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Dr. James
Dr. James, Board Certified Ophthalmologist
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Experience:  Eye Physician and Surgeon
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father of a 20 month boy who needs to get cataract surgery..right eye

Customer Question

Desperate parent about to go insane! Please help! I live in I Puerto Rico and am the father of a 20 month boy who needs to get cataract surgery because of a very large cataract n his right eye. I’ve been toiling with the decision of where to get the surgery done, this is the story:

Pediatric ophthalmologist #1: He studied at DUKE, and said he would perform the surgery himself. I had asked him if there was a difference in getting the surgery done in the US and he said there wasn’t. I had asked this question because I saw that the date of the operation depended on whether Intra-Ocular Lens was “in-stock”. (To be clear, this is an operation that must be done ASAP in children to increase the chance of recovery on that eye). After we coordinate everything I read up on this type of surgery in the internet and see that for pediatrics, they take the eye measurements for the Intra-Ocular Lens while the child is under general anesthesia, this is because you can’t tell toddler to stand still and don’t move. This is very different than what Pediatric ophthalmologist #1 had done which was have a technician take the measurements while I was holding the boy kicking and screaming and moving his eyes all over the place. So I called Pediatric ophthalmologist #1 to ask him about eye measurements for the IOL and he admitted that that was in fact a difference between getting the procedure done in the US vs. PR.

So he called up his contacts at DUKE hospital to have the surgery performed there. One of the questions I asked was that if they took the eye measurements while the boy was under general anesthesia and they said yes. So in that US hospital, they put the boy under general anesthesia, take the measurements, and insert the IOL right there and then because they have a complete stock of IOL’s. The boy goes through gen. anesthesia only once. The thing is my insurance will not cover it because it is a procedure that can be done in PR. I would need a letter from the doctor referring me to DUKE. He was not willing to provide this letter because I he referred my child for that reason: “I would have to refer every child with cataract surgery in PR to the US”.

The operation and trip to DUKE Hospital would cost me around $23,000, which is practically the majority of my savings.

So through my wife’s contacts I was able to get an appointment with Pediatric ophthalmologist #2 in 2 days, a miracle in PR where there are only three pediatric ophthalmologists. We went to him yesterday with the operation in DUKE scheduled but without having bought the plane tickets. I went to him because my wife’s friend had been able to get a hold of him and had asked how he measures the eyes for IOL’s. He had said that he puts his patients to sleep with general anesthesia to take the measurements and he was surprised to find the other doctor did it with the kid awake. But the thing is, he uses general anesthesia twice. One day he uses it to take measurements, with a good examination he orders the IOL, and then uses gen. anesthesia again to perform the surgery on a different day. So when we went to see him he confirmed that was the way he did it. He also said the boy had a very small cataract in the other eye, something Pediatric ophthalmologist #1 had missed. And he confirmed he used gen. anesthesia twice. Not thinking too much of it, and feeling relieved that the eyes would be measured correctly I went ahead and scheduled everything and cancelled the DUKE appointment. So now I’m reading up on general anesthesia and am panicked that my child will have to go through it twice: And with only one day in between.

So my conclusion is that Pediatric ophthalmologist in PR have these two different ways of dealing with the fact that there is not an ample enough stock of IOL’s in PR. Both methods are very scary to me, and my insurance with not cover me in the US because the surgery can be done in PR. And all the while I am decreasing the chances of vision recovery of my child while I ponder my options instead of getting the operation done.

If any of you Ophthalmologists could please tell give me your thoughts on my current situation, getting gen. anesthesia twice, and taking eye measurements while the boy is kicking and screaming.

And also maybe even be able to help me with getting the insurance to cover me in the US. The most important thing I need is a letter from a doctor referring me to the US and stating the reasons.

I don’t know if it is ethical to say this but I am desperate: If any one of you can make it so that the insurance company covers me in a US hospital where they use gen. anesthesia only once and have a great surgeon and ample IOL supply I will compensate handsomely. We can talk over the phone at XXX-XXX-XXXX

Please help me! Whatever you had planned for today please help me and I will be your friend for life!

Below is the information my medical insurance company is requesting to pay for the surgery in the US: (The X’s apparently acknowledge that the Insurer has that information)

___ Medical Order
_X_ Diagnostic and description of actual condition
_X_ Radiography, studies, (confirmation of diagnostic) and /or laboratory examinations
_X_ Relevant medical history
_X_ Evaluation and recommendation of the medical specialist (Ophthalmologist in Puerto Rico) (I was surprised to find this one checked off)
___ Treatment plan (goals and projected treatment time)
___Surgeon’s name
___ Surgery date
___ Institution where the surgery will occur
___ Others:
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. James replied 4 years ago.
Hello,

Unfortunately, the letter will have to come from either of the pediatric ophthalmologists in PR because they have examined your son. What you have read is true with regards XXXXX XXXXX It is best to have accurate measurements and a full exam while the child is asleep will allow this. This is commonly done for children in which it is difficult to examine in the office. It is called an EUA or exam under anesthesia.

Realize that the cataract surgery is only the first step. To treat any loss of vision (amblyopia), your child may need glasses and possibility patching of the left eye to force him to use the right eye. For this reason, it would be best to stay with one doctor for the duration of the treatment.

Though having to go under two sessions of anesthesia is not optimal, it is less traumatic for the child and poses minimal risk.

Please remember to press the accept button so I can receive credit for assisting you.

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