Cataract surgery may be one of the most successful and common eye surgeries in the United States each year, but as a patient, you only have one chance to get it right. This means choosing the right surgeon.
Whether you receive a referral from your eye doctor, follow the advice of a friend, or find a surgeon online, you have the opportunity to get some important questions answered before committing to a surgeon.
Rachel Simpson, MD, ophthalmologist and cataract specialist at the John A. Moran Eye Center, offers this list of questions to ask during your consultation with a potential surgeon, along with the answers you want to hear.
How many cataract surgeries have you done?
If you have any concerns about your surgeon’s experience, it’s definitely a good idea to ask. Most surgeons want their patients to be comfortable, and if asking this question helps you build confidence in your surgeon’s skills, you should ask.
The busiest surgeons often perform 15 to 30 cataract surgeries per week. At this rate, the number of accounts adds up quickly. I quickly lost track of my specific number, and probably most other surgeons as well. The number is less significant than the range.
New cataract surgeons have probably performed between 200 and 300 surgeries, which is more than enough to safely and effectively perform routine cataract surgery. That said, surgeons upon completion of training continue to develop their skills for the first few years after completion of training.
There is a significant difference in skill level between a surgeon who has performed 350 surgeries and one who has performed 5000. There is a much smaller difference between 500 and 5000 and almost no difference between someone who did 1,000 surgeries and someone who did 5,000.
Can you share your patient outcome statistics?
Besides being the most common surgery, cataract surgery is also the safest in the United States. Most experienced surgeons have an overall complication rate well below 5% and a major complication rate of around 1/2000.
Many surgeons may not know their exact complication rate, but they will 100% remember their last complication and when it happened. You may get more useful information by asking your surgeon about their most recent complication, what it was, and how it happened than by asking for a rate.
Can you describe the procedure?
The surgery involves removing the cloudy natural lens and replacing it with a clear, artificial lens. The surgeon uses ultrasound energy to break up the cataract into small pieces and remove them from the eye with a small vacuum. It does not require general anesthesia or stitches and takes about 15 minutes. The procedure requires little or no recovery time.
What are the benefits and risks?
The most important benefit of cataract surgery is that your vision should improve with the removal of the cloudy lens. There is of course some nuance to this, as sometimes you may need glasses to get the best possible vision after surgery, but improving vision is the main reason for performing the surgery.
As with any surgery, there are risks to consider. The most common risk is the need for glasses after surgery.
Cataract surgery can make dry eyes worse, which can be bothersome and difficult to treat.
Serious complications from cataract surgery can include infection, bleeding into or behind the retina, and retinal detachment. These complications are very rare; however, they do occur, so it is important to consider them when deciding to have the surgery.
What type of lens do you recommend and how many operations have you performed with this lens?
Choosing lenses is probably the most confusing part of cataract surgery. Don’t be afraid to ask as many questions as you need to fully understand the options, and be sure to review with your surgeon before surgery to make sure you’re both on the same page.
The choice of the type of lens to be implanted is specific to each patient. I usually tell my patients that it depends on their vision goals after surgery, their profession, hobbies, and other eye conditions.
I usually start by explaining the “standard” lens and how it works.
The standard lens included in the cost of the surgery is a monofocal lens, which means you will be able to see clearly at one focal point. We categorize this as a distant focal point (driving, watching TV, going to the theater, and participating in outdoor activities fall into this category) or a near focal point (reading, sewing, playing music). If you choose to correct both eyes for distance vision with a monofocal lens, you will see well for distance activities but will need reading glasses for anything up close. The reverse is also true.
I usually discuss multifocal lenses if you want to break free from glasses. Unlike the standard lens, these lenses have two focal forces that allow you to see well both far and near. These lenses are considered “premium”, with higher associated costs. Not everyone will benefit from these lenses. For example, patients with significant vision loss due to macular degeneration or glaucoma are not good candidates for these lenses.
Finally, if you suffer from significant astigmatism, I often recommend another high-end lens called a toric lens. Astigmatism is another type of refractive error which, if not corrected at the time of surgery, could mean that you may still need glasses at any time after surgery, even if your nearsightedness or your hyperopia is corrected. As with the multifocal, some patients are good candidates for this lens, and others are not.
How much will a premium lens cost more?
The exact amount for a high-end lens varies depending on the type of lens. You will usually meet with a lens advisor who will review all the options and can tell you the exact cost of the lens you select.
Can you guarantee perfect vision after surgery?
No surgeon can ever guarantee a result; if you meet a surgeon ready to do it, you should run! There is always a chance of getting the best possible vision after surgery, and you may need glasses for some activities or, in some cases, for all activities.
Who will examine me after my surgery to check how I am healing?
Several post-operative examinations usually take place in the days and weeks following the surgery. The first exam usually takes place later on the day of your surgery or the next day, depending on your surgeon. This visit ensures that the lens is properly positioned, that the incisions made during the surgery are healing and that the eye pressure is acceptable. We generally expect the vision to be a bit blurry on this visit. Your surgeon can do the follow-up, but your surgeon’s assistant, who can be a resident or a fellow, can intervene.
We usually re-examine the eye a few weeks after surgery. Each surgeon has a slightly different preference as to exactly when this second visit is, but it is often the visit where we carefully check your vision and prescribe glasses if necessary.
Some surgeons make a final postoperative visit a few months after surgery. This is usually just a final check to make sure everything is stable and the eye is completely healed from surgery.
You should generally expect to see your surgeon or assistant for your postoperative visits. Some surgeons ask their patients to see an optometrist at their last postoperative visit to help them meet their eyeglass needs after surgery.
Is there a possibility that I will need follow-up surgery?
Sometimes the eye may develop posterior capsular clouding, or PCO. This is often called a second cataract or a post-cataract, sometimes described as scar tissue. A PCO results from residual cells of the lens that remain on the casing that once contained the natural lens. If these lens cells are healthy, they can do what cells normally do: grow and replicate. They can never grow large enough to form a new cataract, but they can produce a membrane behind the new lens that can blur vision in the same way as a cataract.
We perform a simple and painless in-office laser procedure that takes less than 5 minutes, called a YAG capsulotomy, to remove the membrane behind the lens. On average, about 20% of patients will require a YAG procedure after surgery. Insurance usually covers this procedure with just a regular office copayment.