Why isn't there a better profile application to guide patients considering cataract surgery? With the surgery so common and so many possible choices the guidance offered seems poor.

Cataract surgery has advanced technologically over the past 20 years to an amazing degree. What was, at the beginning of my training in 1978 a 3 day hospital stay is now an out-patient or even an office-based procedure.

The confusion regarding guidance you refer to is likely due to how fast patient expectations can outstrip some eye doctors' knowledge base and experience. For example, since every cataract is by definition an aged, dysfunctional natural lens in the eye, it has become standard to replace it with an IntraOcular Lens (IOL). The optical qualities of these IOLs have also advanced dramatically to the point where it typically eliminates myopia (nearsightedness) at the same time of implantation during cataract surgery. While "entry level" IOLs are included in the cost of cataract surgery, the use of more advanced technology IOLs is not covered. This means there is often the choice of paying more money out-of-pocket to achieve an even better optical outcome than would typically be the standard case.

There are now astigmatism-correcting (toric) IOLs and even Presbyopia-correcting IOLs. With these, visual performance may not necessarily be perfect, but is often restored or improved to levels a patient has not had since youth. With higher out-of-pocket costs, though, comes higher expectations of course. Without a substantial background in refractive surgery (e.g. LASIK) and the ready access to an excimer and/or YAG laser for post-operative enhancement (if needed), it can be quite challenging for even the best cataract surgeons to meet patient expectations.

I suspect this is why many patents I see are confused about what is actually available in terms of IOLs, minimally invasive procedures, and optical outcomes.

_Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic