?>

Blog

Why Do I have to Pay Out of Pocket for C...
June 8, 2017
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 extra out of pocket it for it....

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 extra out of pocket it for it.

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 those questions, you will first need a little history of both cataract and refractive (correcting errors of refraction such as nearsightedness, farsightedness and astigmatism) surgery.

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 so they fit through a tiny incision 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 means other than surgery, 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 not only to get your cataract removed but also to have your astigmatism (irregular shape to cornea) and presbyopia (the inability to see well up close that hits nearly everyone in their 40’s) corrected.

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 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.

Eyezen lenses: relaxing eyes to help protect visual health

​Digital devices and usages are increasing the demands on our eyes. Closer and variable reading distances, smaller and more pixelated characters and longer exposure to screen glare are causing tired eyes and potentially exposing our eyes to the longer-term consequences of harmful blue-violet light. As many as three out of four people feel that they suffer from visual fatigue.   Eyezen is a new range of lenses designed for a connected life. It draws on extensive Essilor research, and includes two important technologies. The first: Eyezen Focus lens technology brings extra power optimized according to wearers’ profiles in the bottom part of the lens to support the eye’s effort in focusing at ultra-near distances that are typical of handheld devices. The second is Light Scan, a unique light filtering technology drawn from Essilor’s landmark Crizal Prevencia innovation, which protects eyes from the harmful blue-violet light emitted by digital screens.

Within the Eyezen range are different types of solution. Essilor Eyezen are new single vision lenses for permanent wear available in different design optimizations. These support eye focusing efforts according to the physiological needs of three age groups (young adults aged 20-34 years, pre-presbyopes aged 35-44 and emerging presbyopes 45-50 years). Varilux Eyezen are new multi-focal lenses for occasional wear specifically designed for the digital activities of presbyopes. They exist in three designs optimized according to type of screen most used - smartphone/tablet, computer or large screen (TV or projector).  In addition to existing personalization parameters, Varilux Eyezen lenses also offer an exclusive new personalization parameter - screen distance (vision distance to computer screen) to match individual intermediate vision needs. ​ Eyezen lenses represents the latest in Essilor technological innovation – both relaxing eyes from digital eyestrain and contribute to protecting visual health over the long-term.

Essilor®, Eyezen™, Light Scan®, Crizal® Prevencia®​  and Varilux® are trademarks of Essilor International.

Dry Eye Syndrome is characterized by itching, burning, gritty, red eyes. There are many causes for Dry Eye and, consequently there are many treatments.

Your tears serve many important functions. They wash out debris, keep your eyes moist and have special enzymes that neutralize microorganisms that colonize your eyes. Tears are made up of three layers, the lipid, aqueous and mucus layers. The lipid layer is the outer oily section, the aqueous layer is the watery middle part, and the mucus layer is the inner section closest to your cornea. The layers are produced by different glands in your eyelid and a problem with any of them can cause dry eye syndrome. If left untreated, dry eye can cause tissue damage and scarring of the cornea, leading to major vision problems.

There are many factors that can cause dry eyes. Age, certain medications, insufficient blinking, chemical composition of tears and environmental factors like sunlight, wind, dust and smoke. Dry Eye is also the number one complaint of people who wear contact lenses. With all of these potential causes there are also a variety of ways to treat dry eyes.

Artificial tears drops can help simulate tears in your eyes, reducing redness and clearing vision. Wearing sunglasses, cleaning furnace and air conditioning filters, avoiding smoke and using a humidifier can also help you reduce dryness. If you are having problems with a medication or if you wear contact lenses and are experiencing dry eyes, consult with your eye care provider to explore other options.

Because of the wide array of causes and solutions for dry eye, make sure to visit with your eye care provider to determine the best solution for you.

April is Eye Safety Month. Step #1 to ensuring the safety of your eyes is to schedule an eye exam with your optometrist.

Step #2 is making sure to wear sunglasses.

Join us April 1st for special savings on sunglass brands like:

  • BeBe
  • Vera Wang
  • Michael Kors
  • Nike
  • Oakley
  • and more!

Keep your eyes healthy this Spring.

