How do you select an eye surgeon for cataract surgery?

I'm a 40 year old male and need to have a cataract surgery in my right eye.
My aunt, a pediatrician, recommended an eye surgeon in my area. He has a
good reputation and 24 years of experience. I have high myopia, so he sent
me to a retina specialist to make sure my retina is fine. The specialist,
after examining my eye and doing OCT and FA, _convincingly_said to me, "You
don't have to see like this. Have a surgery and you'll see much better." In
contrast, my eye surgeon's take on my surgery is something like, "You MIGHT
see better." I think he's very cautious.

I know that at the end of the day it's the surgeon's skills that matter. I
guess my question is, "Would you be more comfortable with a cautious surgeon
or an assuring one?"

JJ Lee wrote:
> I'm a 40 year old male and need to have a cataract surgery in my right eye.
> My aunt, a pediatrician, recommended an eye surgeon in my area. He has a
> good reputation and 24 years of experience. I have high myopia, so he sent
> me to a retina specialist to make sure my retina is fine. The specialist,
> after examining my eye and doing OCT and FA, _convincingly_said to me, "You
> don't have to see like this. Have a surgery and you'll see much better." In
> contrast, my eye surgeon's take on my surgery is something like, "You MIGHT
> see better." I think he's very cautious.
>
> I know that at the end of the day it's the surgeon's skills that matter. I
> guess my question is, "Would you be more comfortable with a cautious surgeon
> or an assuring one?"

I had cataract surgery a few years ago, and unfortunatley had *many*
complications. The end result is that I have very thick glasses and
still cannot see anywhere near 20/20, even in the one eye that still
works. Unfortunately this means that when it comes time to renew my
license it will be difficult.

Please be sure to get a cautious doc, but one who has done a lot of
these procedures.

JJ Lee wrote:
> I'm a 40 year old male and need to have a cataract surgery in my right eye.
> My aunt, a pediatrician, recommended an eye surgeon in my area. He has a
> good reputation and 24 years of experience. I have high myopia, so he sent
> me to a retina specialist to make sure my retina is fine. The specialist,
> after examining my eye and doing OCT and FA, _convincingly_said to me, "You
> don't have to see like this. Have a surgery and you'll see much better." In
> contrast, my eye surgeon's take on my surgery is something like, "You MIGHT
> see better." I think he's very cautious.
>
> I know that at the end of the day it's the surgeon's skills that matter. I
> guess my question is, "Would you be more comfortable with a cautious surgeon
> or an assuring one?"


That sucks to have cateract(s) at only 40! The biggest problem is you
wont be able to tolerate glasses anymore due to anisometropia. Good
thing you never had lasik because it would have been "wasted" cause
cateract surgury also takes care of your myopia at the same time! How
bad is your vision in the affected eye?

"William Stacy" <(E-Mail Removed)> wrote in message
news:etLfg.37111$(E-Mail Removed) om...
> JJ Lee wrote:
>>
>> I know that at the end of the day it's the surgeon's skills that matter.
>> I guess my question is, "Would you be more comfortable with a cautious
>> surgeon or an assuring one?"
>
> Neither. I would want (and sought out, in my case) the best I could find.
> You want someone who does lots of them (at least 10 per week), who uses
> all the latest techniques (stitchless, eyedrop alone anesthesia, etc), AND
> who won't try to talk you into a multifocal or "focusing" IOL.
>
There's one doctor in my area (New York) who was voted as one of the best
eye surgeons. If I should go for him, should I go through the tests (OCT and
FA) again?

That sucks to have cateract(s) at only 40! The biggest problem is you
wont be able to tolerate glasses anymore due to anisometropia. Good
thing you never had lasik because it would have been "wasted" cause
cateract surgury also takes care of your myopia at the same time! How
bad is your vision in the affected eye?


I noticed you didnt see what I said but please look up anisometropia. I
have seen people totally taken by supprise when they find they can no
longer tolerate glasses!

Wow. Since when is cataract surgery entirely elective? The end result
of a cataract is loss of visual function. The only "elective" aspect
is how much vision loss is tolerable to the patient. There are also
common standards, such as requirements for the operation of a motor
vehicle. LASIK, on the other hand, is elective in virtually all
situations.

Somehow, I believe that our patients expect us to be more than just
spouting fountains of statistics.

