In Minnesota’s Olmsted County, the focus of the Mayo Clinic study, the incidence of cataract surgery more than doubled from 2005 through 2011.
Nationwide, age-related cataracts currently affect 22 million individuals, but that number is expected to grow to 30 million by 2020.
The increased demand for vision-saving cataract operations will place added financial burden on the U.S. healthcare system — a trend for which health-care planners will need to prepare to ensure that everybody receives timely and appropriate treatment, the Mayo researchers stress.
At about $3,000 per eye, cataract surgery already accounts for a hefty amount of vision-related Medicare costs: an estimated $6.8 billion a year.
Major cause: aging
A cataract is a clouding of the eye’s lens, the transparent part of the eye that we use to focus on objects. Most cataracts are caused by age-related changes within the lens, although certain medications, such as steroids, and illnesses, such as diabetes, can accelerate their formation. By age 80, more than half of Americans have cataracts that are severe enough to impair their vision.
But, as the National Eye Institute points out, the term “age-related” is misleading. Many people have small cataracts as early as their 40s and 50s, although their vision may not become seriously affected until age 60 or older.
In cataract surgery, the cloudy lens is removed and replaced with a new, clear one. Today, increasing numbers of middle-aged and older people are opting for cataract surgery rather than simply living with their impaired vision, as generations did in the past.
“The aging baby boomers are working longer, they want to be more active,” says Mayo Clinic ophthalmologist Dr. Jay Erie, in a video released with the study. “They have more demands on their vision. They have to drive at night, the traffic is busier, and they have to see better. And that’s why they’re looking for surgery sooner so that they can remain independent, remain active, and continue to work.”
For the Mayo study, Erie and his colleagues analyzed data on cataract surgeries conducted between 2005-2011 in Olmsted County. The data came from the Rochester Epidemiology Project (REP), a medical-records system shared by the Mayo Clinic and the Olmsted Medical Center. The REP database includes the medical records for virtually all of the county’s population, making it a very accurate source of long-term health-related trends. (The Mayo Clinic and the Olmsted Medical Center provide almost all of the medical care for the county.)
The analysis found that there were 8,012 cataract surgeries in Olmsted County (population: 144,248 in 2010) during the seven years of the study, peaking in 2011 at a rate of 1,100 per 100,000 residents. That compared to a rate of 511 per 100,000 residents in 2004, which was reported in an earlier Mayo Clinic study.
The data showed no indication that the rate is leveling off, the researchers note.
Here are some other key findings from the study:
- The increase in cataract-surgery rates was seen in all ages between 50 and 90 years, but was highest among people aged 80 to 89 (6,940 per 100,000).
- Almost 20 percent of the cataract surgeries performed in Olmsted County were in people younger than 65 years.
- The surgeries were more common in women (1,020 per 100,000) than in men (870 per 100,000).
- Second-eye cataract surgeries increased significantly. After undergoing the surgery for one eye, some 60 percent of patients returned within three months and 86 percent returned with 24 months to have a cataract removed from their second eye.
The study’s findings have limitations in regard to diversity and geography, as the Mayo researchers point out. Olmsted County residents are less ethnically diverse, wealthier and more highly educated than the overall U.S. population.
Factors behind rising rates
The Mayo study notes that an increasing number of people are having cataract surgery in outpatient clinics and that in Olmsted County alone, the number of cataract surgeons has increased 27 percent during the past decade. Could the proliferation of such clinics and surgeons be leading to unnecessary surgeries?
Cataract-surgery rates do increase when surgery is shifted from hospital-based to outpatient surgery clinics, Erie acknowledged in an e-mail response to questions from MinnPost. But he doesn’t believe that shift is fueling the increased demand for the procedure.
One of the reasons for the rising cataract-surgery rates found in the study, he stated, is that “people [are] not tolerating mild to moderate visual impairment [and] consequently are having cataract surgery sooner when compared to years ago.”
“I believe what is happening is that through improved surgical techniques and technology, ophthalmologists now provide a new innovative cataract surgery that is safer, provides better outcomes, improves quality of life, and takes patients to new heights in their life,” he added. “Consequently, and quite naturally and appropriately, this [has] driven increased patient demand for the surgery.”
The challenge will be, of course, to figure out a way to pay for this increased demand.
“Higher surgical rates require more financial resources,” Erie explained. “Placing limits on the number of cataract surgeries performed [as done in some countries] or shifting more cost to the patient will be contentious. Regardless, it is the responsibility of ophthalmology to improve current practice guidelines to maximize the benefits of the individual patient while at the same time minimizing cost to society as a whole — it’s all about value.”