Eye Surgery

[Humphrey Bear]

Just some observations.

I have had cataracts for a few years now - mild, not unduly bothersome.

Then a year ot more ago the one in my right eye developed and matured so that I was blind in that eye. My work has been pretty hectic this year so the earliest I could do anything about iut was now, when I had the opportunity of a couple of weeks vacation.

I went to Pattaya Eye Centre (Dr Narrrawat) in a soi behind Carrrefour. Last year I had been to BPH, but their promised fee went up by over 540% during my two-hour visit and there was also not enough time left before I was due to fly out again (they recommended at least two weeks after the operation before flying). So I went to Dr Narrawat lwst week, had the pre-op examination and went in om Tuesday for the op.

As I had left it so long - mature cataract instead of a developing one - the doctor was a little less than enthusiastic about the enf result. But after an hour and a half under the knife it was all done and dusted. (He had told me 15 minutes, but I went upstairs at 3.30 and cam back down at 5.10, so I think he was over-optimistic. All this with a local anaesthetic, so I was not a little nervous by the end.

At the time no pain, nothing. But later that night it was painful and again yesterday. Now it is virtually pain-free and I can see in 3-D for the first time in a couple of years.

And all for 40k Baht - I now have a few more working years ahead of me, can pass a driving / medical exam and so on.

I must say I am very pleased with this guy - nothing against BPH, but their base price of 45k went up to 75k while I was discussing matters with their eye surgeon. The Pattaya Eye Centre stayed at 40k throughout (plus another 1.2k for the initial examination)

Soppy about any typo's but I have not yet got both eyes working together.

I will go back in three months or so to get the other eye done, which is much less severe, and Dr Narrawat said that that would be a far easier and quicker job.

[Humphrey Bear]

Sorry - his name is Nattawat.

[Jingthing]

Thank you very much for that report, HB.

That price is 40K baht which includes BOTH EYES, or 40K each eye INCLUDING the internal lens?

I think local local anaesthetic is usual for this surgery.

Can I ask about the method for removing the old lens? Do you he used the more modern laser method for that? There have been other reports the this doctor is a bit too enthusiastic in ordering surgery when it is not needed but in your case you obviously needed it urgently, so no issue with that. Congrats on your good result.

Edited November 20, 2008 by Jingthing

[awayfoe]

?????????, what is the topic forum ?????????????

[thaibeachlovers]

Thank you very much for that report, HB.

That price is 40K baht which includes BOTH EYES, or 40K each eye INCLUDING the internal lens?

I think local local anaesthetic is usual for this surgery.

Can I ask about the method for removing the old lens? Do you he used the more modern laser method for that? There have been other reports the this doctor is a bit too enthusiastic in ordering surgery when it is not needed but in your case you obviously needed it urgently, so no issue with that. Congrats on your good result.

Where do you get the "more modern laser method" from? I work in a UK hospital eye department where the normal operation for cataracts is dissolving the old lens with ultrasound and sucking it out ( PHAKOEMULSIFICATION ). The other method is cutting the eye open and manually extracting the lens which is extremely rare now, and normally only used in the event of complications.

To my knowledge the only use of laser is to reshape the cornea to eliminate the need for glasses.

Yes, most operations are done under local, but we do many under general as well.

[phaethon]

15 minutes is about the time it takes him to do the operation. Sobering up a porter, getting you in place and cleaned up, anaesthetics (local), farting around waiting for the surgeon to finish his tea, wrapping you up, locating another sober porter and shipping you back to recovery is what takes the extra time. (i'm not getting at Thais here, this is the UK system... )

The lens sits in a capsule. Easy op. they macerate and suck out the old lens and slip a new one into the capsule. More complex is to replace the whole thing, bit more fiddly and not often needed these days, but maybe yer man resorted to this.

Only one eye is done at a time, that way if anything goes wrong you still have one 'good' eye to work with while they fix the cock-up.

Anyway, it's all very routine now, the Russians pioneered a conveyor belt system, beds rotating around the surgeon like a sushi bar :D

Good luck with recovery and getting the second one done.

(if you are wearing an eye patch be careful if you go out for a curry - they may mistake you for a pirate and sink you)

[Jingthing]

Thank you very much for that report, HB.

