Changing Incidence of Lens Extraction over 20 Years

Abstract

Objective Investigate trends in incidence of lens extraction over the past twenty years. Design Longitudinal population-based cohort study. Participants Persons who participated in the Beaver Dam Eye Study. Methods Eligible persons 43–84 years of age living in the city or township of Beaver Dam, Wisconsin were recruited in 1987–1988. Participants were followed up every five years in 1993–1995, 1998–2000, 2003–2005, and 2008–2010 after the baseline examination in 1988–1990. Examinations consisted of ocular examination with lens photography and grading, medical history, measurements of blood pressure, height, and weight. Adjustments were made for age and sex. Values of risk variables were updated, and incidence of cataract surgery was calculated in each 5-year interval. Main Outcome Measure Incidence of lens extraction with regard to presence of clinically significant lens opacity and visual function. Results Age- and sex-adjusted incidence of lens extraction increased over the four 5-year intervals from 1.8% (95% confidence interval [CI] 1.3% to 2.5%) in the interval between the first and second study examinations to 11.7% (95% CI 9.9% to 13.8%) in the most recent study interval. The increase in incidence of surgery was significantly higher at successive intervals in persons without clinically significant lens opacity at each preceding examination (interval 1: 0.8% [95% CI 0.6% to 1.1%]; interval 4: 9.4% [7.8% to 11.2%]) compared with persons with at least one detectable type of opacity (interval 1: 9.2% [95% CI 6.4% to 13.2%]; interval 4: 16.5% [13.4% to 20.0%]). Recency of examination was not attenuated by adjusting for additional risk factors. There was no evidence that the increased incidence in surgery was preceded by poorer visual acuity, near vision, or contrast sensitivity at the beginning of each interval. Conclusion The incidence of lens extraction has increased over the past 20 years in persons older than the age of 65. The relative increase of surgery is higher in those without any clinically significant lens opacity, and in persons with visual acuity better than 20/40 at an exam as measured five years prior to observed incidence of lens extraction.

Oculo‐visual changes and clinical considerations affecting older patients with dementia

“…Cataracts are highly prevalent with advancing age 218 and the incidence of cataract surgery is increasing in many developed countries. 219 The benefits cataract surgery has on functional vision and quality of life have been well documented for community-dwelling ageing individuals, 220,221 including the oldest-old. 222 This latter study showed that those 90 years of age or older were the most unsatisfied with their vision prior to surgery and that 79% fared better in their activities of daily living after the surgery.…”

The Malaysian Cataract Surgery Registry

“…The trend observed in the Malaysian CSR reflects a reduction in cataract surgery in patients who are cataract blind and an increase in those who have cataract visual impairment. On the other hand, health care demands in developed countries such as the United States, 3 Australia, 4 and Sweden 5 have shown an increasing trend for cataract surgery in people with VA better than 6/12, indicating very early or no cataract.…”

“…The World Health Organization has set a minimum rate required to combat cataract blindness at 3000 surgeries per million people per year. 2 Developed countries such as the United States, 3 Australia, 4 and Sweden 5 have exceeded the recommendation (ie, between 7000 and 11,000 surgeries per million people). On the other hand, developing countries with limited resources but a higher burden of cataract blindness have lower rates.…”

“…6 The cataract surgery rate in each country is affected by the availability of health care resources and is also determined by the level of preoperative visual acuity (VA) at the time of cataract surgery. 7 Besides a rising cataract surgery rate in developed countries, there is an increasing trend toward cataract surgery in people with VA better than 6/12, as shown in the Beaver Dam Eye Study 3 and Melbourne Visual Impairment Project. 4 The National Cataract Surgery Registry in Sweden has shown that surgery in people with preoperative VA of 6/12 or better has increased from 56% in 1992 to 78% in 2009.…”

Small-gauge Surgery in Vitreoretinal Disorders – There is More than Meets the Eye

“…However, diagnosis-related group-based (DRG) reimbursement does not include cataract surgery and vitreoretinal surgery in the same procedure: our clinical goal is to only take our patients to the surgical theatre once in patient-orientated surgery. [2][3][4] Historically, the most common surgical platforms for vitrectomy surgery, since its introduction in 1997, have been the Alcon Accurus or DORC platform systems. 5,6 However, when we pioneered 23-gauge surgery, we experienced an increased rate of retinal detachment following macular surgery.…”