Why does cataract surgery require a hospital stay in Thailand?

[Bangkok Barry]

I wrote a few weeks ago about my eye problems and Thailand's Top optician being unable to correct it with new glasses. I received some excellent advice amongst the usual irrelevant comments.

 

As a result of the excellent advice I attended a private hospital for a proper test, where I was told I had cataracts in both eyes and glaucoma in one. Surgery could be done on the cataracts for 25,000 a time. Okay. But I would need to stay overnight (extra charge of course but free food and dark glasses included ).

 

A two-minute Google check revealed every single entry saying that no overnight stay is required. USA, UK, Australia. Nowhere. A friend in Scotland had it done, with tea and biscuits after and then home. In New Zealand, a friend took his father to be seen, in and out in three hours including recovery time. 

 

So I went to see a doctor who has a clinic in Kalasin and who works at the government hospital there. He confirmed the cataracts and said I didn't have glaucoma and my eye pressure was normal. You'd think a government hospital would charge less, but he wanted 20,000 plus an extra 5000 for him. And he also said I needed to stay overnight.

 

What makes cataract surgery so dangerous in Thailand that instead of going home straight away as you do in the rest of the world we have to stay in hospital overnight for observation, I wonder. I guess the answer has to begin with M or maybe B. It's the same thing. And it seems I'll have no alternative but to give in to the system.

 

Then I have to get a third opinion, somehow, on whether I have glaucoma or not.

[mfd101]

I had a colonoscopy in Oz about 9 years ago, in a private hospital: Go under at 1400, awake at 1430/1500, off home at 1530/1600 (but someone else must drive).

 

I had ditto here at private hospital in Surin City 5 months ago: 3 days & 2 nights in hospital all up - multiple pills & cleanouts, blood tests, inspections, hideous food, inspections, waiting ... From memory about 45KB.

 

My theory (and my b/f agrees) is that Thai medics not unreasonably don't trust Thais to follow instructions both pre- and post-op. So they hold you prisoner from pre- to post-, and charge accordingly.

Edited March 11 by mfd101

[lopburi3]

There is no requirement to stay overnight in hospital but at the low cost of a nights stay it might be a good option as you will need to be seen next morning for treatment.  Saves time and believe government hospital do want you to do so.  At private hospital in Bangkok I did not and wife did not stay overnight.

[ozimoron]

You don't go home straight away in the rest of the world. In Australia you will spend some time in recovery then under a period of supervision which is not short and finally would have to have a person arrive to collect you who identifies themselves to the hospital staff and signs a declaration that they will stay with you and observe you for 24 hours and warns of criminal penalties for failure to do so. Otherwise you stay overnight.

[Bangkok Barry]

1 minute ago, lopburi3 said:

There is no requirement to stay overnight in hospital but at the low cost of a nights stay it might be a good option as you will need to be seen next morning for treatment.  Saves time and believe government hospital do want you to do so.  At private hospital in Bangkok I did not and wife did not stay overnight.

 

I've actually stayed at the private hospital before when I had acute food poisoning, and had to sleep on the couch as the bed was rock solid hard. So it isn't something I'd look forward to, even though it appears to be inevitable. Wife can't stay as we have six burglar alarms (dogs) to be attended to.

[Bangkok Barry]

4 minutes ago, ozimoron said:

You don't go home straight away in the rest of the world. In Australia you will spend some time in recovery then under a period of supervision which is not short and finally would have to have a person arrive to collect you who identifies themselves to the hospital staff and signs a declaration that they will stay with you and observe you for 24 hours and warns of criminal penalties for failure to do so. Otherwise you stay overnight.

 

I'd guess, from what you say (and of course it makes sense) that such overnight stays are quite rare, rather than compulsory as they appear to be in Thailand.

[JackGats]

In the EU they send you back home on the same day PROVIDED you are not home alone. In other words provided there's someone to look after you over the first night.

[greg71]

I had my cataract surgery done at chula hospital here in bkk , operation was done at 4pm was out by 6 30 pm . 

