November 19, 2006

Cataract Surgery - What to Expect, Details, Costs

I have recently had cataract surgery. I am 52 years old and have lived with growing cataracts for at least eighteen years. Before the surgery I tried to research several types of details on the Internet -- details I was unable to find. I wanted to know simple things like: How many doctor's appointments will be required? What will be the purpose of each appointment? What procedures will be performed at each appointment? How much will everything cost? In this post I will answer those questions and more based on my experiences. I will simply show the charges listed on my insurance forms, rather than the amounts I paid. I'm sure your charges will differ based on your region, your doctor, and your insurance (or lack of insurance). My surgery was in Anderson, South Carolina, USA. I will list all the costs at the end of this long post.

First Appointment - examination
This was an appointment I made with an ophthalmologist recommended by my family doctor. The appointment was for 3:00 o'clock. I was told to come early to fill out forms. I got there at 2:35 and spent ten or fifteen minutes filling out two forms. I was called at 3:20. A technician asked me a lot of questions about my eyes, my health, my medical history, and my family's medical history. She borrowed my glasses and used a machine to identify their prescription. I looked into a machine that created a printout about my eyes. I was taken to another room where I was given vision tests using projected letter charts and various lenses. Drops were put in my eyes to numb them. I was given a glaucoma test in each eye using a machine that touched my eyeballs. Drops were put into my eyes to dilate my pupils. I waited a long time in a waiting area.

I saw the doctor at 5:20. He examined my eyes. He asked me a lot of questions trying to determine the effect my cataracts were having on my lifestyle. (If you've been living with cataracts you need to make a list of ways they impact you. Here are some examples from my list. I had trouble driving at night due to the glare from oncoming headlights. I had trouble negotiating rocks and roots in the trail while hiking. I had to use a small flashlight to read menus in restaurants at night.) The doctor told me about the surgery and its risks. He told me to think about it before deciding. He said that day's examination results could be used if I had surgery within ninety days. The total charge for the appointment was $155.

I called the ophthalmologist's office and said I had decided to have the surgery. We selected a day for the surgery and I was given a pre-surgery appointment during the week preceding the surgery. They also made an appointment for me to have an EKG (electrocardiogram) made at the surgery center on the same day as the pre-surgery appointment.

Second Appointment (part 1) - pre-surgery consultation and measurement
My appointment was for 8:30 AM. I arrived at 8:20 and was called at 8:36. I looked into a machine that used a beam of red light to take internal measurements of my right eye. The beam could not penetrate the cataract in my left eye well enough to take measurements. We went into another room. First the lady showed me a small zippered bag containing two eye patches, glasses for sleeping, a clear plastic eye shield, tape, wraparound sunglasses, a bottle of Acular LS eye drops, a bottle of Pred ForteZymar eye drops, and instructions. She gave me lots of instructions verbally and asked if I had questions. Next she took my blood pressure. Then drops were put into my eyes to numb them. The lady touched my eyeballs with a light device that took measurements. She got the right eye's measurements okay, but repeated the process on the left eye four or five times (and gave me more numbing drops halfway through). She was unable to get precise measurements on my left eye due to the density of the cataract. I signed a form authorizing the surgery, authorizing the presence of a medical representative, authorizing trainee observers, and authorizing the operation be televised to the waiting room.

Then I saw the doctor. He gave me some glare tests for each eye by having me read a chart as he manipulated lights in the room. We discussed what type of new lens I wanted and whether I wanted to be near-sighted or far-sighted. We talked about the surgery and he answered my questions. When I left I was told that the day's charge would be part of the surgery fee. I was also given an appointment to see the doctor at 11:00 AM on the day after the surgery.

Second Appointment (part 2) - EKG
At the surgery center pre-op building I signed a federal privacy form, waited a few minutes, and was taken into an office where a lady keyed my data into her computer. She told me the surgery center's facility fee ($2,700) and how much I would have to pay on the day of the surgery ($275). I signed forms authorizing the surgery and authorizing them to bill my insurance company. Then after waiting awhile I went into another room. I signed two forms -- one authorizing an EKG be made and one authorizing the company to charge my insurance company. I took off my shirts, shoes, and socks. The technician stuck little pieces of conductive tape on my chest, sides, and ankles and then attached wires to each piece of tape. She started the EKG machine which printed a chart. Then I waited awhile and went to another room to talk with the pre-op nurse. She gave me instructions about what to eat, wear, do, not do, etc. I signed a form verifying that she had gone over the instructions with me, and I left.

I filled the Zymar prescription at CVS. It was $66.59. My instructions required me to start using two types of drops in my left eye four times a day on each of the three days before the surgery. I was told to call the surgery center after 10:00 AM on the day before my surgery to get the time I should be there for surgery the next day. For the day of the surgery I was told to eat a light breakfast and not to use the eye drops that day until after the surgery. I was told to wear a short-sleeved button-up or zippered shirt and no undershirt. I was told to bring the kit the doctor's assistant had given to me and to have a ride home. I was instructed not to bring any valuables (except $275), wear any jewelry, or wear a watch.

