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Ontario Coverage for Cataract Surgery with Astigmatism
Liz wrote:
My 84 year-old mother needs surgery to correct cataracts but she also has astigmatism. She has been told that there are 2 options 1) new lenses implanted to correct the cataract problem 2) new lenses that will correct both problems at the same time. The problem is that the second option is not covered by OHIP and she will need to pay the Herzig Inst. $3000 to have it done privately. My questions: 1. Is this true – lenses/procedures to handle both are not covered…? 1. If she elects to have it done, what are her options. Is the only option an Institute like Herzig or can she not work directly with an ophthalmologist at a Toronto hospital? Many thanks.
Canadian Association of Optometrists's response:
Your mother has a range of options to deal with her current situation. Most ophthalmologists offer the ability for their patients to have surgery done through their local hospital. In this scenario, OHIP would cover the cost of a conventional intra-ocular lens implant, as well as most of the expenses involved with the surgical procedure. There may be incidental costs for supplement testing that will give the surgeon valuable information about your mother’s eyes to enable them to maximize the chance of success. For a patient with a high amount of astigmatism though, a conventional implant would likely not correct her entire prescription. She would likely have to wear glasses afterwards to fine tune her distance & close vision. If your mother wanted to reduce her dependence on glasses as much as possible, she would have to opt for a premium lens that would be specially designed to try to treat the astigmatism. These types of lenses are not currently covered by OHIP, so the patient would have to cover the difference themselves. There are some surgeons who offer these premium lenses at the hospital. Other surgeons, such as the ones at Herzig, do the surgery in their independent clinic.
You may wish to consult your local optometrist to determine the most suitable option for your mother. There needs to be an important discussion with your mother about her expectations regarding this surgery, as well as her current visual demands. If her visual demands are modest and she doesn’t mind wearing glasses afterwards, perhaps a conventional lens implant would be sufficient. If she is particularly active and would prefer to have increased freedom from glasses, then the added expense of a premium lens implant would need to be considered. A local optometrist would also be familiar with other surgeons in your area, if you choose to consider other alternatives.
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Tanya wrote:
Hi, my name is Tanya. I'm a 22 year old student in university and I've had glasses since middle school. I'm planning a trip to go backpacking and have been looking into laser eye surgery as it would make it much easier to travel. I've had a consult and have been told I am a good candidate. My prescription is -2.75 and -3, my pupils are a bit larger than average, and my cornea thickness is average. I'm looking at the PRK wavefront procedure as I also am a boxer and don't want to worry about the flap getting knocked loose, as well as because of my large pupils. I am still very hesitant though. I am worried about infection causing severe effects as well as halos/starbursts, or having difficulty driving at night. Has the PRK procedure been around long enough for it to be deemed as safe (including long term effects), and do you know of any optometrists who are having the procedure done themselves? Thanks so much.
Dr Carol Doman's response:
Hi Tanya,
It sounds like you have done your homework on laser vision correction. PRK has been mainstream for close to fifteen years now and the first procedure was actually done in 1987 (according to Wikipedia). It is important to go to a reputable laser center. Your optometrist is your best resource for this information as we work closely with laser centers. Risk of infection is very low with PRK and LASIK. Antibiotics are used to help prevent infections. There is a lot more healing with PRK compared to LASIK, but as you know the benefit with PRK is that there is no corneal flap. There are very few problems with halos/star-bursts and night vision today compared to 10-15 years ago. When laser vision correction was first done a smaller diameter of the cornea was lasered, which had the potential of causing night vision problems. However they now laser a much wider area, which has helped tremendously. The wavefront procedure will correct very small imperfections in your eyes, which also helps to prevent glare/halos afterward. The main thing to remember with PRK is the length of healing that is required. For the first two weeks it is quite likely that your vision will be significantly blurry. It takes about 6 months for your eyes to completely heal and for your vision to be stable. I do know a number of optometrists that have had either LASIK or PRK. Overall it is a very safe procedure and there are no long term effects that I am aware of. One other thing to keep in mind is that ideally you want your prescription to be stable before you have laser surgery. That way, there is less chance of your prescription changing after the procedure and you being left with a small prescription. If you are someone who needs a new prescription every year, I would recommend waiting a few years before you have surgery. Most people’s eyes will stabilize in their mid-twenties. Your optometrist would be able to answer any other questions that you might have.
Dr. Doman
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Will Progressives Make Vision Worse
Josie wrote:
Hello. I got my first pair of progressive lenses in October. The distance part isn't that strong. It is – .50. From wearing them all the time will my eyes become dependent on the distance? Will I eventually need a higher distance prescription like -1.00 or higher or will it stay at -.50?
Dr Carol Doman's response:
Josie,
This is one of the biggest myths relating to eyes and vision. Wearing your glasses all the time will not make your vision worse or make you dependent on the prescription. There is a high probability that your distance prescription will stay fairly stable over time. It may change slightly, and sometimes the distance prescription may even improve slightly. What will change is the power of the reading prescription. This generally changes greatly when an individual is between their mid-forties and mid-fifties and then proceeds to level off. And similarly this change in near vision is not dependent on how much you wear your glasses, but unfortunately due to age. I hope this helps.
Dr. Doman
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