[lopburi3]

2 minutes ago, Bangkok Barry said:

 

I've actually stayed at the private hospital before when I had acute food poisoning, and had to sleep on the couch as the bed was rock solid hard. So it isn't something I'd look forward to, even though it appears to be inevitable. Wife can't stay as we have six burglar alarms (dogs) to be attended to.

The are private hospitals and then there are private hospitals - not all are quality - but for out patient operation should not matter as doctor is key to that.

[Pumpuynarak]

I will hazard a guess...........................MONEY

[impulse]

I'd look at the overnight stay as a perk rather than a burden.  One more advantage of an affordable health care system.

 

For a single guy like myself that means I don't have to cajole (or hire) someone to drive me home and stay with me for 24 hours.  And on the rare chance that something does go wrong, I'd be right at the hospital and not an hour (or more) away.

 

Back home in the USA, I'm sure some insurance wonk has carefully calculated the cost savings against the risk of an occasional patient going blind.  (Too bad for the unlucky patients...)   In Thailand, I'm glad that cost analysis leans toward the patient and not the insurance company.  But I freely admit I'm not a fan of healthcare by the $$ numbers, like back home.

 

[samtam]

As others have stated, cataract surgery does not require an overnight stay. However, having had both mine done, first at Rutnin Eye (Bangkok) where the anesthetic procedure caused hemorrhaging, (needle into the eye), I still went home to recover the same day, and administered the requisite drops until I went for a follow up the next week. Given my experience I then had the second eye surgery performed at Samitivej Hospital (Bangkok) with drops anesthetic and went home afterwards. I was picked up by my partner both times, and managed the washing (shower) without getting water anywhere near my eyes. The prices you are quoted seem very reasonable. Rutnin was around THB140,000 and Samitivej around THB75,000 (both eyes normal lenses).

 

My straightforward experience at Samitivej is the norm for these procedures, (as everyone kept telling me before the horror show at the first surgery).

 

Happily everything is OK in both eyes now, and the difference in my sight is dramatically better; I no longer need long distance glasses.

Edited March 11 by samtam

[potless]

53 minutes ago, Bangkok Barry said:

As a result of the excellent advice I attended a private hospital for a proper test, where I was told I had cataracts in both eyes and glaucoma in one. Surgery could be done on the cataracts for 25,000 a time. Okay. But I would need to stay overnight (extra charge of course but free food and dark glasses included ).

I had cataract surgery on one eye in the UK last year. After the surgery I was directed to another room where I was asked a few questions. After about 10 minutes, I asked the lady how long it would be before I could leave. She replied I could leave right away if I felt okay and so I did.  No tea and biscuits. I was on a bus 10 minutes later. I was told to get in touch if I had any major problems. There was no follow up test the next day.                  A watery eye for a few days and eye drops 4 times a day for 2 weeks, then 3 times a day for a week and then twice a week. An examination one month after surgery.                                                                                              However, is the doctor suggesting that you have both cataracts done at the same time? (which I would advise against) That may be a possible reason to stay overnight.    

[Tropicalevo]

57 minutes ago, Bangkok Barry said:

 

I'd guess, from what you say (and of course it makes sense) that such overnight stays are quite rare, rather than compulsory as they appear to be in Thailand.

Not compulsory in Thailand. Just at some hospitals.

I had lenses replaced in both eyes at Bangkok Phuket.

Left eye day one - back to the hotel after a wait in 'the dark room' and then right eye day two.

Flew home on day four.

[Bangkok Barry]

13 minutes ago, potless said:

However, is the doctor suggesting that you have both cataracts done at the same time? (which I would advise against) That may be a possible reason to stay overnight.   

 

No. And interesting info on the eye drops 'dosage'. Thanks.

[Bangkok Barry]

1 hour ago, lopburi3 said:

The are private hospitals and then there are private hospitals - not all are quality - but for out patient operation should not matter as doctor is key to that.

 

The private hospital doctor seems to be good. She spoke English and was informative. The other doctor I saw seemed to want to get me out in the shortest possible time, didn't even check for glaucoma until I asked. Bad vibes about him. Which is why I'm returning to the private doctor.

