Ontario Coverage for Cataract Surgery with Astigmatism
Posted on May 2, 2012, 11:06 am by Canadian Association of Optometrists
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?
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.