Time Trends in Indication for Cataract Surgery

Abstract

performed from 2002 to 2010 (excluding congenital and childhood cataracts) were drawn from the database yielding a total of 14,701 eyes (9,474 first eye surgeries and 5,227 second eye surgeries). To avoid problems with inter-eye interaction, the analyses were separated into first eye surgeries and second eye surgeries. However, only second eyes that were operated on within one year of the first eye were included in the second eye analyses (n=4.677). Thus, 550 eyes that were operated more than 1 year later than the first eye were excluded from the study.At the pre-operative visit all patients had a full ophthalmic examination including determination of best corrected visual acuity and a thorough slitlamp examination after pharmaceutical pupil dilation as well as biometric measurements including determination of axial length and radii of curvatures. Furthermore, patients were interviewed about cataract related symptoms as well as general health status. Any ocular co-morbidities were evaluated. For the statistical analyses, patients were grouped into those with ocular co-morbidities thought to be of significance for the visual acuity (e.g. age-related macular degeneration, glaucoma, previous retinal detachment, or previous vitreoretinal surgery) and those who did not have visually significant ocular co-morbidity (e.g. no other eye disease except cataract or visually insignificant eye disease such as blefaritis).Statistical analyses were performed using the SAS computer AbstractBackground: Due to the increasing proportion of elderly citizens the need for cataract surgery is expected to increase markedly within the next two decades but also the indication level for cataract surgery will influence the need for surgery. The aim of the present study was to examine if the indication for cataract surgery has remained stable over an eight year period in a university clinic setting in the Capitol Region of Copenhagen, Denmark.Methods: All pre-operative visits from 2002 to 2010 were evaluated yielding a total of 14,701 eyes (9,474 first eye surgeries and 5,227 second eye surgeries). Information was drawn from a database where pre-, peri-and postoperative data regarding all cataract surgeries (except for congenital and childhood cataract) performed at the clinic had been entered at the time of examination/surgery. Evaluation of the indication level for cataract surgery was assessed primarily based on visual acuity. Results:In the 8 year period, mean visual acuity increased significantly from 0.18 to 0.24 Snellen (corresponding to 0.74 to 0.62 logMAR) in the eyes that underwent surgery first and in second eyes from 0.29 to 0.41 Snellen (corresponding to 0.54 to 0.39 LogMAR, respectively, p-values <0.0001) and concomittantly the mean age of patients at the time of surgery decreased from 75.4 to 71.6 years in females and 72.1 to 69.1 years in males. Conclusion:During the time period from 2002 to 2010 the indication for cataract surgery changed towards patients being operated at better visual acuities and at younger ages. In the ...

Changing Incidence of Lens Extraction over 20 Years

“…A trend for increasing surgery has been noted in Sweden, 6,8 Denmark, 18 England, 19 and Rochester, Minnesota. 20 Thus our observations are not unique to the Beaver Dam community.…”

Longitudinal changes in global cataract surgery rate inequality and associations with socioeconomic indices

“…In several Organisation for Economic Co‐operation and Development countries, there has been a trend towards reducing thresholds of VI as indications for cataract surgery by insurers and surgeons, owing to improved surgical techniques, technology and functional outcomes. This in turn has also driven increased patient demand . In a 2005 Australian population study, it was noted that when the VI threshold for cataract surgery was changed from 6/60 to less than 6/12, the resultant CSR was seen to increase 3‐fold as a consequence .…”

Clinical practice variation in cataract surgery

“…[4][5][6][7][8][9]25,53,[73][74][75][76][77] However, it must be emphasized that in the past 5 years some countries have stabilized or slightly diminished their ratios. [4][5][6][7][8][9]25,53,[73][74][75][76][77] However, it must be emphasized that in the past 5 years some countries have stabilized or slightly diminished their ratios.…”

“…In recent years, several authors have expressed their concern at the increase of surgical volume, 20,21,53,73-76 which depends on a number of factors, of which the most important is likely to be the increased longevity of the population [4][5][6][7][8][9]20,78 and the corresponding increase in prevalence. [4][5][6][7][8][9]51,[79][80][81][82] As the second factor which determines a CSR we have, together with the increased life expectancy, the threshold level utilized to decide whether a specific patient is candidate for surgery or not.…”

“…[4][5][6][7][8][9] The recent establishment of a new Cataracts Departments in the Reina Sofía University Hospital of Córdoba has brought about modifications in the "cataract process" and implements a new standardized operational procedure which includes quality indicators. To this we must add the rapid increase of cataract surgery in the last 2 decades, a trend which will most likely continue to increase in the future.…”