First, the Disclaimer: I am a patient of Dr. Uday Devgan’s, and I am not a medical person. I am writing this because I think it might be useful for others with cataracts to hear about my experience, but your situation / solution / experience may be quite different from mine.
HIGHLIGHTS and MY ADVICE
Cataract surgery has a high success rate (you may not quite get the expected results, but you will likely still have a big improvement in your vision by having the surgery). However, it is surgery, and something could (and once in a long while does) go seriously wrong for an individual. So it is important to spend effort on the selection process (see the Details section below for more about my process).
There are two major decisions: the ophthalmologist who will do the surgery and the type of artificial lens which will replace your natural lens. I imagine most people simply depend on the ophthalmologist to recommend the appropriate lenses, but be aware that there are different types of artificial lenses, each with advantages and disadvantages (there’s information on the internet, below in the Details section, and from your ophthalmologist), and not all ophthalmologists are comfortable with all of them. As you might expect, there are also differences among ophthalmologists, differences in what they are comfortable offering in terms of solutions, in their experience, in how they keep up with advances in the field of ophthalmology, in their skill level, in their pricing, and in how much they interact with patients.
As a consumer with a huge stake in the outcome, it helps if you have a clear idea of what you hope the final result to be. These overlap, but broadly speaking there are three distances: reading (approx. 15 - 16 inches), computer (25-26 inches) and long distance (more than 6 feet). All 3 of the ophthalmologists I talked to recommended a solution which would result in me wearing glasses after the surgeries (not a big deal for me, since I wore glasses before the cataracts). I expect most people end up wearing glasses for at least one distance, possibly a second pair of glasses for a different distance. The most important question for me was: which distance(s) did I NOT want to wear glasses - reading, computer or distance (see Details below for what I ended up with).
Cataract surgery involves removing your natural lens and replacing it with an artificial acrylic lens. Although it is not impossible, don’t count on being able to replace an artificial lens with another one in the future if you don’t like your first choice. It is difficult to replace one artificial lens with another, and most ophthalmologists will not attempt it.
I used prescription eye drops for 3 days leading up to the surgeries as well as 4 weeks after. I didn’t have any pain or discomfort with my surgeries, and was able to go back to work (office job) the next day.
Dr Devgan is one of the best ophthalmologists in the world, and although I am only one patient, I believe he takes strong and personal interest in each patient, and is keenly aware of the fact that what he does will affect how you see for the rest of your life. In addition, he was highly accessible and very helpful in explaining the options, the procedure and answering all of my (many) questions). I heartily recommend him.
DETAILS (My Process and Experience)
Selecting The Eye Surgeon
My optometrist told me in Feb 2013 that I was developing cataracts, but they were not in a location where they were affecting my vision. She said we should take a ‘wait and watch’ approach. By October the cataracts were beginning to make everything look filmy, as if I were looking through badly smudged glasses. I didn’t like driving at night because lights were unusually bright. As cataracts worsen you become more and more nearsighted, so by the time I went back to see my optometrist in Feb 2014, I had to move my computer screen several inches closer. Even with a new prescription for glasses, by the end of March, the cataracts had gotten so bad that I knew that I had to have them removed soon.
So I talked with the two optometrists I had seen during the last five years and got five referrals. My understanding is that the percentage of cataract surgeries which go wrong is low, but the impact if they go wrong is very big. And I also have the impression that some surgeries go very well (as planned and intended), while others are “successful” (improved vision) but didn’t really result in what was hoped.
When faced with a big decision like this (which ophthalmologist to go with) I’m the kind of person who wants information - lots of information about the options, the risks, the people who will be doing the work, etc. I checked up on all of the referrals on the California State Medical Board web site and none had any problems; I noticed that some did some teaching or research, and others didn’t. Then I looked for their web sites and ruled out a doctor who had only a 1 page site without much useful information, another doctor who is probably quite competent but didn’t appear to be doing much other than running his practice, and a third who didn’t have a web site at all.
The normal process is to first have a consultation, and then to schedule the surgery of the first eye. The consultations are not free, but for me, it was very important to meet more than one ophthalmologist and ask questions about the recommendations and options (there are a number of types of artificial lenses which are inserted into your eye after your natural lens containing the protein clumping, which is what obscures your vision, is removed).
