St Croix River Road Ramblings

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Monday, November 14, 2016

Cataract Surgery record and cost estimate

11/11/2016 Cataract Surgery Details
(This is my medical record of the left eye cataract surgery.  My comments are in parenthesis).  
Date of Surgery: 11 NOV 2016
Visit Type: Outpatient
PostOp Diagnosis: Senile cataract, left eye.  

(Not sure if the cataract was senile or the patient)

Procedure: > Phacoemulsification with implantation of a Toric intraocular lens, left eye.
(slice and dice the old lens suck it out and put in the new one)

Lot/Serial #: 21136080007, Catalog/Model #: sn6at5-17.0D, Implant Name: lens, toric aspheric sn6at5-17.0, Manufacturer: Alcon Laboratories.

(information as to lens information for possible recall.  I wonder if the serial number is written into the lens so my body could be id’d by it like breast implants -- maybe a bar code?)

Implant Placement: Left In the preoperative holding room, the horizontal meridian of the left eye was marked with the patient in the upright position using the Toric lens marking system. The patient was then brought to the operating room where the correct surgical site was confirmed with the patient, the medical record, and all members of the surgical team.

(with the Sharpie pen marked top and bottom for lens on my skin around the eye )

Under monitored anesthesia care, a retrobulbar injection of 2% lidocaine solution with hyaluronidase was given. With adequate anesthesia and akinesia, the left eye was prepped and draped in the usual sterile fashion. A lid speculum was placed to retract the eyelids, and the operating microscope was rotated into position. Using the markings that had been placed preoperatively, the 65-degree meridian was identified and marked using the Toric lens marking system.

( draped -- Covered all of my head but my left eye hole opening with a Menard’s-like tarp, numbed it and propped it open, and got the microscope in place to magnify the eye area.  The doctor didn’t use his naked eye to see what he was doing, but a highly zoomed in view to see all the tiny details of my eye)

A paracentesis was then created at the inferotemporal limbus using a No. 75 blade. Through this limbal paracentesis, the anterior chamber was inflated with Healon Endocoat. The anterior chamber was entered again, this time through the temporal limbus using the diamond blade. A capsulorrhexis was initiated using a bent 25-gauge needle as a cystitome and was completed in continuous and circular fashion using the capsulorrhexis forceps.
(cut a tiny opening into the eye lens lining and got the ultrasonic probe into the lens area)

The lens nucleus was then hydrodissected and hydrodelineated using balanced salt solution injected through a 27-gauge cannula. The phacoemulsification tip was introduced into the anterior chamber and was used to sculpt two perpendicular grooves in the lens nucleus. Using these grooves, the lens was mechanically disassembled into four equal quadrants, each of which was emulsified and aspirated in turn.

(using salt water, pressured syringed the old lens loose from its covering -- the lens capsule, Then using the tiny ultrasound probe like a knife, cut the old lens into four pie wedge sections and then broke each of those four into tiny fragments and sucked them out)
The residual cortical material was removed using the automated irrigation-aspiration handpiece, and the capsular bag was polished with the irrigating polisher. The capsular bag was reinflated with Healon, and the wound did not require enlargement.

(Cleaned up the lens parts. The old lens was held in a capsule (lining) and polished that smooth and clear so all of the old lens was out and ready for the new one).

A 17.0-diopter single-piece acrylic Alcon model SN6AT5 acrylic Toric intraocular lens was loaded into the injection cartridge and was inserted into the capsular bag where it was allowed to unfold in its appropriate position. The lens was oriented at the 65-degree meridian as suggested by the Toric lens calculator.

(Inserted the new lens that was folded up tiny, and then unfolded it into the right spot and adjusted it to be lined up for the astigmatism angle.  Toric is the name for a lens with astigmatism correction built in -- an additional $1000 cost to me, but worth it as it will actually mean I can see distance without glasses).

The lens power selected was based on a careful review of the optical biometry measurements (IOLMaster) that were obtained preoperatively. The residual viscoelastic material was removed in its entirety using the automated irrigation-aspiration handpiece, and the wound was demonstrated to be self-sealing with no suture required. Cefuroxime was instilled into the anterior chamber at the conclusion of the procedure. The lid speculum was removed, and the eye was patched with Maxitrol, following which a shield was placed.
(With everything correct, and the tiny opening so small no sewing up needed, everything was removed, and a few bandages and a shield taped over the eye)

The patient tolerated the procedure well, and there were no complications. The total phacoemulsification time was 42.7 seconds with an average phacoemulsification power of 29.9%. The cumulative delivery of energy (C.D.E.) was 5.16. The patient returned to the preoperative holding room in satisfactory condition.
(The time on the machine to get rid of the old lens was 42.7 seconds,  Probably the machine cost is about $1000 per minute so maybe the time is to charge for that very expensive unit).  

The Medicare estimate of cataract removal appears to show that my cost is $728.  I think my supplemental insurance will cover most of that. I selected a $1000 extra option for the Toric lens to get rid of the large amount of astigmatism in my eye.  I always figured the astigmatism was in the lens, and that it would go away with a new lens, but it is in the cornea in front of the lens which is not replaced in cataract surgery.  The cornea can be fixed with laser surgery sometimes -- what they call Lasik I think.  Anyway I chose to deastigmatize with the lens.  

Medicare estimate  (I pay about $728).  
I chose the Toric astigmatism correcting lens so that added $1000
My Medicare supplemental insurance will likely cover most of the $728 if I have my co-pay deductibles for the year paid already.