Cataract Surgery, Advanced Intraocular Lens (IOL) Options & Costs 

Video Transcript: 

These are the sections covered in the video transcript. Click on any of interest to you to read. 

Thank you for coming today. We appreciate it. 

This is the agenda: I'm going to go over the basic anatomy, and then an overview of the surgery. We'll talk about options, manual surgery versus bladeless laser surgery, and then intraocular lens options.  

There are three different categories of lenses that we use, and I'm going to talk about them. We'll talk about some tools and diagnostics that we use, and then we'll briefly, at the end if we have time, just touch on glaucoma because it's becoming a big trend with cataract surgery.

Dr. Lindahl is our main surgeon and he's the owner of the practice. We also have two ODs.  An OD is an eye doctor that doesn't do surgery, but they do everything else in the office. They're wonderful, they've been with us for years. Our COO is Andrea Zimmerli. I'm Kim, I'm the Former Clinical Director and Beth Egan, RN is our Cataract and Clear Lens Exchange Surgical Coordinator.

Rochester Eye and Laser Center has two RNs, which is not typical for an ophthalmology practice. Dr. Lindahl finds it very important to actually have professional RNs on staff, so that we're doing the best practices for all of our patients.  

What is a Cataract?

This is a picture of the eye so that you can get familiar with the anatomy and what a cataract is. Basically a cataract develops when proteins in your eye kind of clump together, and it prevents a normal movement of light into your eye, therefore distorting your vision.

Basically your lens looks like an M&M. There's a shell of your lens, your natural lens, and then inside, when we're young, there's clear material. As we age, the material clumps up and causes cloudiness and that's why you start going to the eye doctor. You'll get glasses and you'll say, these glasses stink they don't work well. It's because you have a cataract and eventually glasses won't even work anymore. So that's when you know it's time for cataract surgery. That's one of the ways.

There are different types of cataracts and different grades.That's one of the things we look at when you come in. This is a good example of someone who's cataract is very advanced. He had cataract surgery in the left eye. You can see it's just a black pupil and in the other eye there's a milky white cataract. That’s too long to wait. That’s what we used to do in the old ages. We used to wait until the cataract ripens they would say. There was no benefit of doing that, so the new thinking is, let's get it when it starts affecting your life.   

If a doctor says to you, you have a cataract in that eye, then the next question is going to be, is it affecting your life, your daily living? Are you not driving at night because you can't see as well? Are you seeing glare? Our number one complaint is glare around headlights at night that distorts your vision and you can't see well. Also, overall blurriness and we'll go into more symptoms later in the presentation.

Historically, the old way of thinking was, they would let them get this bad. This is actually a lens that they just pulled out of the eye. We don't do that anymore, but in the old days that's how you removed a cataract. You made a huge incision and you just pulled it out. Now it's through tiny, tiny incisions and we break it all up with an ultrasound handpiece and there's not this anymore.

I want to show you what an advanced cataract looks like. It's like the size and weight of an M&M and it has the shell. We leave the shell of the M&M and just take out what's inside. The shell is what's going to support your new lens.This is a clear lens and this is a clouded one.

Symptoms of Cataract 

These are the symptoms I was telling you about. This is when we would be ready for cataract surgery. Basically your vision could be clouded or blurred. Overall you may see those halos or glare, even starburst around the headlights. You'll have difficulty driving at night. The colors will be fading or yellow and your glasses just aren't working anymore.

We'll bring people back, they'll call and say these glasses I just bought, don't work well. They will bring them back one or two or three times. This is because of the cataract. We can't get it right anymore. Eventually you just can't see, no matter what we do. A lot of people don't even realize they're having some of these symptoms and after surgery they're like, oh my gosh this is like a new world. A lot of people see better than they've seen since fourth grade, so it's amazing!

Procedure Options

There are two ways of performing the procedure. I've been in ophthalmology, I started at Genesee Hospital 23 years ago, and it is so crazy how far the technology has come since then. We've been doing this manual surgery since then and it's come a long way.

Dr. Lindahl goes into your eye and he manually makes the incisions. He uses this ultrasound handpiece and he breaks the cataract into four quadrants. He then uses this machine to break the four quadrants and take them out. This is a manual procedure. He does a good job. It's still a good surgery. A lot of doctors only do the procedure manually. It's not a bad surgery, if that's the only thing you can get.

About seven years ago, they came out with a laser called LensX laser. The laser basically assists the doctor with cataract surgery. Before you even go into the operating room, you go sit underneath a laser and this laser does three things.

