Number Of Cataract Extractions Research Articles

Cost and reimbursement of cataract surgery in Europe: a cross-country comparison

The number of cataract extractions has increased substantially over time. At present, cataract surgery is estimated to be the most common single procedure performed in the developed world. The present study compares the costs of a cataract intervention across nine European countries. To enhance comparability, data were collected using a common template based on a case vignette. Adequate data for analysis were collected from 41 providers and were used to evaluate variation across countries and providers. Ordinary least squares and a multilevel model were used to investigate cost variation. Mean total costs per cataract intervention varied considerably from country to country, ranging from 318 euros in Hungary to 1087 euros in Italy. Variations of a similar magnitude were detected for personnel costs and overheads. However, variations in the cost of the lens were more modest. Overall, our results confirm expectations about the causes of cost variations across EU member states, indicating that these variations may be attributable to the quantity of resources used in performing the operation, the price of resources, and the type of setting in which the operation is performed. The study highlights how accounting practices and available cost data differ across Europe. It also shows the feasibility of collecting data on the basis of vignettes using common cost templates. Studies following this approach will gain importance if cross-country comparisons are to be used to promote European benchmarking exercises.

Age-related utilisation of cataract surgery in Sweden during 1992-1999. A retrospective study of cataract surgery rate in one-year age groups based on the Swedish National Cataract Register.

To study the utilisation and increase of first eye cataract surgery in one-year age groups between 60 and 90 years of age during 1992-1999. Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992-1999. The total number of living persons in each one-year age group was collected from the Year Book of Statistics in Sweden (1993-2000). The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one-year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden. The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age-related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.

Cataract surgery in Australia 1985-94.

Cataract surgery is the most common form of major ophthalmic surgery in Australia and a common surgical procedure among the elderly. The purpose of this report is to compile the numbers and rates of cataract extractions and implant of IOLs over the period 1985-94 for Australia. Data were obtained for public and private cataract extractions and IOL implants from state and territory ministries of health and from the Health Insurance Commission. The data relating to cataract surgery were compared with the growth in the proportion of elderly people in the population. The number of cataract extractions has increased by 2.6 times over the ten-year period to 67,459 in 1994 and IOL implants have increased by 2.9 times over the same period to 70,084. The increase in the elderly population for the period was 1.3 times so that there is a relative doubling in the rate of surgery. The proportion of public patients has risen from 19% to 28% from 1985 to 1994. The numbers of cataract extractions and IOL implants was increased at double the rate expected from the growth in the elderly population. Advances in microsurgery and IOL technology have resulted improved outcomes and have created a greater patient demand. The improved outcomes have also lead to ophthalmologists recommending cataract surgery at better visual acuity levels than previously.

Changing indications for penetrating keratoplasty.

The indications for penetrating keratoplasty have changed over the past several years. One hundred and eighty cases of penetrating keratoplasty performed in the Department of Ophthalmology, Naestved Centralsygehus, Denmark, from January 1984 to December 1993, were analysed. Overall pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty (28.3%). This was followed by keratitis (13.9%), Fuchs' dystrophy (13.9%), regraft (11.1%), aphakic bullous keratopathy (10.0%) and keratoconus (6.7%). Pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty in 1989 and in each year from 1991 to 1993. Before 1989 the most common indications were keratitis (18.0%) and aphakic bullous keratopathy (14.8%). The emergence of pseudophakic bullous keratopathy, as the most common indication for penetrating keratoplasty, correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantation performed since the early 1980s. Especially semiflexible, closed-loop anterior chamber lenses used in our department in the early years of the period, have been the cause of subsequent corneal edema.

Changing indications for penetrating keratoplasty, 1971-1990.

We report a retrospective analysis of the clinical indications for 3555 penetrating keratoplasties performed at our department between 1971 and 1990. The cases were distributed among 12 diagnostic categories. Regrafting was the most common indication overall, accounting for 1452 cases (40.8%). Other major indications were, in order of decreasing frequency, keratoconus (17%), scarring secondary to herpes simplex keratitis (11.7%), aphakic bullous keratopathy (5.9%) and interstitial keratitis (5%). Further analysis of the relative percentages in each category within each 5-year interval of the study period was carried out to identify any changes in incidence. Viral disease as an indication for penetrating keratoplasty has shown a gradual decrease in frequency, accounting for only 6.4% of the cases during the last 5-year period (1986-90) compared with 19.6% during the first 5 years (1971-75). This finding is consistent with the marked improvement in the recognition and medical treatment of herpes simplex keratitis. The increase in incidence of grafting for pseudophakic bullous keratopathy in 1986-90 (6.7%) compared with 1981-85 (1.1%) correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantations performed during that period.

