Cataract Surgery Rate and Outcomes

Globally, over 10 million cataract operations are performed each year. Cataract surgical rate and economic indicators have been shown to be closely associated to each other, indicating the strong influence of resource availability on health care delivery. In developed areas, the rate of cataract surgery can reach up to 10,000 surgeries per million population per year. The highest rates have been reported in Malta, Japan, Suriname, Hungary, Croatia, Australia, Argentina, and the United States. In most developing areas in the Asia-Pacific region, and in many countries in Africa, the surgery rate is less than 500 surgeries per million. In some developing areas, the number may be as low as 150 surgeries per million. The WHO has determined that due to population growth and increasing longevity, the number of cataract surgeries performed worldwide has to triple to keep pace with need, with a goal of 3000 surgeries per million population annually.

Cataract surgery is correlated with reduced morbidity. A 2004 prospective study by Harwood, et al found that first-eye cataract surgery was statistically significant in reducing the rate of falling, thereby reducing the risk of fractures, as well as improving visual function and general health status in women over the age of 70. In 2012, a study of over 1.1 million US Medicare beneficiaries aged 65 and older determined that patients who had been diagnosed with cataracts had a reduced risk of hip fracture within 1 year after surgery compared with patients who had not undergone cataract surgery. Patients who have undergone cataract surgery also receive higher scores on standardized cognition assessments after the procedure.

A 2013 follow-up of the Blue Mountains Eye Study showed that cataract surgical correction was associated with significantly better long-term survival of older persons. However, in 2018, a large prospective cohort study conducted by the Women’s Health Initiative showed that in women participants aged 65 and older, cataract surgery was associated with an increased risk for all-cause mortality and mortality attributed to vascular, cancer-related, accidental, pulmonary, and infectious causes. It is unclear whether the results were related to the surgical procedure itself, or to the individual participants postponing the surgery until the hazard rates increased.

Cataract surgery is the most common surgery performed on an outpatient basis in the United States; approximately 3.5 million cataract surgeries are performed each year. The direct medical cost related to the treatment of cataract in the United States, including office visits, surgery, and prescriptions, is approximately $6.8 billion annually. The rate of cataract surgery has increased steadily over the last 3 decades, and so has the rate of second-eye surgeries within 3 months of the first. Although initial studies suggested second-eye cataract surgery had no effect on fall risk, a 2018 prospective study found that second-eye surgery provided additional benefits (73% fall reduction) compared to the number of falls before the first surgery, most likely due to increased binocular visual acuity and increased contrast sensitivity. Cataract surgery has been demonstrated to be a cost-effective intervention for visual improvement in the United States, with an estimated cost per-quality-adjusted life-year gain of $2020 for the first eye and $2727 for the second eye.

• Feng YR, Meuleners LB, Fraser ML, Brameld KJ, Agramunt S. The impact of first and second eye cataract surgeries on falls: a prospective cohort study. Clin Interv Aging. 2018;13: 1457–1464.

• Fong CS, Mitchell P, Rochtchina E, Teber ET, Hong T, Wang JJ. Correction of visual impairment by cataract surgery and improved survival in older persons: The Blue Mountains Eye Study cohort. Ophthalmology. 2013;120(9):1720–1727.

• Gollogly HE, Hodge DO, St Sauver JL, Erie JC. Increasing incidence of cataract surgery: population-based study. J Cataract Refract Surg. 2013;39(9):1383–1389.

• Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005;89(1):53–59.

• Tseng VL, Chlebowski RT, Yu F, et al. Association of cataract surgery with mortality in older women: findings from the Women’s Health Initiative. JAMA Ophthalmol. 2018;136(1): 3–10.

• Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA. 2012;308(5):493–501.

• Wang W, Yan W, Fotis K, et al. Cataract surgical rate and socioeconomics: a global study. Invest Ophthalmol Vis Sci. 2016;57(14):5872–5881.

Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.