Bad Cataract in One Eye. What Now?
January 5, 2022 1:09 PM Subscribe
My (already bad) vision has been degrading rapidly over the past couple years. My eye doctor now says insurance would cover cataract surgery, but I think we were only talking about the bad (worse) eye. What about the other (also bad) eye?
I'm 51, male, and have been very nearsighted for decades and presbyopic for about ten years. I saw my doctor in November and I'm currently supposed to see him again in May. Assume I'm already committed to having the surgery in the eye that needs it and I might bump up my next visit. Surgery in one eye will leave me (at least temporarily) with one eye that's still really bad (-5.25 sph, -1.5 cyl) in a vision imbalance called anisometropia (PDF). My "good" eye also has cataract forming, but as of my eye exam in November it doesn't meet the stated threshold for surgery paid for by insurance, and I can't afford it out of pocket. Is such a large difference between the corrected and uncorrected eyes enough that they just go ahead and do "early" surgery on the other eye, which does have a cataract even if it's not yet a really bad one? I don't know how this works.
I'm trying to figure out what happens in this scenario, and what questions I should ask my eye doctor when I have my next appointment and say I'm ready for surgery. I don't tolerate contacts for all day wear, and I've had such bad luck with toric lenses that when I do manage to wear contacts for a few hours they're not that great. My glasses have the fancy high-index progressive lenses with the cool computer-aided shaping and the last set of lenses (just lenses) cost me over $700. It seems like having glasses with only one strong lens would also be terrible in its own way, aside from the cost.
What's next? What do I ask my doctor? What sort of games will my insurance company play? Will I finally regret being on the High Deductible plan?
I'm 51, male, and have been very nearsighted for decades and presbyopic for about ten years. I saw my doctor in November and I'm currently supposed to see him again in May. Assume I'm already committed to having the surgery in the eye that needs it and I might bump up my next visit. Surgery in one eye will leave me (at least temporarily) with one eye that's still really bad (-5.25 sph, -1.5 cyl) in a vision imbalance called anisometropia (PDF). My "good" eye also has cataract forming, but as of my eye exam in November it doesn't meet the stated threshold for surgery paid for by insurance, and I can't afford it out of pocket. Is such a large difference between the corrected and uncorrected eyes enough that they just go ahead and do "early" surgery on the other eye, which does have a cataract even if it's not yet a really bad one? I don't know how this works.
I'm trying to figure out what happens in this scenario, and what questions I should ask my eye doctor when I have my next appointment and say I'm ready for surgery. I don't tolerate contacts for all day wear, and I've had such bad luck with toric lenses that when I do manage to wear contacts for a few hours they're not that great. My glasses have the fancy high-index progressive lenses with the cool computer-aided shaping and the last set of lenses (just lenses) cost me over $700. It seems like having glasses with only one strong lens would also be terrible in its own way, aside from the cost.
What's next? What do I ask my doctor? What sort of games will my insurance company play? Will I finally regret being on the High Deductible plan?
Response by poster: Oh, I'm assuming there'd still be an unavoidable period with one eye done and the other "not yet," but coping with that for a couple weeks is a lot different than having that just be my life now.
posted by fedward at 2:22 PM on January 5, 2022
posted by fedward at 2:22 PM on January 5, 2022
A friend of mine had cataract surgery a few years ago. They will not do both eyes at one time. He had them done about 6 weeks apart.
posted by heatherlogan at 2:22 PM on January 5, 2022 [1 favorite]
posted by heatherlogan at 2:22 PM on January 5, 2022 [1 favorite]
You will get a new prescription lense for the surgery eye after that settles down (several weeks) and keep the current corrective lense in your eyeglasses on the non-surgery eye, until you get bad enough for it to have surgery.
posted by mightshould at 2:38 PM on January 5, 2022 [1 favorite]
posted by mightshould at 2:38 PM on January 5, 2022 [1 favorite]
I can't tell you how to sweet talk them into getting both surgeries insured, but here are some other options:
Have you asked what it would cost to get the second eye done without insurance? It *might* be affordable. (It seems that this might be referred to as 'refractive lens exchange' if it isn't technically because of a cataract.) Shop around if you do. You could also try getting a second opinion in the hope someone will sign off, or you could ask for a guess as to when the cataract might be bad enough for it to be covered.
Obviously it would be great if you could get them both done in the same year so that they come out of the same deductible. That said, looking at the prices I can find on the web I don't think you are guaranteed you'd meet your deductible with those operations alone (YMMV, and I am hardly an expert on healthcare pricing).
However, your insurance provider will have no doubt haggled a solid discount on the procedure if it's paid for by them. Maybe there's some way of getting the insurer's rates even for an uninsured surgery? I've no idea, but your insurance company might help answer that.
You could at least pay via your HSA - any uninsured cost and the your out of pocket both should be payable this way - which effectively means you're paying from pretax income, and that would equate to about a 20% saving depending on your tax rate.
posted by How much is that froggie in the window at 2:40 PM on January 5, 2022 [1 favorite]
Have you asked what it would cost to get the second eye done without insurance? It *might* be affordable. (It seems that this might be referred to as 'refractive lens exchange' if it isn't technically because of a cataract.) Shop around if you do. You could also try getting a second opinion in the hope someone will sign off, or you could ask for a guess as to when the cataract might be bad enough for it to be covered.
Obviously it would be great if you could get them both done in the same year so that they come out of the same deductible. That said, looking at the prices I can find on the web I don't think you are guaranteed you'd meet your deductible with those operations alone (YMMV, and I am hardly an expert on healthcare pricing).
However, your insurance provider will have no doubt haggled a solid discount on the procedure if it's paid for by them. Maybe there's some way of getting the insurer's rates even for an uninsured surgery? I've no idea, but your insurance company might help answer that.
You could at least pay via your HSA - any uninsured cost and the your out of pocket both should be payable this way - which effectively means you're paying from pretax income, and that would equate to about a 20% saving depending on your tax rate.
posted by How much is that froggie in the window at 2:40 PM on January 5, 2022 [1 favorite]
Anisometropia is a thing. I have a significant difference between the two eyes and as a result I've had to wear contacts in the interim since I had cataract surgery on one eye. You'll have to do the same, probably. I've been wearing contacts for the last several years due to this.
The cataract in my other eye is finally clinical and I'm looking forward to getting that lens changed out too, and being rid of contacts.
posted by doomsey at 3:57 PM on January 5, 2022 [2 favorites]
The cataract in my other eye is finally clinical and I'm looking forward to getting that lens changed out too, and being rid of contacts.
posted by doomsey at 3:57 PM on January 5, 2022 [2 favorites]
Response by poster: Just to resolve this, while my worse eye is past the threshold for surgery, the other eye is bad enough to qualify without anybody needing to make any special recommendations. I’m scheduled for surgery on both eyes, three weeks apart. I can deal with one contact lens for three weeks.
posted by fedward at 11:53 AM on August 13, 2022 [1 favorite]
posted by fedward at 11:53 AM on August 13, 2022 [1 favorite]
Response by poster: Follow-up to the follow-up: one surgery down, and the IOL has already settled into place pretty well. My other surgery is in three weeks and I'm glad I won't have to live with this for very long, because hoo boy. With a contact in my remaining bad eye my stereo vision is imperfect but acceptable. After taking that contact out last night, though, I popped my good eye's lens out of my glasses, and I cannot function like that at all. Anisometropia is a nightmare.
posted by fedward at 6:47 AM on September 8, 2022 [1 favorite]
posted by fedward at 6:47 AM on September 8, 2022 [1 favorite]
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posted by Artifice_Eternity at 2:08 PM on January 5, 2022