June 9, 2012

YAG Capsulotomy after Cataract Surgery - Details, Costs


I had cataract surgery on my left eye and posted a detailed article on this blog about my experience: Cataract Surgery - What to Expect, Details, Costs. That was in 2006. My vision in that eye has become fuzzier, especially during the last few months. I suspected the membrane capsule that holds the artificial lens had thickened, thus reducing my vision. The doctor had made me aware of this possibility prior to my original surgery. The Good Hope Hospital in the United Kingdom uses a good animation to demonstrate cataract surgery and the follow-up surgery that is sometimes required. Click on each label on the left.

The word used to describe a lens sac becoming cloudy is "opacification" (i.e. becoming opaque). When the lens capsule becomes so cloudy that reduced vision interferes with someone's life, then a procedure called "Nd:YAG Capsulotomy" may be performed. The full name of the procedure would be "neodymium:yttrium-aluminum-garnet laser posterior capsulotomy". "Neodymium:yttrium-aluminum-garnet" specifies the type of laser and "posterior capsulotomy" means removal of the rear of the lens capsule. WebMD has a good page about the procedure: Nd:YAG laser posterior capsulotomy for cataracts. The laser is used to burn holes in the back of the lens sac, sort of like the perforation holes around a postage stamp. The membrane tears apart along the perforations, pieces break off, and the pieces become loose inside the eye. The new opening in the lens sac lets light through restoring good vision.        

In the remainder of this post I will describe each appointment and the associated costs. I do not have medical insurance so the costs shown are the actual charges I paid.

First Appointment – examination
April 4, 2012

I arrived at 1:50 for a 2:00 o'clock appointment and was called from the waiting room at 2:29. A lady refractionist asked me to look at charts while wearing my distance glasses so she could determine my current corrected vision in each eye. Then I removed my glasses and she tried different lens until she found the best lens for each eye. My vision with my current glasses and the best vision they could get with new lenses, were so close that no new prescription was needed. My right eye (which has an untreated cataract) was 20/40. My left eye (which has an artificial lens from cataract surgery six years ago) was 20/60. We were interrupted four times during the refraction process.

After completing the refractive tests the lady put yellow drops in my eyes for the glaucoma test. I do not know the name of the drops. They numbed my eyeballs so that I would not feel the tonometry test to determine the pressure in each eye. The drops contained yellow dye that glowed under blue light. I sat with my chin in a machine while the lady slowly made a device touch my eyeball to measure the pressure. Pressure in my right eye was 18. My left eye was 17. According to Wikipedia's article on "Intraocular pressure", normal eye pressure is 10-20 mmHg. Then the lady put drops in my eyes to dilate my pupils. I think she said the name of the drops was Mydriacyl. She led me to an interior waiting room at 2:57.

The doctor came and got me at 3:36. He asked me a series of questions to assess the negative impact my current vision problem is having on my life. He asked if bright lights bother me, if I have any trouble driving at night, if I see white flashes at the edges of my vision, if I see flickering, and more. Then he examined each eye thoroughly using a machine that shown a bright light into my eye. Occasionally he asked me to look a certain direction. He took a lot of notes, I assume to record his observations, and asked me to follow him to another room. There I sat with my chin in another machine. The doctor lined the machine up with my left eye and told me to look at the center of a screen in the machine. Red lights moved in lines forming rays with the center. Then more red lights showed a circle. The lights kept changing and moving around until a picture of my retina was taken. The doctor used a computer to control the machine and I assume his computer screen showed him the picture that was taken. The doctor repeated the process three or four times. He said the cloudiness of my lens capsule prevented him from getting a good picture of the retina. He said he had intended to compare a current picture with the picture he took in 2006 to see if the epiretinal membrane visible in 2006 had grown. He was not able to make the comparison and could not say definitively whether the epiretinal membrane is a problem. He said he thinks I am a good candidate for a YAG capsulotomy. He said there's about a 1% chance of retinal detachment. Then he said actually the risk is a little higher for people who are nearsighted, as I am, but he thinks the risk is low and acceptable. He recommends the procedure. He asked if I had any questions. I had several, which he answered. (Of course, since then I have thought of several more questions which I guess I'll only ask if they become relevant later. If my retina detaches, what happens then? If the epiretinal membrane has grown and does present a problem, what do we do?)

