If you are seriously considering cataract surgery, you
need to first and foremost consider the qualifications and
experience of your potential doctor. The doctor is even more
important than the medical devices used. No amount of
technology can compensate for an inferior doctor.
Do not expect your prospective doctor to respond with our
suggested answers for every question. Some are more
important measures of ability than others. Use your own
common sense. Ask for proof of all claims. Measure the
willingness to respond as much as the response. The doctor
should offer to make arrangements for any requested test or
examination that the doctor does not normally provide.
If you do not completely understand the relevance of any
of these questions, search our website for more detailed
information.
- How long have you been performing cataract surgery?
Not less than three years.
- How many cataract surgeries have you performed
total?
Not less than 200 eyes.
- How many cataract procedures have you performed in
the last 12 months?
Not less than 75 eyes.
- How many cataract procedures of the exact type you
intend to use for me, with the same equipment, and the
same cataract error, the same intraocular lens, etc., have you performed?
Not less than
25 eyes.
This is a very important question. Even a doctor who has
thousands of surgeries behind him or her is a rookie
when using new technology or new technique. You don’t want
eye surgery from a rookie.
- What percent of your cataract surgery patients
receive Snellen Uncorrected Visual Acuity (UCVA) of
20/40 or better?
About 90% is generally considered the
norm. If the doctor gives a higher number, ask for
proof.
If you have uncorrected astigmatism, and especially high astigmatism (greater than about 2.00
diopters), expect the probability of achieving uncorrected
20/40 to be lower.
- What percent of your cataract surgery patients
receive UCVA of 20/20 or better?
About 45% is
generally considered the norm. If the doctor gives a
higher number, ask for proof.
If you have astigmatism, and especially high astigmatism (greater than about 2.00
diopters), expect the probability of achieving uncorrected
20/20 to be lower.
- What percent of your cataract surgery patients
report unresolved complications six months after
surgery? This includes objective and subjective
complications such as inflammation, halos, starbursts,
infection, etc.
Less than 2% is generally considered the norm, with less
than 0.5% being serious complications that require
either extensive maintenance or invasive treatment.
If the doctor gives a lower number, ask for proof. Zero
or a nebulous "almost never" should be cause for
concern. No doctor is perfect. No surgical procedure is
perfect.
- Have you had a successful cataract surgery
malpractice claim of greater than $30,000? Details if
yes.
Not more than one for every 500 cataract surgeries.
That's a 99.5% "success" rate. Not more than three in the
last five years, even if the doctor has performed tens
of thousands of surgeries. Discuss with the doctor the
circumstances of any malpractice case. Consider how they
were handled and how the circumstances may apply to you.
- Will you verify a history of diabetes?
The answer should be
yes as diabetes can cause changes in the eyes that may
make change the probability of an excellent cataract
surgery outcome.
- What percentage of your pervious cataract surgery
patients have had lens exchange surgery, piggy back lens
implant, or phakic intraocular lens implant surgery to
resolve refractive error after cataract surgery?
Explain your policy on these types of surgeries.
Under
5% is a ballpark number but the "why" is much more
important than the percent. The doctor should explain
his/her philosophy on post-cataract surgery adjustments. You don't
want a doctor who will almost never perform
post-cataract adjustments, but you also don't want a doctor who
must perform post-cataract surgery adjustments too often.
A
complicating factor would be if you had previous
refractive surgery like RK, Lasik, PRK, LASEK,
Epi-Lasik, etc., and the calculations for intraocular
lens must be estimated.
- Will you offer me a premium intraocular lens (IOL)
like the ReSTOR®,
ReZoom®, or
Crystalens®?
A
premium intraocular lens is not appropriate for every
individual and nearly always will cost extra. All good
doctors understand the limitations of their tools and
techniques and will recommend what they believe will
have the highest probability
of you receiving the desired outcome.
- Will you perform laser vision correction surgery
like Lasik, PRK, LASEK, or Epi-Lasik after cataract
surgery to "fine tune" the results of my cataract
surgery?
Your doctor may not provide laser vision
correction surgery, but should be able to refer you to
someone if necessary to fine tune the refractive results
of surgery.
- Do you include laser vision correction like Lasik,
PRK, LASEK, or Epi-Lasik after cataract surgery?
It would be highly unusual
for a surgeon to include laser vision correction surgery
in the global fee for cataract surgery. The exception to
this rule would be cataract surgery with a premium
intraocular lens. In any event, discuss the pricing
should laser vision correction be recommended.
- Will you perform Astigmatic Keratotomy (AK) surgery during cataract
surgery to resolve astigmatism?
If yes, discuss this
surgery, its effectiveness, and what additional cost
will be incurred, if any.
- What is the worst cataract surgery outcome
experienced by your own patient? How was it handled?
You want a doctor who knows how to get you out of
harms way if something unusual occurs. You want a doctor
that is cool under fire and is willing to work with
other ophthalmologists who may have specific expertise
outside of your doctor's realm of experience. All
doctors with enough surgical experience have had a poor
outcome. You need to feel comfortable that this
particular doctor can handle problems appropriately. If
your doctor says s/he has never had a poor outcome or a
problem, you may want to politely excuse yourself to the
nearest exit.