DrG

Anon E. Muss wrote:
> On Thu, 1 Jun 2006 19:14:22 -0400, "JJ Lee" <(E-Mail Removed)> wrote:
>
> >I'm a 40 year old male and need to have a cataract surgery in my right eye.
> >My aunt, a pediatrician, recommended an eye surgeon in my area. He has a
> >good reputation and 24 years of experience. I have high myopia, so he sent
> >me to a retina specialist to make sure my retina is fine.
>
> That was wise.
>
> >The specialist, after examining my eye and doing OCT and FA,
> >_convincingly_said to me, "You don't have to see like this. Have a
> >surgery and you'll see much better." In contrast, my eye surgeon's
> >take on my surgery is something like, "You MIGHT see better." I think
> >he's very cautious.
>
> I NEVER recommend elective surgeries, like most cataract surgeries,
> LASIK, etc.
>
> I inform patients of the risks/benefits, tell them the pros/cons and
> answer all their questions to the best of my ability. I tell them
> THIS is your problem and THESE are the options (including doing
> NOTHING). Then the patient makes their decision after being
> completely and fully informed.
>
> I never say, "You need to/should have (elective) cataract surgery", or
> "You should have refractive surgery"*
>
> That is IMHO asking for problem. If something bad happens, I do not
> want the patient to be able to say, "YOU TOLD ME TO HAVE THIS
> SURGERY!"
>
> However, if asked, I will answer the question, "Well, what would you
> do if you were me? Or what would you do if you were in the same
> situation as I was?"
>
> >I know that at the end of the day it's the surgeon's skills that
> >matter. I guess my question is, "Would you be more comfortable with a
> >cautious surgeon or an assuring one?"
>
> I'm not comfortable with ANY surgeon who RECOMMENDS a completely
> elective surgery.
>
>
> * (If a patient has a hypermature cataract, a cataract so dense that I
> cannot adequately visualize the fundus details, then I will suggest
> it. But that is like, maybe, <5% of the time.)

JJ Lee wrote:

>
> There's one doctor in my area (New York) who was voted as one of the best
> eye surgeons. If I should go for him, should I go through the tests (OCT and
> FA) again?
>
>

Voted by whom? If you go to him, let him decide what to do. He will
likely be interested in what's already been done.

w.stacy, o.d.

IMHO, you would be on stronger legal grounds recommending cataract
surgery to someone who obviously "needed it," than by co-managing a
patient whom you "non-recommended" having LASIK and the patient didn't
like the outcome, or suffered ectasia. Whether you recommend a
treatment or not has nothing to do with negligence.

But, your points are well-taken for the most part.

DrG

Anon E. Muss wrote:
> On 2 Jun 2006 05:27:30 -0700, "Dr. Leukoma" <(E-Mail Removed)> wrote:
>
> >Wow. Since when is cataract surgery entirely elective?
>
> When not having it does not result in significant risk of morbidity
> (hypermature cataract) or impair my ability to assess the status of
> the fundus.
>
> Other than that, it's elective. It's certainly not going to "hurt"
> the patient who choses NOT to have cataract surgery in most cases.
> What "bad" happens if they don't have the surgery? Nothing -- except
> they just don't see better.
>
> In a real sense, every surgery is elective. People can choose not to
> have retinal detachment surgery, not have malignant hypertension
> treated, not be treated for a corneal ucler, etc. In those cases I
> strongly recommend against not having those treated. I give them the
> reasons why they should and what will most likely happen if they do
> not. If they choose not to, I would do my best to insist they at
> least see another doctor for a second opinion and do I everything I
> could medicolegally to protect my rear.
>
> >The end result of a cataract is loss of visual function. The only
> >"elective" aspect is how much vision loss is tolerable to the patient.
>
> Exactly. It's up to the PATIENT to decide when the visual function
> has been degraded to the point where the patient DESIRES the surgery.
>
> I do not say, "Your vision is 20/50, you can't pass the DMV test, I
> recommend you have cataract surgery."
>
> I essentially say (this is paraphrased, I go into far more detail that
> this, but I hope you get the idea) "Your vision is 20/50, you can't
> pass the DMV test, if you want to be able to see better, then cataract
> surgery is required. What do you want to do?"
>
> >There are also common standards, such as requirements for the
> >operation of a motor vehicle.
>
> I, like you I am sure, have a few patients who have 20/80 cataracts
> that don't drive and their vision is adqeuate for their demands. IOW,
> they have no complaints. I don't recommend elective cataract surgery
> for those patients.
>
> >LASIK, on the other hand, is elective in virtually all situations.
>
> Yes. And for that very same reason, I never RECOMMEND refractive
> surgery. Our office has comanaged a few hundred patients, and I
> believe for the right patient, it is a great option. But I let the
> patient tell me this is what they want versus this is what I think
> they need.
>
> The last thing I would want a patient of mine who had a poor result
> from refractive surgery to have heard/be in their chart is that I
> recommended they have refractive surgery.
>
> >Somehow, I believe that our patients expect us to be more than just
> >spouting fountains of statistics.
>
> Certainly.
>
> Regardless, for medicolegal reasons, I don't *recommend* (IOW, "You
> should have") elective surgeries -- but that's just me. I say IF YOU
> WANT X, then you need to do Y. Or I might say, for you, I believe
> contact lenses would be the best option. It's a subtle, but important
> distinction -- at least for me.
>
> In fact, I don't recommend contact lenses either -- I examine their
> eyes and offer options. I might say that contact lenses offer
> advantages for you that spectacle and refractive surgery does not --
> and if I were you, I would certainly go with contact lenses. It's all
> about giving my patients options and informed consent.
>
> I do make recommendations all the time though. I recommend people do
> not sleep in their contact lenses (sometimes I do more than recommend,
> other times I tell them). I recommend people with diabetes get at
> least yearly comprehensive eye examinations. I recommend people with
> significant glaucoma risk factors, such as elevated intraocular
> tensions or suspicious or characteristic optic nerve appearance,
> undergo a glaucoma workup. I tell my monocular or very young
> patients, "Your lenses NEED to be in polycarb or trivex. However, I
> recommend trivex." I strongly recommend nearly every patient who
> wears contact lenses have a backup pair of glasses. I recommend
> antireflective coatings for the vast majority of my patients. I
> recommend hi-index lenses for many. For patients that choose soft
> contact lenses, I almost always recommend a silicone hydrogel over a
> HEMA lens.
>
> Basically, I don't make recommendations that I feel, worse case
> *realistic* scenario, I would be uncomfortable defending my actions
> against in a court of law. Every doctor has their own comfort zone.
>
> If I "recommended" a patient had non-elective cataract surgery, and
> that person ended up having a horrible complication, say
> endophthalmitis, and I got sued, I would not feel comfortable
> defending a recommendation of cataract surgery. Lawyers, IMHO, are
> too nasty, heavy-handed and zealous in their clients interests.
>
> Read articles by Jerome Sherman -- I'm sure you know who he is. He's
> at Suny and does a lot of malpractice and expert witness stuff. You
> might be surprised at the stuff that people get sued for and lose in
> when it comes to Optometry malpractice.
>
> I'll give you one last example where I might differ:
>
> I haven't taken a poll, but from informal discussions with them, most
> of my colleagues feel that for a patient who presents with the chief
> complaint of a symptomatic PVD, that an unremarkable standard
> binocular indirect examination (BIO) is adequate from a medicolegal
> standpoint.
>
> It's not. I don't think it's even debateable.
>
> There are NO reliable symptoms that can rule out a symptomatic PVD
> from a retinal tear.
>
> And to rule out a retinal break, one needs to perform careful and
> meticulous BIO *with scleral depression 360 degrees* in both eyes. And
> acceptable alternative is to use a Goldmann-type 3-mirror lens.
>
> Standard BIO alone is failure to meet the standard of care. And if a
> small retinal tear was missed because of failure to perform scleral
> depression which then progressed to RD which causes permanent vision
> dysfunction, I would be unable to defend such a doctor's actions.
>
> If a doctor DID perform BIO with scleral depression and missed it,
> then I would find no fault because that doctor met the standard of
> care. That would however need to be documented in the chart.
>
> An eye doctor needs to perform BIO with scleral depression (or careful
> Goldmann 3-mirror examination of the periphery) for every patient that
> presents with a symptomatic PVD, or refer that patient to a doctor
> that can or that is malpractice if something goes bad as a result.
>
> Do most Optometrists do this on every patient that presents with a
> PVD? In my experience, no. Do most Ophthalmologists do this? No, in
> my experience. They play an odds-game. Do most retinal surgeons do
> this? In my experience, they do.

