Need Cataract Surgery? What You Need To Know

Article by: IPA Staff Len & Gladys Rapoport

I have worn glasses for the past 30 years.  My left eye had the most problems.  I have an astigmatism and eye floaters in that eye, but with glasses I seemed to have managed just fine in the beginning.  As I got older, I noticed I started to have more difficulty driving at night and seeing things clearly.

On coming cars lights had halo’s around them, street lights glared, it was getting more difficult to drive with oncoming traffic shining their headlights in my eyes.  I continued to struggle with clear vision and continually cleaned the lenses in my glasses thinking that would help, but it didn’t.

I Had Cataracts, What Is A Cataract

When the eye’s naturally clear lens becomes clouded, it’s called a cataract. Most cataracts are the result of the natural process of aging. Others may be present at birth or develop as a result of physical, drug, or chemical injury. Cataract surgery, one of the most common operations performed in the U.S., clears up the cloudiness. Click Here to find out more about Cataracts.

I finally realized, with the advice of my doctor , Dr. Ronald Klug at the Ophthamic Physicians of Monmouth in Holmdel, NJ. that it was time to consider cataract surgery.  Over the years the techniques have improved and the new intraocular lenses improved as well.

They can now correct many eye problems but removal of the cataracts will let you see clearly again, but you may still need to wear glasses after successful surgery.

I am 72 years old, in good general health and work on the computer most of the day.  I knew it was the right time for the surgery.

Arrangements For Surgery

I wanted to find out a bit more about the procedure and what to expect after the surgery.

Since most of my work is looking through a camera lens or working on the computer, my eyes are a critical part of what I do.  I needed to be able to see at arm’s length, but also able to see properly when driving at night.

Dr. Klug advised me, after all the measurements were taken, that implanting a minus one lens would enable me to work on the computer comfortably and I wouldn’t need any correction for the right eye. As you read the rest of this article you will find out if the plan worked.

Measuring The Eyes

In order to find the right strength of the intraocular lens to be used during cataract surgery, it was necessary to measure my eyes.  This was accomplished with a number of devices to get the proper sized implant for each eye.  It took a while to get the correct measurements and a bit challenging at times as I had to keep each eye opened and still for about 30 seconds without blinking.

Once this was done I was given the dates for the surgery, pre-op instructions and given two sample sized vials of the medication drops I needed to use before and after the surgery.  The left eye was going to be first and we scheduled the right eye surgery a week later.

The two small vials of ophthalmic solutions they gave me was  Besivance used to treat bacterial eye infections and the other was Nevanac, a medication used to relieve eye pain, irritation, and redness following surgery.  Nevanac is quite expensive and costs about $250 for a small 3 ml vial.  That is approximately 90 drops so it actually costs just under $2.80 per drop.

Two days before surgery I was to use the drops, one drop of each in the left eye at breakfast, lunch and dinner time.  Once the drop entered my eye, I would close the eye for a minute or two to make sure the medication was covering my eye.   I was told to wait 5 minutes between drops so one medication didn’t interfere with the other, but Joan the surgical nurse told me it really wasn’t necessary to wait between drops.

I had a difficult time at first using the eye drops and found information on the internet including videos that helped me master the technique.

For more information on applying eye drops click these links and see our video below:  WebMd – National Institute of Health

How to Apply Eye Drops

The medicinal drops aid the healing process and prevent infection, so they are an important part of the treatment.

The morning of the surgery, I had to put drops in my eye on wake-up and for two hours before surgery, drops 30 minutes apart.

The Surgery

Cataract surgery is done as an outpatient procedure in an operating room, so you don’t have to stay in the hospital. The actual surgery usually lasts about 15 minutes, but of course the total procedure will take about an hour.

Ophthamic Physicians of Monmouth has their own surgi-center in their building.   I got up at 6:30 AM and put in my drops.  Went back to sleep for an hour and started the drops again since surgery was scheduled for 9:30 AM.

My wife and I arrived at the surge-center and I was given a locker to put my clothing and personal items.  I changed into a huge moo-moo type gown, slipper socks, and a cap similar to the ones the  ladies wear in the school cafeteria.  I looked Marvelous!!!!  I was shown into their pre-op area where the anesthesiologist started an IV.

I was than lead into the operating room and was helped on to the operating table, where I was promptly  put in a dream like state.  I was told I would be awake during the procedure.  I was given a sedative through the IV line and numbing drops were placed in my eye.   Novocaine was than injected around my eye to numb the area as well and prevent any movement during the procedure.