That price is 40K baht which includes BOTH EYES, or 40K each eye INCLUDING the internal lens?

I think local local anaesthetic is usual for this surgery.

Can I ask about the method for removing the old lens? Do you he used the more modern laser method for that? There have been other reports the this doctor is a bit too enthusiastic in ordering surgery when it is not needed but in your case you obviously needed it urgently, so no issue with that. Congrats on your good result.

Where do you get the "more modern laser method" from? I work in a UK hospital eye department where the normal operation for cataracts is dissolving the old lens with ultrasound and sucking it out ( PHAKOEMULSIFICATION ). The other method is cutting the eye open and manually extracting the lens which is extremely rare now, and normally only used in the event of complications.

To my knowledge the only use of laser is to reshape the cornea to eliminate the need for glasses.

Yes, most operations are done under local, but we do many under general as well.

Sorry, thanks for the correction of my error. I believe you have accurately described both the modern and old fashioned methods.

Only one eye is done at a time, that way if anything goes wrong you still have one 'good' eye to work with while they fix the cock-up.

I think in Thailand, most times they do BOTH EYES at the same procedure time to save money. Now you can demand doing them separately but probably increases the cost.

Edited November 20, 2008 by Jingthing

[Tywais]

I had both eyes done at Bumrungrad Hospital at the same time but it was elective. Even after he finished the 1st one, about 15 minutes to do it, he rechecked with me about doing the 2nd one. Since I didn't really want to go through all the pre-op procedures and accompanying anxiety had him do the 2nd one, also 10-15 minutes. A small incision, about 2-3mm, and a tiny tube put in and ultrasonic to break it up and vacuumed out. No real pain except when he dropped the iodine in my eyes which burned quite a bit, even though they were anesthetized. Around 35-40k per eye. Vision is better then it has been in decades.

[PattayaDavid]

You guys must be talking about mono or single focus lens replacement as you won't get multi-focus lens implanted for Baht 40,000.

[Jingthing]

You guys must be talking about mono or single focus lens replacement as you won't get multi-focus lens implanted for Baht 40,000.

Yes, I agree. Definitely talking about the mono version. I talked to a doctor before and my conclusion was that the results were more predictable with mono, though with mono would still need to use reading glasses.

Edited November 20, 2008 by Jingthing

[Humphrey Bear]

Thank you very much for that report, HB.

That price is 40K baht which includes BOTH EYES, or 40K each eye INCLUDING the internal lens?

I think local local anaesthetic is usual for this surgery.

Can I ask about the method for removing the old lens? Do you he used the more modern laser method for that? There have been other reports the this doctor is a bit too enthusiastic in ordering surgery when it is not needed but in your case you obviously needed it urgently, so no issue with that. Congrats on your good result.

40k per eye.

I think he used laser for cutting, not sure about the removal - he had talked about ultrasound for the less affected eye, but said that more needed doing for the right eye.

I thought ultrasound was used only in very mild cases, where the coagulated protein was broken down again by the ultrasonics, but to me that is only a tremporary solution, as I would expect re-coagulation to return quite quickly.

He may be a little enthusiastic, but then all surgeons I've met like nothing better than slicing people open and stitching them back.

[Humphrey Bear]

15 minutes is about the time it takes him to do the operation. Sobering up a porter, getting you in place and cleaned up, anaesthetics (local), farting around waiting for the surgeon to finish his tea, wrapping you up, locating another sober porter and shipping you back to recovery is what takes the extra time. (i'm not getting at Thais here, this is the UK system... )

The lens sits in a capsule. Easy op. they macerate and suck out the old lens and slip a new one into the capsule. More complex is to replace the whole thing, bit more fiddly and not often needed these days, but maybe yer man resorted to this.

Only one eye is done at a time, that way if anything goes wrong you still have one 'good' eye to work with while they fix the cock-up.

Anyway, it's all very routine now, the Russians pioneered a conveyor belt system, beds rotating around the surgeon like a sushi bar :D

Good luck with recovery and getting the second one done.

(if you are wearing an eye patch be careful if you go out for a curry - they may mistake you for a pirate and sink you)

To both you and the previous poster - the ultrasonic route, just draining the coagulated matter, was proposed for my left eye, but the entire removal of the sac is what was done on my right eye.