One, it fixes an astigmatism, or part of an astigmatism, depending on how bad it is.

Two, the laser breaks up the cataract that the doctor manually had to break up before.This machine breaks it into hundreds of little fragments, so that then when he goes in with that ultrasound, it's like nothing to get it out. That's a benefit because sometimes, when it's hard to get out, he uses a lot of energy in the eye and energy causes inflammation and causes a longer heal time. So breaking it up makes it easier to get out, leading to less complication, risk and just less inflammation overall.

Three, the laser makes all the incisions. There are two incisions that go on the outside of the eye, so that he can get the two instruments in. Then there's an incision on top of that M&M that I told you about. This is probably the most important part of the surgery because it's a little circle he has to make on top of that M&M, so that he can get in and take all that material out. The circle has to be perfectly sized, so that the new lens sits on it and is centered perfectly. When the doctor does it manually, he does a great job. I witnessed it happening hundreds and thousands of times, but the laser is more precise.

I went over breaking up the lens, astigmatism, and incisions and that's what the laser does. That's like a five minute procedure. You don't even have to be sedated for it. After that you go into the OR and finish up the procedure.

When the LensX laser came out, the biggest benefit was that it fixed an astigmatism. Now that we've been using it in more studies, the latest studies are actually saying, yes that's great it does the astigmatism, but it's even better that it does this incision perfectly. That's just some of the new data out. You can see when he makes the incision manually, he makes it with a little instrument and he tries to get it perfect every time, but the laser is more precise.

Cataract Pre-Op

These are the steps you go through at the surgery center. The nurse will dilate your eye. They take your blood pressure. Anesthesia comes and talks to you. They get you all ready- you don't even have to take your clothes off. You just put a gown over your clothes now. You lay down on a gurney, and then Dr. Lindahl will stop and say hello.

Cataract Procedure

First, if you are having it done bladelessly with the laser, you go to the LensX laser room, followed by the operating room. The whole procedure is approximately fifteen to twenty minutes. Dr. Lindahl is very efficient and very good at what he does.

Cataract Recovery

Following the operating room, you will go to the recovery room. You're at the surgery center for two hours, sometimes it's even less. The actual procedure only takes about twenty minutes.

Q & A-1

Any questions so far?

Q: What anesthesia do you use?

A: It's just like if you had a colonoscopy. They put in an I.V. and they give you a little bit of anesthesia. You're awake because we want you to listen. Dr. Lindahl might say, look at the light, or look up look down, etc. You might not remember a thing, and you'll be relaxed. We numb your eyes so you don't have any pain. By that night, you're going to feel good. You'll be a little bit tired that day, but by the next day, you're going to be feeling fine. Most people go back to work the next day. You do need a ride to that post-op appointment because we do need to check your vision before we can clear you to drive.

Q: How do you get the cataract material out of the eye capsule and leave that capsule in place when you're doing the surgery?

A: At the point you are asking about, the laser has broken everything up and now the Dr. needs to go take that material out and put the new lens in. It's like an ultrasonic and it's called BSS which is a fluid that actually irrigates through the eye and breaks up the cataract as it does. It's constantly replacing fluid in your eye and then taking out the cataract material.

Q: How does it break up the lens and not affect the shell you referred to?

A: I'm very careful. The likelihood of having the capsule disrupted would be maybe one in seven hundred to one in a thousand cases, so it's really straightforward.

Q: If it gets disrupted, can you still repair it?

A: You can still put in a lens and sometimes you have to put it in a little different position. What's behind the lens is called the vitreous jelly. You may have heard of that from biology. Sometimes we'll have to take out a little of that vitreous before we put in the lens.

Intraocular Lenses (IOLs)

There are multiple companies making lenses and multiple types of lenses. We're going to talk about three categories of lenses.

Monofocal Lens - Distance Vision

A monofocal lens is going to help you with distance vision. Just by taking out that cataract, you're going to see better because we're clearing up that the vision. Putting the lens in is going to give you better distance vision. If you don't have an astigmatism, our goal is to decrease your dependency on glasses for distance with this lens. You will definitely need help with reading and intermediate vision. This is a lens that insurance covers.

We look at what your goals are. Do you want to wear glasses less? Do you want to be out of readers, or are you okay with wearing readers, but you want better distance. You need to help us determine what lens to put in and what lens would be right for you.

Toric Lens - Astigmatism Correcting

The next lens corrects astigmatism. An astigmatism is when your eye is not shaped perfectly like a basketball. It's more like the shape of a football, distorting the rays of light coming into your eye. This is something we can fix during cataract surgery.

