Recently a major health insurer declared that it is not medically necessary for anesthesiologists to provide care during most cataract surgeries. During these procedures, the ophthalmologist would be the one to provide all anesthesia services while simultaneously performing the cataract surgery. That’s quite a juggling act—performing microsurgery with no room for error while also having to watch systemic monitors to ensure patient comfort and safety. And it is not what I would want for my own family.
The problem with this recent cost-cutting measure is that it fails the Golden Rule we learned in kindergarten: do unto others as you would have them do unto you. Applied to medicine, it means giving the same high level of care that you would want for yourself. And for me or my family, I want to have an anesthesiologist present. While cataract surgery is a relatively straightforward and brief procedure, it is critical and delicate, too. The patient will see the world, every waking moment, for the rest of his life. Any abrupt motions during the surgery can lead to irreversible damage to fragile ocular structures with visual consequences.
It is normal for patients to have some degree of fear and anxiety about cataract surgery, and I completely understand that. Cataract patients are typically elderly, as cataracts are primarily an age-related occurrence, and tend to have more comorbidities. On your next surgical date, look at the number of patients who have diabetes, coronary artery disease, hypertension, and more.
Cataract surgery requires intense focus by the surgeon because a complication such as a ruptured posterior capsule can happen in a fraction of a second. I take cataract surgery very seriously and I don’t play music or allow side conversations during the course of the surgery. While we are operating, everyone in the operating room is focused on the patient and on ensuring the best possible outcome with the highest level of safety. To ask the surgeon to also watch the monitors and take care of the patient’s health while performing the surgery is too much.
Anesthesiologists do much more than simply administer intravenous sedation. They are in complete control of the patient’s total health. They will frequently treat high blood sugar, elevated blood pressure, and more, all during the course of the cataract surgery. And this care continues into the postoperative period where they monitor the patients’ vital signs carefully and intervene as needed. Monitored anesthesia care is an integral part of modern cataract surgery and the two cannot be safely separated.
Our anesthesiologists even hold the patient’s hand during the surgery. It provides comfort to the patient but also gives subtle signs as to the patient’s status. Clammy palms, a suddenly tight grip, or a loss of muscular tone can all indicate issues such as fear, pain, or worse. If we lose our anesthesiologists, it will become quite difficult for me to do the surgery and hold the patient’s hand at the same time.