It was time to make a decision. I told him I want to do the YAG capsulotomy. He said he does them on Tuesday mornings at the nearby surgery center, the same place he had performed my cataract surgery. He said the surgery only takes about ten minutes. My eye will be numbed and dilated, but otherwise I will not be anesthetized or medicated. He said about two hours after the surgery I will need to come back to his office where a technician will check the pressure in my eye. Then I will need to come back again a few weeks later for a final check of the eye and my vision. He turned me over to his staff to work out the details. It was 4:07. I was with the doctor for 31 minutes.

I may have had to sign a form or two. A lady asked me a lot of questions about my medical history – medicines, allergies, operations, hospitalizations, etc. We scheduled the surgery for a date about twenty days later. She gave me a sheet of instructions. She asked if I could go directly from there to PreOps at the surgery center. I said I could. She called ahead, made sure it wasn't too late in the day, and told me they were expecting me. She drew a little map for me showing me where to go. She told me the doctor's fee for the surgery would be $324.00. Then she handed me off to another lady who wanted money for that day's services. The charge was $225.00. I paid by check. She gave me a receipt, a pair of rolled up sunglasses to put on before going out in the daylight, and said we were done.

First Appointment – part 2, PreOps
April 4, 2012

I drove to the nearby surgery center and after a couple of missteps I found PreOps. A lady took me into her office and spent the next 15-20 minutes updating my information in their computer system, explaining forms to me, getting my signature and initials many times, and making copies for me of all the forms I signed (at my request). When she confirmed my social security number I asked her to delete it. (They only need my social security number if insurance is involved and I don't have insurance.) She ignored my request and continued. I let it go. She told me the surgery center's facility fee would be $1,027.00. She said if I prepaid, the fee would be $514.00, which is a 50% discount. She asked if I wanted to pay right then or if I wanted to pay when I came for the surgery. I said I had only brought one blank check and I had used it to pay my ophthalmologist, so I would have to wait and pay the facility fee on the morning of the surgery. She smiled and said actually I needed to pay right then. I reluctantly gave her my credit card. Before I left she made sure I was aware that the facility fee was an estimate and might be different at the time of my surgery. When we were done I left with the following papers:

Handwritten receipt for $514.00
Machine-printed receipt for $514.00
Brochure about the surgery center
Patient Registration form
Financial and Collections Policy
Authorization for Surgery / Other Procedures and Anesthesia Services (2 pages)
Acknowledgment: Receipt of Notice of Privacy Practices

(I received no Notice of Privacy Practices, although I had to sign saying I had. I didn't notice I had no such document until I was writing this blog entry.)

As I was walking to the car in the rain I realized no one had told me where to go on the day of surgery. I walked back to PreOps, got someone's attention, and asked where to report for the surgery. A lady told me. I left PreOps at 4:55.

Second Appointment – surgery
April 24, 2012

The PreOps instructions sheet said I could eat and take my normal medications before surgery. I arrived at the surgery center front desk at 9:50 for my 10:00 o'clock appointment. After checking me in and making sure their paperwork was in order, the receptionist directed me to the waiting room. I stood for a few minutes watching a real-time cataract operation on a monitor hanging from the ceiling. I also conversed with another man waiting. A nurse called my name at 9:59.

I followed the nurse to a little room where she double-checked several facts – my full name, my birthdate, the procedure I was there for, which eye, and which doctor. She also asked some other questions. I remember one was whether I had any allergies. She went over a page of discharge instructions with me and made me sign the page. She gave me a little yellow circle with a sticky back which she asked me to put on my forehead over the eye to be operated on. She left the room to ask the doctor which drops to give me. When she returned she separated three bottles from the four she had out. At 10:07 she put two numbing drops in my left eye, then one dilation drop, and finally one drop to control pressure. I did not ask her the names of the drugs. She said the doctor would be with me in about twenty minutes, after the dilation drop had taken effect and after the doctor had finished his current cataract surgery. Then she left.

The room was fairly small with cabinets, a counter, the chair I was sitting in, and a small stand in the center of the room with a machine on it. There was a stool on each side of the machine. I got up and read the name of the machine. It was a "YC-1400 Ophthalmic YAG Laser System". The Nidek company has a newer model that looks almost the same, the YC-1800. (A larger picture with specifications is available by clicking the view button near the bottom of this page beside YC-1400.) The nurse returned to check on me at 10:25. She said the doctor would be a little bit longer.

