Jan Cadwell was sick of living with poor eyesight.
The cataracts that had been developing in her eyes for years had gotten so bad that Cadwell, a 71-year-old flight attendant, was missing out on more than half the flights she could have worked. The clouding in her eyes turns car headlights into flying saucers, making it nearly impossible for Cadwell to drive to work in time for early-morning flights.
She was ready for cataract surgery. She just wasn't ready for the cost: $3,000. And when her eye doctor's office wanted $1,575 up front, she canceled.
Feeling out of options, Cadwell shared her story and frustration last month with Philly Health Costs, a health care price transparency project by the Philadelphia Inquirer and 6ABC Action News.
"I am so distraught at this point I'm not at all sure what to do," Cadwell wrote in an email. "Sure, I can afford it but it will take me a couple of months to plan."
Cadwell's luck changed when a pilot read the Inquirer's February article about Cadwell's experience and was moved to help her.
The man, who asked to remain anonymous, wrote Cadwell a check and delivered it to her in person. Both asked to keep private the total amount, but suffice it to say it will more than cover the cost of the surgery.
"I was just shell-shocked," Cadwell said. "This is the kind of thing that happens to other people, not me."
Laser vs. traditional surgery
Traditional cataract surgery, in which the surgeon uses a knife to make a small incision in the eye to replace a clouded intraocular lens, is covered by Medicare.
But Cadwell wanted laser cataract surgery, which is newer, more technically advanced and, as one might suspect, more expensive.
Medicare does not cover the full cost of laser cataract surgery because research has shown that, for the vast majority of patients, the more expensive surgery does not have better outcomes than the traditional, less costly version, said Esen Akpek, a professor of ophthalmology at the Johns Hopkins Wilmer Eye Institute in Baltimore.
"It's just fancier," said Akpek, who performs 400 cataract surgeries a year — none of them with a laser.
"There are patients that come in and talk to me about the laser and I steer them the other way," said Akpek, who did not treat Cadwell. "I don't think it's superior and it's additional cost for the patient."
Cadwell's eye doctor, Michael Kresloff, did not respond to a request for comment. His Collingswood practice's website advertises laser-assisted cataract surgery as a more precise, automated alternative to manual surgery performed with a scalpel.
"The same basic cataract procedure has been done for several decades without a significant breakthrough in technology – until now!" Kresloff & Young Eye Associates says on its website. "It is truly a revolutionary step forward in the science of cataract surgery."
Akpek said that lasers make more precise cuts but that the outcome of the procedure and patients' recovery time are the same as traditional cataract surgery. "The patient won't be able to tell the day after the surgery," she said.
All the same, Cadwell was sold on the laser surgery because she has astigmatism, an irregularity in lens shape that contributes to blurry vision.
Cataract surgery can correct astigmatism. After the clouded lens has been removed, it can be replaced with a special intraocular lens — also not covered by Medicare — to eliminate astigmatism. But these astigmatism-correcting lenses can be implanted during traditional or laser surgery, Akpek said.
Patients must decide for themselves which they prefer, provided they can pay for it.
‘Something that struck my heart’
Having flown private jets for 15 years, Cadwell's benefactor said he appreciated how hard she must have worked to move her way up as a flight attendant over 51 years in the business, and the dedication she must have for the job to still be doing it when many her age have retired.
"I'm not any philanthropist or anything," the semi-retired Delaware County resident said. "It's just something that struck my heart and I said I can do something about it."
He also has cataracts and, although he has not needed surgery yet, said he was pleased to be able to help Cadwell get the procedure she felt was right for her.
"Maybe it will inspire people to help others," he said.
Cadwell expects to have the surgery completed by the summer.