It woks OK - I can see very well out of it already - my problem is trying to coordinate the two eyes. How come babies can do this at less than one year and I can't? I couldn't do it before after a dozen beers, but now I don't even need one!

[Humphrey Bear]

You guys must be talking about mono or single focus lens replacement as you won't get multi-focus lens implanted for Baht 40,000.

Correct.

I have studied the alternatives and multi-focus means multi nearly focussed - not any good for putting a group of five in the centre of the target. With single-focus lenses I can use specific correctional lenses for complete clarity at any distance.

It does mean I have to wear spactacles.\, but I am not on the vanity trail - I only like to shoot things cleanly.

[jmac]

Thanks for the info on this doctor. I am presently seeing him and about to schedule the surgery. Very timely for me.

[Jingthing]

Thanks for the info on this doctor. I am presently seeing him and about to schedule the surgery. Very timely for me.

Would you be so kind as to report your results? I am also considering a procedure.

Another question, the OP reported 40K per eye including mono lens. What would this cost at PIH and BPH?

Edited November 21, 2008 by Jingthing

[Humphrey Bear]

Thanks for the info on this doctor. I am presently seeing him and about to schedule the surgery. Very timely for me.

Would you be so kind as to report your results? I am also considering a procedure.

Another question, the OP reported 40K per eye including mono lens. What would this cost at PIH and BPH?

A year ago I was quoted 45k at BPH when I walked in the door.

Two hours later, it was 70-75k and I had no time to discuss it anyway.

For the initial examination and some eye drops I was charged 4500 at BPH - 1200 at Pattaya Eye Centre.

But PEC is a one-man band - a shop house behind Carrefour. If you need the comfort-zone of a major hospital, then BPH is the place to go.

I currently work in Vietnam, where the procedure is also carried out - and cheaper. But I have not yet found a Viet who knows how to wipe his arse correctly, let alone touch my eyes.

Previously I worked in Saudi, where most of the surgeons are Egyptian. Those I would not trust either - even though I was the Project Manager on a US $ 400M hospital in Jeddah. The equipment was superb, the surgeons knew how to operate them, but had no feeling for patient care whatsoever.

[thaibeachlovers]

Thank you very much for that report, HB.

That price is 40K baht which includes BOTH EYES, or 40K each eye INCLUDING the internal lens?

I think local local anaesthetic is usual for this surgery.

Can I ask about the method for removing the old lens? Do you he used the more modern laser method for that? There have been other reports the this doctor is a bit too enthusiastic in ordering surgery when it is not needed but in your case you obviously needed it urgently, so no issue with that. Congrats on your good result.

40k per eye.

I think he used laser for cutting, not sure about the removal - he had talked about ultrasound for the less affected eye, but said that more needed doing for the right eye.

I thought ultrasound was used only in very mild cases, where the coagulated protein was broken down again by the ultrasonics, but to me that is only a tremporary solution, as I would expect re-coagulation to return quite quickly.

He may be a little enthusiastic, but then all surgeons I've met like nothing better than slicing people open and stitching them back.

I've assisted with cataract ops for 12 years, but you've bamboozled me. We use ultrasound for all cataracts, just takes longer with a mature cataract, but not at all more complicated. Don't follow this stuff about coagulated protein at all. Once the cataract is removed ( properly ) there is nothing left to "re-coagulate"

[thaibeachlovers]

15 minutes is about the time it takes him to do the operation. Sobering up a porter, getting you in place and cleaned up, anaesthetics (local), farting around waiting for the surgeon to finish his tea, wrapping you up, locating another sober porter and shipping you back to recovery is what takes the extra time. (i'm not getting at Thais here, this is the UK system... )

The lens sits in a capsule. Easy op. they macerate and suck out the old lens and slip a new one into the capsule. More complex is to replace the whole thing, bit more fiddly and not often needed these days, but maybe yer man resorted to this.

Only one eye is done at a time, that way if anything goes wrong you still have one 'good' eye to work with while they fix the cock-up.

Anyway, it's all very routine now, the Russians pioneered a conveyor belt system, beds rotating around the surgeon like a sushi bar

Good luck with recovery and getting the second one done.

