Trends Of Cataract Treatment In Italy: A Population Study On Estimated Demand And Allocation Between Private Sector And National Health System Over 23 Years

Cataract is one of the main causes of visual impairment worldwide, and even blindness in many countries, severely impacting quality of life. Nevertheless, cataract surgery coverage rates vary significantly by countries with different income levels, reflecting disparities in access to eye care services. The aim of the study is to explore the figures and possible changes in the approach to treat the cataract in Italy between 2001 and 2023 and to provide an estimate of the overall national demand and the quota covered by the public National Healthcare System (NHS).

Italy has a universal, free, public NHS, but many routinely performed, not expansive clinical practices have been progressively shifted to the private sector, in the last two decades. Every access to the public Italian NHS is associated to an hospital discharge record (HDR) reporting administrative, clinical and demographic information. Records of interest were extracted from the HDR database, comprehensive of 239,560,403 hospitalizations occurred between 2001 and 2023 in the public NHS.

Records of interest between 2001 and 2023 were labeled as phacoemulsification, phacofragmentation, extracapsular extraction, intracapsular extraction and other treatment with IOL, according to the ICD9-CM codes in the HDR. Trends of counts and incidence rates (IR) were explored. Means were reported with 95% Confidence Intervals (CI) and counts with percentages. A Bayesian hierarchical model was used to estimate the national demand of cataract treatment, assuming the IR of 2002 (with 10% error and 95% level of credibility) as baseline to compute the risk of treatment in population over 40, with equal risk over the years. Trends were evaluated by Cox-Stuart test. Significance was fixed at 0.05 for p-values.

4,234,851 records were extracted. The average age was 72.9 (CI: 72.8, 72.9) and 2,408,312 (56.9%) record involved females. The most performed procedure was phacoemulsification (3,958,627 cases, 93.5%), while 4,107,134 (97%) records reported IOL implantation. The number of hospitalizations significantly decreased (p < 0.01) by 90.7% between 2001 and 2023, with maximum value of 461,371 cases in 2001 and a minimum of 36,043 in 2020. Patients’ average age significantly (p < 0.05) decreased between 2001 (73.7, CI: 73.6, 73.7) and 2023 (70.4, CI: 70.3, 70.5). Approximately, between 450,000 and 550,000 cataract surgeries were estimated to be performed yearly, with the public NHS attracting only roughly 10% of the toral estimated caseload.

HDR-based analysis of 2001–2023 shows a marked decline in cataract-surgery hospital admissions in the Italian public NHS. Care progressively shifted to less intensive settings, with same-day models becoming predominant, consistent with appropriateness policies and technological advances enabling safe ambulatory or private surgery. Practice consolidated toward phacoemulsification with near-universal IOL implantation, while ECCE/ICCE became rare; mean age at surgery decreased and women predominated. These findings suggest redistribution and pathway reorganization rather than reduced clinical need, and support integrated national monitoring, including private activity, ideally through a dedicated IOL implant registry.