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1. Preparation

WHAT IS A CATARACT?

The lens of the eye is normally a clear, disc-shaped structure behind the pupil and iris. It focuses light beams on the retina, which is the back part of the eye that sends signals to the brain. The lens also adjusts the focus of the eye allowing clear vision both up close and far away and is mostly made of water and protein. The protein is what keeps the lens clear and allows light to pass through. As we age, some of the protein may clump together and start to cloud a small area of the lens.

Clouding of the lens is called a cataract. When the lens becomes cloudy, vision blurs and over time the cataract may grow, making it harder to see. Common symptoms of cataracts include: •Blurry vision •Colours appear faded •Poor night vision •Seeing a halo around lights •Double vision •Spots in your vision •Sensitivity to bright sunlight or headlight glare at night.

WHY IS IT DONE?

In some cases, the loss of vision is mild enough to allow you to manage with wearing glasses or contact lenses in the early stages of a cataract. However, over time your cataract will progress usually requiring surgical removal. The cloudy lens is removed by surgical incision and replaced with a permanent lens implant.

HOW DO I CHOOSE A SPECIALIST?

Your GP will be able to recommend and refer you to an ophthalmic surgeon. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid.

You can access the Australasian Society of Cataracts & Refractive Surgeons via the website at http://www.auscrs.org.au/. This site is very informative and allows you to access the ophthalmic surgeons in your region.

To access a list of Ophthalmic Specialists who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent. Your doctor will ask you to sign a consent form, which you should fully understand.
• The type of lens to be used and any associated out of pocket expense associated with different lenses, eg Acrysoft or Restore
• In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Visual impairment immediately post the procedure
  • Driving restrictions and managing glare
  • If you will need to continue wearing glasses (usually do for reading and possibly night driving)
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • If you are currently using eye drops you must check continuity both for pre and post procedure of these with your Opthalmologist
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, Heparin.)
  • Arthritis medication
  • Pain medication
  • Insulin

WHERE IS IT DONE?

Cataract surgery is most commonly performed in either a stand alone day only facility or in a hospital day only ward.

HOW LONG IS THE PROCEDURE?

The time needed for cataract surgery will vary, but on average, the procedure takes 10-15 minutes.

WHO IS INVOLVED?

• The Ophthalmologist, your Specialist doctor
• Anaesthetist: they give you medication to numb the eye, make you relaxed and they look after you whilst the procedure is being carried out
• Nurses who will assist with your assessment, the procedure and your recovery
• Pathologist for blood tests

HOW DO I PREPARE FOR THE SURGERY?

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed. You will need to fast for at least 6 hours prior to the surgery. Please follow any instructions given to you by the Day Surgery/ Hospital and your doctor. No facial makeup is to be worn on the day of your surgery. Prior to admission your surgeon will often request you have some blood tests and an ECG (reading of your heart) attended to.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not take any valuables with you
• Leave all jewellery at home, a wedding ring can be left on
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• A hard case for your glasses and a container for your dentures and hearing aid if applicable, labelled with your name

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Cataract Surgery admissions for the financial year 09/10 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 7,488 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 42702.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.
• These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. Assistant in operation. Therefore, the total average medical service charge ($1,860) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all cataract surgery admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the associated paperwork for your stay in hospital.

On admission to the day surgery, the nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. The surgeon has usually already attended to you signing the operation consent form in his rooms at time of booking surgery. An anaesthetist may see you at that time or once you are in the procedure room.

Once this admission procedure is completed, usually you will then be taken to the procedure room. Local anaesthetic drops are used to numb the eye, reduce inflammation and risk of infection and to fully dilate the pupil. In some cases, injections are given to make the eye painless and not able to move during the surgery. Most patients remain fully awake but in some cases a mild anaesthetic may be used if you are very tense, you may wish to discuss this with your surgeon.

WHAT CAN I EXPECT DURING SURGERY?

During the procedure, everything will be done to ensure your comfort. The operating room can be quite noisy due to the buzzing noises of the machinery and the light from the microscope is quite bright.

