1. The question of whether to do surgery or not.
Why do some doctors let me have surgery and others do not?
A: Generally speaking, doctors’ advice is consistent. Many doctors who do not support surgery do so because they insist on the old view that “cataracts need to be matured before they are done”, and many doctors consider the safety of surgery because there are corresponding risks. Doctors who are willing to let their patients have surgery should consider the necessity of medical cataract surgery: surgery can help in the diagnosis and treatment of other diseases of the eye or in the rehabilitation of the eye, except for the patient’s own initiative.
I have lost my vision and want to have cataract surgery, why won’t my doctor do it for me?
A: Generally speaking, doctors support cataract patients to have surgery, but are determined not to do it, more often than not because they think that the patient’s vision loss is not caused by cataract.
2. Problems of pre-operative examination and surgery arrangement.
I want to have surgery and I also have the medical report, is it not necessary to draw blood?
A: Blood sampling is required. Because the medical examination will not check patients for infectious diseases (such as hepatitis B, hepatitis C, syphilis, AIDS, etc.), the state requires that patients must be checked for infectious diseases before surgery, so even if you have a medical report, you still need to have blood drawn.
I want to have cataract surgery on an outpatient basis, but I don’t want to be hospitalized, is it possible? Is it safe?
A: Cataract surgery is a relatively mature surgery and does not require hospitalization. Both foreign hospitals and large domestic hospitals tend to operate without hospitalization. Generally, there is no need to worry about safety. If there is a potential safety problem, the doctor will request the patient to be hospitalized in time. Millions of outpatients in domestic and international eye hospitals have good results each year.
I don’t want to be hospitalized for surgery, but I can’t be reimbursed without hospitalization, what should I do?
A: Some patients need to go through the hospitalization procedure in order to be reimbursed, such as patients who come to Beijing for treatment from abroad and patients with new rural cooperative medical care. Our hospital carries out daycase surgery method, i.e., 2-hour hospitalization or 1-day hospitalization method, which not only ensures the safety of the surgery, but also facilitates the patient to go home to get sufficient rest and reimbursement. It is important to remind you in advance that you should never make up your hospital record afterwards.
I want to have both eyes done, but my doctor told me to have both eyes done one day apart, will that be possible?
A: Cataract surgery is very safe, and the doctor will only recommend the second eye if he/she feels that the first eye is more stable at the time of review. The advantage is that the two eyes can be ordered together, reviewed together, discontinued together, and fitted with glasses together, which saves the patient and family money and hassle, and the laboratory tests and eye examinations do not need to be redone (usually for 3 months). (I often tell my patients, for example, that it is easier to have twins and more tiring to have them one by one. (This may not be appropriate, but it illustrates the point.)
Cataract surgery is relatively simple, but why do I have to do so many tests?
A: Although cataract surgery is very mature, doctors and patients need to understand two questions before doing the surgery: Is it worth doing, i.e., is it effective? Can it be done now, that is, is it safe? A doctor cannot operate on a patient knowing that it will not work, nor will he or she take a great risk to do a surgery that can be postponed. Therefore, doctors will do eye examinations to rule out major eye problems to ensure the effectiveness of the surgery; they will do electrocardiograms, blood draws, and other tests to ensure the safety of the surgery.
I have other diseases in my eyes besides cataract, can I have cataract surgery?
A: Some diseases can be treated at the same time as cataract, such as closed-angle glaucoma and pterygium; some need to be treated before cataract, such as chronic dacryocystitis; some need to be treated separately from cataract (before or after, the surgeon will decide according to the patient’s condition), such as entropion and fundus disease. Please listen to the surgeon’s guidance for details.
Closed-angle glaucoma, will my glaucoma be cured together after the doctor does cataract surgery?
A: Recent studies have shown that after cataract surgery, the anterior chamber will deepen and the narrow atrial angle will become open, and many patients with closed-angle glaucoma will be relieved on their own.
However, not all glaucoma can be cured by cataract surgery. Many patients with closed-angle glaucoma do not need glaucoma medication after cataract surgery, but this is not necessarily the case for open-angle glaucoma; at the same time, in a small number of patients with advanced closed-angle glaucoma, the atrial angle does not open after cataract surgery, so glaucoma surgery is required at the same time.
What kind of IOL should I choose?
A: There are many types of IOLs, and for patients, they need to know the following points in general.
