Cataract Surgery

How much a Cataract surgery cost in India?

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Cataract surgery has no fixed formula to calculate a cost, but there are few rules which worth to be mentioned to help decide right place get operated. Having a relative getting operated is often a ‘once in a lifetime’ experience, and biggest question is how much is it going to cost. Am I been quoted a fair price or I am getting fooled. 

Surgery packages:

Most of the cataract surgeons in India practice what they call as surgical packages for what they charge for doing cataract surgeries. It is mainly limited to uncomplicated age related cataract done under without giving the general anesthesia.

The” Package” include, pre-operative examination, surgeons fee, surgery charges, anesthesia charges, medication given during and before surgery, cost implant (Lens) and hospital stay. it varies from, hospital to hospital , surgeon to surgeon, city to city, type of surgery ( SICS> Phaco> Femto Laser) , type of lens ( Indian Mono-Focal > Indian Multifocal> Multifocal )  and so on. Cost may vary from 10k -150k depending on the combination of doctor, hospital, surgery, lens you have chosen for you.

Cost of the post-operative drugs and additional intervention after the surgery are usually separate.

How to confirm that you have got what you have promised?

At the time of discharge, patient gets the discharge and treatment summary, which mentions name of surgeon, anesthesia, details of surgery and details (name and brand of lens) implanted in the eye. Brakes down of the charges for each item are usually not provided.

Can you bring the lens of your own and hospital to implant it?

Most of the hospital gives a fairly long list of Lens to choose from. One can choose from the available options. Hospitals usually do not allow surgical implants and disposables from outside. It is because hospital has to maintain a huge inventory of each and every disposable and lens in different sizes and numbers and often in multiple numbers as the backup. If a lens or any disposable gets damaged or contaminated while handling it during implantation, hospitals have multiple similar pieces in back up. It is not possible if patients bring a single piece from outside.

More over surgeons often have expertise and a certain comfort level with certain brands of lens, which they implant daily. Most of the surgeons have serious reservations against trying a new lens, in that event of stress of doing a surgery. So they usually do not agree for this.

Brands of Lens

There are many different types of intra-ocular lenses available in India. Most surgeon/hospitals offer surgical packages based on Indian (cheap) and imported (expensive) lenses. Imported lens are costlier than their Indian counterpart and are preferred by both patients (rich) and doctors alike. There are no scientific studies which validate the difference in the quality of the two, this notion continue due the common perception that imported goods are superior in quality.

Indian versus imported lenses

In eighties and nineties, when ophthalmologist began to switch to lens implantation (rather than leaving the eye without the lens and giving the patient thick glasses). At that time the lens needed to be imported from US and Europe, as there were no lens manufacturers in India. Though the imported lens were of good quality but were very expensive. In nineties some Indian companies started manufacturing lens in India. The lens manufactured were quite cheap, but the quality wan not as good as those of the imported once.

Now days there are many Indian companies who are manufacturing the lenses in India, and also exporting it to many other countries, which include US and Europe. Since they have to meet stringent FDA and EC guidelines for that, overall quality of lens manufactures in India matches with any of the manufacturers from abroad.

So in my view, it as far as the  quality  of the comparable lens (similar lens material and design) is concerned, there is no difference.  The imported Lens usually cost 3 to 5 times as much as an Indian lens. Various government bodies are raising concern of this pricing of the lens in India. Quite likely, we may have some government regulation on price control of lens, in day to come.

Imported: Alcon, AMO, Zeiss, Bausch & Lomb, Hoya.

Indian companies: Appasamy, Omni, Aurolabs, Biotech, Care,

Foldable lens versus non foldable (rigid) lens?

Foldable lenses are more popular and expensive that their non-foldable (rigid) counterparts if all other parameters are same (design, brand, country of origin). There are only two scientific studies (one from Thailand, other from France ) which were designed to see the difference  in the vision and other outcomes after the surgery, among these type of lenses. Neither of the two studies reported any difference among the two.

Tips regarding selecting lens packages in cataract surgery.

  • Surgery packages: 10K-150K INR chose as per your budget.
  • How to confirm that you have got what you have promised?  Discharge Summary 
  • Can you bring the lens by your own ? No 
  • Which Brands of Lens is better? All are same. 
  • Indian versus imported lenses, which are better? All are same
  • Fold-able lens versus non-fold-able (rigid) lens, which one is better? All are same

Also read

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Cataract

Inappropriate cataract surgery: is it a myth or reality ?