[Ben Zioner]

1 hour ago, mfd101 said:

I had ditto here at private hospital in Surin City 5 months ago: 3 days & 2 nights in hospital all up - multiple pills & cleanouts, blood tests, inspections, hideous food, inspections, waiting ... From memory about 45KB.

Combined Colonoscopy and Gastroscopy at Bumrungrad, admission at 7 back at the hotel at 11 after debrief with Doctor and a French breakfast downstairs at "Au Bom Pain". Always the same, done it 3 times. About 40k.

 

They gave you a special Farang schedule.

 

[Bangkok Barry]

1 minute ago, Ben Zioner said:

They gave you a special Farang schedule.

 

I think not. When I was there for a test about a dozen Thais arrived with overnight bags ready for admission. They'd also been conned into thinking it was necessary, and being Thai probably accepted it without question as the doctor was of higher status.

[potless]

4 minutes ago, Bangkok Barry said:

No. And interesting info on the eye drops 'dosage'. Thanks.

Several years ago, a sibling had cataract surgery and was given 2 different eye drops to use. The eye drops I was given are "2 in 1" possibly a fairly recent innovation. The anaesthetic was also administered via eye drops. 

[Sheryl]

Not sll hospitals in Thailand require overnight stay.

 

But it is customary in many.

 

Main reason is that room costs are so low that it has littld cost implucation,  and it enables them to ensure adhetence to eye drop schedule.

 

50 some odd years ago overnight stays were common in tne West too. Changed as hospital costs soared. 

[BKKBike09]

4 hours ago, Bangkok Barry said:

He confirmed the cataracts and said I didn't have glaucoma and my eye pressure was normal.

 

FWIW while glaucoma is often associated with elevated eye pressure, it is not the only defining symptom. It is possible to have normal IOP and still have glaucoma. The best test to get is a visual field exam, which any decent hospital will be able to do for you. 

 

IOP also varies during the day (I forget if it's higher in pm or morning).Also, if you've ever had laser eye surgery to correct short sight, your IOP may under-read because the cornea is thinner than normal, so less resistant to the puff of air from the eye pressure measurement machine.

 

Those puff of air machines also aren't as accurate as the old-fashioned way in which numbing drops are put in the eye before the doc uses a physical probe to mechanically measure pressure. If you want an accurate reading, ask the doc to do this (although same under-read caveat applies if you've had some types of laser surgery).

 

 

[Bangkok Barry]

7 minutes ago, BKKBike09 said:

FWIW while glaucoma is often associated with elevated eye pressure, it is not the only defining symptom.

 

Your post is interesting. The first diagnosis (that I have glaucoma) was after the people gathered for the doctor were given an eye drop first while they waited. That didn't happen with the second doctor (who said I don't have glaucoma) and who certainly gave the impression that speed was of the utmost importance and accuracy a distant second. So I'll go with I have it.

[BKKBike09]

6 minutes ago, Bangkok Barry said:

Your post is interesting. The first diagnosis (that I have glaucoma) was after the people gathered for the doctor were given an eye drop first while they waited. That didn't happen with the second doctor (who said I don't have glaucoma) and who certainly gave the impression that speed was of the utmost importance and accuracy a distant second. So I'll go with I have it.

 

I'd suggest getting a visual field test done - specifically one that tests for glaucoma. You stare (one eye at a time) at a fixed spot and click a little button whenever you see a dot of light that seems to appear randomly at different spots close to / further away from the point of focus.

 

Normal eye pressure is basically under 20 mm Hg. According to this info from Moorfields Eye Hospital (about as good an authority as you can get), "Eye pressure can vary by as much as 6mmHg during the day and this can be more common in glaucoma patients".

https://www.moorfields.nhs.uk/sites/default/files/All day measurements of eye pressure .pdf

 

Good luck.

[Bangkok Barry]

3 minutes ago, BKKBike09 said:

 

I'd suggest getting a visual field test done - specifically one that tests for glaucoma. You stare (one eye at a time) at a fixed spot and click a little button whenever you see a dot of light that seems to appear randomly at different spots close to / further away from the point of focus.