You will have a plastic tube called a cannula inserted into your vein, which may be used to deliver medication to make you relaxed and drowsy if required.

You may have leads placed on your chest to monitor your heart and a probe on your finger to monitor your oxygen level.

Before cataract surgery, your eye is measured to determine the correct strength of the intraocular lens to be implanted. This measurement is made with a painless ultrasound test.

During cataract surgery the cloudy lens is removed by surgical incision and replaced with a permanent intraocular lens implant. In most cataract surgeries, a small incision is made in the eye and tiny instruments are used to break apart the clouded lens and remove it. The plastic, acrylic or silicon intraocular lens will be implanted to replace the original clouded lens. The intraocular lens requires no care and becomes a permanent part of your eye.

3. Aftercare

WHAT HAPPENS AFTER SURGERY?

After the surgery, in most cases, you will be allowed to go home after a short stay in the day surgery recovery area. You won’t be able to drive home or to your appointment the following day, so ensure that you arrange transport for these trips. It is also advisable to arrange for extra help at home as you may be limited in your daily activities such as showering, preparing meals and putting in your eye drops. You will need to avoid strenuous or violent activities, keep eyes and lids very clean and no driving until your doctor instructs you.

A patch is placed over the eye and worn until the follow-up examination the following day. Antibiotic and anti-inflammatory eye drops will be prescribed for use for several weeks to assist in the healing process. It is very important to continue these drops until your Ophthalmologist instructs you to stop. Complete healing will take approximately 10 weeks. Further follow up appointments usually take place 10 days after surgery then 2 months later.

It is normal to feel mild discomfort after surgery such as your eye watering or a feeling of discomfort in the eye. This is completely normal and all discomfort should disappear after a couple of days.

Contact your doctor immediately if you experience any of the following symptoms:

• Vision loss
• Pain that persists despite simple pain medication such as Paracetomol (Panadol)
• An increase in eye redness
• Light flashes or multiple spots in front of your eye
• Nausea, vomiting or excessive coughing

If in doubt, ask your doctor to explain these to you in more detail.

1. Preparation

WHAT IS A CATARACT?

The lens of the eye is normally a clear, disc-shaped structure behind the pupil and iris. It focuses light beams on the retina, which is the back part of the eye that sends signals to the brain. The lens also adjusts the focus of the eye allowing clear vision both up close and far away and is mostly made of water and protein. The protein is what keeps the lens clear and allows light to pass through. As we age, some of the protein may clump together and start to cloud a small area of the lens.

Clouding of the lens is called a cataract. When the lens becomes cloudy, vision blurs and over time the cataract may grow, making it harder to see. Common symptoms of cataracts include: •Blurry vision •Colours appear faded •Poor night vision •Seeing a halo around lights •Double vision •Spots in your vision •Sensitivity to bright sunlight or headlight glare at night.

WHY IS IT DONE?

In some cases, the loss of vision is mild enough to allow you to manage with wearing glasses or contact lenses in the early stages of a cataract. However, over time your cataract will progress usually requiring surgical removal. The cloudy lens is removed by surgical incision and replaced with a permanent lens implant.

HOW DO I CHOOSE A SPECIALIST?

Your GP will be able to recommend and refer you to an ophthalmic surgeon. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid.

You can access the Australasian Society of Cataracts & Refractive Surgeons via the website at http://www.auscrs.org.au/. This site is very informative and allows you to access the ophthalmic surgeons in your region.

To access a list of Ophthalmic Specialists who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent. Your doctor will ask you to sign a consent form, which you should fully understand.
• The type of lens to be used and any associated out of pocket expense associated with different lenses, eg Acrysoft or Restore
• In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Visual impairment immediately post the procedure
  • Driving restrictions and managing glare
  • If you will need to continue wearing glasses (usually do for reading and possibly night driving)
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • If you are currently using eye drops you must check continuity both for pre and post procedure of these with your Opthalmologist
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, Heparin.)
  • Arthritis medication
  • Pain medication
  • Insulin

WHERE IS IT DONE?

Cataract surgery is most commonly performed in either a stand alone day only facility or in a hospital day only ward.