The doctor arrived at 10:37. He had the nurse put two more numbing drops in my eye. The nurse asked me to move to the stool beside the machine. The doctor squeezed a drop of what looked like a gel onto a small device on the counter. The device reminded me of a microscope's eyepiece. He asked me to put my chin in the chin cup on the machine and to press my forehead against the forehead rest. He sat on the opposite stool. He reached around the machine with the small device in his hand and pressed it onto my eye. I asked him later if he had put a contact lens on my eye and he said he had. He asked me to stare straight ahead. I saw two vertically aligned red lights. I think I could also see a faint reflection of my lens capsule. The doctor took aim and began clicking something that shot laser pulses into my eye. The lights moved around as he aimed and fired the laser. He asked me to look left. He fired the laser several times. He asked me to look right and fired several times. After the first few shots I started counting. I think the doctor fired the laser 78 times, plus or minus a couple. Throughout the process I could see the membrane he was shooting and I could see bits of it falling away now and then.

Suddenly he was done and told me I could sit back. He squirted liquid into my eye as he held tissues around my eye. I assume he was rinsing off the gel he had put in my eye. He said I might see floaters and my eye would feel scratchy and crusty for a few hours. He said if I saw light flashes, had pain, or noticed anything else obviously wrong to call his office. He wrote a prescription for eye drops and told me to use them four times a day for one week. He said I could fill it at Walmart for $4.00. The prescription was for Pred Forte. He said I could also use other drops to irrigate my eye today if needed. He told me to go to his office at 12:00 so they could check my eye pressure. He said they would also make an appointment to examine my eyes in two weeks to see if I need a new glasses prescription. Then he asked if I had any questions.

I asked the doctor if the device he put on my eye at the beginning was a contact lens. He said it was. I asked him if he had shot laser pulses around the membrane until it fell loose. He said he had made an X across the middle. When the flaps didn't peel back off of the lens on their own he fired shots at the bases of the flaps until each piece fell free. I asked him how long I would probably see the new floaters – hours or days? He responded noncommittally by saying some floaters never go away. He said I might be most likely to see them in the morning when I first sit up. He reminded me that the retina's image is upside down and reversed, which may mean sinking floaters appear to move upward. I am uncertain how that works. Finally, I asked about paying him. No one had asked me for payment yet. He said his office would bill my insurance. I told him I don't have insurance. He said they would handle payment at his office. We were done. The nurse gave me a copy of the discharge instructions I had signed earlier. I left at 10:45. The doctor had been with me for only 8 minutes and my entire time at the surgery center was only 55 minutes.

Second Appointment – post-operation check
April 24, 2012

I arrived at the ophthalmologist's office at 11:59 for the follow-up pressure check. They called me into the back before I had even sat down in the waiting room. A lady took me into a room and asked me if I wear glasses to drive. I said yes. She asked me to put them on. I told her I had left them in the car because I had thought she was just going to check my eye pressure. I reminded her that my eye was still dilated. She said she wanted to check my vision and my pressure. I went back to the car for my glasses. My left eye's vision with my glasses was 20/40 -2, which means I could identify all but two letters on the 20/40 chart line. Three week's ago my left eye's vision with my glasses was 20/60. Even though my eye was still dilated I could see better than I saw three weeks ago. The lady put two yellow numbing drops in my eye for the pressure test. After the test I asked her what the pressure was. She said it was 7. I said a few weeks ago it was either 17 or 18. She tested it again less than a minute after the first test. The second time the pressure was 10. I don't know if the test is inaccurate or if eye pressure changes that much in a minute, but the difference does not encourage confidence in the test. I couldn't help but wonder if she wrote down both readings or just the second one. I asked her what the normal healthy range is. She said 8 to 22. The reason eye pressure is tested after a YAG capsulotomy is because sometimes the eye pressure increases too much after surgery. Obviously I didn't have that problem. I made an appointment for two weeks later and wrote a check to pay for the surgery. The fee was $324.07. The technician gave me my receipt and I left at 12:15.

