Remember, Wills and Bascom Palmer are both teaching institutions. You will have residents and fellows taking care of you. As good as they are at training ophthalmologists, I certainly wouldn’t go to either for something so routine.
I’d find the closest high volume practice close to home. It’s a very routine procedure. You want some who does it a lot. You won’t get that at a teaching institute.
Teaching institutes are great when you have something uncommon where the attending will have more experience than regular practitioners. For routine stuff, you won’t get their attention.
Everyone who has a remotely aged population will have volume. Before I retired, the practice I worked in did about 2000 cases a year. It’s certainly considered a rural region, but we were busier than any big city practice. Bigger cities will have more competition. I’d pick someplace close to home. @rockymtnhigh2 where’s home? PM me if you don’t want to divulge it here. I’ll help you find a place.
It’s your eye. It’s understandable. As a result though, patients are more fearful than the data supports.
It is the most common surgery done in the United States, over 3,000,000 per year.
It’s the least complicated surgery as defined by significant negative outcomes per 1000 cases.
People who aren’t happy either didn’t have realistic expectations, or, more likely, didn’t have the outcomes of their lens choices explained sufficiently.
I don’t have the exact number at my disposal, but I’ve done close to 50,000 cataract post-ops. I can count on one hand the number of really bad outcomes that I’ve seen.
The odds are great. Don’t over complicate it by overthinking it.
I’ll likely need cataract surgery in a few years. My husband is really happy with his corrective lense implants (self-pay). He no longer needs contacts or glasses. I will consider doing same, but not sure how that will work for my eyes. For intense reading, I use no glasses. Most of the time I wear my “computer glasses”, a monovision arrangement that works for most things (computer, TV, around town driving, light reading). I also have my “driving glasses” optimized for distance.
You can always shoot to replicate the prescription you have, just with better clarity. Giving up myopia (nearsightedness) is a frequent cause of disappointment.
I have been very near-sighted for nearly my whole life. I’ve had hard contacts, gas permeable, soft contacts, daily disposables, regular glasses and progressive lenses and now IOL.
Once when I was going for new contacts I tried correcting both eyes for distance figuring I could use reading glasses. It was AWFUL. It absolutely drove me batty. I was putting on glasses every two seconds and taking them off again. Your initial inclination is to get closer to something you can’t see well but it’s the opposite–it needs to be further away. Maybe further than your arms reach. It didn’t last long since it was so frustrating. Just reading labels at the grocery store was frustrating. It was relief to take the lenses out at night and just hold a book super close and relax. I was very glad I had that experience because when it came to cataract surgery I crossed that option off immediately.
I also did monovision with dailies–the monovision (one eye close and one eye for distance) worked very well. Over the course of a week your brain integrates what you see from either/both eyes so your vision is seamless. So I did consider that for IOL also. But I had done it with contacts already–not everyone’s brain makes the shift in perception to make that a good option. If it works then you get away without glasses–but around 30% of brains don’t make the shift and then it’s just a total mess. If you don’t try it with contacts prior surgery I’d be reluctant to consider it.
Lenses keep improving–do ask what brand/type lens your doctor is using. Hopefully your doctor is keeping up with the new improvements in lenses and offering the best.
Another “missing myopia” reason is that for those of us with severe myopia taking off your glasses is like being able to close your eyes and relax with your eyes still open. The world is a bit blurred and soft. It’s easy to tune the world out a bit and still appear present.
My surgeon would not consider monovision for cataract surgery unless you were successful with contact lenses. Fortunately I had monovision contacts for years.
The only thing I’d add to your great description is that there is no “best” per se. There is “latest,” but how individuals adapt is well…individual.
Ideally you want a surgeon who does high volume, who doesn’t jump at every new “innovation,” but rather gives it a couple of months to let others see if they’ll be improvements or go by the wayside.
It’s also helpful to go to a practice that also offers LASIK and other refractive procedures as it’s a little more likely that they’ll be invested in the latest biometry, hitting the target more frequently. If they don’t, they can correct.
That sounds like me, although I fit both instead of one or the other. I blame myself, too, for not doing more research. Also, I placed too much faith in credentials and didn’t ask enough questions of doctors who were always in a rush to get on to their next appointment.
My first surgeon, head of the dept. at a university hospital, didn’t explain much other than to say she did not recommend monovision for people over 60 who hadn’t worn contacts. She also diagnosed early stage macular degeneration. Apparently due to that, she used a yellow IOL in the one eye she deemed ready for surgery but failed to mention it. I continued to wear glasses for poor distance vision and astigmatism, which I have to remove when reading or doing close work, and computer glasses for mid-range distances.
