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You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying out-of-pocket for certain features.
Where did this come from? Why should you have to pay out-of-pocket for cataract surgery? Shouldn’t your health insurance just cover it?
In trying to answer these questions, you will first need a little history of both cataract and refractive surgery, which corrects errors of refraction such as nearsightedness, farsightedness, and astigmatism.
Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.
Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.
The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable, enabling them to fit through tiny incisions of around 3 millimeters.
Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.
Medicare and most other insurance do not cover refractive surgery (LASIK, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by non-surgical means, such as glasses and/or contact lenses.
Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.
The merging of cataract and refractive surgeries is why there are now options to not only get your cataract removed, but also to correct your astigmatism (irregular shape to cornea) and/or presbyopia (the inability to see well up close that hits nearly everyone in their 40’s).
This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.
Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.
If you want to address your astigmatism and/or presbyopia at the time of cataract surgery in order to be less dependent on wearing glasses after surgery, then paying for those components is going to be an out-of-pocket payment for you.
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
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The 2019 National Coffee Drinking Trends report showed that 64 percent of people who participated in the survey said they had drunk coffee the previous day, which is interpreted as daily consumption. This was up from 57 percent in 2016, said the report.
Even though the U.S. population is drinking more coffee than ever, the nation still only ranked 25th overall in per capita consumption. The people of Finland average 3 times as much coffee consumption as people in the U.S.
So what does all this caffeine intake do to our eyes?
The research is rather sparse and the results are mixed.
Here are some major eye topics that have been investigated:
Glaucoma
One study, published in the journal Investigative Ophthalmology and Visual Science, showed that coffee consumption of more than 3 cups per day compared to abstinence from coffee drinking led to an increased risk for a specific type of Glaucoma called Pseudoexfoliation Glaucoma.
Another analysis of several existing studies by Li,M et al demonstrated a tendency to have an increase in eye pressure with caffeine ingestion only for people who were already diagnosed with Glaucoma or Ocular Hypertension, but no effect on people without the disease. A separate study, published by Dove Press, done with the administration of eye drops containing caffeine to 5 volunteers with either Glaucoma or Ocular Hypertension showed that there was no change in the eye pressure with the drops administered 3 times a day over the course of a week.
Summing up the available studies in terms of Glaucoma, the evidence points to maybe a slight increase in Glaucoma risk for people who consume 3 or more cups of coffee a day.
Retinal Disease
A study done at Cornell University showed that an ingredient in coffee called chlorogenic acid (CLA), which is 8 times more concentrated in coffee than caffeine, is a strong antioxidant that may be helpful in warding off degenerative retinal disease like Age Related Macular Degeneration.
The study was done in mice and showed that their retinas did not show oxidative damage when treated with nitric oxide, which creates oxidative stress and free radicals, if they were pretreated with CLA.
Dry Eyes
A study published in the journal Ophthalmology looked at the effect caffeine intake had on the volume of tears on the surface of the eye. In the study, subjects were given capsules with either placebo or caffeine and then had their tear meniscus height measured. The results showed that there was increased tear meniscus height in the participants who were given the caffeine capsules compared to placebo. Increased tear production, which occurred with caffeine, may indicate that coffee consumption might have a beneficial effect on Dry Eye symptoms.
Eyelid Twitching
For years eye doctors have been taught that one of the primary triggers for a feeling of twitching in your eyelid has been too much caffeine ingestion (along with stress, lack of sleep and dry eyes). I have been unable to find anything substantial in the literature to support this teaching. Therefore, I’m going to have to leave this one as maybe, maybe not.
The End Result
Overall, the evidence for the pros and cons of coffee consumption and its effects on your eyes appear to be rather neutral. There are one or two issues that may increase your risk for glaucoma but it also may decrease your risk of macular degeneration or dry eyes.
Since there is no overwhelming positive or negative data, our recommendation is--and this holds for most things--enjoy your coffee in moderation.
Related links
- Study: Coffee is good for your eyes
- Study links caffeinated coffee to vision loss
- Effect of caffeine on intraocular pressure
- Effect of caffeine in patients with primary open angle glaucoma
- Drinking coffee prevents eye damage
- Caffeine increases tear volume
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