I drove to Walmart and got the prescription filled. The bottle of generic Prednisolone Acetate Ophthalmic Suspension (substituted for Pred Forte) was $17.46 (not $4.00 as the doctor said it would be). I put the first drop in my eye at 1:25. Prednisolone Acetate is a steroid that reduces swelling in the eye.

I felt bad for the rest of that day and the next day. My left eye felt scratchy and irritated. I had a headache. I felt slightly nauseous. I saw more floaters than usual in my left eye. I felt slightly feverish and experienced occasional chills and sweats. Prednisolone Acetate showed me how connected my eye socket and mouth are. Soon after putting a drop in my eye I tasted it in my mouth. The taste was bad. The taste lingered, sometimes until time for the next drop about six hours later. I think the eye drops were what made me feel slightly nauseous. I felt better the second day after surgery. The feverishness had disappeared and the floaters had noticeably decreased, although they were still distracting. The drops still tasted bad.

On the afternoon of the day after the procedure I got a telephone call from a nurse at the surgery center. She asked me if I had experienced much redness or swelling in my eye. I said I had not. I told her I had a lot of floaters. She asked if I was satisfied with the service they had provided. I said I was. In retrospect, I wish I had told her that their service was too expensive.

Third Appointment – post-operation follow-up
May 8, 2012

I arrived at 2:15 for a 2:15 appointment. They called me at 2:57. A technician tested my eyes with my distance glasses from 2:57 to 3:04. At 3:06 the doctor came in, examined my left eye, checked my left eye's vision with charts and lenses to see if a new prescription was needed, put yellow drops in my left eye, and measured the eye's pressure. The pressure was 12, which was good. The doctor was satisfied with everything and said the new prescription was so similar to my current glasses' prescription that there was no need for new glasses. He was with me for eight minutes and left at 3:14. When I checked out I was told today's examination was "post-op" and there was no additional charge. The only paperwork I received was a card with my new prescription.

I am quite satisfied with the results of the YAG capsulotomy. When there is no floater in the way my left eye's vision is very sharp at 15 inches. My artificial lens is fixed so there is only one optimal focus distance. The only time my left eye has seen this well was after my cataract surgery in 2006.

Here are the costs rounded to the nearest dollar. Costs are what I was charged and what I paid. No insurance was involved.

Cost Recap

$225 ophthalmologist examination
$514 surgery center facility fee
$324 ophthalmologist's surgery fee
  $17 prednisolone acetate ophthalmic suspension
-------
$1,080 grand total


I am posting this on June 9, one month after my last eye examination. I still have floaters, but they are not as distracting as they were a month ago. My guess is that I have become accustomed to the floaters, plus there are fewer of them. Sometimes a floater will be right in the middle of my vision, causing me to tilt my head and roll my eyeball around until the floater floats to a new position. When there is no floater in the way my vision is sharp. I am very satisfied with the operation.

Here's a link to my 2006 blog entry with details of my cataract surgery:

55 comments:

  1. Thanks for this post. My initial cataract surgery experience was much different than yours - I'll comment over there on that. I've been wondering about Posterior Capsule Opacity, since I've had this sort of glob in one of my eyes, similar to having a contact lens with buildup on it. The potential of retinal detachment scares the crap out of me. I emailed a local eye clinic, explaining my situation - my current health insurance has a huge (for me - 3k) deductible/out-of-pocket - but no one seems to want to tell me what it costs to have the YAG procedure. I'm torn on whether to even go to an eye doctor to have it looked at, since there's no sense if I can't afford the procedure, and I don't want to put a couple hundred into an office visit that won't lead to correcting the problem. I suppose we're captive consumers, forced to shell out some cash just to find out we can't afford the cure.

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  2. SuzyQz, You described a tough scenario. I had similar financial concerns before both my original cataract surgery and before the YAG procedure. I knew each procedure would cost more than I could comfortably afford and I had no insurance. In both cases I did what it sounds like you're doing. I waited until the negativity of the symptoms outweighed the cost of doing something about them. Good luck! Thanks for posting.

    By the way. I've had two Blogger blogs for several years and I think your comment is the first one I have not been notified of by email. I discovered it by accident when someone tried to post a spam comment.

