I’m an ophthalmologist, performing around 800 cataract surgeries annually. A puzzling aspect in my practice is that the reimbursement for surgery remains unchanged whether I use standard or astigmatism-correcting toric intraocular lenses, despite the latter’s higher cost. This situation seems to rely solely on the doctor’s ethical choices. Surgeons who prioritize profit over their patients’ post-surgery vision quality might choose not to use the more expensive astigmatism-correcting lenses. Unfortunately, many patients are unaware of this aspect of their surgery.
Understanding Astigmatism
Astigmatism arises when the cornea or lens of the eye is irregularly shaped, failing to focus light accurately on the retina. This irregularity, akin to a football’s shape compared to a perfect sphere, causes blurred or double vision. Glasses and contact lenses are designed to correct this by precisely altering light’s path into the eye.
Post-Cataract Surgery Astigmatism
In cataract surgery, while the cloudy lens is removed, the corneal astigmatism remains, potentially leading to blurred vision. Addressing this residual astigmatism is crucial for clear post-surgery vision. Toric intraocular lenses, specifically designed to counteract corneal astigmatism, are employed for significant corrections. These lenses are more intricate and costly to manufacture. Yet, many of us, as surgeons, are driven by the heartfelt joy and satisfaction we feel when our patients exclaim with delight, “I can see so clearly now!” after surgery.
The Skill with Toric Lenses
Inserting toric lenses requires high precision. They must be perfectly aligned with the cornea’s curvature to effectively correct astigmatism. This demands significant expertise and sometimes advanced technology, ensuring the lenses are placed accurately for optimal vision.
Voluntary Choice in Japan
Despite the additional costs and efforts, Japan’s medical fee system doesn’t provide extra compensation for using toric lenses. It’s a voluntary choice for surgeons, reflecting their commitment to patient care. Many of us choose these lenses, driven by the joy of seeing our patients achieve the best possible vision. While this doesn’t increase our financial reimbursement, patient satisfaction and personal referrals are rewarding. However, I advocate for a medical fee system that better reflects these additional efforts, to encourage higher quality care and motivate healthcare providers.