Third Appointment - cataract surgery
A friend drove me to the surgery center. We arrived at 7:30 AM as instructed. I paid a $275 deposit. My friend was told which monitor in the waiting room would show my operation. I was called at 7:35. I was asked to remove my shoes and place them in a bag which was provided. I was given little socks with rubberized soles to put on over my socks. I was given a flimsy hair bag to put on my head. I laid down on an operating bed and was attended by three nurses. A pulse and oxygen monitor was clipped onto my left index finger. They took my temperature and blood pressure (which was 185/86, much higher than my usual 116/67). Drops were put in my eye. An intravenous needle was put in my right arm and Versed was administered. The needle was painful and felt like it was being pulled sideways. I complained about the pain and the nurse repositioned it so that it no longer hurt. A nurse put a Xanax pill into my mouth. It began dissolving on my tongue and tasted terrible before the nurse gave me water to drink. Xanax reduces anxiety. Several different drops were put into my eye. The only drops the nurse named for me were Lidocaine, a topical anesthetic. One nurse kept asking me questions like when and what had I eaten last, when did I last empty my bladder, was I in any pain, and more. I kept talking to the nurses and asking questions until they gave me another intravenous dose of Versed. Then I was wheeled into the operating room.

It's hard to remember much of the procedure due to the effects of the Versed. I remember being uncomfortable and making them adjust my pillows and arm supports. The operation lasted twenty minutes, from 8:20 to 8:40. I was lying on my back on the operating bed throughout the operation. I know I talked to the doctor and asked questions during the operation, but I don't remember the questions or the answers. The doctor cut a slit in the side of my eyeball and inserted a device that used sound waves to shatter the lens. He used a small vacuum to suck out the lens pieces. He inserted a folded lens, positioned it, and unfolded it into the capsular bag (i.e. the membrane sack that holds the lens). The sound device and the base unit it was plugged into made eerie noises while I was seeing weird images due to the tool in my eyeball. It reminded me of the old TV series "The Outer Limits" and I said so. A few times during the operation the doctor told me to look at a light or look to the right. I only felt pain once, and I mentioned it. Rather than adding more anesthetic the doctor said we were finished. The nurses removed the various things attached to me. I was surprised when they removed heart monitor leads stuck to my chest, which I had not known were attached. I was helped into the waiting room, given a small cup of Coke to drink, and given verbal and written instructions. The doctor came out to see me and asked me if I had any questions. I asked him the make of the lens. He said Alcon and said I'd get a card with the lens information on it. The doctor told me there was an air bubble in my left eye but not to worry about it. He said it would go away on its own. He told me not to shower that day or the next. He said he would see me at his office the next morning at 11:00 AM. The nurse who gave me the drink and instructions gave me a card containing the specifics about my new lens. We left about 9:00, just one and a half hours after we arrived.

I used my three bottles of eye drops, caught up on my email, ate lunch, researched my lens model, and did other non-demanding stuff around the house. About 2:30 PM I became uncontrollably sleepy, as if one of the drugs was wearing off. I taped my plastic eye shield over my left eye, lay down on the bed, and went to sleep. At 4:30 I was awakened by my telephone. I answered thinking it was my friend who said he might call later to check on me. It was my surgeon, not one of his assistants, but the surgeon himself. He just wanted to check on me, make sure I was doing okay, and confirm our appointment for 11:00 the next morning. Wow. I don't think I've ever had a doctor call me at home to check on me.

Fourth Appointment - examination the day after surgery
My appointment was for 11:00, the doctor saw me at 11:08, and I left at 11:15. The doctor examined my eye, had me read eye charts using various lenses, put drops in my eye, and examined my eye again. He said there is some plaque from scarring on the back of the lens bag that he will remove with a laser later if it proves to be a problem. The appointment's charge would be part of the surgery fee.

Fifth Appointment - one week after surgery
I was called back quickly and looked into a machine that made a printout about my eye. The technician repeated the procedure several times before she got a printout she found acceptable. She made me read eye charts inside the machine. Using the machine's corrective lens my left eye's vision was 20/25. She asked me about any problems I've had. I listed the following four. First, I see a black arc extending from top to bottom on the left edge of my field of vision. Second, when there's a light source on my left I see flickering reflections along the left edge of the lens. Third, there's still a slightly fuzzy area in my field of view, as if I still have a cataract. Fourth, I felt shooting pain in my left eye about ten times that day, the first day I felt any pain since the day after the surgery.

The doctor saw me from about 4:10 to 4:23. He put a numbing drop in my eye and used a machine to check the eye's pressure. I discussed the four problems with him. He had never had a patient report seeing the black arc. He advised me to ignore it so that my brain can filter it out. (I have found references on the Internet to the black arc I'm seeing. It's called "negative dysphotopsia".) He said the edge glare should decrease as the lens bag seals and opacifies around the edge of the lens. He said the fuzzy patch is due to scar tissue on the back of my lens bag. He said with my vision correctible to 20/25 we shouldn't do anything about the scar tissue. The day's pain was because I stopped using the Acular LS drops the previous day, and those drops are for pain. He gave me another bottle of Acular LS and told me to use it four times a day until the bottle ran out. I was given another appointment time in about three weeks. At that appointment if all is well, I'll get a new glasses prescription. Today's charge was again part of the overall surgery fee.