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  3. Very informative. Thanks for the post. I am scheduled to have the YAG laser capsulotomy next month on my right eye, and I didn't have it described to me all that well (just the basics). I have insurance, but I'm not sure how much will be covered, so thanks to you I now know about what to expect as a maximum. I'm looking forward to having this done.

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  4. Before both my initial cataract surgery and before the YAG surgery I tried to research them online, but I was unable to find any detailed descriptions of the procedures or the costs. The scarcity of such data is what prompted me to take notes throughout both processes and write my blog articles. I'm glad you found the information helpful. Good luck with your surgery. I think my fever and headache following the YAG procedure were uncommon. I hope your procedure goes smoothly without negative side effects. Good luck!

    Jon

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  5. Jon, thank you for sharing your laser surgery experience, I am having the same problem more than 2 yrs post cataract surgery. I am so worried about this surgery to cut a hole in the lens sack and I was so pleased to read your comments, I was of the understanding they cut a hole in the front rather than at the back of the lens. I feel a little better after your post. Thank you Maureen

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  6. I'll glad my post alleviated some of your stress, Maureen. Don't worry. You'll love how much clearer your vision is after you have the procedure done. Good luck! Thanks for posting. - Jon

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  7. I detached my retina after a cataract surgery. I also need a YAG laser operation. My retina MD said that he believes strongly that the relationship between detachment and YAG is spurious. He believes that the actual causal factor for the detachment is the cataract surgery. People don't get YAG surgery unless they had a cataract surgery. And some portion of them suffer a detachment after a YAG surgery but his contention is that it was unrelated... simply related to the cataract. As I suffered the detachment before I got a YAG treatment which I need, and the detachment has since healed, he told me that he doesn't believe that I am at risk for retinal detachment from the YAG. Just another perspective. Good luck to everyone.

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  8. That's interesting. I have always experienced floaters and flashes of light around the edges of my vision, which can precede retinal detachment. I remember after my YAG surgery a technician at the ophthalmologist's office asked me if I had seen any white light flashes at the edge of my vision. I said I had. That got her attention and she asked me more questions. When I told her that I wasn't seeing any more of the flashes than I normally see she relaxed. I see white flashes the most when I exercise every morning. I see more flashes in my right eye, which has never had surgery, than I see in my left eye, which had both cataract and YAG surgery. Thanks for posting. - Jon

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  9. I will add to this article for those of you who are considering this surgery, but are concerned about cost. The initial appointment to determine I needed the YAG capsulotomy (DATE: 6/27/13): $56 for the refraction, and a $45 specialist copay with the rest being covered by insurance. I had an unmet $1,500 required by my insurance company, so I had to pay the total cost of the actual surgery out of pocket. (Surgery DATE: 7/9/13) There were two separate fees: $562.07 paid to the doctor. $628.50 facility fee. I live in Orlando, FL and the surgery was performed in Maitland, FL. I'd had clouded vision I'm my right eye for over a year before getting the YAG because I was waiting until I could comfortably afford it (and it finally got so bad I couldn't take it anymore! ) This article is an almost exactly match with my own experience. But since I haven't had my follow up appointment or been prescribed the steroid drops yet, I can't speak to the affects of them. It is also too to tell how much my vision has improved. I do have a LOT of floaters. I have had surgery for retinal detachment, cataract surgery, and laser surgery to strengthen the retina. The YAG I had today was less invasive than any of those. As you see I'm back on the internet same day. ;) Hope this info helped someone out. I know before I had it done I was really scared about the price tag attached to everything. Thank you very much to the person who wrote this article. It can alleviate a lot of fear just knowing what to expect.

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  10. Thanks for posting your experience with YAG surgery, Kiersten. It looks like your surgery was more expensive than mine. I'm sure anyone who reads our posts will appreciate the additional information. Thanks.

    Jon

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  11. thank you for your informative blog. I wish I had read it before I had the YAG procedure.I had the procedure done at the Doheny Eye Center at USC here in Los Angeles. I would imagine it will cost thousands.what I find surprising his how little information I was given. No follow up sheet no follow up visit for 4 months check my pressure right after the operation it was 21 before and 17 after. I had a very rough day yesterday after the procedure dry itchy dull pain very bloodshot eye. when I called the day after to see if this was normal another doctor called me back and said to use liquid tears which didn't seem to do much. My wife had an unopened unexpired prescription of Zylet words seem similar to PredForte so I tried that and it seems a little better

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  12. Thanks for sharing your experience. I hope your eye recovers quickly and the price isn't too high. Good luck! - Jon

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  13. Thanks, Jon, for all of the helpful information, especially on the cost. I have insurance with a huge deductible. I will be getting the procedure done soon.