There are a couple different ways to treat an astigmatism. One, the laser treats part of it, or sometimes all of it depending on your degree of astigmatism. A lens that we use called a toric lens also fixes an astigmatism. There's also something that we used to do frequently before the laser came out, called an LRI. It's basically a manual incision that Dr. Lindahl makes on your cornea, to change the shape of your cornea. 

This is the lens I was telling you about. We call it an astigmatism correcting IOL, or toric lens. Basically a monofocal meaning one, you toric lens will help you with distance. It will fix your distance, but if you have an astigmatism this also fixes the astigmatism making things more sharp and clear. This is a second level of lenses. There's monofocal and then there's toric. Insurance covers part of the toric lens, but most of it is out-of-pocket, and we'll get into that more at the end.

I want to show you Dr. Lindahl's results. We did a study of 40 patients and as you can see, pre-op, they had an astigmatism which was 0.76 all the way beyond 2 diopters. He then did the surgery and put in a toric lens, and out of those 40 patients, 36 of them had less than a half a diopter of astigmatism after the procedure, which is wonderful. This is better than the national numbers for this kind of surgery. Three of them had less than 0.75 and one person had less than one, so amazing numbers. This shows you the kind of work he does, just to brag a little bit about Dr. Lindahl.

Multifocal Lens - All distances

The third category is for patients who want that near vision. We're all aging and you eventually lose the ability to see up-close because your lens loses that elect elasticity. The elasticity can't accommodate your vision anymore, so that's when you start needing those reading glasses.

This lens, which we call a multifocal lens, can be an extended depth of focus lens, or an accommodated lens. These lenses help decrease your need for glasses overall. We can't ever guarantee that a hundred percent of the time you wouldn't need glasses, but this lens is going to help you with distance, it can fix an astigmatism, because it also comes in toric, it fixes intermediate, and it gives you functional near vision.

Now you're never going to see up here again because God just took that away from all of us, but it would be functional near, meaning like 16 to 18 inches, depending on which lens mix he puts in. It's not to say if you're in a dark restaurant,  and there's poor lighting and little type on the menu, you might need some help, but our goal is to aim for 80% of the time you'll be glasses free.

PanOptix Trifocal Lens- All distances

There's a new lens that just came out called PanOptix Trifocal Lens, that is even better transitions than the other technology. It's not like wearing a bifocal or trifocal. It transitions so you won't notice  the line, or have to move your head a certain way to see. People often say they don't really tolerate progressive lenses that well. This is totally different in that the lens does all the work. You don't have to adjust your head.

If we get a patient to see well at distance with this lens, that is 20/20 to 20/25. Then this lens is going to give you mid-distance, which is say a computer screen. It's 22"- 24", and what we call near distance at 16". It's usually where people like to read. Say you're a five-foot patient. You're going to have a different reading distance than a 6'4" person. We can show you what this lens can do, but those distances 24" and 16" will serve just about anybody.

The PanOptix Trifocal lens just came to the US. They've been using it since 2015 in Europe. It's Europe's go-to lens. The US takes a little longer to get technology just because it takes longer to get approved by the FDA. Dr. Lindahl was the first person to put it in a patient in Rochester. 

This is an exciting lens for people that want to reduce their spectacle dependence at both distance, intermediate and near. I can't tell you how many we've put in, but I would say at least 10 to 15 patients, maybe 20. 

All of these lenses that are multifocal, are meant to be put in both eyes. They're not something you put it one eye. It's a new visual system for people and we like to use the term, for whatever reason, my active seniors. So, if you love to do a lot of things like garden and read, or you want to be less dependent on glasses, then this is a terrific lens.

The other thing we always look for, is people who take their glasses off to read, which there's a lot of them, and especially if you're a woman and you take your glasses off to read. You also can put your makeup on without your glasses because that's a near task. I always encourage patients, if they've got otherwise healthy eyes, to consider using a multifocal lens because it's going to make them really happy. I've used this lens a lot of in the last a few months and you know I'm really loving it. It's a wonderful lens.

Like I said, the FDA here requires different things than the equivalent FDA in South America or Europe. So, we haven't had it for a number of years, but it's been put in over a million people in Europe and is a well studied lens. 

Putting in the lens is the same technique, so remember, when you're paying for something here out-of-pocket, you're paying for the technology number one, and then a bit of extra work on our part to make sure we've got the lens that's appropriate for you. It's not, and some people worry about well it's a different lens it's harder to put in, it has nothing to do with that.

