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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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Development of Myopia
Bernie wrote:
I'm a 47 year old male. I started wearing glasses for very mild myopia and astigmatism at age 18. I was told at the time that by age 23 my prescription would probably stabilize, but that has not happened. I just found out last week that my myopia and astigmatism have changed yet again (my myopia is now at -4).
My question is: is there a chance that this will go on into old age? What am I doing wrong? I read a lot (under good lighting) and I spend a lot of time in front of a computer (two to three feet away), but that is my job unfortunately. Besides, I have countless colleagues who do the same and do not even wear glasses.
Which brings me to my second question: given that no one in my family wears glasses, is it possible that I caused my own myopia/astigmatism by studying and reading too much when I was in my teens? I've heard of studies that claim there's no correlation between reading/studying and myopia, but I find that hard to believe.
Your answers are much appreciated.
Dr Henry Smit's response:
Dear Bernie:
The debate about whether or not doing close work contributes to the development of nearsightedness has been argued for years without reaching a definite conclusion. It is believed that a number of factors contribute to the development of myopia, with genetic predisposition being near the top of the list. Although no one in your family wears glasses, I would not be surprised if you had more distant blood relatives who also had some measure of myopia.
It is true that, in typical cases, myopia stops progressing once the person’s eyes have reached their full adult size – usually in their early twenties. That being said, I have certainly seen patients in my practice who, like you, have continued to become more nearsighted through their adult years. A good number of them, like you, had spent a lot of time doing near tasks, but for many that was not the case. Additionally, there are many people today who spend much of their work time doing close work, and then spend several hours of leisure time doing close work such as reading or working on a computer. For most of these people, myopia does not progress.
Bernie, I don’t think the amount of near work you did was the cause of your nearsightedness. It could be argued that your near work may have contributed in some difficult to measure fashion, however, I do not think you need to blame yourself for your nearsightedness. The mechanisms that cause myopia are complex and not yet fully understood and not usually entirely attributable to the amount of close work that has been done.
Hope this is helpful.
Dr. Smit
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Astigmatism Occurring in Second Eye Years After the First
Amalia wrote:
Is it normal to have astigmatism in only one eye and then after a couple of years have it in the other eye as well? Is it an indication of worsening eyesight or a normal occurrence?
Dr. Sally Aldayeh's response:
Hi Amalia,
Yes it is normal to have astigmatism initially in one eye and then in both eyes. As long as your optometrist confirmed this is not due to eye disease, this change in your astigmatism is a normal occurrence. Thank you
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