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Sunday, 18 July 2010


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Interesting, very interesting.
The perils of having to pay insurance premiums for optical (or any other) surgery,
and then being advised there's only so much Money available.

I much prefer the Canadian (Ontario) system, which
may have done the same, however insurance
paying for the surgery would not have been as large a factor. Bottom line, your vision is restored, and spectacles are required.

You can still see albeit with limitations.

Nobody said the golden years would be easy, for any of us.


Sorry to hear that. I know its not a consolation - but, as someone who's been down that path (not for eyes, tho.), it could well have been the case that even if you paid $1,500 per eye you might still not have achieved the intended results... I hope you're not feeling bad you didn't.

Did an optometrist do your surgery?

Seems rather short sighted, (no pun intended) to not pay the additional co-pay up front to achieve better vision. I bet the cost of glasses over the remainder of his life would be far more than the $3000 up front cost. But as Christopher pointed out, he still might have had to wear glasses anyway. This is one of the reasons I have not opted for corrective eye surgery, even though I am a prime candidate. I have been wearing contacts for 25 years and now need reading glasses to see up close. This works OK for me. Without my contacts I am able to see things within a couple of inches of my eyes. I would lose that ability if I had corrective surgery and would have to rely on reading glasses anyway for very close work.

I've had the same procedure but chose the higher cost Toric lenses which avoids wearing glasses except for reading. The results have been as advertised. It's been well worth the extra cost. I'm totally satisfied.

I'm looking at the same surgery, and I'm paying the extra. IMO, it's basically the cost of a few pairs of glasses over the next 10-15 years. Pay now and be done, or pay little by little and have to wear the glasses... I'll pay now.

Firstly I presume you follow up was with your opthalmologist, not your optometrist? Anyway,I wasn't promised perfect vision at all. I was just happy to get rid of the double vision problem and yes, my far vision is good enough to be able to drive without specs, but I still use them. Hope things go well.

As an eye surgeon, I never, ever guarantee results for eye surgery. I never even hint at it. When dealing with the close tolerances of the eye, and with living tissue, lots of things can happen. Quite frankly, I think that it is a miracle that a cataract can be removed and an intraocular lens can be placed, all through an incision that is less than 3 mm long.
I am not sure what you mean by "double astigmatism", but perhaps you mean "mixed astigmatism", where one principal meridian is myopic and the other meridian 90 degrees from that is hyperopic. The eye has a two lens optical system. The lens of the eye does about one-third of the focusing of the light, and the cornea does the rest. So the cornea is the big player. Preoperative measurements of the cornea can help to predict the amount of post-operative astigmatism. The surgeon can then counsel the patient as to optional procedures or intraocular lenses that may be appropriate to reduce the astigmatism. If the amount of the astigmatism is small, it might not be prudent to attempt to reduce it further. If you are still unhappy with the optical result, you might be a candidate for a refractive procedure on the cornea, such as photorefractive keratectomy (PRK), LASIK, or LASEK.
The correction of optical aberrations such as astigmatism is a refractive procedure and, as you note, is not covered by insurance or by Medicare. A visually significant cataract is a medical condition, and it is appropriate that it is covered by insurance. But the options to go beyond that, to correct for astigmatism or for presbyopia so that the patient is less dependent upon the use of glasses, is refractive surgery, and is not considered to be medically necessary. Put another way, the intent of cataract surgery is to reverse the loss of vision caused by the cataract. Improving the patient's lifestyle is considered to be optional.
In an earlier post, you discussed the optics of the Tecnis lens implant, which has an aspheric optic that is designed to reduce spherical aberration. In the United States, Medicare pays the ambulatory surgery centers extra to cover the cost of the Tecnis and other similar lenses when they are used, so there is usually no extra out of pocket costs to the patients for these lenses. Most, but not all, insurance plans in the United States follow Medicare rules. According to the Canadian Ophthalmological Society, the correction of astigmatism and other higher order optical aberrations, including asphericity, are services that are not correctable by "standard" lens implants and are therefore not covered by provincial or territorial health care systems. From reading this, it seems that, unlike the United States, aspheric lens implants such as the Tecnis are not covered by the Canadian system, and are options that cost extra.

My last pair of glasses cost $900 and i have 20/40 vision and nothing unusual about my eyes.They are the "digital" lens and bifocal(invisible), coated, but, nothing that special.

Mind you, I have never had such good vision through glasses before.

But, upgrading my eyes for $1500 per eye? that sounds like a bargain compared to $900 glasses every few years.

Eugene Meatyard was an optometrist in Lexington, Kentucky.

I have followed this with very great interest. I have over four diopters of astigmatism in each eye, approaching five if rounded off to single integers. After 64 years of coping, being very, very picky about eyeglass lenses, and having developed a strong ability of mental compensation, I am really tired of the limits placed on me by astigmatic error as opposed to my otherwise 20/40 eyes.

So, there is no using an eyecup on the camera eyepiece without glasses. The "diopter" correction only focuses eyeglasses, not eyeballs for me. Cameras without a "high eyepoint," or poor magnification, mean that the entire scene on the ground glass and the little data windows inside the viewfinder are not viewable when wearing the absolutely necessary spectacles.

My optometrist mentioned in a recent exam that my only hope is that when I get cataracts, lens implants might someday make the correction. Alas (well not really alas), I have no cataracts. He says carving up my corneas would leave little flesh behind.

I am very curious as to how high an order of astigmatism the current lens implants might reasonably correct.

Better vision is worth a lot more to me, than say the price of a mere car.

Any input on the limit of the ability of implants to correct astigmatism would be welcome. Link? Thanks.

Dave Ralph


Thanks to all the commentators throughout the series. I am very satisfied with the results. Sure beats being blind (yikes!).

Jeff, Tom, Roger
I suppose 3K isn’t that much in the long run if you’ve got it. I ain’t got it. Spent it all on gear.

No, the post-op follow ups were with the optometrist who first spotted the problem.

R. Edelman
I wrote this as a mainly ignorant and scared layman trying to explain things from my point of view. As we attorneys like to say, you have superior knowledge in the area. Thanks for adding to the discussion. As for guarantees, those were purely my impressions garnered from conversations with the various experts I talked to. This is a very complex science, one that I am very grateful for.

Christopher Lane

Ralph, there are several options including hard and soft contact lenses and for those with cataracts and the novel Light Adjustable Lens. During routine small incision surgery a specialised adjustable lens is inserted and can be tuned afterwards to compensate for any residual prescription. This is a US technology from Calhoun vision.

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