June 2014




Benefits of cataract surgery

by Michelle Dalton EyeWorld Contributing Writer


New studies confirm what ophthalmologists already knewcataract surgery is well worth the cost

As anterior segment surgeons can attest, there is a definite "wow" factor after cataract extraction/ IOL implantation surgery. While ophthalmologists in general know cataract surgery can greatly improve quality of life, a few recent studies bear that out from a financial perspective as well. Organizations like ASCRS, the American Academy of Ophthalmology, and AARP have educational websites for prospective patients to learn about the benefits of surgery. There are also patient handouts for those who do not have Internet access. But misperceptions still exist. AARP found in a survey co-sponsored by Alcon (Fort Worth, Texas) that misinformation about cataract surgery is prevalent, with some believing the procedure is painful, that self-diagnosis will let people know when surgery is needed, that cataract is unrelated to overall health, that halos are normal, and that recovery can take weeks. Here, EyeWorld summarizes several newly published studies confirming the benefit to society of cataract surgery.

Socioeconomics of cataract surgery

Cataract surgery was 34.4% less expensive in 2012 than in 2000 and 85% less expensive than in 1985, said Melissa M. Brown, MD, professor of ophthalmology, Thomas Jefferson University, Philadelphia, and president and CEO of the Center for Value-Based Medicine, Flourtown, Pa. Initial cataract surgery yielded an extraordinary 4,567% financial return on investment to society over the 13-year model, she and colleagues wrote in a new study.1

Dr. Brown said one of the more interesting findings was that while second eye surgery did not confer societal cost savings over the initial surgery, "bilateral cataract surgery improves quality of life even more than we had anticipated." The societal benefits range from the patient's ability to return to work and/or regain self-sufficiency to getting the caretakers, usually younger family members, back into the workforce as well. And with about 1 million people undergoing cataract surgery in one or both eyes in the Medicare population who do not belong to a health maintenance organization, those numbers start to quickly add up.1

"From a societal perspective, performing cataract surgery should be encouraged for those that are 20/60 or more as a result of the cataract," she said. "We have good data to support its cost benefits."

Unfortunately, the study also confirmed what anterior segment surgeons already knewphysician fees have plummeted during the same time period, having decreased 89.9% since 1985. Cataract surgeons' reimbursement fees are 10.1% of what was paid in 1985. Dr. Brown's group noted the national average 2013 cataract surgeon fee was $667.1 The group concluded that cataract surgery "is a paradigm for the premise that healthcare interventions, in addition to creating substantial patient value, also can create considerable economic wealth."

Further, when the cost of vision impairment of those under the age of 40 is included, there is a total burden of $104.8 billion in 2012 dollars for the whole U.S. population, excluding refractive correction.2 For more on the impact of vision loss on those under age 40, see sidebar.

Extending life

Another large cohort study, the Blue Mountains Eye Study,3 evaluated 354 Australians aged 49 years and older who were diagnosed with cataract-related vision impairmentsome of whom had undergone surgery and others who had notand were assessed between 1992 and 2007. Those who had undergone surgery had a 40% lower long-term mortality risk compared to those who did not have surgery. "Correcting cataract patients' visual impairment results in improved outcomes beyond that of the eye and vision, and has important impacts on general health," said Jie Jin Wang, PhD, Centre for Vision Research, Westmead, Australia. The association between correction of cataract-related visual impairment and reduced mortality risk is not clearly understood, but plausible factors may include improvements in physical and emotional well-being, optimism, greater confidence associated with independent living after vision improvement, as well as greater ability to comply with prescription medications, the group noted.

Dr. Wang said one limitation of the study is that participants with cataract-related visual impairment who did not have cataract surgery could have had other health problems that prevented them from undergoing surgery and that these other health problems could partly explain the poorer survival among non-surgical participants. Nevertheless, findings from a larger cataract surgical cohort showed similar survival benefit in patients who have had visual impairment corrected after cataract surgery, compared to patients whose visual impairment persisted after cataract surgery.4

Vitamins may delay cataract onset

The Physicians' Health Study, a cohort of 14,641 middle-aged and older U.S. male physicians, found that daily multivitamin use decreased the risk of cataract, but did not have a significant effect on visually significant age-related macular degeneration.5 The randomized, double-masked study was conducted between 1997 and 2011, where half the participants took a common daily multivitamin, and the other half took a placebo. Participants were also randomly assigned to vitamin C, vitamin E, and beta carotene supplements. The researchers found that in the placebo group, 945 cases of cataract developed, which were self-reported and confirmed by medical records, while only 872 cases of cataract developed in the multivitamin group, representing a 9% decrease in risk. This risk was even lower, at 13%, for nuclear cataract. "If multivitamins do reduce the risk of cataract, even by a modest 10%, this rather small reduction would nonetheless have a large public health impact," said William Christen, ScD, the study's lead author.

Multivitamin daily use seemed to have more benefits for older men, but the trend did not reach statistical significance. The study authors added the findings were consistent with results of two other studies conducted outside the U.S.

"Long-term daily multivitamin use may have a small to moderate beneficial effect on risk of cataract, particularly nuclear cataract," the authors said.


1. Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: A new economic paradigm. Ophthalmology. 2013;120:23672376.

2. Wittenborn JS, Zhang X, Feagan CW, et al. for the Vision Cost-Effectiveness Study Group. The economic burden of vision loss and eye disorders among the U.S. population younger than 40 years. Ophthalmology. 2013; 120:17281735.

3. Fong CS, Mitchell P, Rochtchina E, Teber ET, Hong T, Wang JJ. Correction of visual impairment by cataract surgery and improved survival in older persons: The Blue Mountains Eye Study Cohort. Ophthalmology. 2013; 120:17201727.

4. Fong, CS, Mitchell P, Rochtchina E, de Loryn T, Tan AG, Wang JJ. Visual impairment corrected via cataract surgery and five-year survival in a prospective cohort. American Journal of Ophthalmology 2014;157:163-170.

5. Christen WG, Glynn RJ, Manson JE, et al. A multivitamin supplement and cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2013, article in press.

Editors' note: The sources have no financial interests related to their comments.

Contact information

Brown: mbrown@valuebasedmedicine.com
Christen: wchristen@rics.bwh.harvard.edu
Wang: jiejin.wang@sydney.edu.au


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