How to Choose a Cataract Surgeon
When it's time for cataract surgery, choosing the right eye surgeon is an important decision that could make the difference between an acceptable outcome and a great one.
Freedom from eyeglasses after cataract surgery requires the use of premium intraocular lenses (IOLs) that may require your cataract surgeon to have special expertise and experience with this sort of IOL to insure a good outcome.
Which Type of IOL Will You Choose?
Conventional monofocal IOLs usually provide excellent visual acuity for driving and other distance vision tasks, but you typically will need reading glasses after cataract surgery if you choose this type of intraocular lens.
(You can reduce your need for reading glasses if you choose monovision cataract surgery with conventional monofocal IOLs, but this means only one of your eyes will see distant objects clearly.)
Most people want to be less dependent on eyeglasses (or be "glasses-free") after cataract surgery. This demand has led to the development of modern IOLs that can correct vision at all distances. These premium intraocular lenses are called presbyopia-correcting IOLs and require special expertise of your cataract surgeon.
Medicare and most private health insurance policies will cover the cost of standard cataract surgery with conventional monofocal IOLs. If you want a presbyopia-correcting multifocal IOL or accommodating IOL, this will require you to pay the extra cost for these premium intraocular lenses out-of-pocket.
You also will want to find a cataract surgeon who has embraced this new technology and is comfortable using these advanced lenses for cataract surgery.
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Choosing a Cataract Surgeon for Standard Procedures
Cataract surgery is so common that you probably have friends, neighbors or relatives who have undergone the procedure. When you need surgery yourself, ask around for a referral.
Here are a few questions to ask someone who has undergone standard cataract surgery:
- Was the surgeon's staff friendly and courteous throughout the entire process?
- Did they explain billings thoroughly and clearly?
- Did the surgeon take time to explain the procedure, including potential complications?
- Was the patient made fully aware of all options, including types of lenses that were available?
- Were premium IOLs discussed?
- Was the outcome successful? If not, why not?
- Was follow-up care given promptly, when needed?
As you sort through recommendations of friends and family, you'll be able to narrow down your choices. Also consider asking your optometrist or general ophthalmologist who made the initial diagnosis of your cataracts for a recommendation.
When you schedule your first appointment with a cataract surgeon, you need not feel committed at that point. Take time to ask the surgeon and staff plenty of questions, and make sure you are comfortable that this is the person you want for your procedure.
You might want to check out the surgical center as well. While very rare, one issue involving cataract surgical centers might be their infection rate after cataract surgery. Most surgery centers will have these numbers available on file.
Naturally, you will want to make sure that the surgical center you choose has not been associated with anything more than a very rare or isolated incident of this type.
Questions to ask your cataract surgeon include:
- How many procedures have you done?
- Has your surgical center ever had an outbreak of eye infections affecting multiple patients? If so, how many times?
- Who sees patients on the first postoperative day? Is it the surgeon, another ophthalmologist or an optometrist?
Your cataract surgeon or a member of his or her staff also should give you handouts and other information describing the procedure itself, potential cataract surgery complications and what you must do to prepare for surgery.
Choosing a Cataract Surgeon for Premium Lenses
If you are interested in premium IOLs that can correct presbyopia and reduce your need for reading glasses after surgery, be sure to ask the surgeon if he or she routinely uses these lenses.
Presbyopia-correcting IOLs that have been FDA approved for use in cataract surgery performed in the United States include: AcrySof IQ ReSTOR (Alcon), Tecnis Multifocal (Abbott Medical Optics) and Crystalens (Bausch + Lomb).
AcrySof IQ ReSTOR and Tecnis Multifocal are multifocal IOLs that require precise placement and centering in relation to the eye's pupil to function appropriately and accurately. For this reason, many surgeons recommend the added precision of a laser cataract surgery procedure if you choose this type of presbyopia-correcting IOL.
Even when positioned perfectly inside the eye, multifocal IOLs sometimes can cause noticeable glare and halos at night. Be sure to discuss this possibility thoroughly with your cataract surgeon during your eye exam and consultation prior to surgery.
The Crystalens is an accommodating IOL, which means it moves in response to action of your eye's focusing muscle to provide vision at multiple distances. This lens has certain advantages and disadvantages, compared with multifocal lenses. Again, your cataract surgeon should discuss details of what you can expect as an outcome.
You'll know your cataract surgeon is taking the right approach for premium IOLs if:
- No guarantees of "perfect vision" are made.
- You are told you still might need to wear eyeglasses for certain tasks and conditions.
- You are advised to keep your expectations realistic.
- Your surgeon has a good follow-up policy to address any problems or complications after surgery.
- You are advised that enhancement procedures such as astigmatism correction may be needed and these are explained fully, including possible extra costs.
While premium IOLs are a major innovation in cataract surgery, the decision to have a cataract procedure with a premium lens is yours alone. Consider all information available about these lenses before making your decision, and be wary of a surgeon who "oversells" the concept.
No IOL of any kind produces perfect results for every person, and your surgeon should make sure you understand that.
All cataract surgeons who insert premium IOLs also are skilled with standard IOLs. However, not all surgeons who insert standard IOLs will use premium IOLs in a procedure.
If your surgeon chooses not to insert premium IOLs, ask why and then get a second opinion from a surgeon who does use these types of IOLs.
You also can validate a cataract surgeon's credentials by checking online membership lists or directories of professional organizations such as the American Academy of Ophthalmology or American Society of Cataract and Refractive Surgery. State licensing boards also can validate a surgeon's credentials, as can the National Practitioner Data Bank.
Also, consider your comfort zone: Are you someone who typically embraces the latest technology, or do you usually prefer a "tried and true" approach that has been in use for several years.
You should be able to count on your cataract surgeon to guide you regarding exactly which procedure best fits your needs and personality.
[Page updated September 2015]