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
RonAKA
Posted
I went in for my first pre-op consult today, and thought I would give a quick update on what was involved and what it means for me.
They asked a few health questions and took a list of my current medications, and what my last A1c was. No blood test. Then I was given a very brief vision test to establish my vision in each eye. From there the shape of my eye was measured with two different machines, one which apparently gives the topography of the cornea, and the other more internal. Then drops were put in my eyes and another test or two.
After a short wait I saw the surgeon, who reviewed the test results, did a quick visual exam, He gave a brief overview of the results and what he recommends. I have a cataract in each eye, but the one in my right eye lens is much worse, and the only one they would consider for surgery at this time. I still have 20/20 vision in my left good eye. When I asked whether or not I needed a toric lens in my bad eye, he said "No", because my eye shape shows there should be very low residual astigmatism. One machine showed a 0.4 correction would be needed and the other showed zero. This was somewhat surprising, but I do know correction is not done at 0.7 or less. He said that if there is any residual astigmatism it could be easily corrected with a laser incision. The future from my currently good eye is less clear. He said that eye showed non uniform astigmatism, and it may not be ideal for a toric lens either. That will be a down the road discussion I guess.
I asked if the AcrySof non toric lens was aspheric and he said yes it was, and our heath care system paid for the cost of it. I asked about the risk of glistenings with the AcrySof, and he said the issue was overplayed by some in the industry, and he has never removed a lens because of it. He did say he would use the Tecnis lens if I insisted. I left it at AcrySof, although he said I could change my mind later if I wanted.
The discussion about the use of a multifocal lens was very short and to the point. I had decided against it anyway, but what he said was that he would not put one in his own eye, so he felt it was unethical to charge thousands of dollars to put one in somebody else's eye. It would appear if one really wanted one, they would have to find a different surgeon.
His recommendation was to go with a pure monovision full distance lens in this eye and then when it came to the second eye, consider a monovision solution. I explained that this eye was my non dominant eye, and I thought the full distance correction was always put in the dominant eye. He said that was common but not necessary, and I should still think about it for the second eye. I suppose that would give me the opportunity to try it with a contact trial solution after my operated eye heals. I have not dismissed it, and have lots of time to think about it now.
He of course gave no predication on how long my current good eye would last, but said I should have no issue with an full distance IOL in one eye and an eyeglass correction for the other one, for the interim period.
Now it appears I have a 6 month wait until the actual surgery. I never asked if I will be measured again to make the final lens selection, but I presume they will at either another pre-op appointment, or right before the surgery.
Hopefully this may be of some help to those just getting into the cataract stream like I now am.
chen78740 RonAKA
Posted
it's surprised to see that AB will pay aspheric monofocal lens. OHIP will only pay very basic monofocal lens and there will be out-of-pocket cost for any other lenses including aspheric.
RonAKA chen78740
Posted
Yes, he said that we are very fortunate in Alberta to get this lens at no out of pocket cost. As I understand it, the lens will be the AcrySof IQ Aspheric Monofocal IOL. He said that if I insisted he would would use the Tecnis lens instead, and it is also covered even though it is another $200. I will go with the one he recommends though. But, I guess I should do some research on the Tecnis lens as well so I can call it an informed decision. All I know about it is that the Tecnis is apparently less susceptible to glistening, but is less stable in the eye.
mjcg RonAKA
Posted
Thanks for the update! Sounds like you have a really good surgeon (I like him and I've not even met him haha). Don't forget us six months from now - we will want to hear how your surgery and recovery goes!
Chris53317 RonAKA
Posted
A couple of comments Ron. I think it is unlikely that your eye will be tested a second time before surgery as there is usually very little change over 6 months, but your circumstances could be different. My test/evaluation to surgery, in Toronto, was 3 months, but the normal is 6 months.
With one eye being fitted for full distance you will have the option of mini-monovision when it comes to the second eye (a reversal of the normal situation with the dominant eye as your surgeon suggested). Mini-monovision is a normally maximum of 0.75D between the two eyes, which could mean that reading glasses will be needed for very small print. It is suggested that most people cannot tolerate a larger difference (the double vision issue). Alternatively, the second eye can also be done for full distance supplemented with reading glasses.
RonAKA Chris53317
Posted
Yes, I think you are right about the topography test not being done again. I was a little underwhelmed by the process. On the first machine they used on my cataract eye, it seemed to take multiple coloured photographs that I guess showed the shape of my eye. It took less than a minute after the test started. The technician was pleased it only took one try to get an acceptable result. The second (lesser cataract) eye took two tries. The whole measuring process took less than 15 minutes. I was expecting much more.
My thoughts are that when vision is stable after the cataract surgery, I will get my eyes tested, to get a new eyeglass prescription. As I am diabetic I get my eyes checked annually to determine if there is any diabetic related issues with the retina. I will be a few months overdue for that check anyway. I will need glasses changed anyway to compensate for the now corrected cataract eye. There is no break on glasses cost when one side is essentially plano, so the thought would be to get progressive prescription lenses for both eyes. I also plan to use this prescription to get a monovision trial lens for the remaining uncorrected eye. I go to Costco for this, and they are very good at giving me different power lenses to try to see what I like. The last time I did this I ended up with one eye under corrected by 1.25 to give me near vision. I recall at the time, that 1.5 was considered maximum. Today I have seen some are using up to 2.0 under correction, although that seems like a lot. One report, Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost, I have read in BMC Ophthalmology, defined mini monovision like this:
"Pseudophakic mini-monovision was chosen for this study because the gradual difference between the two eyes is more tolerable by patients than full monovision. For purposes of this study, the definition of mini-monovision is the near eye calculated between − 1.25 and − 1.50 diopters spherical equivalent. In all patients the dominant eye was corrected for distance vision. Toric IOLs or limbal relaxing incision were used on patients who had corneal astigmatism greater than 1 diopters. Two patients who previously wore monovision contact lenses, the refractive outcome was calculated for − 2.00 diopters. The same experienced surgeon (M.G.) performed all of the surgeries under topical anesthesia using a standard phacoemulsification procedure. All patients were treated with aspheric IOL implants (AcrySof®IQ IOL or the AcrySof® Toric/IQ IOL)."
In any case I will take guidance from my surgeon, but will also use the contact lens trial to experiment with what I like and can tolerate. I also plan to explore options to improve any residual astigmatism in the first cataract operated eye. As I understand it, mini monovision is most successful when visual acuity is maximized first.
Thank you for your comments. And as you mention full distance monofocal lenses in the second eye will remain an option that I will also consider seriously. It reduces the near vision solution to simple OTC reading glasses.
Chris53317 RonAKA
Posted
Your are doing all the right research, and the six month wait gives you time to make a very informed decision. The outcome should be great, and the Costco plan is a wonderful idea.
RonAKA Chris53317
Posted
Yes, and the 6 months is a very minimum. I am not sure when they will be prepared to do my second eye as I suspect it will have to deteriorate significantly from the current 20/20 I have in it now, before I can go on the wait list for it. It could be years away! I'm thinking a year minimum from now, and that is probably quite optimistic, or pessimistic, depending on how one looks at it! I will hopefully be able to use that time to do the limbal relaxing incision to correct for any residual astigmatism, if it is significant enough to be of value. The surgeon has suggested that as an option to consider, but of course the need will only be known after the cataract surgery has been done.