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Medicare Widens Options for Cataract Surgery

Corrective Replacement Lens Is Allowed for Seniors Able To Pay an Additional Sum

Medicare has changed its rules so that senior citizens who undergo cataract surgery will be able to opt for a high-tech replacement lens that also corrects reading vision. The change, announced on Medicare’s Web site yesterday, represents a policy shift that could widen access to other cutting-edge medical technologies for patients covered by the federal health insurance plan for the elderly. The lenses are considered a significant advance in vision correction but hadn’t been available to Medicare patients until now. Surgeons who use the implants have been offering them to younger patients willing to spend perhaps $4,500 an eye, but they couldn’t offer them to Medicare patients, who constitute the vast majority of people undergoing surgery for cataracts. Under the old rule, surgeons weren’t permitted to charge Medicare patients for the difference between the cost of a conventional cataract surgery, which uses an older type of lens to replace the eye’s natural lens, and a similar procedure that uses the new implant. Medicare pays about $2,000 for a standard cataract surgery, including the lens and fees for the facility and the surgeon. Now, Medicare patients willing to spend an extra $2,500 or so of their own money can get one of the new lenses instead.

“This is an Emancipation Proclamation for Medicare patients,” declared Jeffrey Whitman, a Dallas eye surgeon who has implanted about 600 of the new lenses. “We have had to tell Medicare patients that this isn’t for you, it’s for everybody else. Now we can be nondiscriminatory.”

More cataract procedures are performed in the U.S. and world-wide than almost any other type of surgery. A cataract is an age-related cloudiness that occurs in the lens of the eye. The rule change recognizes that the new lenses treat two distinct medical conditions: one that is covered by the Medicare program, cataracts, and one that isn’t, presbyopia, the loss of near vision that typically requires people to use reading glasses by the age of 45 or so.

“This is a model we can continue to use and explore when it fits into the category” of a technology upgrade, said Leslie Norwalk, deputy administrator at Medicare, in an interview. “There may be other technologies that come down the road where this approach may make sense — we will have to wait and see.”

Ms. Norwalk said legal issues had slowed the agency’s decision to make the cataract-surgery policy change. The agency wanted to allow patients to purchase upgraded lenses, but at the same time wanted to protect beneficiaries from unethical surgeons who might

try to bill patients more for conventional cataract surgeries. The decision is a giant boost for companies that make the new lenses and the surgeons who are implanting them.

Dr. Whitman uses the Crystalens, made by Eyeonics Inc., a closely held company in Aliso Viejo, Calif.

“This is clearly the biggest decision in our small company’s life — it expands our market four or five times,” said Andy Corley, chief executive officer of Eyeonics. “We believe this is a win-win for everybody.”

“This is a major event for Alcon as well as competitors who are developing and/or marketing intraocular lenses with a presbyopic refractive component,” said Peter Bye, an analyst at Citigroup Smith Barney who upgraded his rating on Alcon’s stock. The analyst said the ruling increases the market potential for such products to 2.8 million procedures in the U.S. this year, five times what had been expected. The decision opens the door to cataract surgeons to promote the technology to their Medicare patients. For surgeons, such procedures are significantly more lucrative than conventional cataract surgery.

Dr. Whitman says the higher fees reflect the much more time-consuming measurements and postoperative care that such patients need. Using the new lenses is “more akin to refractive [vision correction] surgery than cataract surgery” because of patient expectations for excellent vision, he said.

Eyeonics has been trying for five years to get the Medicare rule changed, said Mr. Corley. “There were high-level meetings, but they kept delaying and delaying,” he said. The matter received more attention after U.S. Rep. Christopher Cox, a California Republican, stepped in.

“It was a Catch-22 situation because Medicare would pay for cataract surgery and a lens, but it wouldn’t pay for cataract surgery with a product that was meant to be in lieu of the [standard] lens,” Rep. Cox said in an interview. “Federal policy should not discourage technological advance,” he added.

Within a lifetime, most will be diagnosed with cataracts. Cataracts are nothing to fear and can be removed with a very simple procedure. Cataracts form in the lens of the eye and make it hard for patients to see well at night, distinguish between colors and often times can prevent one from partaking in the joys life has to offer simply because one cannot see as well as they used to. Once the cataract is starting to make a negative impact in a patients life often times cataract surgery is recommended. The surgery it self takes about thirty minutes and each eye is done on separate days. At Morris Eye Group we often tell patients that they are lucky to have cataracts due to the fact that technology has changed so much that often times patients see much better than they ever did even before surgery! With premium lens choices patients now have visual options when it comes to cataract surgery. With the Restor lens patients can now read a book, watch TV, cook and use the computer without the need for glasses. With the Toric implant many patients are able to see well in the distance and remove their astigmatism all in one surgery! This allows for excellent distance vision without the need for glasses. There are so many options out there that can really be life changing that there is no need to be fearful of the surgery but rather one should be excited about their options.