After the surgery and for about a week or so it looked like I had a black eye.  I joked and told friends, you should see the other guy.  My discoloration was from the injections and taking a blood thinner for my heart made it look worse than it was.

While under the anesthesia I felt comfortable, as if  I was dreaming. I did see lights and activity in my eye, but I was in a state of deep relaxation and the entire procedure only lasted minutes.

The Surgery Video

Read more on WebMD about the surgery and proceedure

Recovery

I woke up in the pre-op room and was asked how I felt and if I would like some juice and cookies.   I felt as if I had palsy, my entire left side of my face was numb.  They assured me it would wear off soon and I would return to normal in a few hours, it did.

Because I wasn’t able to eat for 12 hours before the surgery, I was actually glad they offered me cookies and juice which was like a reward of sorts for being a good patient.  Dr. Klug told me I did very well, funny, I was totally out of it, numb and dumb so it is funny that I did well. I told him I didn’t do anything and that he did all the work, he smiled. They put a patch over my left eye with some surgical tape to hold it in place.

Finally after resting and letting the anesthesia wear off some more,  it was time to leave. I was given instructions on how to use the drops after the surgery and they added one more medication Durezol.  Durezol is an ophthalmic medication and is used to treat eye pain and inflammation caused by surgery.

I had brought a pair of old glasses with me because so they could remove the left lens from so I could wear the glasses, see with my new implant through the left side and still see through my uncorrected right eye through the right lens in the glasses.

The patch they taped to my left eye was to be worn each night for the first few nights to prevent any damage to my left eye.  Scratching the eye during sleep or moving the implant was a possibility so the patch would prevent any harm to the eye and implant.

Week Two – Complication

I was informed that I would be able to see things better immediately and I did see the improvement, but it wasn’t perfect yet.  Wearing the glasses with one lens was a bit tricky at best.  At night holding my left eye open only, I would see a double images so I had a feeling there was a problem.

I read that even after cataract surgery prescription glasses may still be necessary for many patients, especially older ones.  Since I was scheduled for surgery on the right eye now in three days and wasn’t sure the left eye was OK,  I decided to visit Dr. Klug on the Monday before the right eye surgery was scheduled.

They only perform these surgeries on Wednesdays.  Dr. Klug informed me that the problems I had experienced with the left eye was most likely caused by tight stitches used to close the opening made to insert the implant.  It was only a 1/4″ and but if the stitches were tight this could cause the problem I had been experiencing.

We scheduled a return visit the following week to remove the stitches and to be sure my eyesight was restored to the new normal.  I than made a new appointment for the second eye surgery the following month.  This would allow plenty of time to see how the left eye was doing and give it more time to heal.

I felt more confident now that I did some research on the procedure and know what the outcome should be.  Going back I will be more relaxed and less anxious knowing that this procedure it a straight forward one, with excellent outcomes for the patients.

Medication and Surgical Costs

Cataract surgery is usually covered by Medicare and health insurance, so that is a good thing.  The surgery itself only takes minutes, but the preparation and recovery is what takes most of the time.

The cost of the medication drops I needed was not covered by Medicare Part D.  The small samples I was given at the doctor’s office, would not cover the total amount I needed so I would have to buy additional medication.

The cost of the three medications ran from $150 to $250 per  vial.  Sample vials from the doctor was only 1 ml (millilitre), the prescription Durazol and the Besivance is packed in 5 ml vials (150 drops each) and the Nevanac was available in a 3 ml vial, 90 drops.

There are 30 drops to a millilitre. I did some fast calculations and found out that over the 6 weeks I might need to take the drops, and if I had to take them three times a day, I would need 126 drops of each solution for each eye.  However, I discovered that the medication is not required three times a day after the first week and the Besivance wasn’t required after the first week either.  Only the Durezol and Nevanac were the only two and that was only twice a day until the doctor felt they were no longer needed.  So I was relieved that the meds wouldn’t be as expensive as I had thought.

The most expensive medication was the Nevanac which costs around $250 for a 3 ml vial or 90 drops.  That worked out to $2.78 per drop.  The other two meds cost around $150 each for a 5 ml vial.  Since the meds are used less and less as each week passes, I would estimate the total cost of the three for both eyes to be around $300 per eye. Which is not bad considering you might be able to save even more if your doctor can supply you with enough Besivance for the first couple of weeks of use.

Ask Questions

It is important to know and ask your questions before the surgery so you won’t be surprised later on.  Be sure to ask your doctor if he has extra samples to give you so you may not have to buy some of the medication you will use.