- Have you ever had malpractice insurance coverage
denied?
Answer should be no.
- Are you self-insured for malpractice?
Answer
should likely be no, however in some circumstances self
insurance may be appropriate. Discuss the circumstances
with your surgeon.
- Are you currently under investigation by the agency
that provides the license that allows you to perform
cataract surgery? Has this license ever been revoked,
suspended, or otherwise restricted? Are you on any sort
of license probation?
Generally, the answer should be
no, but if there are any licensing concerns, consider
the circumstances. As an example, a doctor who five
years ago was fined a few hundred dollars for an
advertising problem may not need to be automatically
excluded. Surgeons new to that state may be on probation
for a period of time. Discuss any licensure issues with
the doctor and come to your own conclusion about
disqualification as a potential doctor.
- Have you ever had hospital or surgical facility
privileges revoked?
Answer should be no.
- Have you ever had your Drug Enforcement Agency (DEA)
certification revoked, suspended, or otherwise
restricted?
Answer should be no.
- Have you ever been convicted of a felony?
Generally, the answer should be no, but discuss the
circumstances and come to your own conclusion about
disqualification as a potential doctor. A problem 20
years ago when a college student may not be important
today.
- Have you ever been arrested for being under the
influence of, or in the possession of, any controlled
substance?
Generally, the answer should be no, but
discuss the circumstances and come to your own
conclusion about disqualification as a potential doctor.
A problem 20 years ago when a college student may not be
important today.
- Have you ever been treated for substance abuse or
mental illness as an adult?
Generally, the answer
should be no, but discuss the circumstances and come to
your own conclusion about disqualification as a
potential doctor. A problem 20 years ago when a college
student may not be important today.
- Have your ever been refused participation as a
provider in a health insurance plan?
Answer should be
no, except in the case of managed care, which excludes
doctors for reasons other than medical competency.
- Is the medical equipment you will use specifically
approved by the Food and Drug Administration (FDA) for
the recommended procedure and intended parameters? If
no, explain why it is not FDA approved and/or off-label
use.
The equipment should be FDA approved (hardware
and software), however the specific parameters for its use
for you may not be FDA
approved. Surgeons are legally able to use FDA approved
tools beyond FDA approved parameters in some
circumstances. This is called off-label use and should
be discussed with your doctor if applicable to your
circumstances.
- If an additional surgery is required, what will you
charge for the additional procedure?
Answer should be
no charge for a directly related corrective procedure
within a specified period of time, usually about a year
after surgery. If there is a charge, consider the
affordability if needed.
- If another doctor will be comanaging pre- and/or
postoperative care, can I see you at any time without my
comanaging doctor’s authorization?
The answer should
be yes. You should be able to go directly to the surgeon
at any time you feel it is appropriate.
- What should I expect my vision to be like for the
first few weeks after surgery?
The answer should
include an explanation of eye patching, minor fluctuations,
blurriness, minor halos, minor starbursting, glare, etc.
These side-effects may occur, but commonly resolve during the
six-month healing process.
- Will you perform a complete cataract examination
including evaluating the medical health of my eyes both
before and after surgery?
The answer should be an
unqualified yes and the medical component of the exam
must be performed by an ophthalmologist (medical eye
doctor).
- Will my vision fluctuate after surgery? How long is
the healing period?
If the doctor says, "Twenty
minutes and all will be fine" you may want to move on.
Cataract surgery is relatively quick but the healing and
fluctuations may continue for weeks or longer. Cataract
surgery is more of a six-month process than a Two-Day
Miracle even though it is possible you will have perfect
vision within days after surgery.
- Will you perform a contrast sensitivity test before
and after the surgery?
The answer will probably be no,
but should be yes. Contrast sensitivity testing is not
currently routine and not all doctors have the
technology available. Your doctor should offer to
arrange for you to receive this test at your expense at
another location.
- Will you perform a glare sensitivity test before and
after the surgery?
If your cataract is advanced, glare
testing may not be necessary. Your doctor should offer to
arrange for you to receive this test at your expense at
another location.
- Will you perform an axial scan before the surgery?
The answer should be yes.
- Will you perform a test to determine tear volume (Schirmer)
and tear breakup test (TBUT) prior to making a
recommendation about cataract surgery?
Answer should
be yes. These tests help determine if you have unusually
dry eyes. Dry eyes are a medical condition that should
be treated and managed.
- Will you measure the size of my pupils when
naturally dilated in a variety of light variables prior
to making a recommendation about surgery?
The answer
should be yes for conventional intraocular lens and must
be yes for premium intraocular les. This is an important
test to determine if you my have a higher than normal
probability of postoperative problems in low light
environments and/or if you will achieve the desired near
and distance vision with premium intraocular lenses.
Dilation needs to be natural and without medication.
- Will you require me to be without contacts for a
period of time before the examination that will
determine final calculations for surgery? What is this
period of time?
