Wrong iol for me, not sure of options to fix

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Hi - I had cataract surgery on my left eye approx a month ago. During the initial consult, my doctor said I would get a standard monofocal lens set for distance, that other lens were not an option due to glare and contrast issues. Having been near sighted since a child, and working in IT, being able to read electronic devices such as a pc is important to me. When I voiced my concerns to the doctor, I was told I can wear readers for near vision. So I went forward, expecting to make lemonade from lemons.

Not long after the surgery, I was told I could have opted for near vision, as well as correction for my astigmatism with a premimum lens. I feel the doctor did not disclose all my options prior to surgery to make an informed decision.

I have verified with a different practice that it can be fixed though most likely will be considered elective by my insurance. I reached out to a different doctor at the original practice who also confirmed this, who also advised they will waive their charge ($6000) but I will have to cover the hospital charge ($15000 if no insurance).

While I appreciate covering their cost, my desire to get a premimun lens, like a trulign that is accomadating aspheric toric monofocal set for near vision, may be an issue for them to cover. Not too comfortable about my covering the hospital cost for what to me, seems like a mistake on the doctor's part due to the level of experience.

Any suggestions on my options as I am not happy with leaving it set to far distance and wish to resolve it before doing the other eye?

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  • Posted

    Same thing happened to me.  Prior to the surgery I had told him that I would on a computer for 8-9 hours a day and my enjoyment is reading, crossword puzzles ect, they said that is very important that you told us that, after surgery I cannot see close at all have to use readers.  I can see far away but I am not a forest ranger so not sure why they chose that!  Plus my middle vision is all screwed up.  Some things are to far to see with my readers and not far enough to see with my good far vision.  Keep saying I wish I would of not had it done

     

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    • Posted

      There isn’t much choice but to have surgery if you have cataracts.  I couldn’t see well enough to drive.  I did anyways waiting for surgery but drove only in areas I was familiar with.  Couldn’t see road signs till I was very close to them.

      From your comment ‘wish I wouldn’t have had it done’ mean you did not have cataracts to begin with?

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    • Posted

      Yes I did have cataracts in both eyes.  But I wish that he would have made it that I was still able to see close like I was before and only needed glasses for driving or far away

       

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    • Posted

      It is a shame the doctor didn’t discuss targeting your IOL to have nearer vision. I am not sure why they assume those wanting monofocal lenses want distance vision.  I have often wondered if it had to do with driving and passing the vision test.  I know when first diagnosed with cataracts it is the ability to pass that test (or not) that allows for coverage of surgery under our Canadian Medicare plan.   But since I have always worn glasses for distance can’t see why they’d care if I worn them for distance after cataract surgery.

      Have you considered progressive glasses for intermediate and near so that you don’t have to keep changing pairs of glasses?

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    • Posted

      Sue:

      I think that doctors tend to correct for far because that setting will result in the greatest numerical range of vision. They can give you "12 ft to infinity" vs "4 ft to 8 ft" or "8 in to 14 in". I would never want close focus but I can certainly understand wanting an intermediate range where you could function around the house normally and only need glass for driving or something of that nature. 

      I'm actually amazed at just how narrow my vision is now when I wear reading glasses (through the eye with the IOL) and I understand why surgeons don't want to target this range. Literally, I have functional vision from 8" to 12" and that's it. I feel like I'd spend all of my time moving objects into that tiny band of clear vision. 

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    • Posted

      Yes understand your point about distance providing a greater range.  My surgeon only discussed targeting plano with monofocals.  It hadn’t occurred to me to target intermediate distance.  There are a few who are very happy with that setup on the forums and may have been a good alternative option for me.  Guess if one still has good near vision when cataracts hit like myself the thought of losing that reading distance is unnerving to say the least.  I guess going with the know (wearing glasses for distance only) is where I was most comfortable with.  When it seemed as though my vision would be other way around with monofocals set for distance that really swayed my decision to Symfony lenses.  
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  • Posted

    Hi Joe - seems doctors either push premium lenses as it means more profit to them or when it is on Medicare they assume you don’t want that expense and just discuss monofocal lenses - although the standard lens can be targeted for computer distance and then you would wear glasses for distance.  That may have been something that would have interested you to avoid that expense (which I find excessive) but I live in Canada where Medicare is free for all although one has to wait a long time for elective surgeries.

    I gather you are looking at options for 2nd eye.  Since you are getting good distance vision with first eye why don’t you consider another monofocal standard lens for 2nd eye nearer - say 1.50 diopters in.   That way you’ll have good useable vision for distance and computer distance and just need readers for reading.  This way you’ll avoid any night vision issues associated with multifocal lenses.  You could target even closer at 2.0 but not everyone can tolerate full monovision.

