Swedish study finds unacceptably high rate of unwarranted cataract surgery

A review of the Swedish National Cataract Registry shows that about 4.0 per cent of patients in 2012 and 5.5 per cent in 2013 received cataract surgery without a discernible clinical indication, Mats Lundström MD PhD, Karlskrona, Sweden, reported. Of these, 19 per cent perceived greater visual disability after surgery than before, another 10 per cent reported no improvement and 9 per cent ended up with worse visual acuity after surgery.

The study examined indications for 4,325 first eye and 2,974 second eye procedures performed at 46 surgical units in the month of March. Cases with documented preoperative visual acuity of 20/40 or less, patient dissatisfaction with vision, perceived difficulty performing daily life functions due to vision problems or a surgeon’s reason for surgery, such as anisometropia or high IOP, were excluded. That left 47 first eye surgeries and 142 second eye surgeries without what reviewers considered an adequate clinical indication.

Projecting these numbers onto an entire year, this means about 900 first eye surgeries and 2,500 second eye surgeries were done in Sweden in 2013 with a 30 per cent risk of not perceiving better visual function and a 9 per cent risk of worse visual outcome after surgery, Prof Lundstrom said. “If we go outside of health care and talk about these risk numbers for delivering a service or product, they are definitely, definitely, definitely unacceptable.”

Prof Lundstrom intends to follow the trend for 2014. He also will start a discussion within the ophthalmic community about indications for cataract surgery – before payers do it for the profession.