Eyeworld

EW CATARACT March 2014 25 by Michelle Dalton EyeWorld Contributing Writer Benefits of cataract surgery A s anterior segment surgeons can attest, there is a definite "wow" factor after cataract extraction/ IOL implantation surgery. While ophthalmologists in general know cataract surgery can greatly improve quality of life, a few recent studies bear that out from a finan- cial perspective as well. Organizations like ASCRS, the American Academy of Ophthalmol- ogy, and AARP have educational websites for prospective patients to learn about the benefits of surgery. There are also patient handouts for those who do not have Internet ac- cess. But misperceptions still exist. AARP found in a survey co-spon- sored by Alcon (Fort Worth, Texas) that misinformation about cataract surgery is prevalent, with some be- lieving the procedure is painful, that self-diagnosis will let people know when surgery is needed, that cataract is unrelated to overall health, that halos are normal, and that recovery can take weeks. Here, EyeWorld summarizes several newly published studies confirming the benefit to society of cataract surgery. Socioeconomics of cataract surgery Cataract surgery was 34.4% less expensive in 2012 than in 2000 and 85% less expensive than in 1985, said Melissa M. Brown, MD, profes- sor of ophthalmology, Thomas Jef- ferson University, Philadelphia, and president and CEO of the Center for Value-Based Medicine, Flourtown, Pa. Initial cataract surgery yielded an extraordinary 4,567% financial return on investment to society over the 13-year model, she and colleagues wrote in a new study. 1 Dr. Brown said one of the more interesting findings was that while second eye surgery did not confer societal cost savings over the initial surgery, "bilateral cataract surgery improves quality of life even more than we had anticipated." The socie- tal benefits range from the patient's ability to return to work and/or re- gain self-sufficiency to getting the caretakers, usually younger family members, back into the workforce as well. And with about 1 million peo- ple undergoing cataract surgery in one or both eyes in the Medicare population who do not belong to a health maintenance organization, those numbers start to quickly add up. 1 "From a societal perspective, performing cataract surgery should be encouraged for those that are 20/60 or more as a result of the cataract," she said. "We have good data to support its cost benefits." Unfortunately, the study also confirmed what anterior segment surgeons already knew—physician fees have plummeted during the same time period, having decreased 89.9% since 1985. Cataract sur- geons' reimbursement fees are 10.1% of what was paid in 1985. Dr. Brown's group noted the national average 2013 cataract surgeon fee was $667. 1 The group concluded that cataract surgery "is a paradigm for the premise that healthcare inter- ventions, in addition to creating substantial patient value, also can create considerable economic wealth." Further, when the cost of vision impairment of those under the age of 40 is included, there is a total bur- den of $104.8 billion in 2012 dollars for the whole U.S. population, ex- cluding refractive correction. 2 For more on the impact of vision loss on those under age 40, see sidebar. June 2014 continued on page 27 New studies confirm what ophthalmologists already knew—cataract surgery is well worth the cost Vision loss and economic burden T he Vision Cost-Effectiveness Study Group found the economic burden of vision loss and eye disorders among people younger than 40 in the U.S. to be $27.5 billion in 2012, with $21.9 billion attributed to adults between the ages of 18 and 39. 2 Diagnosed disorders (including optometry visits) totaled $7.3 billion; children have a higher prevalence of diagnosed conditions primarily because of disorders of the conjunctiva, the group found. In contrast to the Medicare-age group, patients and families bore 70% of the economic burden; patients paid 25% of costs for diag- nosed disorders but more than 66% for vision aids, the group wrote. As might be expected in this patient group, cataract is not a leading disorder. The highest cost disorders were (in descending order) disorders of the globe (19%), injuries and burns (16%), disorders of the conjunctiva (12%) and other eye disorders (12%). Strabismus accounted for 13% of the costs for children, but only 2% of the cost for adults. "The total monetary value of the loss of well-being from vision impairment and blindness for the population younger than 40 years was $10.8 billion, including $4.1 billion for children and $6.7 billion among adults younger than 40 years," the group wrote in Ophthalmology. With estimated costs of more than $100 billion, vision loss and eye disorders rank in the top 5 costliest diseases in the United States, the authors wrote. 20-31 Cataract_EW June 2014-DL_Layout 1 6/3/14 12:20 PM Page 25

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