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