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    An OD’s perspective on his own cataract surgery

    I had to make the same decisions I asked my patients to make

    For years, I have been an advocate of early cataract surgery in any symptomatic patients. As we all know, the progression of cataract development is an unavoidable process, so why delay the inevitable? You get the ability to plan future refractive error, to minimize visual symptoms and lifestyle restrictions, and to pre-plan a convenient time and schedule.

    Related: Why wait to recommend cataract surgery?

    Last fall, at age 69, I was in the position of being able to follow my own best advice. Although my best-corrected vision under optimal conditions was still in the 20/25 range, my contrast sensitivity was noticeably reduced, and my best-corrected acuity was reduced to 20/40 under glare situations. I was also experiencing an increase in streaks and halos around lights at night, as well as a need for more and more illumination for visual chores like color coordination and fine detail close work. 

    Katherine Mastrota, OD, FAAO, center director at Omni Eye Surgery, worked with me through my cataract surgery process from initial evaluation through post-operative care. My surgeon was Douglas Grayson, MD, Omni’s cataract specialist. Dr. Mastrota and I thought it would be interesting for me to share my personal and professional observations on a process that until now I have seen only from the other side of the slit lamp biomicroscope.

    Related: Experiencing retinal detachment as an OD


    Decisions for the cataract patient

    As we all know, there are a number of decisions that must be made before cataract surgery can take place. Before comanagement, the surgeon typically chose the refractive outcome for the patient, usually deciding on bilateral distance vision. In the modern practice dynamic, this decision is now shared between doctor and patient. In my case, they were one and the same. As a lifelong myope, I have always understood the benefits of myopia, even more so as a presbyope. I wear contact lenses for sports, athletics, and some social activities, but single-vision distance correction has been a frustrating experience since my mid 40s. I reasoned that the frustration of poor acuity at near would be even more troublesome with no accommodation. Having personal experience with monovision, I chose it as my refractive goal, understanding that there is no perfect substitute for the young, clear, healthy, accommodating human eye. 

    The next decision to be made is tried and true vs. new and sexy; or more technically put, phacoemulsification vs. femtosecond laser-assisted cataract surgery. Medicare and other insurers have so far considered femto to be an upgraded, non-essential procedure, and has made it an out of pocket option for patients. Many ophthalmological surgery centers have chosen to incorporate the laser fee into the price of upgraded toric or multifocal intraocular lenses (IOLs), removing the choice of femto vs. phaco from the equation. In my case, needing only spherical monofocal IOLs, I could choose either procedure.

    Related: Integrating laser cataract surgery

    I am frequently asked to help my patients choose the right procedure for them. Frankly, in many cases, the real concern is whether the new laser treatment is worth the difference in cost. Every ophthalmologist performs phaco, and most have probably never done anything else. If you, as a professional, feel that femto is in your patient’s best interest, and there are many reasons why it might be, you should consider steering your patient to a surgeon who can offer either procedure, like Dr. Grayson. 

    I realized that I was in a unique position to compare the two procedures from a patient’s perspective, so I opted to have one of each.

    Next: Phaco in the left eye, femto in the right

    Charles Klein, OD
    Dr. Klein graduated from PCO in 1967. E-mail him at [email protected]


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