New techniques make cataract surgery faster, less traumatic
By Thomas Heath,
In the early 1960s when I was in grammar school, my dad disappeared for a few days into the hospital. He was in his mid-50s and had poor eyesight, and mom said he was going to have his eyes fixed.
Dad returned home some days later with a big patch over his eye from cataract surgery. It took him months to fully recover. I remember my mom opening the palm of her hand, unraveling a tissue and showing two tiny white things that had been removed from my father’s eye.
A year ago, at age 56, I had the same surgery in my right eye. It was a breeze. The surgery — one of the most common medical procedures in the world — took 15 minutes, and the entire visit took less than two hours. Afterward, I walked around the corner with my wife, Polly, for lunch.
Within a day, I was a new — if slightly bionic — man with no more cataracts blurring my vision. Not only that, but my surgeon/ophthalmologist, Daniel Pluznik, implanted a state-of-the-art lens that corrected my vision so that I didn’t have to wear glasses anymore. I felt so lucky compared to what my dad went through.
Fifty or 60 years ago, my career might have been sidelined by cataracts. But cataract care has seen major advances in recent years.
Good thing. If you live long enough, you are almost certain to get them. They can come on slowly or very fast (mine came out of almost nowhere in a few months), and can ruin your quality of life. Cataract comes from the Latin term for “waterfall” for the whiteness it causes in the back of the lens. None of my doctors could say with certainty what causes it. It’s probably genetic.
Once cataracts reach a certain point, the Pluzniks of the world swoop in and pull up the shade.
“It’s as close as you get in medicine to instant gratification,” said the 43-year-old doctor.
It pays, too.
Ophthalmology is one of the more lucrative specialties in the medical world. Pluznik said ophthalmologists’ salaries range between $200,000 and $400,000 a year. He may make even more than that.
I don’t begrudge him a dollar. He spent about a decade in medical school and residency, works in a high-pressure profession that requires great skill, and performs a valuable function by restoring people’s sight.
Danny, as he likes to be called, grew up in Montgomery County in a science-oriented family. His father, who has a doctorate in microbiology, is a researcher at the U.S. Food and Drug Administration. His mother is an audiologist.
He got the medical bug studying chemistry at the University of Maryland, College Park, during the late 1980s. He walked into Bethesda’s Suburban Hospital one summer day early in his college career and asked if he could volunteer.
He was a gofer in the operating room, wheeling people around on gurneys, fetching supplies and helping nurse technicians. He watched surgeries in his spare time, enjoying the technical aspects of it the most.
“I didn’t mind the blood, as long as it wasn’t my own,” he said.
A good student, he attended the University of Maryland Medical School, located in Baltimore, and eventually narrowed his speciality down to two choices: ear, nose and throat (known as ENT) and ophthalmology.
Pluznik picked ophthalmology because it’s a highly visual specialty, where the physician can see exactly what he is doing without any guesswork.
“You dilate someone’s eye and see blood vessels and nerves,” he said.
He also liked the predictability of the hours.
He was accepted into the ophthalmology residency program at the Washington Hospital Center in D.C. in 1995, which lasted four years. He performed his first solo cataract operation at age 28 on an elderly man from Central America who was legally blind. Cataracts are the leading cause of blindness in the developing world, but not in the U.S. and other wealthy countries, where people have cataracts removed before significant vision loss.
Cataract surgery is a highly technical procedure that involves an incision a tiny fraction of an inch in length. It’s a marvel, really. Once Pluznik has made the incision with a laser or blade, he breaks up the clouded lens with ultrasound. Then he vacuums the pieces out of the eye. He then slides a folded new lens through the tiny opening. The new lens unfolds, restoring the patient’s vision. Time elapsed: 15 or 20 minutes.
He performs them like clockwork. It sounds awful, with the needle-in-the-eye stuff, but there is very little discomfort. I wanted someone who does it all the time.
“You have to have a knack for it,” Pluznik said.
Advances such as new lasers have allowed doctors to make smaller and more precise cuts in the eye, allowing for much quicker recoveries and better outcomes.
Perhaps the biggest advance has been the new lenses like the one I chose to receive at considerable cost out of my own pocket. They not only fix the cataract, but they also permanently correct your vision, replacing your eyeglasses.
“What I do now in surgery, I didn’t do literally a year and a half ago,” Pluznik said.
The new lenses have opened up a whole new level of care for eye patients. They have also created a new revenue stream for enterprising ophthalmologists like Pluznik, who embrace new technologies.
“You have to keep evolving,” he said.
My cataract removal cost $4,126, of which I paid $3,131 out of my own pocket. My insurer paid the rest. Around $2,478 went to Pluznik for conducting the procedure, his pre- and postoperative visits, and to cover the special bifocal lens he installed that upgraded my vision. Another $430 went to the eye surgery center where he performed the operation, and the rest was a special test I needed and for eyedrops.
Pluznik does about 350 cataract surgeries a year, usually at a surgery center that he owns with some other physicians. The cataract treatment is most of his practice, but he also does glaucoma care and eyelid surgery, in addition to regular office appointments. Those revenue streams bring in around $1 million before his considerable costs.
He works with three other ophthalmologists in a downtown D.C. office and a satellite in Rockville, which they opened in 2006 to serve more of the suburban Montgomery County population.
All four contribute to the basic costs of running the business, which include rent, insurance, utilities, 14 employees, accounting and expensive equipment such as the $500,000 laser they purchased. Their compensation is based on their individual productivity.
Between the four doctors, they see about 70 to 80 patients a day.
I wish my dad could have been one of their patients.