Cataracts are the leading cause of visual loss in adults age 55 and older and the leading cause of blindness worldwide. By age 65, about half of the human population has a cataract, and by age 75, almost everyone has a cataract. However, cataracts are highly treatable, and through advances in both cataract surgery and intraocular lenses (IOLs), more people are experiencing full restoration of their vision than ever before. The physicians at Morris Eye Group have performed thousands of cataract surgeries. If you or someone you know would like a cataract evaluation with Morris Eye Group you can visit our offices in San Diego, Carlsbad and Vista to learn more.

A cataract can progress very slowly, and, in some cases, the eye’s lens will simply thicken without clouding, causing only loss in distance vision. In those earlier stages, or when clouding of the lens isn’t present, symptoms can often be addressed with stronger glasses or contact lenses, brighter lighting, or the use of a magnifying glass.

When vision loss progresses to the point where it affects your daily life and/or safety, surgery to remove the lens will likely be necessary. In situations where a cataract is in combination with one or more diseases or condition, your doctor also may recommend surgery even if your vision is only mildly impaired. This could happen if your cataract is interfering with the examination or treatment of other parts of your eye.

When a cataract is the only disease present, surgery is, in the vast majority of cases, very successful. In fact, millions of people in the U.S. undergo this vision-saving procedure each year. Dr. Jeffrey Morris performs cataract surgery every week and has had a very large success rate with patient satisfaction after their cataract surgery was complete. To visit Morris Eye Group for cataract surgery, call our San Diego, Carlsbad or Vista office.

If you have cataracts in both eyes, your doctor may recommend surgery on the eye with the poorer vision first. The second procedure will be completed after the first eye has healed.

Unlike other diseases or conditions, where the eye care professional often dictates when surgery or treatments are necessary, cataract surgery is a decision arrived at by both patient and physician. To determine if the time is right for you make an appointment with one of the doctors at Morris Eye Group. Cataract consultations are performed in our Encinitas and Oceanside offices.

Ultimately, only you know how your vision is affected and how much your cataract interferes with your quality of life.

Cataract surgery is a simple operation where a surgeon removes the eye’s clouded natural lens and replaces it with an artificial, intraocular lens (IOL). The entire procedure is generally done on an outpatient basis and usually lasts between 15 and 30 minutes. Patients may experience little to no pain and can usually return to their normal activities the following day.

Cataract surgery is not LASIK, a type of laser surgery in which the cornea is reshaped to improve vision. Morris Eye Group does perform LASIK surgery however; LASIK surgery will not correct cataracts.

The Procedure

Your surgeon will make a small incision at or near your cornea and insert an instrument about the size of a pen tip to break up and remove the cloudy lens. Once the natural lens is removed, the IOL is inserted through the same incision and set into its permanent position.

Cataract surgery is considered one of the safest and most effective medical procedures. More than 3 million cataract surgeries are performed each year in the United States alone. But not every cataract surgery is the same.

Phacoemulsification. This technique is the most advanced and most commonly used. It requires a very small incision on the side of the cornea (an eighth of an inch or smaller). Because of the size and location of the incision, stitches are rarely needed, and the eye heals rapidly.

Extracapsular surgery. This type of surgery, which usually takes place outside the U.S., is used for very dense or rigid IOLs, It requires a larger incision and stitches are needed, so it takes longer for the eye to heal. More than 90 percent of patients who receive this type of procedure see 20/40 or better.

Intracapsular surgery. The earliest cataract surgeries performed hundreds of years ago involved this procedure, where both the lens and the capsule are removed. Today Intracapsular surgery is hardly ever performed, even in developing countries, and is generally reserved for cases in which the lens has dislocated because of injury and an accompanying disease.

Delaying surgery

Depending on the severity of your vision loss, you may be able to take some simple steps to delay surgery. Options include getting a new pair of prescription eyeglasses and increasing your home lighting. You may also reduce glare indoors by repositioning lights or outside by wearing polarized sunglasses. Morris Eye Group has two large optical shops to help you with all of your optical needs. The opticians at Morris Eye Group fit patients for glasses and contact lenses in Carlsbad and Vista. Call our San Diego office to make an appointment today.

What is an Intraocular Lens (IOL)?

Much like a camera, your eye’s natural crystalline lens plays an important role in focusing images. When a cataract clouds the lens, it makes it virtually impossible to see clearly.

When your cataract progresses to the point that daily tasks become difficult and interferes with your quality of life, you will need cataract surgery. During surgery, your eye’s natural lens will be replaced by an intraocular lens, or IOL. At Morris Eye Group we offer both monofical and multifocal lens implants. A multifocal lens implant allows a patient with cataracts to not only have the cataract removed but also be free of glasses. Morris Eye Group, in Carlsbad and Vista, help patients to make a decision about which lens implant would be best for them every day. To make an appointment with a doctor at Morris Eye Group please call our Encinitas or Oceanside office direct line.

An intraocular lens is an artificial lens made of plastic, silicone or acrylic that performs the function of the eye’s natural lens. Most of today’s IOLs are around a quarter of an inch in diameter and soft enough to be folded so they can be placed into the eye through a very small incision.

Morris Eye Group treats people with cataracts that live in San Diego.

What are Cataracts and What Causes Them?