Q: So do you wait until you can do both of the eyes of the patient?

A: We can do both eyes even if you don't have a bad cataract in the other eye. You really don't need to have bad cataracts in both eyes. Let's say they want a multifocal lens. Let's say you start nearsighted and we put in the lens to make you good at distance. You are always going to have an imbalance between the two eyes. So we can do the other eye even if it has very little cataract to bring it up. You don't have to have, in certain circumstances, a bad cataract.

Let's just say you're over 50. Some people will come to us in that age group, for LASIK. Once you get to about that age I start thinking well is it better to do LASIK, or is it better for you to have cataract surgery? If they've got some early cataracts that we can demonstrate some glare disability, and we have a measurement to do that, then we can do those cataracts and you get coverage for the cataract part of it, but you don't get coverage for the lenses.

Clear Lens Exchange

Then there's another group of patients that choose to have Clear Lens Extraction or Clear Lens Exchange. In other words, in a 60 year old with no cataracts, we have the ability to take the lens out and put a new one in, allowing for all-distance vision. It's much better to do this than to do LASIK. This procedure is more common if patients know something about it first. Patients need to know the procedure's not going to be covered by insurance without the existence of a cataract. In addition to the fee for the procedure, patients have to pick up the fee from the surgical center as well, so that gets more expensive. I've done a number of patients who self-insured because they wanted it done. So there are different possibilities, but typically the people that I do the procedure for will have some mild cataracts, so for the cataract part, the facility fee is covered.

You will never get a cataract if we do a Clear Lens Exchange. It's sort of a philosophic issue as well because if people want cataract surgery at a younger age and have it done, there is out of pocket expense, but remember Medicare. If you look at what it costs, cataract surgery is the third largest medical procedure the government pays for. It is certainly one of the higher numbers with about 3 million done each year. I think Medicare may even encourage people in the future to have cataracts taken out at an earlier age.

Q & A - 2

Q:  I have dry eyes. How does that affect healing after the procedure?

A: We always look for dry eye. We always work a patient up for dry eye because that's part of the total workup for cataracts. We define how dry your eyes are and what we're going to do about it before surgery.

Q: Are these lenses hard or soft inside the eye?

A: They are acrylic lenses and foldable, so that would be considered soft.They are a different material than contacts are made of. They're either made of silicone, like most of the ones that I use, or acrylics. We don't use the hard lens anymore. We get your measurements at the pre-surgery workup. Then we choose a lens based on the size of your eye, the length of your eye, and the cornea curvature of the eye.Then we choose that lens that will bend the light rays appropriately and put it right on the retina.The lens has rings that change the focal point and is engineered to do what it's supposed to do.

Q: Does a toric lens change the shape of the eye?

A:  I'm not changing the shape of the eye, I'm just putting in a lens that treats that inside the eye. LASIK changes the shape of the eye. LensX changes the shape at the corneal surface, and that's very successful. The Femto laser used in cataract surgery can only fix a partial or small amount of astigmatism. So without having LASIK, we really like the toric lenses for when there is a greater amount of astigmatism. Toric has been a nice addition to our armament.

The Cataract Testing Process

I'm just going to tell you a little bit about our cataract process, which is pretty individualized. In Rochester, we're the only one that does the process this way. We do it all in one visit. Most places do it in two visits, but we know how busy you are and we know that it's hard to get to doctor's appointments, so we combined everything we need into one visit.

The one visit is a long appointment, it's one and a half to two hours. You would come into our office, which most of you saw and if you didn't see it, please stop in and see the office. It's beautiful. We just renovated to two years ago.

So you start with a specialized tech that does your basic eye exam. She does all the testing we need to do for your cataract surgery. She's taking pictures of your eyes. She's doing a test called an IOL master, and that's what determines what lens and what lens strengths that we're going to put in your eye. After that, we're going to put you in a room and either Beth or I will come in and talk to you. We will give you the spiel, that we kind of just gave you, in more detail.

This is what's going to happen during this appointment. Dr. Lindahl's going to come in he's going to take a look at your eyes and determine what you're a good candidate for. We're going to look at your health history, what meds you're on. We're going to look at what your lifestyle is, like what your hobbies are, if you're retired, if you're working. All of these things go into how we determine what would be the right lens for you.

We meet for 10-15 minutes and Dr. Lindahl looks at all the testing you just had. He takes a look at your eyes and tells you what he thinks that you should get based on all the information. Then Beth and I go into an office with you and and let you decide what your options are. That's the whole appointment.