Dr. Leukoma wrote:
> IMHO, you would be on stronger legal grounds recommending cataract
> surgery to someone who obviously "needed it," than by co-managing a
> patient whom you "non-recommended" having LASIK and the patient didn't
> like the outcome, or suffered ectasia. Whether you recommend a
> treatment or not has nothing to do with negligence.
>
> But, your points are well-taken for the most part.
>
> DrG
>
> Anon E. Muss wrote:
> > On 2 Jun 2006 05:27:30 -0700, "Dr. Leukoma" <(E-Mail Removed)> wrote:
> >
> > >Wow. Since when is cataract surgery entirely elective?
> >
> > When not having it does not result in significant risk of morbidity
> > (hypermature cataract) or impair my ability to assess the status of
> > the fundus.
> >
> > Other than that, it's elective. It's certainly not going to "hurt"
> > the patient who choses NOT to have cataract surgery in most cases.
> > What "bad" happens if they don't have the surgery? Nothing -- except
> > they just don't see better.
> >
> > In a real sense, every surgery is elective. People can choose not to
> > have retinal detachment surgery, not have malignant hypertension
> > treated, not be treated for a corneal ucler, etc. In those cases I
> > strongly recommend against not having those treated. I give them the
> > reasons why they should and what will most likely happen if they do
> > not. If they choose not to, I would do my best to insist they at
> > least see another doctor for a second opinion and do I everything I
> > could medicolegally to protect my rear.
> >
> > >The end result of a cataract is loss of visual function. The only
> > >"elective" aspect is how much vision loss is tolerable to the patient.
> >
> > Exactly. It's up to the PATIENT to decide when the visual function
> > has been degraded to the point where the patient DESIRES the surgery.
> >
> > I do not say, "Your vision is 20/50, you can't pass the DMV test, I
> > recommend you have cataract surgery."
> >
> > I essentially say (this is paraphrased, I go into far more detail that
> > this, but I hope you get the idea) "Your vision is 20/50, you can't
> > pass the DMV test, if you want to be able to see better, then cataract
> > surgery is required. What do you want to do?"
> >
> > >There are also common standards, such as requirements for the
> > >operation of a motor vehicle.
> >
> > I, like you I am sure, have a few patients who have 20/80 cataracts
> > that don't drive and their vision is adqeuate for their demands. IOW,
> > they have no complaints. I don't recommend elective cataract surgery
> > for those patients.
> >
> > >LASIK, on the other hand, is elective in virtually all situations.
> >
> > Yes. And for that very same reason, I never RECOMMEND refractive
> > surgery. Our office has comanaged a few hundred patients, and I
> > believe for the right patient, it is a great option. But I let the
> > patient tell me this is what they want versus this is what I think
> > they need.
> >
> > The last thing I would want a patient of mine who had a poor result
> > from refractive surgery to have heard/be in their chart is that I
> > recommended they have refractive surgery.
> >
> > >Somehow, I believe that our patients expect us to be more than just
> > >spouting fountains of statistics.
> >
> > Certainly.
> >
> > Regardless, for medicolegal reasons, I don't *recommend* (IOW, "You
> > should have") elective surgeries -- but that's just me. I say IF YOU
> > WANT X, then you need to do Y. Or I might say, for you, I believe
> > contact lenses would be the best option. It's a subtle, but important
> > distinction -- at least for me.
> >
> > In fact, I don't recommend contact lenses either -- I examine their
> > eyes and offer options. I might say that contact lenses offer
> > advantages for you that spectacle and refractive surgery does not --
> > and if I were you, I would certainly go with contact lenses. It's all
> > about giving my patients options and informed consent.
> >
> > I do make recommendations all the time though. I recommend people do
> > not sleep in their contact lenses (sometimes I do more than recommend,
> > other times I tell them). I recommend people with diabetes get at
> > least yearly comprehensive eye examinations. I recommend people with
> > significant glaucoma risk factors, such as elevated intraocular
> > tensions or suspicious or characteristic optic nerve appearance,
> > undergo a glaucoma workup. I tell my monocular or very young
> > patients, "Your lenses NEED to be in polycarb or trivex. However, I
> > recommend trivex." I strongly recommend nearly every patient who
> > wears contact lenses have a backup pair of glasses. I recommend
> > antireflective coatings for the vast majority of my patients. I
> > recommend hi-index lenses for many. For patients that choose soft
> > contact lenses, I almost always recommend a silicone hydrogel over a
> > HEMA lens.
> >
> > Basically, I don't make recommendations that I feel, worse case
> > *realistic* scenario, I would be uncomfortable defending my actions
> > against in a court of law. Every doctor has their own comfort zone.
> >
> > If I "recommended" a patient had non-elective cataract surgery, and
> > that person ended up having a horrible complication, say
> > endophthalmitis, and I got sued, I would not feel comfortable
> > defending a recommendation of cataract surgery. Lawyers, IMHO, are
> > too nasty, heavy-handed and zealous in their clients interests.
> >
> > Read articles by Jerome Sherman -- I'm sure you know who he is. He's
> > at Suny and does a lot of malpractice and expert witness stuff. You
> > might be surprised at the stuff that people get sued for and lose in
> > when it comes to Optometry malpractice.
> >
> > I'll give you one last example where I might differ:
> >
> > I haven't taken a poll, but from informal discussions with them, most
> > of my colleagues feel that for a patient who presents with the chief
> > complaint of a symptomatic PVD, that an unremarkable standard
> > binocular indirect examination (BIO) is adequate from a medicolegal
> > standpoint.
> >
> > It's not. I don't think it's even debateable.
> >
> > There are NO reliable symptoms that can rule out a symptomatic PVD
> > from a retinal tear.
> >
> > And to rule out a retinal break, one needs to perform careful and
> > meticulous BIO *with scleral depression 360 degrees* in both eyes. And
> > acceptable alternative is to use a Goldmann-type 3-mirror lens.
> >
> > Standard BIO alone is failure to meet the standard of care. And if a
> > small retinal tear was missed because of failure to perform scleral
> > depression which then progressed to RD which causes permanent vision
> > dysfunction, I would be unable to defend such a doctor's actions.
> >
> > If a doctor DID perform BIO with scleral depression and missed it,
> > then I would find no fault because that doctor met the standard of
> > care. That would however need to be documented in the chart.
> >
> > An eye doctor needs to perform BIO with scleral depression (or careful
> > Goldmann 3-mirror examination of the periphery) for every patient that
> > presents with a symptomatic PVD, or refer that patient to a doctor
> > that can or that is malpractice if something goes bad as a result.
> >
> > Do most Optometrists do this on every patient that presents with a
> > PVD? In my experience, no. Do most Ophthalmologists do this? No, in
> > my experience. They play an odds-game. Do most retinal surgeons do
> > this? In my experience, they do.