 

Normal eye pressure is basically under 20 mm Hg. According to this info from Moorfields Eye Hospital (about as good an authority as you can get), "Eye pressure can vary by as much as 6mmHg during the day and this can be more common in glaucoma patients".

https://www.moorfields.nhs.uk/sites/default/files/All day measurements of eye pressure .pdf

 

Good luck.

 

Sounds like good advice, but finding anyone to do that in Thailand might be a challenge, especially in the NE region.

[BKKBike09]

On eye pressure generally - don't obsess over it. This seems pretty good guidance (I put in the blue highlighting):

 

Raised eye pressure – how to know if there is a problem 

Most people have an eye pressure that measures between 10mm and 20mmHg. However, this number can be lower or higher and still be fine for your eye. Normal pressure is said to be less than 21mmHg, but the number can be higher and your eye still be normal.

Ocular Hypertension (OHT) means raised pressure (over 21mmHg) but no damage to the nerve and full visual fields. If the pressure in your eye is over 21mmHg then you may be told you have raised pressure. If it less than 30mmHg you may not be advised to have treatment, as long as everything else is healthy with your eyes and your general health. If you have a family history of definite glaucoma you may want to consider starting pressure-lowering treatment.   

 

Only a small number of people with OHT develop glaucoma over the following five years 

This means you can decide to have a regular examination of visual fields once a year or every two years. As long as your visual field is full and your nerves are unchanged in appearance, then you are fine at that time, but further checks are sensible.

There are exceptions and some people have pressure less than 20mmHg, yet still develop glaucoma, which confirms that glaucoma is about more than just pressure in the eye.

Normal pressure is the pressure at which no damage occurs to the nerve. For some people this is as high as 30mmHg. The higher the pressure the more likely that, in time, damage will occur to the eye and vision. Below is a table to help you describe what the level of pressure means.

 

https://www.drray.co.uk/eye-conditions-treatments/raised-eye-pressure/

[BKKBike09]

4 minutes ago, Bangkok Barry said:

Sounds like good advice, but finding anyone to do that in Thailand might be a challenge, especially in the NE region.

 

It's a pretty common test so I'd have thought a big hospital in KK / Udon / Ubon would be able to do it.

[lopburi3]

2 minutes ago, Bangkok Barry said:

 

Sounds like good advice, but finding anyone to do that in Thailand might be a challenge, especially in the NE region.

Iif they dilate and check should be able to determine glaucoma - the visual field test will indicate how serious - but normally they are done together as below. 

Quote

How will my eye doctor check for glaucoma?
Eye doctors can check for glaucoma as part of a comprehensive dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for glaucoma and other eye problems. The exam includes a visual field test to check your side vision.

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma#:~:text=What is glaucoma%3F,a comprehensive dilated eye exam.

[lopburi3]

5 minutes ago, BKKBike09 said:

 

It's a pretty common test so I'd have thought a big hospital in KK / Udon / Ubon would be able to do it.

Don't believe they are that common in normal hospitals - my top rated private hospital here in Bangkok referred those needing VFT to Rutnin Eye Hospital until just a few years ago (when they purchased a machine).  In USA shopping mall optometrists had them decades ago.

[BKKBike09]

3 hours ago, Bangkok Barry said:

Sounds like good advice, but finding anyone to do that in Thailand might be a challenge, especially in the NE region.

 

I Googled the Thai for Visual Field Test + Khon Kaen and Bangkok Hospital KK / KK Ram Hospitals both have the equipment:

 

เครื่องตรวจลานสายตา (Computerized static perimetry)

https://www.bangkokhospitalkhonkaen.com/th/center/แผนกจักษุ

 

เครื่องตรวจวัดลานสายตาอัตโนมัติ : Automated Visual field Analyzer

http://www.khonkaenram.com/th/services/clinics-and-centers/eye-center

 

[BKKBike09]

3 hours ago, lopburi3 said:

Don't believe they are that common in normal hospitals - my top rated private hospital here in Bangkok referred those needing VFT to Rutnin Eye Hospital until just a few years ago (when they purchased a machine).  In USA shopping mall optometrists had them decades ago.

 

Maybe some years back but these days I think all the big private hospitals - or at least any one big enough for an Opthalmology Dept - should have it.