Pseudophakic bullous keratopathy

The number of cataract extractions in Switzerland has tripled since 1981. In 1986, a total of 15,500 cataract operations were performed, 95% of which were accompanied by an intraocular lens implantation. In spite of this tremendous increase pseudophakic bullous keratopathy remains a rare indication for keratoplasties: between 1980 and 1986 only 20 grafts were performed at the authors' clinic for irreversible corneal edema following lens implantation. After implantation of posterior chamber lenses, penetrating keratoplasty for corneal decompensation is performed after a significantly shorter period (one year) than with anterior chamber lenses (three years), or in iris-supported lenses (four years). In Switzerland, the incidence of pseudophakic bullous keratopathy among patients with posterior chamber lenses is around 0.1 to 0.3%. A long-term investigation of the endothelial cell density over a period of seven years in 16 patients with a Binkhorst two-loop lens revealed a quite stable and satisfactory cell density of 1600 cells/mm2.

Glaucoma Management in Pseudophakia

The ever-increasing number of cataract extractions followed by insertion of intraocular lenses has resulted in the emergence of a new group of patients with severe glaucoma. A series of 41 patients (45 eyes) referred for evaluation and management of uncontrolled glaucoma in pseudophakia is presented. Glaucoma had preexisted in 23 eyes. Sixteen different mechanisms were responsible for the postoperative glaucoma. Among the 41 patients were three with acquired pigmentary glaucoma. The case report of one of those three demonstrates that nonfixation of an Anis posterior chamber intraocular lens was the means by which iris pigment was dislodged. In all cases medical therapy was instituted or intensified, but resulted in acceptable glaucoma control in only 14 eyes. Laser procedures were used in 24 eyes, and laser therapy followed by medical therapy resulted in control in 19 eyes. The remaining 12 eyes underwent 31 surgical procedures, including three enucleations.

The outlook for intraocular lenses through 1990

Extracapsular cataract extraction with posterior chamber intraocular lens implantation has become the most successful intraocular procedure ever practiced. The number of cataract extractions and intraocular lenses implanted have increased enormously over the past decade. One might ask if a saturation point is near. The progress of cataract extraction and intraocular lens implantation is reviewed from 1973 to 1983 and an attempt to predict their volume to 1990 is made. Significant research and development factors and their impact on the domestic and foreign markets are presented. Because of these and demographic factors, it is concluded that we are not nearing the saturation point in cataract surgery or the intraocular lens industry.

An update of the indications for penetrating keratoplasty. 1979 through 1983.

We performed a retrospective analysis of the clinical and pathologic diagnoses of 497 corneal buttons that had been submitted to the Estelle Doheny Eye Pathology Laboratory, Los Angeles, during the five-year period 1979 through 1983. The leading indications, in order of decreasing frequency, were pseudophakic bullous keratopathy (17.5%), regrafts (15.1%), aphakic bullous keratopathy (10.9%), corneal trauma (9.3%), and Fuchs' endothelial dystrophy (9.1%). The emergence of pseudophakic bullous keratopathy as the most common cause for penetrating keratoplasty correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantations performed since the mid-1970s. Less frequent indications for penetrating keratoplasty included the following: corneal scars (6%); active ulcerative keratitis (7%); keratoconus (6%); keratitis secondary to virus (5%); non-Fuchs' corneal dystrophies (3%); congenital corneal opacities (3%); interstitial keratitis (2%); and chemical burns (1%).

Epidemiologic aspects of cataract surgery. I. Trends in frequencies.

A 51% increase in number of cataract extractions during the period 1970-79 is found. Neither population growth nor changes in age structure could alone account for this increase. Other factors such as economic resource allocation, changes in indications for cataract surgery and increased demand appear to be involved in this increase. Two large danish data sources were examined to determine the age and sex specific cataract extraction rates 1977-79. These rates are found to be in part equivalent to rates reported from England but substantially lower than rates found in USA. The age and sex specific rates are used as basis for estimation of number of extractions year 2000. A 60 to 80% increase is likely because of population growth in the older age groups, extention of indications for cataract surgery and more demand for good vision in old age.

EPITHELIAL INVASION OF ANTERIOR CHAMBER FOLLOWING CATARACT EXTRACTION

EPITHELIAL invasion of the anterior chamber is a most malignant postoperative complication of cataract extraction. Estimates of the incidence vary from 0.06 1 to 0.11 per cent. 2 When one considers the number of cataract extractions that are performed by surgeons of varying abilities and with various methods, the incidence of this complication is remarkably low. Since this is an infrequent complication, the finding of 5 cases during the past two years merits report. REPORT OF CASES Case 1. —Mr. P. J., aged 70, was examined at the Kings County Hospital. A mature cataract in the right eye and an immature cataract in the left eye were noted on routine ophthalmologic examination. The preoperative physical and laboratory studies 3 revealed little of clinical significance. A preliminary iridectomy of the right eye was performed on Aug. 20, 1947. The patient was readmitted to the hospital for extraction of the cataract on