    Even if you go with a premium lens - shop around - it should cost more than $3000.  I think they are over billing you for the hospital.  Just my opinion.

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    • Posted

      You say you think they are overbilling for the hospital.

      My husband's bill showed $6700 for the surgery center, $1158 for the anesthesiologist (IV sedation) and $4054 for the doctor--PER EYE!

      The Medicare approved cost (what they paid) was $1753  This is in the US. And this doesn't even include the $2500 he paid per eye for the upgraded Symfony.

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    • Posted

      I do think over billing occurs.  In Canada where I live since we have national health coverage (and there are pros and cons to that) our gov’t since Jun 2012 wants all premium lens costs paid to the hospitals not the opthomologist’s office.  We get a credit of $300 which is what gov’t would cover for a monofocal and we pay hospital difference between the standard and premium lenses.  This was to stop the practice of surgeons over billing their patients for premiums lenses.  If I lived in Quebec their Medicare system is now paying for the premium lenses.   Wish I still lived there!   Down side of our health care system is huge wait times to see specialists.  Currently I have an 18 month wait to see an ENT.  Driving me crazy.  I keep calling to see if there is a cancellation to get in earlier.
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    • Posted

      Hi Sue.An, if I am not mistaken in BC the credit is $200/eye or $250/eye. I too find Joe's bill excessive and msg him but did not hear from him.  From Susan44499's numbers, her DH's paid out-of-pocket US$15,159 for both eyes.

      [US$11,912 (less US$1,753) + (US$2,500x2) = US$15,159] holy mackerel!

      If my husband had opted for private surgery at our surgeon's clinic (BoydVision), it would only be C$3,500/eye, including Laser (PRK) touch up.

      Private surgery using standard soft lens like what I had, it would be C$1,750/eye.

      And we both are now enjoying clear vision.

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    • Posted

      I guess amounts vary slightly between provinces.  When I opted for Symfony lenses my surgeon let me know I had to call the hospital and pay for them.  Day

      Don’t we’re $1,200 per lens and I got a credit for $300 each lens.  

      I wonder how Quebec manages with paying premium lenses under Medicare?

      But thankful I have good vision for $1,800 .  Can’t imagine forking our prices quote in US$ .  That would add another 30% on top of our Canadian dollar - ouch!

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    • Posted

      I'm counting my blessings every day.

      Also I learn that Beijing, Hong Kong and Singapore are charging private cataract patients more than double or triple of what our eye surgeon charges here in Vancouver, British Columbia.

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  • Posted

    First of all, although you are not happy with your intermediate vision and the near vision, you should be happy that you have a good distance vision and that you are not having all the night vision issues people are having with the "premium lenses" such as multifocal lenses or the Symfony lens. Your issue is easily correctable by glasses, while those the night vision issues with those lenses are not.

    The best choice for what you do with your left eye depends on what your current vision is with the right eye. If you can share your prescription for the right eye (spherical and cylindrical) , we may be able to give you more specific advice.

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  • Posted

    I was in similar working situations, as you.  I have been near sighted for my entire adult life and prided myself on being able to read - even very fine print - without glasses.  I used my computer without glasses, although they were progressive lenses. Fast growing cataract developed in my left eye and I discussed near vision option for my surgery.  Doctor said it was my choice, but his goal was to have his patients not needing glasses for everyday life and rely on readers when necessary.  I went with near vision IOL (18.5 D) and am typing this without glasses.  I have 20/20 near vision and have a new prescription to correct distant vision in the operative eye.  Left eye has a mild cataract and I really can now see the difference with brightness between the two.  I will wait until that cataract has "matured" and will have surgery, probably a year away.

    I was a candidate for premium lens but the out of pocket expense was beyond my reach.  Sorry to hear you are having this difficulty.  Not much consolation, but since you were going to wear glasses for distance, you might have to resign yourself to wearing glasses for near vision and forego the expense of correcting the previous surgery.

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    • Posted

      <steve09278> wrote "I went with near vision IOL (18.5 D) and am typing this without glasses. I have 20/20 near vision and have a new prescription to correct distant vision in the operative eye".

      100 / 18.5 = 5.4 cm which is 2.I inches focal point. Did you really get an 18.5 D IOL?

      I want to keep my near vision and am trying to decide between -3.5 to -4.5.

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    • Posted

      The 18.5D referred to will be an IOL power which will yield very different results for people depending on their eye biometry (axial length, corneal power etc).  Hence it's no use when comparing results and expectations.

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