(1) Whether they are imported: They should all use imported IOLs, or at least all of them. This is because the national situation determines that domestic patients have concerns about the quality of domestic products, and domestic IOLs range from a few tens to a few hundred dollars, and rarely exceed one thousand dollars.
(2) Do I need to use the most expensive IOLs?
IOLs are generally divided into three types according to price: expensive, medium and cheap, the differences are
Expensive: Folding crystals, multifocal crystals, and for people who are “in a particularly good eye condition” (please refer, if you have other eye diseases or may need fundus treatment in the future, such as diabetes, it is recommended not to install them)
Medium: generally around 4000-5000 RMB (price is set by the price bureau, doctors have no right to set the price) It is a folded lens, aspheric IOL. It is suitable for use in small incisions (around 3mm) for ultrasound emulsion surgery.
Ordinary IOL: The price is usually around $1600-2500 and is a spherical IOL. The visual effect of aspheric and spherical IOLs in bright environment is about the same, and the visual aspheric IOL in dark is a bit better than spherical IOL.
There used to be cheaper domestic IOLs: generally between a few tens of dollars – 3 or 4 hundred dollars, almost no one uses them, hard IOLs, which cannot be folded. Therefore, it is not suitable for small incisions (about 3mm) in ultrasound emulsification surgery. This IOL is no longer available in our hospital because it has not been used for many years.
(3) Why can’t some patients choose a “good” IOL?
My personal opinion is that expensive multifocal IOLs are not recommended if there is a risk of developing fundus disease. Older people often have other eye diseases and systemic diseases such as diabetes and hypertension, so I personally do not recommend expensive multifocal IOLs.
How much will cataract surgery cost?
The cost of cataract surgery includes.
(1) The cost of surgery and some consumables: about $3,100 for a single eye and $6,200 for both eyes.
(2) IOL cost, IOL is a consumable for surgery and can be reimbursed by Beijing Medical Insurance for about RMB 1,100, and about RMB 2,200 for both eyes. The reimbursement ratio is different for each person, so please consult the reimbursement department of the patient’s own unit for details.
For example, if a patient with medical insurance chooses an IOL of about 2500 RMB, he or she will have to pay about 4000 RMB for the surgery in both eyes (all costs for the surgery in both eyes are about 11000, and medical insurance may cover about 7000 RMB). If you choose an IOL of about 4500 RMB, you will have to pay about 8000 RMB for the double eye surgery yourself (all the costs of the double eye surgery are about 15000, and the medical insurance may cover about 7000 RMB).
3.Surgery has been booked, attention after going home and on the day of surgery
First of all, please understand that there are many surgeries in ophthalmology every day, and the time you make an appointment to come to the hospital is the doctor’s estimate based on the regular surgery time. Although the cataract surgery time is short but patients have a long waiting time for preoperative preparation, about 2 hours. We hope you can understand the special nature of ophthalmology surgery, adjust your mind, wait patiently and make the surgery harmonious with good cooperation between doctors and patients.
Important precautions.
(1) Actively control diabetes, hypertension and other systemic diseases. On the day of surgery, please take your normal dose of glucose-lowering medication and insulin injection for diabetic patients, and continue to take your normal dose of medication for hypertensive or heart disease patients.
(2) Myocardial infarction or cerebral infarction should be operated only after six months of stabilization.
(3) Pre-operative antimicrobial eye drops need to be ordered, usually 12 times (e.g. 4 times daily for 3 days or 1 time every hour for 12 times).
(4) Anticoagulants and blood-activating drugs: they can be used, but if several anticoagulants are used at the same time (e.g. warfarin and aspirin at the same time, etc.), they need to be discontinued with the consent of the internist.
(5) Eat breakfast normally on the day of surgery. If you are notified of a possible noon or afternoon surgery at the time of your appointment, please eat lunch early.
Some tips.
(1) In the morning of the day of surgery, please clean the head and face, empty the bowels and urine, and do not wear makeup.
(2) On the day of surgery, patients should wear clothes that are open from the inside and outside to facilitate intraoperative monitoring, and try not to wear pullover clothes (such as undershirts or pullover cotton sweaters).
(3) Patients should take off dentures, watches, jewelry, hearing aids and other valuables before surgery, and change into a hospital gown before entering the operating room.
(4) Please be accompanied by a family member on the day of surgery to assist with hospitalization or bill payment procedures.