November 18, 2004 (Ira Pilgrim)


As it turns out, in most jurisdictions, simultaneous bilateral cataract surgery costs less for the patient and hospital. Generally, however, the doctor also receives a reduced fee for operating on the second eye during the same sitting. For instance, in Ontario, simultaneous bilateral cataract surgery costs the hospital $500 less, and the physician's fee is reduced by 15% for the second eye.

Steve A. Arshinoff

It was a crystal clear night with a full moon. The moon had a halo around it. I held a card in front of one eye and just barely blotted out the moon and the halo disappeared. The next day I phoned my optometrist who told me that the halo was caused by cataracts. When I drove at night, approaching headlights also had halos. I looked it up and read that cataracts are due to the lens of the eye clouding up.

By the time I started my eightieth year, the cataracts in both of my eyes were bad enough so that I had difficulty reading, particularly when the light wasn't perfect. My optometrist and I agreed that the time had come to have it fixed.

After W.W.II, ophthalmologists were able to replace the lens with a plastic lens. Before 1967, replacing the lens was a difficult operation that required up to 10 days of hospitalization. In 1967, ophthalmologist Charles D. Kelman(1930-2004) was having his teeth cleaned with ultrasound and got the idea that he might shatter the lens with ultrasound and suck it out through a small incision in the cornea. He tried it on a number of cats which were destined to be destroyed. It worked and the operation in use today was developed. After many trials and errors, the operation now in use was perfected.

Cataract surgery has progressed to where it takes less than 20 minutes to do the actual surgery. After anesthetizing the cornea with eye drops and dilating the pupil with eye drops, the surgeon, working through a microscope, makes a small incision (less than 1/4 inch) in the cornea of the eye, dissolves the lens with ultrasound and sucks and flushes it out. He then replaces it with a plastic lens. Aside from a dilated pupil which requires sun glasses or an eye patch after the surgery, the patient can go home and feels fine. There is a routine that the patient performs that involves antibiotic and anti-inflammatory eye drops for many days before and after the surgery. This operation is now done on about 3 million people in the US and another 3 million in Europe every year.

I read everything that I could find on the internet about cataract surgery, and there was plenty. It also had information on the surgeons in my area who performed cataract surgery. They were all ophthalmologists and members of the American College of Surgeons. I chose one on the recommendation of my optometrist. Then came a problem.

I had cataracts in both eyes and wanted them both fixed at the same time. An excellent article by a Canadian surgeon made a persuasive case for doing them both at the same time (Steve A. Arshinoff, MD, FRCSC; see ) . There was a web page from a Colombian surgeon, who routinely did it that way. Apparently it is done that way in many countries, but not in the US. I tried to convince my local ophthalmologist to do both at the same time and gave him a copy of the above article. He wasn't convinced. While he was polite, the message was clear; he would only do the surgery one eye at a time with about a month between the two operations. I had been given a Hobson's choice. (Hobson was a stable keeper, and when a person wanted to rent a horse, he could have any horse in his stable, as long as it was in the first stall.) If I wanted both eyes done at the same time, I could have gone to Canada and, were I wealthy, I might have done just that. As it was, I relied on Medicare, which only operates in the US. I did it his way.

The day after the surgery I was amazed. Colors were brighter and everything looked clearer, brighter, and amazingly more beautiful. Six months later, I am still enchanted with how much more beautiful the world has become. It seems to me that the autumn colors have never been so exquisitely brilliant, although I suspect that it isn't because the colors are brighter, but that my new eyes can now see them as they are. At my age, moments of exquisite beauty are worth a hellovalot more than similar moments were in my youth.

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