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There have been media reports in which the doctors and the hospitals have been accused of performing cataract surgeries when these are not actually required. The question is, are these really fake news or are actually happening?

Media reports a recent media report, attributed rapid rise in the number of certain type surgeries being done at various hospitals , to the fact that some of these surgeries are been done for economic reasons only. The patient may not have actually needed one. Among the many surgical procedure, the cataract was reported to be the commonest.

Targets to meet: News report say that in corporate hospitals, the doctors are pressurized to perform more surgeries to increase the corporate profits as surgeries offer greater financial return in shorter time. Consequently some of the patients are advised to undergo cataract surgery in spite of the fact the patient can manage without it. It further suggested that those who are advised to undergo surgery should better have a second opinion, which is very much concerning. Similar concern are also been reported from advanced counties as well.

The Optometric-Ophthalmic Kickback Scheme: Dr Robert P. Gervais reported the arrangement of kick back system practiced in US, in which patients are predominantly operated to make money, by ophthalmologist in cooperation with optometrist. It is surprising that it is practiced in a country like US where documentation and other regulations are so diligent followed. The scenario could be much worse in India where it is difficult to enforce government regulations.

Also read: 

cataract surgery : an ultimate patients guide
How much a Cataract surgery cost in India?

 

Scientific reports: a number of scientific publications have reported the documentation of performing unnecessary surgeries to be as high as 30 percent for certain type of surgeries. Practices of unnecessary surgical procedures in Indian scenario are been well documented in case of caesarean deliveries and hysterectomies under government insurance schemes .

Government stand: a senior government minister have expressed concern on this issue and share the perception that kick back, cut and commission is prevalent in some segment of practice. They have also ” considering to bring some type of oversight for pathological laboratories and diagnostic centers to end the corrupt practices including possible nexus between doctors and the laboratories, and cartelization among diagnostic centers

Doctors and representative medical bodies: They largely dismissed the concerns over profit-driven tests and procedures as a “perception,” saying corruption is less widespread than the media would have it appear. “The medical profession is noble and will remain noble,” “There are people who are corrupt, they are facing charges and they are being punished.”

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Credit: Pixabay

Conclusion: Though the actual figures may actually be debated as what percentage of doctors are indulging in these kind of practices but these reports certainly points to the maligning of reputation of whole profession. These will only add to stricter government regulation and legal scrutiny of clinical practice and practitioners.

Please share your comments below.

Cataract Surgery

Cataract surgery: an ultimate patient’s guide

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What should you do if you are told that you have cataract. It’s a step wise guide to help you decide what to pick when you have multiple options to choose. The aim is to enable you to take an informed decision at every cross road of your treatment plan.

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You had  problem in reading the fine print in the newspaper . You went to a doctor and he/she says you have cataract. You ask him why is it has happened, and he/she consoles you that it’s simply because of aging and not much you could have done. When you ask him/her, what should you do, the often the answer is “go for surgery”.

Such an experience leaves a patient with more question than any answer to his problem. here is the list of steps you should take to handle it.

Step one: Do not panic.

Cataract is a very common clinical condition and is treatable.

At any point of time, there are about 20 million people in whole world who have cataract, and about third of them are in India. Around half a million people undergo cataract surgery every year in India alone, which means that it is very much treatable. Internet has lot content on this topic, but I would recommend NIH and Wikipedia as reference sites for basic information about cataract. Do not correlate that information with your case as it will leave you more confused.  Ask you doctor the questions you have about yourself.

Step two: Confirm why you developed the cataract?

Usually its age, but there could be others reasons also. There are many types cataract, and many ways to classify it. Do not try to find the answers on internet because it require lot of professional expertise to decide the cause. Just because you have , diabetes, does not mean you are having a diabetic cataract.  Ask your doctor to explain. Its important to know the reason . discuss with your doctor, the other medical conditions , you have,  like diabetes, hypertension, asthma, thyroid dysfunctions etc.

Step three: Do you actually need surgery?