Before the pandemic began we moved and a couple of years later I saw a new ophthalmologist. He determined the other eye was about ready for surgery, prescribed stronger distance lenses in the meantime. He was surprised when I mentioned macular degeneration. He didn’t comment on the yellow lens from the first surgery, and did not use the same when he did the surgery on the other eye. This doctor is part of a high volume practice and used to do laser surgery but decided that its outcomes are no better than traditional methods and just incur greater expense for the patients.
At a follow up visit, I mentioned that I’d noticed a difference in color perception from one eye to the other. For example, a pale pink looks more peach when viewed by the eye that was operated on first. That’s when the doctor apparently first noticed the yellow IOL, and when I first heard about it. He shrugged it off and said most people would never be aware of the difference. He also reiterated that he didn’t see signs of macular degeneration. I also mentioned that I was aware of a black arc at the outer side of my field of vision. He expected it go away within six months. It’s been over a year and a half and there’s no change in the negative dysphotopsia, so I guess it’s permanent. I didn’t experience that with the first eye.
The main discernable benefit for me is slightly improved vision when reading or sewing, for which I still remove glasses. However, I’m not feeling confident the vision screening done at that practice by a non-MD. I had some concerns last year, and my experience this year made me determined to go elsewhere. Maybe I expect too much from my distance vision glasses, but it’s unnerving to not be able to read street signs easily while driving and I have trouble with some text on our big screen TVs.
I don’t mean to discourage anyone about cataract surgery. I know folks who were delighted with their outcomes and know no one IRL who experienced problems. Mainly, I wish I’d read more, asked more questions and perhaps gotten a second opinion. I’m also still baffled about the difference in opinion between these doctors, both board certified with years of experience, on the macular degeneration diagnosis which colors my feelings about the whole business.
The yellow was probably a short wavelength blocking Acrysoft. They were the rage until they weren’t. The literature purported that color perception wouldn’t be impacted, but how could it not. I’m certain that was a statement about bilateral Acrysoft implants.
It’s irritating when physicians dismiss patient complaints like that.
As for the MacD, almost 90% of patients over 50 have some evidence of drusen. A subset of doctors mistakenly call it MacD. It’s not. It’s a precursor officially named drusen maculopathy. The official diagnosis of MacD is squishy, because different papers describe it different ways. The important thing is to have it staged to see one, if you even have it, two, if AREDS vitamins are appropriate, and three, what your 5 year risk is.
Anyone who willy nilly throws the term around without scheduling a follow-up visit with an OCT is being cavalier, lazy, incompetent, or maybe all three.
You could see a retina specialist, but you’ll get a yearly wallet biopsy for something that at worst sounds very early. Just ask your current provider to do a macular OCT.
I will be seeing an opthalmologist on Thursday for cataract surgery on my second eye. My other eye was done about 7 years ago. I am going to this Bay Area opthalmologist because he is experienced in multi-focal lenses. For more information on different kinds of lenses, there are some good videos on Youtube https://www.youtube.com/@ShannonWongMD
There are good and bad reviews on Yelp on this clinic. I was thinking of going to that clinic because he guarantees a lense replacement if you don’t like the new implant.
I will say the practice I went to did a VERY high volume in LASIK surgery also in addition to cataract surgery. It was almost surreal --it was like stepping into a well-oiled machine.
The number of various diagnostic and measurement taking machines was a bit overwhelming. I was shuffled from room to room to sit in front of machines (and sometimes twice for double check).
The doctor was very upfront about probablility outcomes and possible side effects like the probabilities of halos etc. after surgery and the time it may take for those to go away (or not.). Certainly did not sugarcoat. All said, I think I could’ve used a bit more direction in choosing what I wanted but I’m sure he wanted it to be my decision. At the time I was most interested in no glasses (go for it!) and he seemed confident that multifocal lenses would provide that for me. I did a lot of research AFTER the initial visit–up until the visit I didn’t have enough information to really ask some of the questions that needed answering.
I will be needing to think on this, talk to my ophthamologist. If I did monovision correction (like my compromise “computer glasses” at cateract surgery, not sure I’d still be able to have a solution to have stronger driving glasses.
Yes, I do almost everything (including walking around house and driving locally with the computer glasses)… except I take them off for heavy duty reading (and sometimes do computer without them, mostly needed them fo intense computer tasks like I did while working.). I swap them for my driving glasses for long drives, theater performances, etc. My transition glasses/sunglasses (used for running, pickleball) are the stronger driving prescription.
Btw - Even though I’m willing to splurge to get prescription implants I would not rule out doing the default lense… continuing my glasses regimen.
