Cataract Surgery: A Bargain, Despite the Price

SUNDAY Sept. 23, 2007 -- Everyone, if they live long enough, will suffer from a cataract that clouds the vision in one or both eyes.

Because of that, doctors expect spending on cataract surgery to surge in the coming decades as the population ages, part of an overall increase in vision costs among older Americans.

However, it's money well spent, experts say.

Cataract surgery is one of the most cost-effective surgical procedures to address vision problems in seniors, said David B. Rein, a researcher with RTI International in Research Triangle Park, N.C., who authored a recent study of the economic costs of vision disorders.

"It gives a great amount of benefit in terms of years of unimpaired vision, compared with dollars spent," Rein said.

In fact, it's one of the only therapies that actually cures the condition, rather than simply holding the line against future deterioration.

"You're removing a lens that is clouded, a dirty lens, and you're replacing it with a lens that's clear," Rein said.

A cataract is a clouding of the lens in the eye, which affects a person's ability to see clearly. Most cataracts are related to aging. By age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the U.S. National Eye Institute.

Major vision problems cost the U.S. economy about $35.4 billion a year, including $16.2 billion in direct medical costs. And because cataracts are frequent and inevitable, they make up the biggest chunk of those direct costs -- about $6.8 billion, according to Rein's research.

The primary way to treat cataracts is to remove the eye's lens and replace it with an artificial one.

These surgeries have been around for decades, and doctors have become remarkably adept at performing them, said Dr. Marco Zarbin, professor and chairman of the Institute of Ophthalmology and Visual Science in New Jersey.

"During the past quarter century, there have been remarkable advances," Zarbin said. "Ninety-five percent of patients report impressive improvement in their vision."

Most cataract surgery removes the lens through phacoemulsification, in which a probe inserted through a small incision in the side of the cornea breaks the lens into tiny pieces using ultrasonic waves. The surgeon then removes the pieces using suction.

This technique has gone through countless refinements, Zarbin said, and is far evolved from traditional cataract surgery. In that procedure, the lens was simply cut away.

"Back in the 1960s, people were kept in the hospital for two weeks following cataract surgery," he said. "Their heads were held in place with sandbags. Now, people have the surgery with topical anesthesia and go home the same day. It's just what you'd hope for in medicine. It's really true progress."

The replacement lenses are also improving.

In early days, patients were fitted with a lens that only provided one range of focus. Near could be in focus, or far, but not both.

But improvements in intraocular lenses are producing results that are coming closer and closer to mimicking the human eye, allowing people to change their focus from near to far.

"There's a real push to develop intraocular lenses that give people focus at distance and near," Zarbin said. "There's a real interest in improving those capabilities. I'm very sure that one day that's the lens that everyone will get, an accommodative lens."

These improvements mean that, even though more money is being spent on cataract surgery, the American people are getting a bigger bang for their buck, Rein said.

"Compare the cost for cataract extraction surgery to the treatments that address age-related macular degeneration or diabetic retinopathy," he said. "The costs are much lower, and the results are much better."

Patients can actually expect improved vision, rather than vision that simply won't get worse.

"When you're treating glaucoma or diabetic retinopathy, you're trying to prevent further visual impairment from occurring," Rein said. "With cataracts, you can restore their vision to what it was before."

Cataract surgery also helps keep older people entertained and more engaged, Zarbin said. "I think when you're older and have a less active lifestyle, things like reading and watching television gain a greater importance," he said.

"You also have to consider the cost of taking care of those patients if you didn't have the therapy to treat them. We are way ahead as a society by paying for those treatments, because they cost less than caring for all these debilitated and blind people," he added.

More information

To learn more about cataracts, visit the U.S. National Eye Institute.

Posted: September 2007


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