(if you are wearing an eye patch be careful if you go out for a curry - they may mistake you for a pirate and sink you)

To both you and the previous poster - the ultrasonic route, just draining the coagulated matter, was proposed for my left eye, but the entire removal of the sac is what was done on my right eye.

It woks OK - I can see very well out of it already - my problem is trying to coordinate the two eyes. How come babies can do this at less than one year and I can't? I couldn't do it before after a dozen beers, but now I don't even need one!

Sounds like you had an ICCE done. Only seen 1 of those in 12 years. Used to be common 20 years ago.

I also worked in Saudi. Didn't have Egyptian doctors, but the Saudis had no compassion for patients at all. Must be why all the Saudis that can afford it go overseas for their medical treatment!

[thaibeachlovers]

I had both eyes done at Bumrungrad Hospital at the same time but it was elective. Even after he finished the 1st one, about 15 minutes to do it, he rechecked with me about doing the 2nd one. Since I didn't really want to go through all the pre-op procedures and accompanying anxiety had him do the 2nd one, also 10-15 minutes. A small incision, about 2-3mm, and a tiny tube put in and ultrasonic to break it up and vacuumed out. No real pain except when he dropped the iodine in my eyes which burned quite a bit, even though they were anesthetized. Around 35-40k per eye. Vision is better then it has been in decades.

If you had pain when the iodine was put in, your eye had NOT been anaethetized properly. If you complained, they should have added more drops before proceeding.

By the way, <deleted> has happened to the speed on the forum, I know surgeons could do the whole op in the time I've spent waiting for the page to load!

[Lopburi99]

Thanks for the info on this doctor. I am presently seeing him and about to schedule the surgery. Very timely for me.

Would you be so kind as to report your results? I am also considering a procedure.

Another question, the OP reported 40K per eye including mono lens. What would this cost at PIH and BPH?

Hi, a few comments about my cataract surgery of last year (in the U.S.) which may be of interest to you both and others. I had the opportunity to have the surgery (including new lens implant) under insurance coverage before coming to Thailand so I decided to do so even though my cataracts were not advanced yet. I now regret having it done because I have developed "floaters" in both eyes which I understand is not uncommon after cataract surgery. The damned floaters are like large floating blurry clouds (not like bits of thread) passing through my field of vision. There is no medical remedy for these other than the risky and not recommended vitrectomy (sp?) in which the inner eye fluid is replaced with saline. Supposedly the floaters sometime dissolve or "drop" from the field of view, but mine never did. Happily, the brain eventually learns to mostly ignore them which reduced them to being minor annoyances only, which my brain has finally done after about a year.

In conclusion, in my particular case, I regret not delaying the surgery because my vision had not yet faded. But who knows, maybe I am better off getting it done when I did. One other thing: I believe my floaters may have been caused by my habit of sleeping on my stomach/face which sometimes puts pressure to the eye while asleep. In each eye the floaters did not develop until after about two weeks from the surgery. My doctor said this would not have caused the floaters but I don't believe him. Soooooo, good luck when you do have your surgery and be sure to use the protective eye covers for awhile. Also, if you are a stomach sleeper, try hard to stop doing it to avoid any possible damage to your eyes. My two cents worth.

Edited November 22, 2008 by Lopburi99

[Jingthing]

Lop, that is interesting. Sorry to hear about your floater problem.

I have heard that it is almost totally expected for people to develop a condition called "secondary cataracts" some years after the surgery, easily corrected I think with laser? I think that is a different thing than the floater problem you have.

The other issue you brought up is that is it possible to get the procedure too early? The OP waited too long for one eye, but you brought up the issue of your concern that you didn't wait until the a more optimum time. Perhaps thaibeach can comment.

Edited November 22, 2008 by Jingthing

[Tywais]

I have heard that it is almost totally expected for people to develop a condition called "secondary cataracts" some years after the surgery, easily corrected I think with laser? I think that is a different thing than the floater problem you have.

In my case the floaters came first and what prompted me to see a doctor. It was sudden, woke up one morning and there they were in both eyes. The doctor spotted a small cataract in my right eye. Over the next 2-3 years it (cataracts) got progressively worse and included the left eye. I was at a point of considering stopping work due to no longer able to correct the vision with glasses.