We schedule all your appointments, which would be two surgeries, usually about a month apart. We do one eye at a time. We do one eye and then about two weeks later we do your second eye. We see you the day after each eye. We see you again a week after your first eye to get you ready for your second eye, and then we see you, or your regular eye doctor sees you, three weeks later. We make all those appointments for you at that first work-up visit.

Usually we're scheduling surgery out about a month from your work-up visit, but it doesn't have to be like that. If you come in and have all the testing, as long as you have the surgery within a year, we won't have to bring you back again for re-testing.

Some people go home and think about it. It's up to you. If you want to finish the appointment today, so that you don't have to come back again, you can make your decision today. If you don't mind coming back again, to do the consents, and the financials and everything have to be specific to the lens, so we would need you back to complete that. So, if you couldn't make a decision that day, absolutely you can come back again.

Cataract and Diabetes

Q: Are there any long-term risks for people with diabetes?

A: We pay close attention to diabetes. It's an excellent question. If someone has diabetes, but there's no changes in the back of their eye, there's no diabetic retinopathy, then the risks are the same as a non diabetic. If they have some swelling on the back of the eye that's due to diabetes, then there are a couple of additional risks. Most of the risk has to do with swelling after the surgery. We actually treat them a little different with drops afterwards. If they have a retina doctor, the retina doctors often will treat either a couple of weeks before cataract surgery, or a couple of weeks after, to try to avoid any issues.

Q: My sister had the cataract surgery and then she had to go back and have it tweaked. Was that the laser?

A: The most common thing we have to do, within one to three or four years post-op, is a laser to tidy the capsule that we leave in. Your own cells can grow over the back part of that capsule and it causes sort of a haze in your vision. It'll be like looking through a dirty windshield and we clear that up with a simple laser. That's the most likely thing that needs to be done after.

There's an occasional patient that may have to have a different lens put in. We rarely would have to explant the lens and put in another one. That would be very rare, but that can happen.That's a simple procedure, but you have to go through it again and take the old lens out and put in a new one. This is the kind of education that Beth and I would go over before the surgery. I give you a copy of the lens options.

Cataract Surgery & IOL Lens Options & Costs

If you want to look at the lens options sheet (https://www.rochestereyecenter.com/cataract-advanced-lens-options), I will talk you through it. There are different options of what you can get. It really depends on your eye health, what other problems you have, and what you would be a good candidate for. Some people can't get the laser because they have some corneal issues, or there's something going on in the back of the eye, so basically that's what we're determining. These are all the different options we offer.

The first category is just a standard cataract surgery. That's manual surgery and that's putting in that monofocal lens. This first category is going to help you with distance vision. The monofocal lens helps with distance. The only out-of-pocket expense you would have here is whatever your copay or deductible would be. You can look at your insurance card today and call your insurance company and say, "I'm having cataract surgery at the Brighton Surgery Center, could you tell me what my copay will be when I go there?" They'll tell you exactly what it's going to be. Your co-pay is the only out-of-pocket expense for the monofocal.

The second column is the toric lens, the astigmatism correcting cataract surgery. This category is going to help you with the distance vision but it's also going to fix your astigmatism, if you have one. Out-of-pocket cost is approximately $2300, and that includes the laser as well. That includes all of our fees, and then all of the surgery centers fees. In order to use the laser you have to pay the surgical center because insurance doesn't cover it. You have to pay for the lens and Dr. Lindahl's professional fee. We offer 0% interest financing for two years to help your pay for it.

The third column is the advanced technology lens. It's the multifocal lens that we talked about, that's going to help you with near, intermediate, distance and astigmatism. That one is approximately $3,100 also available with 0% financing.

The only other option is if you were getting the monofocal lens, but wanted to fix a small astigmatism with the laser. That's the next column. The laser alone with a monofocal lens costs approximately $1200 per eye.

Dry Eye Treatment (LipiFlow)

The last column is one of the treatments that we do for Dry Eye. If you come in and you have really bad Dry Eye, we would do a dry eye workup.

There are different reasons why people have Dry Eye. Sometimes the glands underneath your lid that secrete oil, as we age, basically everybody over 40 years old, they start disappearing. Then your eye is not producing that oil layer. There are two layers, then there's a fluid layer. Your eye dissipates the oil. Dry Eye prevents it from dissipating, so if those glands aren't working well, what happens is your glands get goopy and they're not draining and then they die. So LipiFlow which is like a spa treatment for the eye and it's like a massage. It massages those glands open.

