The funding of eye care in Ontario is an issue in ophthalmology as well as in optometry. Before COVID, the wait time for cataract surgery in Kitchener-Waterloo was already 8-12 months, the longest it has ever been. It now seems to be 12-18 months and getting worse. This is due to chronic underfunding from the Ontario government.
Cataract surgery under OHIP takes place locally at St Mary’s Hospital and the cost is usually only a $200 measurement fee to improve visual outcomes. The brand of monofocal intraocular implant lens (IOL) is chosen by OHIP and although the surgeon can choose the power of the lens to best suit the patient, there is always some sort of spectacle prescription left after surgery (either for reading, for distance or both).
Private cataract surgery has recently come to K-W and has allowed surgeries outside of St. Mary’s Hospital. This has given more choice to patients but can also be more confusing. Extra costs of these lenses can be between $3000 and $9000 for both eyes depending on the type of lens.
Premium Monofocal IOL – This is the same basic type of lens but with better optics. The surgeon will usually try to get the patient as close as possible to fully corrected for one distance (usually the far distance) but will still usually require at least reading glasses and sometimes multifocal glasses. Patients who currently can read at near without glasses (and only put glasses on for distance) can request this outcome instead but only one distance can be corrected with a monofocal lens.
Toric Monofocal IOL – This lens still only corrects one distance but for patients with significant astigmatism has a better chance of giving them the best uncorrected vision at one distance. These still usually require at least reading glasses and sometimes multifocal glasses after surgery.
Multifocal IOL or Multifocal Toric IOL – This is similar to a multifocal contact lens where the patient sees distance and near images at the same time, which usually reduces dependence on glasses after surgery. This may provide independence from spectacles, however depending on pupil size and lighting, glasses for specific tasks may still be necessary even with a multifocal IOL. There may also be some ghosting of images even with spectacles overtop.
Multifocals are the most expensive of the IOLs but may be the “best” choice if independence from glasses is the primary motivation. For patients who are happy to wear glasses after cataract surgery and whose primary motivation is clarity of vision then a monofocal IOL with continued use of glasses for distance or near or both may still be a better option.
Please think carefully about your options and ask your questions early as this is generally a decision that cannot be reversed.
Dr. Ellison, Dr. Singh and Dr. Faria