After a lot of research regarding this and the techniques arranged to have it done in Bangkok. The doctor, who I must say was very patient in answering all my questions, also informed me that secondary within 1-2 years is not uncommon (around 60% may have to have treatment). In my case, about 18 months. Went back and just a couple of minutes for each eye with a laser and it was done. That was probably 10 years ago and they are fine. Floaters still there but not that noticeable now.

[bunnaag]

@ thaibaechlovers

I was told that especially if people are very shortsighted there is a possibility that after a cataractoperation the retina might detach.Also did you during all those years happen to encounter a patient who not only is in need of a catarct operation but also has Gliose epiretinal and in one eye Synchisis.I was quoted a price of approximately 50 000 Bath per eye for cataractoperation including monofocal linse from the Rutnin Eyeclinic.If both eyes are operated on which is advised even if in one eye the cataract is not too bad the time period between the operations should be approximately 2 weeks.

[tonyevans]

I had the surgery about 2 years ago performed by Dr Nattawat when he worked at BPH. From memory the cost per eye was roughly 40k baht for the surgery and 10k baht for the lens. My insurance company covered the cost of the surgery but not the cost of the lens.

I had the operation some 2 weeks apart and like others after some 3 weeks I had the ' floaters ' in each eye. Now 2 years later I have accepted the floaters a little but they are still an annoyance especially driving at night when the headlights of oncoming cars look like snow cystals.

Dr Nattawat recommended wearing specs with minimum correction and this has helped a little.

In spite of this I am pleased I had the operation when I did as the cataracts would almost certainly have got worse over the years.

Hope this is of interest to anyone considering this operation.

Tony

[Humphrey Bear]

(if you are wearing an eye patch be careful if you go out for a curry - they may mistake you for a pirate and sink you

To both you and the previous poster - the ultrasonic route, just draining the coagulated matter, was proposed for my left eye, but the entire removal of the sac is what was done on my right eye.

Sounds like you had an ICCE done. Only seen 1 of those in 12 years. Used to be common 20 years ago.

I also worked in Saudi. Didn't have Egyptian doctors, but the Saudis had no compassion for patients at all. Must be why all the Saudis that can afford it go overseas for their medical treatment!

I'ne been sunk by many a Vindaloo (is that why they're called VindaLOO?)

Don't know what the procedure was called - but the surgeon explained what he was going to have to do beforehand and told me it would be more difficult and more risky than the Phase-whatsit that he usually does.

I;ve found Saudi surgeons better than Egyptians, but then I've seldom met them in Saudi - usually working outside the Magic Kingdom. And Naghrabi Eye Centre is a butcher's shop.

[Lopburi99]

I had the surgery about 2 years ago performed by Dr Nattawat when he worked at BPH. From memory the cost per eye was roughly 40k baht for the surgery and 10k baht for the lens. My insurance company covered the cost of the surgery but not the cost of the lens.

I had the operation some 2 weeks apart and like others after some 3 weeks I had the ' floaters ' in each eye. Now 2 years later I have accepted the floaters a little but they are still an annoyance especially driving at night when the headlights of oncoming cars look like snow cystals.

Dr Nattawat recommended wearing specs with minimum correction and this has helped a little.

In spite of this I am pleased I had the operation when I did as the cataracts would almost certainly have got worse over the years.

Hope this is of interest to anyone considering this operation.

Tony

Something else which may be of interest. Before I had my first eye done the Dr. premeasured the eye. It was upon this measurement plus his general experience that he predicted the best dimensions for my mono lens implant. Then when I had the actual surgery he implanted the lens. A few days later he tested my vision in that eye to determine how close his guess was. In my case, my new vision was fine for reading but in need for correction (contacts or glasses) for distance vision. He asked me if I wanted a new lense implanted in that eye which would give me almost perfect distance vision but suggested I try keeping it as is because he said in the other eye he could now (on the basis of the knowledge gained from my first eye procedure) insert a mono lense which would be almost perfect for distance vision. Then I would have one eye good for reading and one eye good for distance. He called this "monovision". This would allow me to avoid wearing glasses all together because the brain uses the appropriate eye as needed. This is what I did. Quite successful! I usually wear no glasses at all. I ended up buying some glasses anyway so I could have both eyes corrected perfectly for distance vision while driving, but for reading no glasses are necessary. If it weren't for the damned floaters I'd be 100% satisfied overall. But as stated earlier, I've finally gotten somewhat accustomed to the floaters so everything is basically OK now. More information if you are facing a similar situation.