Cateract surgury is both elective and a neccessary. Someone who doesnt
drive and spends most of his time home eating, reading, watching TV,
sleeping may not bother with the surgury. Same for someone with risks
of other problems including retina detachment. People with only one
good eye because the other has diseases, retina detachment or amblyopia
are much more reluctant because if theres a complication in the good
eye they dont have the other eye to fall back. You can have
complications from cateract surgury that can make your vision WORSE
than it was with cateracts. I know one guy who ended up overcorrected
and induced astigmastim and other disortions in his vision. He said his
new vision wasnt any better than his old vision so he was unhappy. He
also couldnt wear glasses anymore due to anisometropia.
Lasik is generally reguarded as completely elective

On 2 Jun 2006 13:16:29 -0700, (E-Mail Removed) wrote:

>Cateract surgury is both elective and a neccessary. Someone who doesnt
>drive and spends most of his time home eating, reading, watching TV,
>sleeping may not bother with the surgury. Same for someone with risks
>of other problems including retina detachment. People with only one
>good eye because the other has diseases, retina detachment or amblyopia
>are much more reluctant because if theres a complication in the good
>eye they dont have the other eye to fall back. You can have
>complications from cateract surgury that can make your vision WORSE
>than it was with cateracts. I know one guy who ended up overcorrected
>and induced astigmastim and other disortions in his vision. He said his
>new vision wasnt any better than his old vision so he was unhappy. He
>also couldnt wear glasses anymore due to anisometropia.
>Lasik is generally reguarded as completely elective

As always, I don't know what the eye doctors would do without you
coming along to clarify things.