Living Well

Ask These Five Questions Before a Doc Cuts Your Eyeball

Rebecca Bobo is the kind of doctor I would send my mom to...

She presented research at a seminar on 10 years of eye surgery data at a Georgia hospital for residents and fellows at my hospital. It showed massive differences in the success rates of eye surgeries performed by doctors in training.

Some doctors' surgeries caused patients to suffer severe complications from the surgeries (ones that can lead to blindness), while other doctors' surgeries had zero complications.

If you were considering eye surgery... wouldn't you want the doctor who had a successful surgery? Yet no one was tracking it...

This type of common-sense approach is the most important thing doctors should do – measure their rates of success. It helps build their credibility and lets their patients see their track record. Sadly, as Dr. Bobo found out, docs rarely track this.

I asked Dr. Bobo about her research... and how to use it to help evaluate the critical information when considering eye surgery... Together, we came up with the best questions to ask your doctor before going under the knife.

Your doctor should give simple answers, too. If you sense any hemming and hawing, find another doctor.

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Here are the questions to ask:

1) Do I really need surgery? This is especially true for the most common type of eye surgery (with more than 2 million surgeries annually), cataract removal. I am amazed at how often doctors tell patients they need cataract surgery when they don't. The cataract should come out when you (the patient) feel you are having problems, not because your doctor wants to do surgery.

First, your doctor should do a "glare" test – with a bright light – before determining the need for surgery. A bad cataract distorts the bright light and makes it nearly impossible to see with this test. But if your vision only "glares" to 20/40 or even 20/50, you probably don't need surgery.

2) Do you keep surgical statistics and if so, what are they? Eye surgery is the safest surgery there is. Your surgeon should be able to tell you how many cases he has performed, what percent of those have had a complication (it should be less than 2%), and what percent required a different lens due to complications (it should be less than 1%).

Most "complications" are minor and go away after a day or two – but make sure your doctor's numbers are low.

Also, he should be able to tell you the number of patients who contracted endophthalmitis. The answer should be either zero or one. This is a very dangerous infection that leaves people blind. It's rare, and you have no reason to get surgery from someone who has had more than one in his career. I know several cataract surgeons who have performed more than 10,000 procedures without an infection.

Ask your surgeon for a printout of his statistics. He should keep them on a computer. If he can't give you one, run out of there.

3) Do you use the support of an anesthesiology team during the surgery? If your doctor says no, I'd go elsewhere. The last thing you want is a problem with your medication, heart, or breathing while your surgeon is working inside your eyeball. Imagine if something were to happen to you, and your eye surgeon has to STOP taking care of your eye to manage your vital signs.

If your doctor tries to convince you that he can handle it all... tell him thanks, but no thanks. Sure, the odds of a problem are slim, but why take the chance when so many good eye surgeons work with an anesthesiologist or a nurse anesthetist (a sort of half-doctor, half-nurse who specializes in anesthesia and works under the authority of an anesthesiologist)?

4) Do you use antibiotics before and after surgery? Make sure your doctor uses antibiotics before and after surgery. A regimen of three days before surgery and a week or two afterward is the minimum. The worst infection you can get is one in the eye after cataract surgery – it's a blinding infection. But it's almost impossible to get if you take antibiotics.

5) How do you numb my eye? The answer might be "topical" or a "nerve block." Topical means simply using eye drops on top and a little anesthetic inside. The nerve block requires a needle to inject anesthetic around the eye.

If your surgeon is up-to-date on his technique and skills, he has no reason to be sticking needles around your eye for surgery. Sure, some old-school doctors stick with nerve blocks because that's what they originally learned. But if it were my mother, I'd make sure the surgeon's statistics were that much better before telling her to take the extra risk of another needle.

I hope your doctor can answer these questions honestly and with confidence. Cataract surgery can be one of the most rewarding surgeries there is. Both patients and doctors get a lot of benefits from a successful case. In minutes, you'll be seeing better, and the results are easily measurable.

But make sure your eye surgeon is open to sharing information with you before you have the cataract removed. Take the time to get to know your doctor by asking these five questions.

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