Hello! Dr. Croley here today and this is Case of the Day. We are going to be discussing an interesting case that came in. This person came in the office today with a complaint that they are being scheduled for cataract surgery, and wanted to make sure that they really need to have the cataract surgery performed. So, this person’s vision was about 20/30 in each eye with their present glasses, and with a new refraction we were able to get this person to 20/20 on both eyes.
So it looked like, at least from the refraction, this person did not need a cataract surgery because we got him a 20/20 vision. It turns out, this person was about 53 years old, and was very nearsighted. That is, the prescription was a minus 6 which is pretty good amount nearsighted and only needed a stronger prescription in order to see 20/20 again.
On eye examination, this person had no cataracts present at all. So unfortunately, they had been scheduled for cataract surgery without even a cataract being present.
Really, when does a cataract really need to be done? And so we’re gonna go over that today so that way if you have a cataract surgeon told you, you need cataract surgery, you know when you really should consider having the surgery done.
There is not really, except in very, very rare circumstances, a medical necessity for you to have a cataract surgery. There are instances with very complicated eye terms, like phacolytic glaucoma and hypermature cataracts that can lead to glaucoma in which it is medically necessary for you to have the cataract removed, but that’s extremely rare.
Also, if you had a retinal problem that needed an operation and your retinal surgeon needed to have that lens removed or cataract removed, then that would be a medical necessity because you needed to have that cataract removed for your retinal procedure.
In those very few, rare instances, you actually have to have your cataract removed. So therefore, the reason you want to have your cataract removed is because you are complaining that your vision is not adequate. You’re not able to see the things you need to see, do, read, do your work, drive a car, drive a car at night, any of those kinda things, that if you’re having enough difficulty that you’re willing to have an operation, then that’s when you should consider having cataract surgery.
There are actually rules and guidelines that are written for when insurance or medicare is going to pay for your cataract surgery. A lot of doctors have sort of ignored those things, and they just put down the vision necessary to get you through so you qualify for cataract surgery, but there really are guidelines and those guidelines are: that you’re supposed to have 20/50 or worse vision in your eyes for cataract surgery; and you could, in some instances, have a glare test done, if you weren’t 20/50, to where you would meet the criteria with a glare test.
A glare test is testing your vision with a light shining in your eye, and there are different pieces of equipment that are used to do that. The reason being is that we test vision in an eye exam room, that the room is dark, and we are testing black letters on a dark background and that is not always real world vision. That’s what we used as standard so that we can measure people’s vision but that’s not like driving at night with headlights coming toward you and not driving into the sun. So certain kinds of cataracts or worse, with that glare and then you really do need cataract surgery under those circumstances.
So, the final thing is, just because you are told that you need cataract surgery done, that is not necessarily the case. If you’ve any concern that some doctor is trying to talk you into having a cataract surgery, you need to have another opinion because the reason that you will need surgery is that you are unhappy with the quality of your vision, glasses cannot be changed to make you see better, and therefore you’re willing to take the risk associated with cataracts because the benefit is going to be worth it because you’re going to have much better vision.
So if you have any questions you can try to contact us through the website and we will be happy to try to answer those. Until the next time, on our next Case of the Day, may God grant you with great vision and healthy eyes.