I first talked with the ophthalmologist recommended by my optometrist (Doctor Number One). It turned out that he generally recommends only monofocal lenses whereas my optometrist recommended accommodating lenses. So this first ophthalmologist recommended Dr. Devgan.
I then talked with an ophthalmologist in an expensive location (Doctor Number Two) who works with several other ophthalmologists and optometrists, and has a very impressively furnished office suite (original artwork in expensive frames, etc) with numerous examination rooms with different pieces of equipment in them, and a number of support technicians rushing from room to room. It was a big operation, and it became apparent that they attract a lot of folks from the entertainment business - singers, members of rock bands, athletes, etc. After my technician performed various tests and scans the ophthalmologist came in and spent 5-7 minutes giving me his recommendation and answering my questions. Next, I was sent to the office of a scheduling person. I was pleasantly surprised that the scheduling person was able to clarify the options available and the one recommended by the doctor, but there were some questions that she said I’d need to ask the doctor about when I came back for an appointment with another technician who would take additional and more detailed measurements. This scheduling person also attempted to give me an estimate of the out of pocket costs for me but ended up saying that she’d call my insurance company to get the details. The ophthalmologist and his staff all seemed very competent, but I felt like a widget on an assembly line, and it wasn’t very easy to catch the ophthalmologist to ask questions.
My third appointment was with Dr. Devgan. The décor in his office more normal, and I learned from one of the ladies at the front desk that she used to work for Doctor Number Two, and that she much preferred working for Dr Devgan; indeed I felt that the general tone of the office was more personal and congenial - the staff were busy and efficient but had the time to chat a bit and answer questions (I like to ask a LOT of questions). I felt most comfortable with Dr Devgan (he spent probably 20- 30 minutes answering all of my questions), so I decided to schedule my surgeries with him. The first eye surgery was done on April 29 and the second on May 12.
The Options and Choices of Lenses
There are a number of choices of types of lenses (there’s information on the internet so I won’t go into too much detail here), but some ophthalmologists seem to favor some over others. My perception is that mono-focal lenses are the most straight forward, that multi-focal lenses need somewhat more skill / care in placement in your eye, and that accommodating lenses are generally the trickiest. (There are also toric lenses but they were not relevant for me since I didn’t have severe astigmatism).
In the end, all three ophthalmologists offered similar recommendations - monofocal lenses with the option of having one eye better at “reading” distances and the other better at “computer” distances. This means that the natural lens in each eye would be replaced with artificial acrylic lens with different prescriptions. When reading a book I would be using my right eye more, when working at the computer I would be using my left eye more, and I would wear glasses for distance (e.g. when driving.)
This solution is not for everyone, but before cataracts I never wore glasses except when driving, and my eyes have been quite different since I was 8 years old, so it was not important that the artificial lenses have the same prescriptions - my brain has no problem handling the difference. What was important to me is that I really didn’t want to wear glasses when working at the computer or reading.
My understanding is that Medicare covers the cost of using monofocal lenses, but does not cover the additional cost of other types of lenses and does not cover the cost of any additional surgery beyond removal of the natural lenses and insertion of the artificial lenses. I opted for a couple of additional incisions in each eye to correct my astigmatism (I haven’t yet gone for an exam to get a prescription for new glasses, but I expect I will need less or no correction for astigmatism compared to my pre-cataract prescription). There was additional out of pocket cost, but it was worthwhile for me.
None of the three doctors were enthusiastic about accommodating lenses or multifocal lenses for me.
A problem with multifocal lenses is that you cannot see as well in low light conditions (problems of clarity, might have halos around lights at night) because of the fact that these lenses actually create two images on your retina. My understanding is that a multi-focal lens is broken up into two types of little squares, in checkerboard fashion. Every other square has a different focal length. The result is that a multifocal lens forms two images on your retina. 41% of the light entering your eye forms one (close) image, and 41% of the light forms the second (more distant) image; your brain is able to pay attention to the relevant image, depending on whether you are trying to see something close or far. 18% of the light is simply lost. As a result, it is harder to see clearly with multifocal lenses in low light conditions.
