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1993.02.25 :  Cataract Surgery

Contact:  Bob Isquith (301) 227-8364, ext. 159
February 25, 1993

       Leading eye and health care experts said today that
physicians and patients should not rush into cataract surgery if
glasses or visual aids can provide satisfactory functional vision
and the patient's lifestyle is not compromised.  
       Cataract surgery is absolutely necessary only in the
presence of diseases such as glaucoma and diabetic retinopathy,
according to members of a private-sector panel of experts whose
recommendations were released today by the Agency for Health Care
Policy and Research.  
       About 1.35 million cataract surgeries were performed in
1991 at a cost of approximately $3.4 billion to Medicare alone. 
It is the most common surgical procedure among Americans over 65,
and while younger people develop cataracts less frequently, they
too require the surgery at times.  But the experts' guidelines
encourage patients and ophthalmologists to consider such options
as stronger glasses, magnifying lenses, pupil dilation and simply
waiting until the cataract becomes more burdensome.
       The leader of the panel, Denis O'Day, M.D., said, "The
operating surgeon and patient should discuss the risks and
benefits of cataract surgery, and then weigh them against the
degree to which a cataract interferes with daily activities. 
Ultimately, the decision must be made by the patient."  Dr. O'Day
chairs the department of ophthalmology at the Vanderbilt
University School of Medicine.

       J. Jarrett Clinton, M.D., administrator of the sponsoring
agency, a part of the U.S. Public Health Service within HHS, said
that cataract surgery is low risk but not risk-free. "Not
everyone who develops a cataract wants surgery, nor does everyone
need it unless their quality of life is affected.  Some may never
need an operation." 
       According to Dr. O'Day, currently there are no objective,
independent measures of functional impairment that can serve as
precise indications for surgery.  The panel believes that the
development of such measures should be a priority.
       The guidelines do not recommend cataract surgery solely to
improve vision if: 
     o    The patient does not desire surgery.

     o    Glasses or visual aids provide satisfactory functional  
             vision.

     o    The patient's lifestyle is not compromised, or

     o    The patient is medically unfit.

       The guidelines also emphasize the importance of post-
operative care to cataract surgery outcome.  The guidelines place
responsibility for follow-up care on the operating surgeon and
recommend defined roles and responsibilities for
ophthalmologists, optometrists and other members of a team of
appropriately trained professionals, including community health
nurses and social workers.

       The panel reviewed nearly 8,000 published studies on
cataract care as well as information provided by consultants,
specialty societies and others.  The draft guidelines were widely
circulated to cataract experts for review and comment before they
were made final.
       Included in the guidelines are findings from cataract
outcomes published by a team of researchers on the incidence of
retinal detachment after use of YAG-laser capsulotomy--a
procedure undergone annually by more than 600,000 previous
cataract surgery patients to correct opaqueness of the remaining
lens capsule.  The study found that the procedure is associated
with a nearly four-fold increase in the risk of retinal
detachment.  The AHCPR-funded cataract Patient 
Outcomes Research Team project, which is led by Earl Steinberg,
M.D., of Johns Hopkins University, is examining variations in
cataract treatment and short- and long-term outcomes and costs
associated with cataracts.

       The cataract guidelines have been endorsed to date by the
American Academy of Ophthalmology, Association of University
Professors of Ophthalmology, American College of Surgeons, 
American Society of Ophthalmic Registered Nurses, National
Society to Prevent Blindness and the Alliance for Aging Research.

       The guidelines are the fourth published by AHCPR, whose
mission is to improve the effectiveness, quality, and
accessibility of health care.  Sixteen other clinical practice
guidelines, including ones on depression, HIV illness, cancer
pain, and low-back problems, are under development.

       Copies of Cataract in Adults: Clinical Practice Guideline,
an accompanying quick reference guide for clinicians, and a guide
for patients, are available free from the AHCPR Publications
Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907; or by
calling 1-800-358-9295.


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