By David Mallory, M.D.

    The cataract operation is the most frequently performed surgical procedure in Medicare beneficiaries, with more than 2.5 million procedures performed annually.

    A mega study of 90 previous studies of cataract surgery results involving more than 68,000 eyes was published last February. The conclusion was that, although not free of complications, modern cataract and intraocular lens implant surgery is a safe procedure resulting in excellent vision.

    In this day and age of cost containment, managed care, and limited resources, documenting visual improvement, no matter how remarkable the increase, may not be enough. Evaluation of health care in older populations focuses on quality of life as the critical outcome of treatment.

    A large prospective study was recently done to test how an improvement in vision effects quality of life. The results were unequivocal that an increase in vision was directly related to an increase in quality of life. Cataract surgery was the main reason for improvement in vision in this study.

    The National Health Service in England pays for only one cataract to be removed. The Lions Club in this country sends eye surgeons to Great Britain to perform free cataract surgery for people who are denied surgery or have a wait of more than a year and are severely incapacitated. Even in this country, a large insurance company recently announced it would only pay for one cataract operation per person.

    In an attempt to determine and quantify the effect on quality of life of cataract surgery on a first eye, a second eye, and both eyes, a large study was conducted. It found that the subjective improvement in vision and quality of life improvement were roughly equal in each eye after cataract surgery.

    These studies support policy recommendations that cataract surgery on both eyes remain the appropriate treatment. Health care planners should be aware that cataract surgery may well provide "more bang for the buck" than any procedure in all of medicine with regards to improvement in quality of life.

David Mallory M.D. is a cataract, intraocular lens and laser surgery specialist in practice at the Southwest Eye Clinic.

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