surgery, and I'm really pleased with the outcome. True, I'm still nearsighted, but the vision in this eye is crystal clear. I'm all about getting the other eye done now (this eye sees the world with a yellow tint), but they say the cataract will likely not be ready for surgery until I'm in my 80's (I'm 65).
So ask questions, be patient, and schedule your surgery. You'll be glad you get it done.
RonAKA mjcg
Posted
mjcg said "I also had only one eye done and needed the lens IOL to be "in sync" with my other eye to avoid double vision outcomes."
I have read that comment before, but I am puzzled about what the concern is here? Is this an issue of prism? I have never had any correction for prism.
My thoughts were that it would not make any difference if one eye is corrected with an IOL for distance, while the other eye was corrected (until it is done) with an eyeglass lens. My plan was to wear a contact in my current good eye for distance and just use reading glasses for up close. Then when my cataract eye stabilizes, I would get a new eyeglass prescription that would include a normal eyeglass correction for distance, astigmatism, and a +2.5 add in my current good eye, and essentially a plano distance and +2.5 add for the IOL eye. I would then wear these glasses until the second eye was done. Is there a reason why that would not work?
JBR RonAKA
Posted
I have found a similar 'double vision' situation since my cataract operation.
My left eye has now been reduced to around -2, whereas my right eye (corrected by spectacles) remains at over -4.
I find that there is no problem with double vision whilst looking forward or to the right, but when I turn my head to the right and look to the left through the spectacles lenses, beyond a point double vision occurs. No major problem, actually, as I have learnt to turn my head slightly in order to look to the left!
I'm hoping that when the day comes for me to have my right eye done (slowly developing cataract), the difference in prescription between my two eyes will be rather lower and the double vision situation will either be less pronounced or, perhaps, disappear completely.
mjcg RonAKA
Posted
In my particular case, after a vitrectomy (cataract is the guaranteed side effect of this type of eye surgery) I ended up with unequal refractive powers between both eyes (7.25 and 4.50). My surgeon needed to make sure both eyes would end up "in sync" - no more than 1.5-2.0 between the two eyes to avoid double vision issues. If I'd gone with a distance lens, or multifocal, my "good" eye would have needed lasik or early cataract surgery. I doubt I've explained this correctly! Sounds like you just wanted to know why the appointment would take so long, but I went rambling on. Sorry about that!
RonAKA mjcg
Posted
Thank you mjcg and JBR for you comments about the potential for double vision. I will try to remember to ask the surgeon about that potential.
For reasons that I don't totally understand (except that my natural lens is losing flexibility with age) my distance vision has been slowly getting better over recent years. My remaining non IOL corrected eye will require about -1.5 spherical and -1.0 cylindrical correction with eyeglasses. I think that is a pretty mild prescription, and not a lot different from a perfect scenario in the IOL eye at 0 spherical and 0 cylindrical.