The answer should be yes and for a
significant period of time. We recommend several weeks
without soft contact lenses, longer for hard contacts.
Some doctors feel a few days is enough, but we recommend
longer. You want your surgery calculations determined
after your cornea has returned to its natural state, no
matter how long that takes.
- If I had refractive surgery (RK, AK, Lasik, PRK,
LASEK, Epi-Lasik, P-IOL) will you contact my previous
doctor for measurements to help determine the
appropriate power for my replacement intraocular lens?
The answer should be yes, but the needed information
may not be available. Many refractive surgeons record
the measurements for intraocular lens calculation before
refractive surgery and this information can be very
helpful, however not all refractive surgeons perform
this service and the information may not be available,
however your cataract surgeon's office should attempt to
gain this information.
- Will a patient with more than eight diopters myopia
be referred to a retinal specialist for evaluation?
A
general ophthalmologist can perform an evaluation of the
health of the retina, however cataract surgery has more
risk of retinal detachment the higher the myopia. The
greater the myopia, the more an evaluation by a retinal
specialist may be needed.
Keep in mind that even if you have had cataract surgery that corrects you to 20/20, your eyes
are still the same length as they were before surgery.
If you were more than eight diopters myopic before
Lasik, you are still eight diopters myopic even if your
lens has been replaced and has reduced your need for
glasses.
- How often and when will you perform postoperative
examinations?
Commonly will be 14 hours after surgery,
2-4 day after surgery, periodic exams for 2-3
months, as needed with adverse event. These exams might be performed by an
eye care professional other than the surgeon.
- When will you provide me with a copy of your written
informed consent?
The doctor should offer to provide a
copy immediately upon asking this question. A week
before surgery is adequate. You need to read and
understand every component. This is not just a legal
formality, but an explanation of what can happen.
- Will you provide contacts for me to wear to simulate
monovision prior to surgery? How long will you want me
to wear these contacts before I make my decision about
monovision?
Contacts should be provided free with at
least four weeks wearing time before monovision decision
must be made, unless the patient is already accustomed
to monovision.
- Will you provide me the names and contact
information of at least five previous patients who have
had the exact same surgery with similar cataract error?
Answer should be yes, and doctor should already have
such a list compiled. Don't expect to get a list of
dissatisfied patients, but these people can tell you
what going through the procedure is like. You may want
to talk with patients who had surgery recently and some
who had surgery several months ago.
- Will you allow me to observe a surgery?
Operating
suite access restrictions may preclude surgery
observation, however a simulation such as an animated
video may be available.
- Does my occupation, leisure activities, and hobbies
have any bearing on my candidacy for premium intraocular
lenses?
Answer should be yes. People who require
exacting and detailed vision or rely heavily on good low
light vision are possibly not good candidates for
some premium intraocular lenses and should be screened
appropriately.
- Does my general medical and medication history have
any bearing on my candidacy for cataract surgery?
Answer should be yes. Some conditions that have nothing
to do with the eyes may complicate some types of
cataract surgery.
- Does using Hormone Replacement Therapy (HRT) have
any bearing on my cataract surgery?
Guys, you don't
get asked this one but all post menopausal women should
asked. Fluctuations in refractive error are often
related to hormonal changes.
- Who will pay for multiple corrective lenses if I
experience fluctuation in visual acuity while healing?
Whatever the answer, consider this as a part of the cost
of the surgery.
- Are there any reasons why I would not have excellent
cataract surgery results?
This is a blanket question to provide you and your
doctor an opportunity to discuss in more detail what you
can reasonably expect from the proposed surgery.
Whatever the answer, it needs to be the same as what you
perceive to be an excellent result. If you cannot
reasonably expect to receive what you consider to be a
successful result, you may not want to have surgery.
- What certification do you hold, if any, from the
American Board of Ophthalmology, American Board of Eye
Surgery, or other organization? If not all, why?
It
may be important for you to know if the doctor desires
the additional oversight of these organizations. Some
are more valuable than others
The American Board of Ophthalmology (ABO) does not provide
any evaluation specific to cataract surgery. Certification
is valid for a lifetime, or 10 years if recently certified.
ABO certification would be conspicuous by its absence.
The American Board of Eye Surgery (ABES) is an ophthalmic
group that provides peer-reviewed certification for cataract
surgery.
ABES certification is valid for seven years.
Consider the relevance and value of these and other
certifications the doctor may have achieved.
- If I am unable to afford the normal $3,000 to $600
out-of-pocket
expense for needed cataract surgery, will you work with
organizations like Cataract Free America®, Mission
Cataract USA, or the Senior EyeCare Project to provide
the waiver of some or all of your fees.
Be realist in
what you expect as an answer. Almost all surgeons
provide care with reduced or no compensation, but
medicine is a business and this particular surgeon may
have already provided a significant amount of care under
these or similar programs. If your surgeon is not able
to provide the care you need with out-of-pocket expense
you can afford, then ask your doctor to refer you to one
of these organizations or contact them directly.
