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Q: What is included in the Refractive Management package?
Dr. Rex Hamilton is a specialist in modern refractive cataract surgery. This field makes use of advanced diagnostic instruments and procedures to maximize visual function following cataract surgery and minimize the use of glasses. The cost of these advanced diagnostic tests, studies, analysis, and procedures are not covered by Medicare or medical insurance. In addition, achieving this high level of visual function requires significant additional time pre-operatively to analyze and plan the surgical treatment. During surgery, additional time is required to treat astigmatism. Finally, because the bar is so high for achieving adequate vision without glasses, there is a significant chance of needing a fine-tuning procedure (e.g. PRK or LASIK) to optimize the post-operative result. The cost of all of these aspects of modern refractive cataract surgery is included in the Refractive Management Fee.
Q: Is Astigmatism Management included in the Refractive Management package?
Yes. Please see the Astigmatism Management FAQs page for details.
Q: In what situations is Refractive Management mandatory?
Refractive Management is required when the goal of surgery is to function without the aid of glasses. This includes the following situations:

  1. Multifocal Intraocular Lens Implantation
  2. Extended Depth of Focus Intraocular Lens Implantation
  3. Accommodative Intraocular Lens Implantation
  4. Monovision with Monofocal Intraocular Lens Implantation
  5. Monovision with Toric Intraocular Lens Implantation
  6. Monovision in patients who have had previous LASIK, PRK or RK

Q: What is NOT included in the Refractive Management Package?
The Refractive Management fee does NOT include the use of the Femtosecond Laser or the ORA Intraoperative Aberrometer, or the cost of specialty lenses (e.g. Toric, Multifocal, Extended Depth of Focus, Accommodating IOLs). If one of our surgeons has recommended one of these specialty lenses, a member of his staff will provide you with the cost of the lens.
The Refractive Management Fee does NOT include any of the post-operative procedure that may be required due to medical conditions that can arise following the cataract surgery which are typically covered by insurance (e.g. YAG Capsulotomy for posterior capsular opacity).
Q: Are there other options?
The other option is to perform the surgery without addressing the astigmatism. Astigmatism can be treated after surgery if a patient does not like the vision and the surgeon determines that correcting the astigmatism will improve the vision. The correction will be performed using PRK or LASIK which is not be covered by Medicare or other Health insurance. In this case, the cost will be significantly higher than if the astigmatism management was performed during the initial surgery. It is possible to discount the cost of astigmatism correction at the time of initial surgery because our surgeon is already in the operating room to perform the cataract surgery.
Q: Will I need Refractive Management in both eyes?
Almost always the answer is yes. Separate pre-operative evaluation, including corneal topography, must be performed on each eye to determine the surgical correction of astigmatism specific to each eye. In unusual situations (e.g. cataract surgery has already been performed on one eye, one eye has retinal disease, advanced glaucoma or other disorders limiting visual potential, amblyopia, etc.) the Refractive Management Fee may be appropriate for only one eye. One of our surgeons will discuss all options with you to decide on the best choice for your individual situation.
Q: Will I need reading glasses if I choose Refractive Management?
The goal is to provide functional vision without reading glasses. Astigmatism correction alone does not provide excellent vision at distance and near without glasses. If you have chosen the Refractive Management option, the surgeon is suggesting that astigmatism correction, combined with certain lens options, can provide useful distance and near vision without glasses. These lens options include: multifocal and extended depth of focus lens implantation and monovision lens power targeting. After evaluating your eyes, the surgeon will inform you of your options and make a recommendation as to which options he or she feels is best for your particular situation.
Q: Are there any risks or side effects?
Please see the AMO Tecnis Multifocal Intraocular Lens Implantation FAQs or AMO Tecnis Symfony Lens FAQs for details on side effects of these options. If an Accommodative IOL is selected, the main side effect is that the predictability of the refractive endpoint is more variable. This means there is a higher chance of needing reading glasses and/or a PRK or LASIK fine-tuning procedure than if the multifocal or Symfony option is chosen. If the monovision option is selected, there is going to be reduced depth perception and a ghost image that you must adapt to. If you have not used contact lenses in a monovision setup prior to the cataract surgery, this adaptation may take several months. The surgeon will take all of these factors into account when he makes the recommendation as to which option he feels is best for your specific situation.
Q: Does it require additional visits?
When the goal is to see without glasses at all distances, the bar is much higher in terms of the expected outcome. This often translates into more visits, potential additional post-operative fine-tuning procedures and the need for reassurance that the healing process is proceeding as the surgeon expects. All of these factors likely translate into more frequent post-operative visits than would be required for standard non-refractive cataract surgery.
Q: Can I receive a refund if I still require reading glasses for very small print?
No. As with any surgery, results are subject to individual healing patterns and a host of variables beyond our control. No guarantees can be made with respect to the final result. However, our surgeons will assess your individual situation with great care and recommend additional procedures (e.g. PRK or LASIK) if he feels there is a good chance of further reducing your dependence on glasses. Remember, however, that the goal is to provide distance, intermediate and social near vision without glasses. Social near vision includes menus, pricetags, computer, and cell phones. Smaller print may require reading glasses and our physicians may tell you that in order to see the very small print without glasses, anything we can do surgically may then compromise the distance vision without glasses.
Q: When do I have to decide?
We would like you to decide at the time of the scheduled preoperative visit. At a minimum, you need to let us know one week before surgery.
Q: What do I do if I want refractive management?
You should tell one of our office staff. They will have you sign a non-covered service waiver next to a bold YES. If you do not want it, you will sign the waiver next to a bold NO.