Is cataract surgery conducted more frequently than necessary?

Cataract surgery may be used more frequently in the UK than is necessary, according to study results published in the January 2009 issue of the British Journal of Ophthalmology.

Because of the almost four-fold increase in UK cataract surgery rates between 1989 and 2004, Professor Nick Black of the London School of Hygiene & Tropical Medicine, UK and colleagues assessed patients before and three months after cataract surgery (n=745) to determine whether the threshold at which it is determined surgery is necessary has been lowered. The metrics measured by questionnaire included patient-reported visual function, complications, quality of life and patient-determined surgical success.

The patients reported an increase in visual function (from 83.2 to 93.7) but the deterioration in self-reported general health status was reflected in a decrease of the reported quality of life. Of all patients, 8.9% (n=66) reported at least one complication. The researchers determined that an increase of 5.5 in the visual function score is the appropriate level for surgery, only 70% of the operations conducted would be classified as appropriate; however, only 51% of operations were appropriate based on patients' report of "much better" vision (a 12.2 visual function increase). Although visual function scores did not increase in 25% of patients, 93.1% reported the outcome of the operation as "good", "very good" or "excellent".

The researchers concluded that, although cataract surgery is now more widely available and utilized than previously, it is difficult to determine whether unnecessary operations are now being performed.