NEW YORK CITY — Ophthalmologists in the U.S. have expressed concern that economic incentives may lead some eye care practices to direct cataract patients toward more expensive multifocal lenses, which may not always be medically appropriate. This practice carries risks of patient dissatisfaction and the potential need for additional corrective surgeries.

Patients undergoing cataract surgery typically choose between a standard lens, which insurance covers, and a multifocal lens, which requires an out-of-pocket payment of around $5,000 per eye. Ophthalmologists state that these lenses are not suitable for every patient, and some who are not ideal candidates may require revision surgery due to dissatisfaction with visual results.

The American Academy of Ophthalmology reports approximately 4 million cataract surgeries are performed annually in the U.S., with around 80% using standard monofocal lenses. Standard lenses generally provide distance vision, necessitating glasses for reading. Multifocal lenses offer a broader range of vision but require out-of-pocket payment.

Christina Prescott, an ophthalmologist specializing in complex cataract and corneal surgery at NYU Langone Health, explained the importance of patient suitability. "If you have a perfectly healthy eye, you get a perfectly good surgery, and you hit the target exactly, it's amazing," Prescott said. She added, "But if your eye has any pathology, or your surgery doesn't go well, or you're not on target, then you lose a lot of quality of vision."

Patients with pre-existing conditions such as macular degeneration, epiretinal membrane, or diabetic retinopathy are not considered suitable candidates. Corneal issues, including irregular astigmatism or prior laser vision correction, can also impact performance. Retinal surgeon Dimitra Skondra, also at NYU Langone Health, noted that "retinal problems do not let the lens function as it's supposed to function, and as a result, they don't have the vision they were expecting."

In some high-volume practices, patients may receive information about lens options from a "lens coordinator" instead of a physician. Roberto Pineda II, an ophthalmologist at Mass Eye and Ear in Boston, said, "I do a lot of lens exchanges for unhappy patients." He added, "I do think that sometimes economics wins."