Cataract Surgery in San Francisco: Lens Options, Medicare Coverage and Choosing a Surgeon

Where cataract care happens in San Francisco

Five institutions run eye departments in the city. Each has its own front door, and two of them, the VA and Kaiser, are tied to specific groups of patients. Hours and services differ, so call before you go.

UCSF Ophthalmology

UCSF's academic eye department lists anterior segment (front-of-eye) surgery among its services, along with cornea, glaucoma, retina and several other subspecialties. Its clinical faculty has 45 full-time members. Eye clinics are at the Wayne and Gladys Valley Center for Vision, 490 Illinois St. in Mission Bay, and the Ambulatory Care Center, 400 Parnassus Ave., 6th Floor. The main patient line, including appointments, is (415) 353-2020.

CPMC Department of Ophthalmology (Sutter Health)

California Pacific Medical Center says it has provided eye care in the Bay Area since 1885. Its Department of Ophthalmology is based at the Pacific Vision Eye Institute, 711 Van Ness Ave., Suite 250, which houses several clinics and an ambulatory surgery center. The department is open Monday to Friday, 8:30 am to 5:00 pm; phone (415) 600-3901. The institute also houses the resident-run Lions Eye Clinic of San Francisco, which serves low-income and uninsured patients.

Zuckerberg San Francisco General

The city's public hospital runs an Ophthalmology and Optometry Clinic at 1001 Potrero Ave., Building 5, 4th Floor, Suite 4M; phone 628-206-8025. UCSF ophthalmology assigns a vice chair to this hospital, and UCSF residents rotate there.

San Francisco VA Medical Center

The VA's ophthalmology service lists cataracts among the conditions it treats, along with glaucoma, macular degeneration and diabetic eye disease. Visits are by appointment only. The medical center is at 4150 Clement St., at the end of the Muni 38 Geary/Ft. Miley bus line, and the main line is (415) 221-4810.

Kaiser Permanente

Kaiser runs a closed HMO system. Its Vision Essentials ophthalmology department at the Geary Campus, 1635 Divisadero St., 3rd and 4th floors, offers eye exams, urgent eye care, surgery and diabetic screening, with ophthalmologists, a retinal specialist and optometrists on staff; phone 415-833-2020. There is also a Kaiser optical center at Mission Bay, 1600 Owens St., 3rd Floor.

Independent practices and surgery centers operate in San Francisco too. We do not list or rank them, and the same checks apply to every surgeon.

Hospital, teaching program or private practice?

There is no single right setting. What matters more is the specific surgeon, a clear plan and costs you understand before the day of surgery. A few local facts help you ask better questions:

• UCSF and CPMC both train ophthalmology residents, and UCSF residents rotate through UCSF Medical Center, UCSF Benioff Children's Hospital, the SF VA Medical Center and Zuckerberg San Francisco General. At a teaching site, ask who will perform your surgery and who supervises.
• Some eye surgery takes place in an ambulatory surgery center rather than a hospital; CPMC's Pacific Vision Eye Institute, for example, houses one. Ask where your surgery will take place and whether that affects the bill.
• Kaiser members and veterans should start by asking Kaiser or the VA how eye surgery works within their system.

Lens choices: the questions to ask

The AAO describes a related operation, refractive lens exchange, as replacing the eye's natural lens with an artificial lens to improve vision. If your surgeon's office describes some lenses as standard and others as premium or an upgrade, these questions help you compare like with like:

• Which lens types do you offer, which would you choose for my eyes and my daily life, and why?
• With each option, what should I expect for distance, computer work and reading, and will I still need glasses for some tasks?
• Which part of the cost would my plan pay, and which part would I pay myself? Can I have that in writing before I decide?
• If one eye is done first, when would the second eye be scheduled, and does that change the lens decision?
• What happens if the result is not what we planned?
• Who is the surgeon of record, and where will the surgery take place?

Medicare and other coverage: get it in writing

We have not yet reviewed current Medicare rules on cataract surgery and lens options from primary sources, so we do not summarize them here. What we can offer is a process that works whatever your coverage:

1. Call your plan firstAsk whether you need a referral or prior approval, and whether the surgeon and the surgery location are in your network.
2. Ask for an itemized estimateAsk the surgeon's office to separate the surgeon's fee, the facility fee and any lens upgrade or extra testing.
3. Get any self-pay amount in writingIf part of the cost would be yours, get the amount in writing before you sign anything.
4. Veterans: start with the VAThe SF VA Medical Center's ophthalmology service treats conditions including cataracts, by appointment only. Main line: (415) 221-4810.
5. Kaiser members: start inside KaiserKaiser runs a closed HMO system. Vision Essentials at 1635 Divisadero St. offers surgery; call 415-833-2020.
6. Low income or uninsured: ask about the Lions Eye ClinicThe resident-run clinic at CPMC's Pacific Vision Eye Institute serves low-income and uninsured patients. Start with the department line, (415) 600-3901.

For adult children helping a parent

• Run the license and board checks together before the consultation, using our verification guide.
• Go to the consultation if your parent wants you there, and write down the answers to the lens and cost questions.
• Ask the surgery center for written instructions on arrival time, who must accompany the patient and the follow-up schedule. Follow those instructions rather than general advice online, including ours.
• Plan transport early. The SF VA Medical Center, for example, sits at the end of the Muni 38 Geary line.
• Keep copies of every estimate and coverage answer in one place.