HOW LONG IS THE PROCEDURE?

The time needed for cataract surgery will vary, but on average, the procedure takes 10-15 minutes.

WHO IS INVOLVED?

• The Ophthalmologist, your Specialist doctor
• Anaesthetist: they give you medication to numb the eye, make you relaxed and they look after you whilst the procedure is being carried out
• Nurses who will assist with your assessment, the procedure and your recovery
• Pathologist for blood tests

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Cataract Surgery admissions for the financial year 09/10 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 7,488 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 42702.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.
• These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. Assistant in operation. Therefore, the total average medical service charge ($1,860) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all cataract surgery admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

HOW DO I PREPARE FOR THE SURGERY?

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed. You will need to fast for at least 6 hours prior to the surgery. Please follow any instructions given to you by the Day Surgery/ Hospital and your doctor. No facial makeup is to be worn on the day of your surgery. Prior to admission your surgeon will often request you have some blood tests and an ECG (reading of your heart) attended to.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not take any valuables with you
• Leave all jewellery at home, a wedding ring can be left on
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• A hard case for your glasses and a container for your dentures and hearing aid if applicable, labelled with your name

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the associated paperwork for your stay in hospital.

On admission to the day surgery, the nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. The surgeon has usually already attended to you signing the operation consent form in his rooms at time of booking surgery. An anaesthetist may see you at that time or once you are in the procedure room.

Once this admission procedure is completed, usually you will then be taken to the procedure room. Local anaesthetic drops are used to numb the eye, reduce inflammation and risk of infection and to fully dilate the pupil. In some cases, injections are given to make the eye painless and not able to move during the surgery. Most patients remain fully awake but in some cases a mild anaesthetic may be used if you are very tense, you may wish to discuss this with your surgeon.

WHAT CAN I EXPECT DURING SURGERY?

During the procedure, everything will be done to ensure your comfort. The operating room can be quite noisy due to the buzzing noises of the machinery and the light from the microscope is quite bright.

You will have a plastic tube called a cannula inserted into your vein, which may be used to deliver medication to make you relaxed and drowsy if required.

You may have leads placed on your chest to monitor your heart and a probe on your finger to monitor your oxygen level.

Before cataract surgery, your eye is measured to determine the correct strength of the intraocular lens to be implanted. This measurement is made with a painless ultrasound test.

During cataract surgery the cloudy lens is removed by surgical incision and replaced with a permanent intraocular lens implant. In most cataract surgeries, a small incision is made in the eye and tiny instruments are used to break apart the clouded lens and remove it. The plastic, acrylic or silicon intraocular lens will be implanted to replace the original clouded lens. The intraocular lens requires no care and becomes a permanent part of your eye.

3. Aftercare

WHAT HAPPENS AFTER SURGERY?

After the surgery, in most cases, you will be allowed to go home after a short stay in the day surgery recovery area. You won’t be able to drive home or to your appointment the following day, so ensure that you arrange transport for these trips. It is also advisable to arrange for extra help at home as you may be limited in your daily activities such as showering, preparing meals and putting in your eye drops. You will need to avoid strenuous or violent activities, keep eyes and lids very clean and no driving until your doctor instructs you.

A patch is placed over the eye and worn until the follow-up examination the following day. Antibiotic and anti-inflammatory eye drops will be prescribed for use for several weeks to assist in the healing process. It is very important to continue these drops until your Ophthalmologist instructs you to stop. Complete healing will take approximately 10 weeks. Further follow up appointments usually take place 10 days after surgery then 2 months later.

It is normal to feel mild discomfort after surgery such as your eye watering or a feeling of discomfort in the eye. This is completely normal and all discomfort should disappear after a couple of days.

Contact your doctor immediately if you experience any of the following symptoms:

• Vision loss
• Pain that persists despite simple pain medication such as Paracetomol (Panadol)
• An increase in eye redness
• Light flashes or multiple spots in front of your eye
• Nausea, vomiting or excessive coughing

If in doubt, ask your doctor to explain these to you in more detail.