Cataract Surgery Rates Rise, Threshold Decreases

Larry Hand

January 09, 2015

Trends in cataract surgery over the course of a 5-year period, from 2008 to 2012, show decreasing thresholds for surgery, decreasing surgical complication rates, and better visual outcomes, according to an article published in the January issue of Ophthalmology.

Mats Lundström, MD, an ophthalmologist on the Faculty of Medicine, Lund University, Sweden, and colleagues analyzed data from the Malaysian National Cataract Registry, the Dutch National Cataract Register, and the Swedish National Cataract Register for the 5-year period.

The analysis included outcomes from 404,714 cataract extractions from the Netherlands, 412,542 cataract extractions from Sweden, and 137,524 cataract extractions from Malaysia. It does not cover refractive lens exchange.

Their results may also be generalizable to the United States.

Mean age at the time of surgery ranged from 74.6 years in Sweden to 64.6 years in Malaysia. Trends showed mean age to be slowly decreasing in Sweden, stable in the Netherlands, and slowly increasing in Malaysia.

The 5-year changes in preoperative visual acuity reached statistical significance for all three countries. The percentage of eyes operated on with 20/200 vision or worse preoperatively decreased 28% in Sweden, 22.5% in the Netherlands, and 6.3% in Malaysia (P < .001 for all).

The investigators found the same pattern for eyes with visual acuity of 20/40 or worse.

Age-related macular degeneration as a comorbidity decreased in Sweden, remained stable in the Netherlands, and increased in Malaysia. Glaucoma as a comorbidity increased in Sweden, decreased in the Netherlands, and remained stable in Malaysia. Diabetic retinopathy as a comorbidity was highest in Malaysia, decreased in the Netherland, and increased in Sweden.

A 5-year decrease in capsule complications frequency reached statistical significance in all three countries (Netherlands and Malaysia, P < .001; Sweden, P = .04).

Improvements in postoperative visual acuity also reached statistical significance in all three countries for 20/20 or better (P < .001 all) and 20/40 or better (P < .001 all).

Cataract Surgery Rate

The cataract surgery rate increased from 8000 per 1 million population to 10,000/million in Sweden and from 10,600/million to 11,000/million in the Netherlands, and varied from 2000 to 3000/million in Malaysia.

Overall, the investigators found that cataract surgery on eyes with poor visual acuity preoperatively was associated with surgical complications, and that surgery on eyes with excellent preoperative visual acuity was associated with adverse outcomes.

The investigators conclude, "The decision on timing of cataract surgery is a complex one, and the one-size-fits-all approach does not work. This decision must be shared between the individual surgeon and the individual and adequately informed patient, balancing the potential benefits to the patient's visual function against the estimated risks. However, from these large data sets, we learned that late surgery on an eye with poor vision means increased risk for complications, whereas early surgery with excellent preoperative visual acuity means increased risk for poorer visual acuity. The optimal timing for cataract surgery lies between these 2 stages of cataract growth."

Dr Lundström told Medscape Medical News, "Our finding that a low [cataract surgery rate] is related to operating on a cataract in a more advanced stage and risking more complications is absolutely generalizable. Also, the fact that operating on a cataract in a very early stage with excellent preoperative visual acuity means an increased risk for a worse visual outcome."

Ophthalmologists should strive to achieve optimal timing for cataract surgery in their own practices and push for a modern and sufficiently high cataract surgery rate on a national level, he added. Higher cataract surgery rates are associated with fewer people going blind.

US Picture?

"[O]ur epidemiology data in Olmsted County, Minnesota, is nearly identical to the increasing incidence of cataract surgery seen in Sweden and Denmark," Jay C. Erie, MD, professor of ophthalmology at the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News. "Incidence trends in Olmsted County tend to accurately reflect trends nationwide when US national data is available.... [S]o I would say that with regard to cataract surgery rates, this data reflects the cataract landscape in the [United States]."

Dr Erie continued, "Our increasing cataract surgery rates are due, in part, to a significant increase in cataract surgery in both eyes, rather than limiting cataract surgery to one eye. The authors' findings are consistent with studies done elsewhere, that the vision threshold for surgery is changing."

This research was supported by the European Society of Cataract and Refractive Surgeons. The authors and Dr Erie have disclosed no relevant financial relationships.

Ophthalmology. 2015;122:31-38. Full text


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