The Evolution of Cataract Surgery: The Most Common Eye Procedure in Older Adults

Lorne Bellan, MD


Geriatrics and Aging. 2008;11(6):328-332. 

In This Article

Abstract and Introduction


Cataract surgery is the most common refractive surgical procedure performed on aging individuals. Major advancements in surgical and lens technology have led to enormous increases in surgical volume because of the improved safety profile and outcomes. Current research holds the potential for restoring full vision, including accommodation, without the need for glasses in the near future.


Good-quality vision is one of our most prized possessions. Surveys have shown that sight is the sense that people most fear losing.[1,2] Vision problems are common among older adults, with a slightly higher prevalence in women than in men (Figure 1). The bulk of the correctable visual problems is secondary to refractive errors, problems with focusing images sharply on the retina, which can be corrected with glasses or contact lenses. Cataracts—the clouding of the lens—is, however, becoming an increasing problem. Between 1994 and 2003, the proportion of older adults who self-reported the presence of cataracts rose from 14% to 20% in the Canadian community health survey.[3] It is speculated that a greater awareness of treatment possibilities, resulting in a higher demand for surgery, may be a reason for this rise. The removal of a cataract followed by the implantation of an intraocular lens is the principal refractive surgical procedure performed in older adults. Cataracts are a major public health issue, especially in developing countries, since they are responsible for 47.8% of the world's total blindness.[4]

Figure 1.

Percentage of Older Adults with Vision Problems

Annual direct health care costs for vision loss in Canada in 2006 were estimated to be $2.9 billion.[5] Correction of refractive errors accounted for $190.5 million, while cataract surgery represented the single largest cause sector—estimated at $513.4 million. This large cost is directly related to the frequency of the procedure. In 2002, the rate for cataract surgery was approximately 8,000 cases per million persons in Canada,[6] midway between the reported rate in the United States (7,000 per million) and Australia (9,000 per million).[7] Cataract surgery is relatively inexpensive compared with other surgical interventions. The cost per quality-of-life years gained ranges from $2,023 to $2,727 in the United States, depending on whether the first or second eye is being studied.[8] This compares very favourably with other procedures (e.g., hip arthroplasty at $2,279, knee arthroplasty at $6,535, implantable defibrillator at $21,804, in U.S. dollars).[9] The cost-effectiveness of the procedure is further increased when considering the indirect benefits that have been attributed to cataract surgery, such as reduced rates of automobile accidents[10] and hip fractures[11] among individuals who had visually significant cataracts.


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