You have something like 25 glands that go across your eye. If they die, they never come back. We're not trying to get them back, we're trying to preserve what you have, because once you lose it, it's gone forever. If you see people with really irritated looking eyes, it's because they probably don't have any glands left. You want to preserve what you have.

The LipiFlow treatment takes 12 minutes. You're in room for about 20 minutes. We try to make it last two-to-three years per treatment. You can make it last longer by doing the right things in between, which would be artificial tears four times a day, like high-quality artificial tears. You can also use warm or cold compresses, at least twice a day. We encourage people to use flaxseed or extra-virgin olive oil in your cooking, or omega-3 oils. That will help keep things good too. These suggestions make the LipiFlow treatment lasts longer and keep those glands cleaned out.

To determine your level of Dry Eye, we need to take a picture of that lid. We use a machine that flips your eyelid, it doesn't hurt, it takes two seconds, no big deal. We take a picture of your glands. Then we do one other test that tells us if this a fluid issue, or is this a gland issue. We determine the treatment after we determine what your problem is.

LipiFlow is literally like a spa treatment. You're laying down in a chair and we just put two applicators in your eye and it just massages those glands. We don't need Dr. Lindahl to do it, Of course he orders what you need.

Dry Eye is covered by insurance but only if you needed eyedrops and that depends on your individual insurance company. They do cover the eye drops but they don't cover LipiFlow. A LipiFlow treatment is $600. We offer one year, 0% interest financing, which is $50 per month for 12 months.

Dry Eye really affects your vision. People go to eye doctors for years and then come here for a cat consult and they obviously have had dry eyes for years and they were never treated. The first thing we say, is forget the cataracts right now, let's figure out this dry eye. Make sure you go into a good doctor that's actually knows dry eye. Make sure they're doing the correct test and that you're getting a good dry eye workup.

Some signs of dry eye, if you don't know are, fluctuating vision throughout the day. If you have a cataract and it's affecting your vision, that's going to fluctuating vision all day. It's not going to change throughout the day. If you have dry eye, then one part of the day you're blurry and then later it will come back.

We learned about these new wipes because part of dry eye could also be bacteria that forms on your lashes and it clogs things up and causes dry eye. If you saw the pictures of it, you'd be like oh my God. It's a little mite you can see under the microscope. We sell these wipes in the office now. They are tea tree wipes which kill that bacteria or mite. We want them dead. These wipes are only sold in ophthalmology offices and they're truly made just for this. They're great! We're all addicted to them because they also help with wrinkles. They have skin moisturizer. So you do your eyes and then you go around your whole face. They are around $20, but they last for a long time. There's 60 of them in the package. Instructions say to use one for each eye. I use one side and flip it over and use the other side, so they last two months. I have my kids use it because they also help with acne, so it's like a miracle drug.

Then we also sell really good artificial tears called Oasis. They're so great that they can't keep up production. They're just very lubricating and people find that they have to use less throughout the day than the normal restasis or sustain drop. We started selling them in the office because people would be confused when the got artificial tears. They would see that wall of eye drop rows at Walmart, so we thought it's just easier if we sell them. Then they know they're getting the right ones. They're preservative free and it's a multi-dose vial, so that you don't have to carry around all those separate tubes. It's better to get preservative free because there it's less irritation on your eye.

There's a new treatment that's the final treatment if nothing else works for a patient. They can draw a patient's blood and spin it down to take the plasma out. They then make a tear out of your own plasma. We send our patients to Strong Memorial Hospital, because they're the only ones that do it in Rochester. You shouldn't have a reaction to it because it's your own plasma.

Cataract Conclusion

We don't sell, we educate you on what all the options are, and then you make the choice. We're not pushing this advanced technology. If we didn't offer it, it would be a disservice to you because then you would go back to your friend and be having lunch and they would say, "I got this lens I don't need any glasses for this menu." Then patients would come back and say, "Why didn't I get that lens?"

We offer everything to every patient but we do not push. It's ultimately your decision. It's all based on your goals. In some cases, we try to persuade patients to do things. I had a patient that had a four or five diopter astigmatism, which is the worst we've ever seen. He just wanted the monofocal lens. He had Parkinson's disease and was already falling and then also had terrible vision, like a minus ten. I finally talked him into a better lens and he literally came back with gifts for us. He's like, "I have never seen like this ever, in my whole life." I brought his son in and I'm like, this needs to happen, so you guys have to figure it out, because it really needs to happen. It's going to change his life and it did. So some people we try to lead.