If you are not on a government health plan like Medicare or any others, your doctor might have a money-saving coupon for you as well.  On the Besivance the coupon allows the first fill at only $35 a savings of over $120, but the coupon is not valid for anyone on a government health plan, like Medicare.

My Medicare D considers these meds as tier 3 and 4 and pays almost nothing of the total costs.  Frankly I haven’t even met the $350 yearly deductible, so the insurance doesn’t help me or my wife much each year.  I am told however that some policies will pay a larger portion of these costs so check with your insurance company to see how much they will pay for the meds.

Information You Should Know

Knowing what the procedure is and watching this video can help you understand the entire process and surgical procedure.  It should relieve a lot of the anxiety you might feel before going for this type of surgery.

On a side note, I had asked about laser eye surgery and Dr. Klug informed me only the hospital has the equipment which is huge and quite expensive and actually makes the operation three times longer then the conventional methods.  For a skilled surgeon this is a relatively simple procedure.  So laser surgery is not a real option.  Different doctors use different techniques.  Some like to close the eye with a couple of stitches to help the healing and avoid infection.  Others may not and some, as is the case in this video, opt to use a treated contact lens that is self dissolving.

After seeing the video in this article, I realized there laser also known as Refractive surgery, is not used too often for cataract surgery. This type of surgical procedure is used to correct common vision problems (nearsightedness, farsightedness, astigmatism and presbyopia).  Once done this surgery will reduce dependence on prescription eyeglasses and/or contact lenses.

Now almost three weeks after surgery on my left eye, my mid-range vision in that eye is 20/20 and sharp and clear.  However, looking at distant objects is now that clear.  I know I wore Tri-Focal lenses that allowed me to see far, mid-range (my computer) and of course reading or close range, but now things would be different.

Even though there are multi-focal lenses like crystalline and others that enable the wearer to see more than the one focal range, reports I have read showed there have been many complications with these. In addition, medicare and other insurance companies will not cover the additional costs of these lenses that can often cost over $2500 each.

We have to understand that the older we get the more dependent many of us are on multi-focal eyeglasses.  So Dr. Klug decided to give me a minus 1 lens in my left eye for perfect mid-range viewing and the right eye will have no correction at all.  The glasses will correct my vision now, but again, no fuzzy images due to a cloudy lens called cataracts.

Come back and visit this article next month for further information and the final outcome of my second eye surgery. Hopefully, if all goes as planned I will be able to see things clearly again, turning back the clock on my vision is something I am looking forward to in the near future.  I want to thank Dr. Klug and his wonderful staff for helping me through this process and taking the time to answer all my questions.

Right Eye Surgery Completed

I am happy to say that the right eye surgery was completed and it went very smooth indeed. I knew exactly what to expect, reminded Dr. Klug to be sure not to stitch too tight, he smiled and said he wouldn’t and he assured me I wouldn’t have a black eye as I did on the left side.

He was correct, the procedure was very easy for me, my face wasn’t numb from the Novocaine and I was really ready to go home minutes after the surgery, but had to wait 30 minutes to do so.

It is only a few days since this last surgery and I can now see without the aid of glasses.  I am thrilled with the results, now I have one lens in the left eye for optimal mid-range viewing and the right eye for distance.  Both work together to give me the two ranges and the brain merges the together for seamless vision.

I have gone for my final consultation now 3 weeks after the right eye surgery and although I can see without glasses, there is still some blurry vision, so we decided that I should get a pair of progressive lens glasses, similar to what I used to wear but without as much correction as before.  With the new glasses I will have the option of wearing them at all times or just when I think I may need them.  I have been wearing glasses for so many years that when I look at myself without the glasses it doesn’t look like me. I also discovered that those on Medicare can have one pair of glasses paid for by the government through a eye glass retailer who is a Medicare provider.  They don’t allow for fancy frames, but saving another few hundred dollars is a nice gift.

A Retirement Celebration

We also had a celebration after my surgery as well.  I was informed that I was the last patient Dr. Andrea Engel the Anesthesiologist and sister of Dr. Mark Engel would have after her very long career. She was retiring and I felt honored to be her last patient after the thousands she has cared for.

I did ask if they had a tee-shirt for me that said: “I was Dr. Engels Last Patient”, but alas no tee-shirt just juice and cookies, which was fine.

Visit Their Website

Dr. Klug’s website has a lots of  great information with guides and instructions for this type of surgery.  Visit it now if you want to learn more about the services they offer and the procedures.  Please mention you read this article.

Ophthalmic Physicians of Monmouth
733 N. Beers St
Holmdel, NJ 07733

Tel: 732-739-0707