Cataract surgery may be one of the most efficient, common eye surgeries in the U.S. each year, but as a patient, you only have one opportunity to get it right. That means choosing the right surgeon.
Whether you get a referral from your ophthalmologist, follow a friend's advice, or find a surgeon online, you have the opportunity to get answers to some important questions before you commit to a surgeon.
John A. Moran Eye Center ophthalmologist and cataract specialist Rachel Simpson, MD, offers this list of questions to ask during your consultation with a potential surgeon—along with the answers you want to hear.
How many cataract surgeries have you done?
If you have concerns about how experienced your surgeon is, it is definitely a good idea to ask. Most surgeons want their patients to be comfortable, and if asking this question helps you develop trust in your surgeon's skill, you should ask.
Most busy surgeons often perform 15-30 cataract surgeries per week. At that rate, the number count adds up fast. I rapidly lost track of my specific number, and likely most other surgeons have as well. The number is less significant than the range.
New cataract surgeons have likely performed between 200-300 surgeries, which is more than enough to safely and efficiently perform routine cataract surgery. That said, surgeons right out of training continue to develop their skills for the first few years after training ends.
There is a significant difference in skill level between a surgeon who has done 350 surgeries and one who has done 5,000. There's a much smaller difference between 500 and 5,000 and almost no difference between someone who has done 1,000 surgeries and one who has done 5,000.
Can you share your patient outcome statistics?
In addition to being the most common surgery, cataract surgery is also the safest in the United States. Most experienced surgeons have an overall complication rate well below 5% and a major complications rate of around 1/2000.
Many surgeons may not know their exact complication rate, but they will 100% remember their last complication and when it occurred. You may well get more helpful information by asking your surgeon to tell you about their most recent complication, what it was, and how it happened than you would by asking for a rate.
Will you describe the procedure?
Surgery involves removing the cloudy natural lens and replacing it with a clear, artificial lens. The surgeon uses ultrasound energy to help break the cataract into small pieces and remove them from the eye with a small vacuum. It doesn't require general anesthesia or stitches and takes around 15 minutes. The procedure requires little, if any, recovery time.
What are the benefits and risks?
The most significant benefit of cataract surgery is that your vision should improve with the removal of the cloudy lens. There is some nuance to this, of course, as sometimes you may need glasses to achieve the best possible vision after surgery, but improved vision is the primary reason to perform the surgery.
As with any surgery, there are risks to consider. The most common risk is the need for glasses after surgery.
Cataract surgery can worsen dry eye, which can be bothersome and challenging to treat.
Severe cataract surgery complications may include infection, bleeding in or behind the retina, and retinal detachment. These complications are very rare; however, they do occur, so it is important to consider them when deciding to have the surgery.
What kind of lens do you recommend for me, and how many surgeries have you done with that lens?
Lens choice is probably the most confusing part of cataract surgery. Don't be afraid to ask as many questions as it takes to thoroughly understand the options, and make sure you review with your surgeon before surgery to ensure you are both on the same page.
The decision of what type of lens to implant is unique to each patient. I usually tell my patients it depends on their goals for vision after surgery, their profession, hobbies, and other ocular conditions.
I usually start by explaining the "standard" lens and how it works.
The standard lens included in the cost of surgery is a monofocal lens, meaning you will be able to see clearly at one focal point. We categorize this as either a distance focal point (driving, watching TV, going to the theater, and engaging in outdoor activities falls into this category) or a near focal point (reading, sewing, reading music). If you choose to correct both eyes for distance vision with a monofocal lens, you will see well for distance activities but will need reading glasses for anything up close. The reverse is also true.
I usually discuss multifocal lenses if you want to be free of glasses. Unlike the standard lens, these lenses have two focal strengths that allow you to see well at both distance and near. These lenses are considered "premium," with higher associated costs. Not everyone will benefit from these lenses. For example, patients with significant vision loss from macular degeneration or glaucoma are not good candidates for these lenses.
Finally, if you have a significant amount of astigmatism, I often recommend another premium lens called a toric lens. Astigmatism is a different type of refractive error that, if not corrected at the time of surgery, could mean you might still need glasses at all times after surgery, even if your near- or far-sightedness is corrected. As with the multifocal, some patients are good candidates for this lens, and others are not.
How much extra will a premium lens cost?
The exact amount for a premium lens varies based on the lens type. You will usually meet with a lens counselor who will review all the options and be able to quote you the exact cost for the lens you select.
Can you guarantee perfect vision after surgery?
No surgeon can ever guarantee an outcome; if you meet a surgeon willing to do that, you should run! There is always a chance to achieve the best possible vision after surgery, and you may need glasses for certain activities or, in some cases, all activities.
Who will examine me following my surgery to check on how I am healing?
Several post-operative exams usually occur in the days and weeks following surgery. The first exam usually occurs later on the day of your surgery or the day following, depending on your surgeon. This visit ensures that the lens is well positioned, the incisions made during surgery are healing, and the eye pressure is acceptable. We usually expect the vision to be a bit blurry at this visit. Your surgeon may conduct the follow-up, but your surgeon's assistant, who might be a resident or fellow, may step in.
We usually recheck the eye a few weeks after surgery. Each surgeon has a slightly different preference on when exactly this second visit should be, but this is often the visit where we carefully check your vision and prescribe glasses if needed.
Some surgeons do a final post-operative visit a few months after surgery. This is usually just one last check to make sure everything is stable, and the eye is completely healed from surgery.
You should generally expect to see your surgeon or assistant for your post-operative visits. Some surgeons will have their patients see an optometrist for their final post-operative visit to help with any glasses needs after surgery.
Is there a possibility I'll need follow-up surgery?
Sometimes, the eye can develop a posterior capsular opacification, or PCO. This is often referred to as a second cataract or an after-cataract, sometimes described as scar tissue. A PCO results from residual lens cells that remain on the case that once held the natural lens. If those lens cells are healthy, they can do what cells normally do: grow and replicate. They can never grow enough to form a new cataract, but they can produce a membrane behind the new lens that can blur the vision much the same way a cataract can.
We perform a simple, painless, in-office laser procedure that takes less than 5 minutes called a YAG capsulotomy to clear away the membrane from behind the lens. On average, about 20% of patients will need a YAG procedure after surgery. Insurance usually covers this procedure with just a regular office copay.