On November 16, 2018, the Wall Street Journal published an article written by Daniel Akst with the clickbait title, “What Doctors Don’t Tell You About Cataract Surgery.” I applaud the author for bringing the topic of cataract surgery into the mainstream media, but I wish the article had more detail, particularly with regards to differentiating refractive surgery from cataract surgery.

As basic as it seems, cataract surgery is designed to just correct the cataract and not necessarily to provide a specific refractive result. The concept of presbyopia, the near benefit of mild myopia, the option of premium intraocular lenses, and even monovision were all touched on, but none are covered in sufficient detail to really educate the public.

The patients interviewed in this article seemed upset when they traded mild myopia for an emmetropic outcome. Others were bothered by the brightness in daylight, presumably owing to the increased light transmission of the intraocular lens compared with the cataract.

The entire article reminded me of the importance of exceeding patient expectations to deliver happiness after cataract surgery. This means obtaining the highest level of excellence and visual recovery from the cataract surgery, but it also means setting appropriate patient expectations. In this regard, I have a few pearls for readers of the next clickbait article about cataract surgery:

  1. If it’s not broken, don’t fix it. If you are happy with your current level of vision, whatever it may be, do not pursue any surgical options. However, if you are unsatisfied with your vision because it limits your ability to enjoy your daily life, then consider cataract surgery.
  2. Cataract surgery is only to fix the cataract. That means removing the cloudy human lens, which we call the cataract, and replacing it with a manmade lens implant. You will still need glasses for many, if not all, activities. If you wish to address your eyeglass prescription, such as astigmatism, at the same time of the cataract surgery, then you can pursue refractive surgery options at an extra cost.
  3. The manmade lens implant tends to be better than cloudy cataracts, but it will never perform as well as the healthy human lens you had at age 25 years. In fact, there are no manmade body parts (lens implants, heart valves, or artificial hip joints) that work as well as young, healthy, human body parts. None.
  4. Finally, surgery is more art than commodity. You are paying for the expertise of a surgical artist and the results will vary depending on whom you choose. While we like to think that all surgeons are equal, there is, in fact, a bell-shaped curve distribution of surgical skill. Choose your surgeon carefully and go with your gut and recommendations from those you trust.



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