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  14. Hi Eric, I'm glad you found my information helpful. Good luck with your procedure! Thanks for posting. - Jon

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  15. The most useful explanation I've read on posterior capsulotomy. Very helpful. Really good to hear from a real person who has written in detail than to read the large quantity of eye surgery marketing websites, that tend to be very light on any downsides. Good luck with your sight. gerald

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  16. Thanks for your comment, Gerald. I'm glad you found my write-up helpful. Before both my cataract surgery in 2006 and my capsulotomy in 2012 I was frustrated by not being able to find any details about the procedures online. That frustration inspired me to take a lot of notes during each procedure and write my blog posts. - Jon

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  17. Thank you for writing such a detailed account of this procedure -- had cataract surgery on each eye 4 years ago and experienced significant decrease in vision within the last year. Limited funds put off making an eye appointment but did not want to continue losing vision -- found out I need a YAG posterior capsulotomy in both eyes. Your blog informed me not only what to expect but gave a general estimate of the cost. This has lowered my stress level many fold -- I now have information on what to expect -- can ask informed questions and can save out for the financial cost. Best of all I know I will be able to see again!!

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  18. I'm glad you found the details I posted helpful. The main reason I posted both my original cataract surgery article and then this YAG capsulotomy article was that I was unable to find detailed information about the procedures and costs online. I lasted six years before deciding to have my YAG procedure, although my vision begin decreasing after much less time. Now the vision in my eye that didn't have surgery has gotten so bad that I need to have cataract surgery on that eye too. Good luck with your YAG procedure. I hope it goes smoothly for you and doesn't cost a great deal more than mine cost. I am in South Carolina, where expenses might be lower than expenses in northern cities or out west. Thanks for posting! - Jon

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  19. Thank you for your wonderful article. I just left the eye doc and he said that I need the Yag procedure in my left eye. I had cataract surgery almost three years ago and am just now having cloudiness in my left eye. Thanks to your great article, now I know what to expect.

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  20. I'm glad you found my post helpful, Debbie. I hope your procedure goes well. Good luck! And thanks for posting. - Jon

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  21. Interesting articles, I just had A YAG procedure done in my right eye, (Cataracts were removed 2 years ago), amazing difference in sight...will be doing left eye in 6 months at regular eye exam....insurance copay was 45 bucks...

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  22. It's wonderful that you are able to have the YAG procedure done so conveniently at your doctor's office rather than having to contend with the fees and scheduling of a special surgery facility as I did. It's amazing how inexpensive your procedure was too. Thanks for posting. - Jon

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  23. JON - THANK YOU SO MUCH . I AM CONSIDERING
    YAG SURGERY AND YOUR POST HAS BEEN MOST
    INFORMATIVE AND HELPFUL IN THAT I NOW KNOW WHAT TO EXPECT - THANKS AGAIN .

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  24. I'm glad my article helped you. Thanks for posting. Good luck! - Jon

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  25. Thank you so much for your post. I will have my YAG Laser on Jan 15,2015. Your post is very useful. The price really high.

    Have a Happy New year.

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  26. Hi Mai, I'm glad you found this article and I'm glad you found it helpful. I hope your YAG procedure goes well. Good luck! - Jon

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  27. Thanks for the information! I am scheduled for the YAG surgery on March 9 for my right eye, and March 16th for my left eye. My doctor didn't spend that much time with me at all, but he has a good reputation and has been doing this procedure for a long time. However, as expected, and due to the fact that I really can't deal well with anything touching my eye ball (had general anesthesia for both cataract surgeries due to poor reactions to local), I am very very nervous about getting this done. I am looking forward to having better vision, though. Wish me lock?