Sincerely,

Dr. Paul, OD and Staff

In trying to answer the question of how blue light affects eye health we need to explore several topics.

Sunlight Exposure and Damage to the Eye

There have been multiple studies over the years that have shown excessive exposure to sunlight might cause damage to the eyes and the eyelids.

There is a very strong association with exposure to ultraviolet light and the incidence of skin cancer on the eyelids.

Research has demonstrated that exposure to sunlight also increases the risk of cataracts.

These studies include:

  • Chesapeake Watermen Study (Taylor et al. New Engl J Med. 1988; 391:1429-33.)
  • Beaver Dam Eye Study (Cruickshanks et al. Am J Public Health 1992; 82:1658-62)
  • Salisbury Eye Evaluation (West et al. J Am Med Assoc. 1998; 280:714-8)
  • Blue Mountains Eye Study (Mitchell et al. Ophthalmology 1997; 104:581-8).

The majority of this research implicates the UV portion of sunlight as the source of the damage, not blue light.

So where does the blue light problem come in?

Blue Light and Its Potential Effect on the Retina

Most of the evidence pointing to the potential detrimental effects of blue light has been inferred from an accumulation of several experimental studies, rather than any studies of direct correlation

A study by Han et al. (Nature 1976; 260:153-5) demonstrated that the retina of a rhesus monkey was most sensitive to shorter wavelengths of visible light with a maximum sensitivity at 441 nm, which is in the violet/blue spectrum.

Some of the studies mentioned previously that demonstrated a connection between sunlight exposure and cataracts also showed some increase in the amount of macular degeneration seen later in life in these same patients. Since UV light is almost completely absorbed by our own natural lens, the portion of sunlight that reaches the retina is the visible portion of light. Experimental evidence has shown that it is the blue/violet end of the visual spectrum that is the mostly likely cause of retinal damage.

The Beaver Dam eye study mentioned above showed that people who reported more than five hours of summer sun exposure in their early years had a higher rate of early macular degeneration. And since it appears that the blue/violet end of the visible spectrum causes the most retinal damage, it infers that blue light may be the major culprit.

Blue Light and Sleep

Blue light suppresses melatonin receptors. Suppressing these receptors helps improve “wakefulness,” so exposure to blue light during daylight hours helps keep us awake and attentive.

This same exposure to blue light in the evening may inhibit your ability to get to sleep by suppressing those same receptors.

Therefore, it might be wise to limit your exposure to screens on cell phones, tablets and E-readers in the hour or two before bedtime if you are having trouble falling asleep.

Another alternative is to wear blue-light-blocking lenses when using those devices in the evening. Wearing those same glasses in the daytime might actually decrease your attentiveness.

So What Should You Do?

Remember, the strongest evidence that light causes health problems is still the damage that can be done from the UV spectrum in sunlight. Cataracts and eyelid skin cancer are both strongly correlated with sunlight exposure. A good pair of sunglasses during daylight hours is the most important health benefit you can give yourself when it comes to protecting yourself from light damage.

As far as blue light is concerned, it might make sense to consider blue-light-filtering lenses if you are staring at light-emitting screens all day, particularly in the evening hours when exposure to blue light might throw off your sleeping patterns. The evidence that blue light exposure is a definitive risk factor for macular degeneration, especially at the levels given off by screens as opposed to sunlight, is much less clear.

So the answer is, there some evidence that there are some real possible health risks with exposure to blue light. But the degree of hype the subject is getting - especially by some specialty eyeglass makers - might be out of proportion to the degree of evidence that these effects are truly harmful at the levels to which we are currently being exposed.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

After a lot of hard work with EyeMotion, our website company, we’re pleased to be launching our brand-new website.  Our goal has been to create a site that would assist you in learning about us, whether it’s finding our location or email form, reading about our wonderful eye doctors, or discovering some of our quality products and services.

Have questions about an eye issue?  We think you might also benefit from our great optometric content on eye diseases and conditions.

Our plan is to use this area to keep you informed on new offerings, sales, trunk shows, events, and so much more.  Check back here from time to time to keep updated.

We’re glad you found us, and we hope to see you soon!

Patient Testimonials