Cataracts are degenerative changes in the structure of the eye that form when protein in the lens begins to clump together, clouding a small area of the eye. This cloud will continue to grow and interfere with vision. They can occur in one or both eyes. While the most common cause of cataracts is age, they can also be caused by eye trauma, certain medications, and various environmental and lifestyle factors. Additionally, some cataracts are congenital. You can find out more about cataracts by making an appointment in our Encinitas or Oceanside office. We evaluate people that have cataracts and live in San Diego, Encinitas, Solana Beach, Oceanside, Vista, Carlsbad and the rest of North County.

Symptoms of Cataracts

Protein clumps that cloud the eye reduce the sharpness of vision in several ways. An individual with cataracts may experience blurry vision or be unable to see bright colors at their true intensity. Lights may seem excessively bright, and halos may appear around them. Double vision is another symptom that indicates a cataract has formed.

How are Cataracts Diagnosed?

The way to know if you have a cataract is to come to Morris Eye Group and see one of our doctors. Cataracts can be detected with a full optical examination, including pupil dilation, a visual acuity test, and a tonometry test. Since early cataract diagnosis and monitoring can protect your vision, regular exams are advisable. Catching cataracts early helps patients more easily find a cure.

Cataracts Progression

At first, a cataract only affects a small portion of the eye’s lens. Over time, the cataract grows, often so gradually that the patient does not notice it. When the entire lens has become clouded, ophthalmologists refer to the cataract as a “ripe” or “mature” cataract. At this stage, cataracts can cause severe vision problems.

Types of Cataracts

Finding out what type of cataract you have helps determine the most appropriate course of treatment. By seeing a doctor at Morris Eye Group we can determine the type of cataract you have.  The most common type of cataract is age-related, though there are also congenital cataracts, which form at birth or during early childhood. Other types of cataracts include secondary cataracts, which are particularly common in diabetics, and traumatic cataracts that are the result of eye injury.

Is There a Treatment or Cure for Cataracts?

The only cure for cataracts is surgery. Cataract surgery is indispensable in providing patients with freedom from clouded, blurred, or dimmed vision. Morris Eye Group does cataract surgery for patients in San Diego and North County. There are many types of cataract eye surgery that may be used to best treat a patient’s condition.

Recovery after Cataract Surgery

After cataract surgery, patients generally feel mild discomfort. Usually, though, over-the-counter pain relievers are sufficient for numbing any pain or itching you might feel. Cataract surgery patients sometimes experience temporary fluid discharge and sensitivity to light following their operation.

Who is at risk for developing cataracts?

Younger people are usually not affected—it is older people who are at greater risk. Of people who are 60 years of age and older, approximately 60 percent have had their vision impaired by the formation of cataracts. Cataracts are the main cause of vision loss in those over the age of 55. Injury, disease, and heredity may also result in cataracts.

What does cataract treatment consist of?

Cataract treatment normally consists of cataract surgery. During cataract surgery, the lens of the eye is removed and replaced by a new, artificial lens. In most cataract surgeries, an intraocular lens (IOL) is used. The IOL may be made of silicone, plastic, or acrylic. At Morris Eye Group we offer a wide range of IOLs including the Restor and the Rezoom lens which give patients the patient the ability to be glasses free for most of their activities. For the few patients who cannot tolerate IOLs, cataract treatment would consist of regular soft contact lenses or glasses.

How effective is cataract surgery?

The American Society of Cataract and Refractive Surgery (ASCRS) states that 98 percent of all cataract surgeries have positive results. Cataract surgery risks are lower in patients who undergo extracapsular or phacoemulsification surgery, both of which leave the eye’s capsule intact. Most patients report improved vision and few complications after cataract treatment.

What will my recovery from cataract surgery be like?

Cataract surgery recovery time is considered to be approximately six weeks. However, most patients should find that any pain or discomfort will subside within a day or two of their surgery. Immediately following cataract surgery, patients may experience some pain and irritation of the eye. Many patients also experience increased light sensitivity and a small amount of fluid discharge after cataract surgery. Special pills and eye drops may be prescribed to promote healing and regulate the pressure inside the eye. Pain relievers may also be taken during the first few days if necessary. Follow-up exams allow the physician to monitor patient progress. Sunglasses or eye shields can help protect the eye while it is healing. You can purchase sunglasses from the Morris Eye Group optical shops in Encinitas and Oceanside.

What are the odds of achieving normal vision after cataract surgery?

Despite the marked improvement that cataract surgery offers, most patients will continue to wear contacts or glasses after their cataract treatment, unless a patient decides to have a Smart Lens implant/ Restor/ Rezoom IOL. After cataract surgery, there will be a period of recovery time while the eyes adjust to seeing without the cataract. If only one eye is treated, the eyes must learn to work together again. Many everyday activities can be resumed soon after cataract surgery, although patients may experience blurry vision for a time. Driving may be impractical and unsafe at first; the physician will advise the patient on the appropriate time to begin driving again after cataract treatment. Also, patients who receive intraocular lenses (IOLs) may notice some color distortion at first. This should resolve itself within a few months, as the eyes adjust to the new, clear lenses of the IOLs.