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  28. I'm glad you liked my information. Thanks for posting. Good luck! - Jon

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  29. I am having the YAG surgery on March 23rd. I had a multifocal lens surgery in November 2013 and had to have the lens replaced in November 2014 and now this. I keep hoping that my vision will finally be clear. Susan

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  30. The YAG procedure is quick and straightforward. Waiting for the drops to take effect beforehand takes a lot longer than the laser procedure. Good luck on the 23rd. I hope it goes well for you and you finally get good vision. - Jon

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  31. I'm adding my information to help. I have BCBS of AZ insurance with a high deductible. I am listing the amounts billed and the BCBS contracted amounts that I paid.
    Initial visit: $132 billed, $77.45 contracted
    Refraction at that visit: $55 billed, $20.01
    YAG capsulotomy physician fee: $908 billed, $310.73 contracted
    YAG capsulotomy facility fee: $955 billed, $552.80 contracted
    So I paid $960.99 total. I would have had to pay $2050 if I didn't have insurance.
    My procedure was very quick. At one point during the zapping, he said he was going after the floaters and zapped away. I did have some pain with the procedure so it was hard to keep my eye open. The pain went away after a couple of days and was not too bad. I had absolutely no floaters and my vision in that eye is spectacular and I no longer have glare issues with that eye. I did not have a post-op intra-ocular pressure check. I did have a 2 week optometrist appointment that was included in the surgery fee. -Nancy

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  32. Thanks for posting your data, Nancy. It's good to see your current costs for the procedure in Arizona. I'm sure other readers will find the info helpful. - Jon

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  33. Thank you for all of your information. My cataracts were done in 2013 and now I have a heavy film over my right eye. I have an appointment on June 23 for a consultation (my regular eye doctor said I need the YAG done) this consultation is with my original cataract surgeon. Insurance is giving me a hard time,so I don't know costs yet. One question I will have is, will the film grow back again. Again thank yo for all of the information posted here. Kathy

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  34. You're welcome, Kathy. I'm glad you found what I posted helpful. If you come back and post your costs after you have the procedure I'm sure others will appreciate it. Good luck! - Jon

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  35. I really appreciate the amazing details you shared in this blog. I am more assured by you than those professionals with their duty of care and being charged so much for so little information. It amazed me how they hand instructions and contracts in fine prints since their patients are vision-impaired. I need to have YAG laser and I am clearer now to check how much my insurance would pay and which doctor to go to to have it done. Thank you so much.

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  36. Yes, doctors and their staffs are often surprisingly unconscientious, like in your example of giving vision-impaired patients documents printed in small print. If they would simply try to treat patients the way they would like to be treated it would make the experience much better. In my case, I like to know what they are doing to me and why, but I almost always have to ask before they tell me. Good luck with your surgery! Thanks for posting. - Jon

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  37. These posts have been really helpful to me as I have Macular degeneration also, and routinely have the Avastin shots in the eye scheduled for YAG. Both eyes have had cataract surgery several years ago, and so far one is still doing well. I kept looking to see if driving is allowed after the YAG proceedure. I'd like to keep it simple if possible as I know from the avastin shots in my eyes I need to go home, eat some food, and try to nap for a few hours to avoid the irritation. Did anybody require a driver? This is an excellent post, as my eye surgeon did not go into detail, and most of the info I found was of little help. I have insurance for the surgery, but will ask about the coverage before hand to be sure.

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  38. I had to have someone drive me home when I had cataract surgery, due to the intravenous sedative they administered, but I drove myself home after the YAG procedure. I hope your procedure goes well. Good luck! Thanks for posting. - Jon

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  39. Okay I know practically everyone says that they had floaters after the yag, but how long do they last, and do they ever go away for good?

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  40. Hi Lena, I'm the one who wrote this blog article. I don't know when the post-YAG floaters disappeared, but now four years later, I don't have them. I still see a floater occasionally for a few days, but it startles me because I don't get them much anymore. I had floaters before my cataract surgery and before the YAG procedure, so the floaters I see occasionally now may have nothing to do with the operations. Maybe someone who had no floaters before the procedures will post their experience too. Thanks for posting. - Jon

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  41. Thanks Jon for your prompt response!

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  42. Amazing how JoN had to pay a bit over a $1000.00 without insurance and the other paid $960. with insurance. Who's getting ripped off here?