[Humphrey Bear]

Something else which may be of interest. Before I had my first eye done the Dr. premeasured the eye. It was upon this measurement plus his general experience that he predicted the best dimensions for my mono lens implant. Then when I had the actual surgery he implanted the lens. A few days later he tested my vision in that eye to determine how close his guess was. In my case, my new vision was fine for reading but in need for correction (contacts or glasses) for distance vision. He asked me if I wanted a new lense implanted in that eye which would give me almost perfect distance vision but suggested I try keeping it as is because he said in the other eye he could now (on the basis of the knowledge gained from my first eye procedure) insert a mono lense which would be almost perfect for distance vision. Then I would have one eye good for reading and one eye good for distance. He called this "monovision". This would allow me to avoid wearing glasses all together because the brain uses the appropriate eye as needed. This is what I did. Quite successful! I usually wear no glasses at all. I ended up buying some glasses anyway so I could have both eyes corrected perfectly for distance vision while driving, but for reading no glasses are necessary. If it weren't for the damned floaters I'd be 100% satisfied overall. But as stated earlier, I've finally gotten somewhat accustomed to the floaters so everything is basically OK now. More information if you are facing a similar situation.

The eye that has been treated is good from 1m to infinity, but I need +3 for reading. The eye yet to be treated is OK for reading but an optician friend in Top Charoen fixed me with a lens for distance.

When I next return from Vietnam (February) I will have the other eye done and will hopefully have a balance.

For climbing round large construction sites I need to have 3D vision or I could kill myself. Having been desk-bound for several years now I want to get back to combining site supervision with paperwork - and lots of luverly overtime.

[thaibeachlovers]

@ thaibaechlovers

I was told that especially if people are very shortsighted there is a possibility that after a cataractoperation the retina might detach.Also did you during all those years happen to encounter a patient who not only is in need of a catarct operation but also has Gliose epiretinal and in one eye Synchisis.I was quoted a price of approximately 50 000 Bath per eye for cataractoperation including monofocal linse from the Rutnin Eyeclinic.If both eyes are operated on which is advised even if in one eye the cataract is not too bad the time period between the operations should be approximately 2 weeks.

Guys, I assist with operations, but I am not a doctor. Any medical questions should be referred to a medical person, though I have found that most queries can be answered with a google search.

[thaibeachlovers]

I have heard that it is almost totally expected for people to develop a condition called "secondary cataracts" some years after the surgery, easily corrected I think with laser? I think that is a different thing than the floater problem you have.

In my case the floaters came first and what prompted me to see a doctor. It was sudden, woke up one morning and there they were in both eyes. The doctor spotted a small cataract in my right eye. Over the next 2-3 years it (cataracts) got progressively worse and included the left eye. I was at a point of considering stopping work due to no longer able to correct the vision with glasses.

After a lot of research regarding this and the techniques arranged to have it done in Bangkok. The doctor, who I must say was very patient in answering all my questions, also informed me that secondary within 1-2 years is not uncommon (around 60% may have to have treatment). In my case, about 18 months. Went back and just a couple of minutes for each eye with a laser and it was done. That was probably 10 years ago and they are fine. Floaters still there but not that noticeable now.

The only post cataract laser treatment i am aware of is for a condition when the capsule behind the artificial lens becomes opaque and a YAG laser machine is used to remove the capsule.

Once I get back to work next week, I will be able to ask the surgeons about some of the queries, and ( hopefully ) give some authoritative answers.

[Mobi]

Against my better judgement, but really having little choice, I went to the Eye Centre at Bangkok Pattaya today, as I am seeing things floating in front of my left eye.

It is early days, but I have to say I was very impressed with the whole experience, from the nurses, to the state of the art equipment and mainly to the specialist, who spoke perfect Englsih, was extremely caring, and spent a lot of time doing various tests and checking my eye.

The charges were extremely reasonable, considering the time and attention given to my problem(s) (I have glaucoma which he also checked)

I will see what happens on my follow up visit next week.

It is possible that they have my records 'flagged', as I have been a very voluble 'trouble maker' in the past