I’m 58 years old, and have cataracts developing. Besides that, I’ve been mildly near-sighted for the past 45 years, and I have a little presbyopia, as one might expect at my age. Other than that, I’ve been told my eyes are free of any other defects. I am interested in exploring the possibility of cataract surgery. I'm not at the point where I absolutely have to do anything yet, but I am ready to consider it, and I recently scheduled a consultation with an ophthalmologist to explore my options.
When I first got there, they gave me a video presentation to watch that turned out to be (in my opinion) mainly a sales pitch for multifocal intraocular lenses. It talked about how unsatisfactory the results of cataract used to be before IOLs, and then it went on and on and ON about how whatever brand of mutifocal IOLs this particular doc uses were the greatest thing since sliced bread, and how many patients didn’t need to wear glasses at all afterwards. Very little information was provided about about monofocal IOLs, but the implication was that they would be a very poor second choice.
Later on, after the doctor completed my exam, we started to talk about the surgical options. He began by informing me that nobody's insurance covers the extra cost of multifocals. NOBODY'S. EVER. I have no idea if that's even true, but at the time my interest in multifocals pretty went out the window, since I don't see any way I can afford to pay the added costs out of pocket. So the conversation naturally switched to monofocal lenses...and that is where things pretty much ground to a halt. He was extremely reluctant to share any information that would give me any idea what I could expect my vision to be like with monofocals. The only thing he would say was that I "should be able to see better WITH GLASSES" [he emphasized "with glasses"] afterwards. That sounded pretty vague to me, but when I attempted to find out more he would NOT answer my questions.
I should interject here that I had done quite a bit of research prior to seeing the opthmalologist. I had read about the various IOL options and felt I knew a bit about them. In particular, it was my understanding that monofocal IOLs can provide clear vision within SOME limited range, either close up OR farther away, but you need glasses to be able to have a full range of vision at various distances (near, far, and in between). I had read that the most common scenario is to use iols that provide decent distance vision, in which case one would then need glasses for reading, closework, and possibly for in-between ranges. I had also read that it was possible (though less common) to choose the option of having good closeup vision without glasses and relying on glasses for distance tasks like driving (and possibly for some intermediate tasks). The second option is more appealing to me. With my mild degree of near-sightedness, I have NEVER been 100% dependent on glasses. Until very recently, I had excellent closeup vision and didn’t need glasses for reading or other closeup tasks. Even though I have worn progressive lenses with a reading prescription in the bottom part of the lenses for years, I used to be able to see BETTER up close and read more comfortably WITHOUT glasses and was in the habit of taking my glasses off to read until quite recently. It's only been in just the past few years that I've been gradually having to rely more and more on glasses for seeing up close with the result that I am more dependent on glasses than I’ve ever been before. Even now, I take them off a lot. (I actually HAVE to take them off to use the computer, because I can’t see the screen properly with any part of my progressive lenses.)
So that’s where I was coming from. prior to my visit with the ophthalmologist. I want to empahsize that I already knew going in, even before he said a word about it, that I would have to continue to use glasses after cataract surgery with monofocal lenses. I accepted that that was a given, and I was fine with it. I didn’t think I would have to be 100% dependent on glasses for absolutely EVERYTHING, though. From the research I had done, I THOUGHT I would have to use glasses some of the time, but necessarily ALL of the time. Furthermore, since I am not 100% dependent on glasses NOW, I’m not interested in going ahead with the surgery yet that’s what it would mean. My cataracts are not bad enough yet that I’m ready for that kind of a trade-off.
When I attempted to explore the issue of whether I would be able to see ANYTHING AT ALL without glasses, he flatly refused to discuss it. All he would do was repeat that I would “probably” have better vision “with glasses.” When I attempted to reframe my questions and explain where I was coming from and what I wanted to know, he REPEATEDLY accused me of “demanding guarantees.” I can assure you I DID NO SUCH THING! All I wanted to do was get more information about the range of possibilities that might be available with monofocal lenses. But the more I tried to explain that I didn’t expect ANY guarantees and just wanted INFORMATION, the more he behaved as if I was TOTALLY out of line. He seemed to think it was unreasonable of me to ask ANY QUESTIONS at all about whether I might be able to see anything whatsoever without glasses after having monofocal IOLs implanted. After going back and forth for a while and being accused over and over again of “demanding guarantees,” I was in tears. I am not a person who cries easily as a rule, but I left that place SOBBING.
I am still confused about why my questions were so objectionable to him. I didn’t feel that what I was asking was unreasonable, but he made me feel like I had done something TERRIBLE, like I had broken some unwritten rule regarding what kind of questions one is allowed to ask an ophthalmologist. The only definitely decision I made that day was that I never want to darken THAT doctor’s doorway ever again. I’m sure I’ll have cataract surgery sooner or later, and I am equally sure that HE will not be doing it. Beyond that, though, everything is still up in the air.
I’d like to see another ophthalmologist, but at the same time, I’m afraid to. I don’t want to go through that again. If that’s how most ophthalmologists view the type of questions I was asking, then I guess my only option is to stay away from them until my vision is bad enough that being 100% dependent on glasses won’t sound so bad by comparison.
What kind of questions ARE okay to ask? Was I completely off-base to think that with monofocal IOLs I might be able to have ANY usable vision at all without glasses? Everything I’ve read leads me to believe not, but this ophthalmologist seemed to strongly feel otherwise. He’s the expert. Isn’t he?