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  43. johnuff1, Yes, I paid $1,080 without insurance in SC and Nancy paid $960 three years later in AZ. From that it looks like Nancy saved $120 by having insurance, which cost much more than $120. However, Nancy also said without insurance her cost would have been $2,050. So having insurance saved her $1,090. Even so, I daresay Nancy's insurance cost her a lot more than $1,090. Thanks for your comment. I think everyone needs to rethink the value of insurance. It's a shame not buying insurance is illegal now in the US.

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  44. Thanks so much for your information! I have cloudy vision 3 years after cataract surgery. Since I don't have insurance, I didn't want to pay for exams from 2 doctors. I now know to go straight to my eye surgeon. Since I'm uninsured, your info gave me at least an idea of how much I would be paying, not just for the doctor's fee but the entire cost. I'll post my total cost in Tennessee after I have the surgery. Again, thank you!

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  45. Hi Deb. I'm so glad you found my information helpful. Thanks for posting and good luck with your surgery!

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  46. Thanks for your comments. I could not find any info except yours and this procedure scares me because I have already had 2 retinal detachments in the same eye after cataract surgery with and IOC lens and now they say I have to have a Yag because of haze build up in about 7 years after the original cataract operation. Your comments about the Yag causing floaters is particularly scary, since I also had to have a vitrectomy in the same eye to get rid of the floaters after the original cataract operation. Thanks also for the cost information. Good luck to you. Glad to hear your floaters are going away and the Yag helped you to see clearly. It makes the risk seem worthwhile.

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  47. My floaters following the YAG procedure did slowly go away. Now it's four years later and I sometimes have one small, bothersome floater that appears as a small bright spot with a black border. Even though it's small, it's quite distracting when it's in my field of view. When I'm outside I keep thinking it's an insect coming toward me from one side. I have waited several years too long to have cataract surgery on my right eye. I need to get that done soon.

    Good luck with your YAG procedure. Hopefully it will go smoothly and you will have good vision in that eye again. I'm glad you found this article helpful. Thanks for posting.

    Jon

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  48. I had the Yag procedure yesterday and my vision did improve but is still a bit hazy. A year ago I had retinal detachment surgery and 3 mos. ago, cataract surgery.
    All the results have been "excellent" to quote all the surgeons. So how soon after the Yag procedure did your vision improve? Immediately, in a couple of days? Not referring to floaters but clarity of vision in general.

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  49. My procedure was four years ago so I am not positive of my answer, but I think my vision was clear as soon as the dilation wore off. Even with the dilation still in effect I saw more clearly than I had before the procedure. When the dilation wore off I think I saw as clearly as I was going to see. Good luck! Thanks for posting.

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  50. Thanks John. Whatever is going on is not related to the Yag procedure which was easy and did improve my vision. Hope I improve but there is a small % of retinal surgery patients who never end up with perfect vision. Guess time will tell.

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  51. I really appreciate reading all this, my cataract surgery was done in May 2012 both eyes a week apart. I've noticed my right eyesight is cloudy. I'm sure my doctor never warned me of this happening but oh well...I did find out from him before the surgery that I have early macular degeneration so the cloudiness is scary. Thanks! This blog has been very helpful.

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  52. I'm glad you found my blog helpful. Thanks for posting! Good luck with your vision!

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  53. Thank you for this. I'm having it done tomorrow for a wrinkle in the capsular sack causing diagonal lines when viewing headlights. My doc explained nothing other than my eye would be dilated and numbed, and it was a quick procedure. I feel better prepared knowing what will happen. Haven't found this detail anywhere else.

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  54. It mystifies me why doctors seem so reluctant to share the details about the procedures they recommend to their patients. It seems like just following the golden rule of doing unto others as you would have them do unto you would make such communications automatic. I'm glad you found my post helpful. The reason I wrote the post was because, like you, I was unable to find details about the procedure online. Good luck with your procedure! I hope it solves your visual problems. - Jon

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  55. I found your blog on "vision loss after cataract surgery" both informative and reassuring. It's essential to address concerns about potential complications, and your article does just that with clarity and insight. Understanding that vision loss, although rare, can occur helps alleviate anxiety for those considering cataract surgery. Your emphasis on the importance of early detection and prompt consultation with an eye specialist in case of any issues is invaluable. Thank you for providing valuable information that promotes informed decision-making and reassurance for those on their cataract surgery journey.

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