Cataract Surgery and Treatment

Cataracts can be treated with a number of refractive procedures which replace the damaged lens in the eye. Cataracts can be treated with surgery and the use of intraocular lens (IOL) such as the ReSTOR^® lens, or a multifocal IOL lens such as the ReZoom^® lens.

Learn About Cataracts

10 Things Everyone with Cataracts Should be Aware of Before Having Surgery:

1. Location. The most convenient method of cataract surgery available today is performed at in-office Medicare-Approved Eye Surgery Centers dedicated exclusively to eye surgery, as opposed to multi-specialty hospital-based surgery facilities.
   
   
2. Costs. Patients having hospital-based cataract surgery are likely to incur hundreds of dollars in additional out-of-pocket costs for themselves, as well as Medicare and their insurance carrier, when compared to having surgery at in-office Medicare-Approved Eye Surgery Centers.
   
   
3. Safety. A recent multicenter study compared results and safety of various surgical techniques and technologies used in Cataract surgery. Conclusions: Scleral tunnel incision placement, intraocular lens made of PMMA, and use of intraocular antibiotics each contribute to enhanced overall success and safety. Additionally, Cataract surgery performed at an in-office Eye Surgery Center has a lower incidence of infection and complications than hospital-based cataract surgery.
   
   
4. Anesthesia.  Patients should be aware that injection-type (needle) anesthesia is no longer required for cataract surgery, which can result in complications that are not encountered with eye-drop anesthesia.
   
   
5. Experience.  Eye surgeons who devote a majority of their time in the operating room gain a higher level of experience in the latest methods of advanced cataract surgery, thereby optimizing results.
   
   
6. Fee Splitting.  Patients should be aware of a common practice known as “Fee Splitting.”  Some eye doctors have monetary arrangement with their referring optometrist.  This may increase costs and add inconvenience to the patient and family and decrease continuity of care.
   
   
7. Multiple Billing.  When it comes to cataract surgery costs, cataract patients can encounter multiple billing for the same procedure when their surgery is not performed within the environment of a Total Eye Care facility.
   
   
8. Sub-specialization.  The most effective and convenient method of cataract care is found within the same practice where the surgery and post-operative follow-up care is provided by a team of highly trained sub-specialists.
   
   
9. Staffing.  Those staff who are specially trained and dedicated specifically to cataract care can ensure maximum comfort, safety & convenience during your procedure and post-operative follow-up care.
   
   
10. Total Eye Care.  Cataract patients should choose a facility that can provide them (and their families) Total Eye Care coverage, which maximized convenience, cost-savings and—most importantly—results.

What are Cataracts?

With a clear normal lens, the images are focused clearly on the retina (LEFT IMAGE). Vision is clear. With a cataract, the lens is cloudy, causing the image to become blurred and yellowed (RIGHT IMAGE). Vision is hazy, and colors become faded.

What causes cataracts?

A cataract is caused by a change in the chemical composition of the lens. The most common cause for this change is the natural aging process. As we mature, the normally flexible, clear material of the lens becomes hard and cloudy. Unfortunately, there is no way to prevent the development of cataracts. Everyone who lives long enough will eventually develop the problem.

Although most commonly seen in adults after the age of 40, cataracts can occur at any age. The condition may be present at birth or caused by an injury to the eye. Infections and other eye diseases, such as glaucoma and eye tumors, may cause the development of a cataract. Vision loss is usually gradual as a cataract develops.

What are the symptoms of cataracts?

• Dimming or blurring of vision
• Halos or glare around lights
• Double vision
• Colors appear less brilliant
• Feeling of "film" over the eyes
• Frequent changing or cleaning of glasses
• Difficulty driving or reading

What to Expect on Surgery Day:

You will arrive at the surgery center about an hour prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.

A very small incision will be made and a tiny ultrasonic probe will be used to break up the cataract into microscopic particles using high-energy sound waves. This is called phacoemulsification.

The cataract particles will be gently suctioned away. Then, a folded intra-ocular lens (IOL), or multifocal IOL lens will be inserted through the micro-incision, then unfolded and locked into permanent position. The small incision is "self sealing" and usually requires no stitches. It remains tightly closed by the natural outward pressure within the eye. This type of incision heals fast and provides a much more comfortable recuperation.

You will go home soon after the surgery and relax for the rest of the day. Everyone heals somewhat differently, but many patients report improvement in their vision almost immediately after the procedure. Most patients return to their normal activities within a day or two.

New Study Outcomes:

A study commissioned by MedPAC and undertaken by RAND Health in October, 2006, Further Analyses of Medicare Procedures Provided in Multiple Ambulatory Settings, concluded that with respect to all statistically significant measurements after risk adjustment, cataract patients had fewer adverse outcomes (endophthalmitis, iris prolapse, cataract fragments, and persistent corneal edema) following surgery furnished in the ASC, as compared with the HOPD. As for program savings, in 2006 alone, Medicare saves over $400 ($1,388 in the HOPD vs. $973 in the ASC) each time the cataract operation is performed in an ASC rather than a hospital, translating to hundreds of millions of dollars in expenditures annually. Moreover, out-of-pocket spending by the Medicare beneficiary is lower when his care is provided in the ASC rather than the hospital. Simply stated, with respect to cataract surgery, the highest volume Medicare surgical procedure, the ASC is the predominant choice of the Medicare beneficiary because the quality of care provided is demonstrably high and the cost savings to the patient and the program are significant.

 ASCRS / OOSS - Proposed changes to the ambulatory surgical center payment system and CY 2009 payment rules. Click Here.