Just because you have the cataract, does not automatically means you immediately require surgery. Mostly it is the compromised vision resulting from the cataract that people decide to have the surgery. Sometimes there could be other reasons as well, which are decided by your doctor only. You should discuss with your doctor, the extent to which your vision is compromised due to cataract, in involved eye and with both the eyes open, and the likely visual gain after cataract surgery in these situations.

An important reason for people to be unsatisfied with surgical outcome, is the lack of significant improvement in vision after surgery. You should also discuss what exactly is the room for improvement in your vision after surgery, in involved eye and with both the eyes open.

Step four: Can it be postponed?

Mostly it is not an emergency. Discuss with your doctor, about the duration for which it can be conveniently postponed. Cataract due to aging, unless contraindicated by the doctor, can be easily postponed for few months to accommodate more pressing employment and family matters.

Step five: when to get operated?

I think the two conditions mentioned below should be met before surgery is planned in age related cataract.

  1. Reasonable expectation of improvement in vision after surgery
  2. Stable associated diseases like, diabetes, hypertension, asthma etc.

Step six: where to get operated?

There are no rule of thumb to identify a good hospital from the rest, but certain general guidelines may be followed.

  1. Prefer a hospital/ facility which accredited by some accreditation agencies like NABH in India.
  2. Dedicated eye hospitals have better developed facilities for eye care that an eye department in a multi-specialty hospital.
  3. A facility with multiple eye surgeon practicing different eye specialties has better services than single surgeon facility.
  4. If you have personal acquaintance with the reputed individual surgeon, that’s the best choice.

Step seven: what type of surgery should you have ?

Most commonly surgical method for age related cataract is Phaco-emulsification with posterior chamber lens implantation, commonly known as Phaco. It’s neither required nor  possible in every patients.  There are other surgical methods also which are required in certain conditions in certain types of patients. You should discuss with your doctor which surgery is best in your situation. You should never insist for a particular type of surgery with your doctor.

Step eight: what type of anesthesia should you have ?

It’s same as surgery. Topical anesthesia in which the eye is anesthetized with a drop of anesthetic, is common way the age related cataract is operated, but there are other methods of anesthesia which are required in certain situations. You should discuss with your doctor which anesthesia is best in your situation. Insisting for surgery under topical anesthesia only, is a bad idea.

Step nine: what type of lens should be implanted ?

Posterior chamber lens are commonly used, unless it is not possible to implant that lens in eye due to medical reasons. They rigid and fold-able. Fold-able lens are better. They are available by different brands, and place of manufacturing (Indian /imported). Often the imported lens are expensive. I could not find a single scientific report which says that visual gain after surgery has any relation with the brand or the place of manufacturing of lens.

Monofocal and a multifocal lens

Other important issue is to decide between monofocal and a multifocal lens. The latter is supposed to provide functional vision for both near and distance, but lens are expensive. But that does not guarantee spectacle free life after the surgery. Some cases may still need glasses for certain type of task, even after an uneventful cataract surgery with multi-focal lens. Moreover it is associated with certain type of vision related complications like glare and reduced contrast of images. An article by Dr. Evans appropriately explain the pros and cons. If you want to know more, than there are many good scientific publications on this issue. Discussion with your doctor is the best way out. If you are still in doubt, gamble on mono-focal lens.

Robotic/Laser assisted cataract surgery

It’s a new technique in which some critical surgical steps are done using high precision laser. Other steps are common between laser assisted and traditional method. The down side is that it is more expensive that traditional method. The available scientific evidence by researchers (Popovic MDay AC) does not document any significant in the visual outcome after either of these techniques.

 Step ten: What are complications of surgery of surgery?

Complications during and after surgery are associated with every surgical procedure. Cataract surgery is no exception to this rule.

 Posterior capsular Rent ( PCR ) is (relatively common complication ) occurring during the surgery  and Endoththalmitis ( infection in the eye after cataract surgery) is uncommon complication happening after completion of the cataract surgery. These may require vitreo-retinal surgical support.  Discuss with your doctor regarding the availability of back up facility in hospital and its policy regarding the management of this complication.

Step eleven: Post operative care  after cataract surgery

Eye hygiene, protection and regular use of eye drops/medications constitutes the basic post operative care. But the care is individualized as per surgery and patient parameters. Its important to clearly understand it and follow the instructions issued.

share you opinion  on this issue in the comment section. Point out the issues i have left or you have a different take.

Also read

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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