Cataract Surgery

by Edward R. Annis, M.D.

Throughout the ages cataracts have blinded more people than any other affliction of the eye. They begin as little cloudy spots in the lens of the eye, but can gradually spread until vision is blocked. It was the ancient Greeks who named the disease because people with cataracts see the world as if they were looking through a waterfall.

The diagnosis of cataracts is no cause for alarm. A cataract is not a tumor or cancer. Most cataracts develop as the result of the normal aging process, but there is great variation in that sometimes they develop in the early 40's while others do not arise until the 80's. Some develop because of injuries to the eye, some the result of certain diseases, and occasionally they are due to hereditary conditions. Cataracts are not contagious and they do not spread fro one eye to the other. Very often they grow by different rates, so that vision is better in one eye than in the other.

There are often false claims that pills, vitamins, drops or certain foods can clear cataracts, but there is no evidence that any of these have been demonstrated to work. In light of modern medical knowledge today the only treatment which can be depended upon is the surgical removal of the clouded lens by a physician with special training and experience in this field of surgery.

In many patients the cloudiness is minimal, or off center, so that vision is only slightly impaired.

Most surgeons delay surgery until the cataract reaches a stage where it interferes with what a patient wants to do. This could be because of worry about driving skills, the inability to enjoy reading or cooking, or because a patient just does not feel confident in everyday activities.

Like most eye surgery cataract surgery is definitely major surgery and, as is true in all surgery, it carries some risk. In the hands of today's well-trained eye surgeons, however, risk is minimal and the safe and satisfactory removal of cataracts is among the most frequently performed of all major surgical procedures.

Because many patients are able to return home on the same day and only a few hours after the surgery is performed, many people consider cataract surgery as a minor procedure which is easily performed. This can be a dangerous conclusion and many people have had serious problems as a result.

Surgery of this type is most demanding and those doctors who obtain consistently good results are the eye surgeons who have had extensive training in performing operations under technically advanced microscopes. The sutures used to repair the eye's delicate tissues are finer than a single human hair and are almost invisible until view under the microscope.

Depending upon the location and extent of the of the cataract the operating surgeon decides on one of several procedures which may remove all of the lens or sometimes only a part of the lens leaving a part of its capsule in place.

After the lens is removed a substitute lens must be provided to focus light so that patients can again see. In years past thick glasses were needed to restore sight. They often provided excellent vision, but because they magnify what is seen, objects often appear closer than they really are. In more recent years contact lenses proved to be of much greater value for many patients because they allow a broader visual field and less distortion of images.

For the past fifteen or more years with proven techniques and ever better materials better results have been obtained as surgeons have been able to implant intraocular lenses in many patients. These are tiny discs of plastic which allow great numbers of people to enjoy normal or nearly normal vision. Sometimes glasses are needed for additional correction, but with or without glasses every year more than one half million people benefit from these great advances in eye surgery.

Because of the speed with which new developments have occurred in the treatment of eye diseases and because even the most experienced surgeons encounter occasional problems and complications, leading surgical ophthalmologist have formed the American College of Eye Surgeons. Members of this College meet to exchange knowledge and working together they have helped to establish the American Board of Eye Surgery. The American Board of Eye Surgery oversees continued research and teaching to assure that today's practicing eye surgeons and those being educated to practice in the future will be kept informed of those new developments and procedures which have been demonstrated to possess real value for patients. The Board of Eye Surgery assures the American people that doctors are being continually educated to bring to them the great benefits of specialized study in the diagnosis and treatment of diseases of the eye.

Medicare & Cataract Surgery

Cataract surgical procedures can allow persons a second chance at seeing clearly. The payment for this surgery can be handled in many ways, but one of the most common for persons over 65 is Medicare. Medicare payments by the governments over the past year has and is making dramatic changes.

To qualify for Part B Medicare (that's the portion that allows for the doctor's billing), a person must be at least 65 years of age or have received Social Security Disability Benefits for a 24 month period. For those individuals 65 years of age and older and still working or qualifying for a group insurance plan, they may select Medicare to be the secondary insurance. Medicare allows for cataract extraction, either one or both eyes, and there are no restrictions on the time period between doing the first eye and the second eye. The decision to have cataract surgery may involve additional testing by a doctor. The costs you incur for these test are allowed by Medicare.

Changes in Medicare over the past year did not eliminate any services, but they imposed rules governing payment to the doctors. They created a maximum amount a Medicare patient can be charged for cataract surgery and made a reduction in the payment amount to the doctor. One must always be aware that continued reduction of payment by Medicare will make it difficult to continue the present level of care. The American College of Eye Surgeons is concerned that all patients receive quality care which involves proper learning of new procedures, research, equipment and staff.

Further reduction of Medicare payment may cause doctors to evaluate services. A doctor, or his staff, will go over the details of your surgery, care, and cost of services connected with this care.

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