As I understand it, accommodating lenses are available only in one model from one manufacturer and have been around for only about 10 years. The muscles in your eye are supposed to attach to the accommodating lens and the lens is somewhat flexible (a range of maybe 1.5 diopters, in contrast the range of maybe 5 or 6 diopters for a 14 year old). So the idea is that an accommodating lens is supposed to function kind of like a natural lens, and might even result in no longer needing glasses at all. The problem is that they don’t always work as hoped. So as Doctor Number Two told me, he doesn’t recommend accommodating lenses unless the patient is very aggressive about not wanting to use any glasses after the surgeries. It sounded to me like it is a gamble as to whether they will work as hoped, and a problem is that once you’ve had cataract surgery, you should NOT expect that you can have a second surgery to replace one artificial lens with another. In fact, most ophthalmologists will not perform such an operation. They refer such cases to a select few other doctors who are willing to tackle such challenging cases (there are issues of scar tissue and less predictability with respect to results).
The Operation
Eye drops were used to administer local anesthesia to my eye. Then I was anesthetized through an IV, but I apparently was conscious and responsive throughout the operation. Because of the IV anesthesia, I only remember some bright lights. Dr. Devgan performed the operation in just 10-15 minutes.
Cataract surgery usually involves two separate operations. Apparently it is not critical to wait very long between them (out of town patients sometimes have the first eye operation one day, go for the post-operation checkup the next day, have the second eye operation the third day, followed by another post-operation checkup the fourth day, and then fly home the fifth day).
Dr .Devgan told me that I can get new glasses a month or so after the second operation. It takes a while for the eye to recover and become stable.
Dr. Devgan had me use three prescription eye drops for three days before the operation, and then for a varying number of weeks after (the longest was 4 weeks of one type of prescription eye drop). I found the whole cataract surgery procedure to be a quick and painless experience.
The Results and My Recommendation
The ability to see again clearly is truly incredible! The only thing I can think of that might come close in importance is the ability to hear, and given a choice, I’d far rather lose my hearing. Because of the cataracts, I lost the ability to drive, and was rapidly losing my ability to work on the computer. Everything was fuzzy and somewhat yellow tinted. It is such a pleasure to see clearly; the colors are much brighter and sharper as well.
One thing that I noticed is that there’s a more abrupt transition from an object being in focus and to being out of focus as that object moves closer or farther from me. Before the cataract surgery, the muscles in my eye would adjust the thickness of my natural lens as something moved closer or farther, but the monofocal (artificial) lenses are not adjustable. This is minor difference from my pre-cataract vision, and not one that causes any problem.
Dr Devgan is very well known and respected among his peers. He is at the top of his game and at the forefront of his field.
1. He has done numerous eye operations on other doctors and ophthalmologists.
2. He’s told me that a significant number (15%) of his patients fly in from out of town.
3. He has developed several tools used in eye operations (check his web site).
4. He has demonstrated techniques live, performing actual operations to audiences of up to 1000 other ophthalmologists a number of times (6 or more, I believe).
NOTE: If you’d like to see what happens in a cataract surgery, see his videos on YouTube.
5. He is on the faculty of the Jules Stein Eye Institute at UCLA.
6. He gets referrals from other ophthalmologists when something has gone wrong and it is necessary to remove an artificial lens and replace it with another. That is a difficult operation that should not be done unless it is really necessary to do so, and therefore as mentioned above, most other ophthalmologists will not replace an artificial lens with another one.
7. He has relationships with and consulted with a large number of companies in his field, and therefore has ready access to new options as they emerge.
He is very enthusiastic about his work, and always striving to “raise the bar” and improve his knowledge and skill set. And (very important to me) he is very available and helpful in answering questions (questions which he probably has heard a zillion times before.) I sent him a number of questions in the days leading up to my operations, and he answered quickly (same day, often within a couple of hours).
As you can tell, I am a very pleased and appreciative patient, and recommend him with the utmost enthusiasm.
by Jia S
xxx.xxx.5.0
June 01, 2014