Sixth Appointment - one month after surgery
I was called at 2:30 for my 2:00 appointment. A technician had me look into a machine that made a printout about my eye. Another technician applied numbing eye drops and checked the pressure in each eye. She also swapped lenses and had me read eye charts until she determined my glasses prescription. Then the doctor tried to use a Zeiss machine to make a detailed image of my retina. He couldn't do it because my pupil was too small. So he put drops in my left eye to dilate it. Fifteen minutes later a technician took the picture of my retina. The doctor examined the picture on a computer screen and made a printout. He then examined my eye again (since it was dilated). He told me my retina was too thick. He wanted to make sure all inflammation from the surgery was gone before giving me a new glasses prescription, so he prescribed two eye drops: Prednisolone AC and Acular LS. He told me to use one drop from each bottle four times a day for one month, waiting five to ten minutes between each drop. I left at 4:20. The charge for this visit was $100. At CVS the Prednisolone AC cost me $16.59 and the Acular LS cost me $81.59.

Seventh Appointment - two months after surgery
I arrived at 10:25 for a 10:30 appointment. They called me at 11:00. I looked into the machine that made a printout about my left eye. I worked with a technician to determine my glasses prescription, for bifocals. My vision was corrected to 20/25 and I got two letters on the 20/20 line. Then she put numbing drops in my eyes and tested their pressure -- 15 in each eye. Then she put dilation drops in my left eye and I waited for the doctor. The doctor saw me from 11:55 to 12:20. He examined my left eye and then used the Zeiss Optical Coherence Tomography (OCT) machine to analyze my left eye, first with a normal analysis and then with a detailed analysis. He let me look at the images and explained them to me. The medical term for my condition was "sub-clinical cystoid macular edema" which simply means "a swollen retina". The extra month of eye drops worked. The fluid was no longer in my retina. My retina was no longer swollen. The doctor told me to continue the Acular LS eye drops four times a day until the bottle is empty. He told me to continue the Prednisolone eye drops four times a day for two more days and then taper off for three weeks by decreasing the number of drops by one at the start of each week. I got my glasses prescription and left. I did not buy my glasses at the ophthalmologist's office.

I ordered my new glasses from America's Best. The glasses were ready eleven days later. I picked them up, drove home, and discovered I couldn't read my computer screen with the bifocal lenses, even though we had used a tape measure to get the distance right in determining the prescription.

Eighth Appointment (due to incorrect glasses)
They called me at 3:55 for my 3:45 appointment. The doctor checked my new glasses in a machine and said the glasses were correct for my prescription. He then worked with me to determine a new prescription, and we used my tape measure to make the focal distance 27 inches for the bifocal lenses. The new prescription was different from the prescription from 18 days earlier -- for both distance and for the bifocals for each eye. We corrected my vision to 20/30. The doctor tested the pressure in my left eye and then administered dilating drops. When the eye was dilated he examined the eye and took pictures of the retina to make sure the swelling had not returned. It had not. The assistant who wrote the new prescription card for me wrote "remake" on the card. The next day I took the glasses and the new prescription to America's Best. They agreed to replace the lenses at no additional charge.

A week later I picked up the glasses. They're still not right but I'm trying to adapt to them. The sharpest focus through my bifocal lens is 17 inches for my right eye and 22 inches for my left eye. There is no distance that's sharp for both eyes. My computer screen is 27 to 33 inches from my face when I sit comfortably working at the computer. Neither eye focuses properly at that range. My distance vision is okay through the top lenses, but only for a tiny part near the center of each lens. I have to turn my head to directly face whatever I want to focus on. (My previous glasses were standard plastic lenses and I could see clearly by shifting my eyes toward whatever I wanted to see without turning my head. I can't do that with these polycarbonate lenses.) I first noticed the limited focus area driving home from picking up the glasses. I discovered I had to turn my head toward road signs as they passed to read them. If I kept facing straight ahead and simply shifted my eyes to read the signs the signs were out of focus.

The time from my initial ophthalmologist appointment to when I picked up my glasses was 122 days, or four months (July 17, 2006 to November 16, 2006).

Here's a recap of the costs related to my cataract surgery. Each cost is rounded to the nearest dollar. I will update the list if I receive more bills.

$155 Ophthalmologist
$67 Zymar drops
$181 EKG
$300 Outpatient Anesthesia
$200 Outpatient Surgery
$2,500 Outpatient Surgery
$144 Ophthalmologist Radiology
$1,650 Outpatient Surgery (surgeon's fee)
$100 Ophthalmologist
$17 Prednisolone AC drops
$82 Acular LS drops
$177 Glasses
$100 Ophthalmologist
$5,673 Total

Other Blog Accounts of Cataract Surgery
Sneakeasy's Joint: Eye Survived Cataract Surgery Fine
Distractions, reflections: 20/20 vision in my left eye
Michael Swanson's Blog: Cataract Surgery
The Dedalus Log: Second Sight