All About Cataracts

The specialized equipment required for modern cataract surgery can be prohibitively expensive for small rural hospitals, especially those with low patient volumes. Often this means rural residents must travel long distances to a metropolitan health care facility to have their cataracts removed.

Surgical outsourcing allows eye surgeons to provide modern cataract surgery at small rural hospitals.

Cataract surgeon Jamie M. Monroe, MD, has found a solution: surgical outsourcing. For the past eight years, Dr. Monroe, who is surgical director and owner of Cataract & LASIK Center of Utah in Orem, Utah, has been using the services of a surgical outsourcing company called Sightpath Medical to help her provide state-of-the-art cataract surgery in small rural hospitals.

In the October 1, 2010 issue of Ophthalmology Times, Dr. Monroe describes how the outsourcing company allows her to choose her preferred surgical equipment, instruments, supplies and intraocular lenses (IOLs), and the company brings it all to the rural hospital on designated days. The hospital pays for the outsourcing services on a per-case basis without having to make a large capital investment in its own cataract surgery equipment.

The outsourcing service also provides certified technicians and surgical staff to assist the cataract surgeon during the procedures.

Dr. Monroe co-manages the pre-operative and post-operative care of her remote cataract patients with their local optometrist.

According to Dr. Monroe, she now performs cataract surgery at rural hospitals ranging from 100 to 300 miles from Orem, and patients are extremely appreciative to have access to high quality cataract surgery close to home with no need for extensive travel.

A new Veterans Health Administration study confirms the safety of cataract surgery, finding a low mortality rate 90 days after the procedure, even among high-risk patients.

Researchers at the VA Medical Center and at Warren Alpert Medical School of Brown University (both in Providence, Rhode Island) evaluated 45,082 patients in the National Patient Care Database who had significant cataracts and who underwent outpatient cataract surgery at VA hospitals between October 2005 and September 2007. Mean patient age was 71.8 years, 97.6 percent of patients were men and the postoperative follow-up period was 90 days.

The most frequent systemic health problems among the patients in the study were diabetes (40.6 percent), chronic pulmonary disease (21.2 percent), cancer (12.5 percent) and congestive heart failure (9.5 percent).

The study data revealed the mortality rate within 90 days after cataract surgery was 7.1 per 1,000 patients (0.7 percent).

Independent risk factors for mortality within the 90-day follow-up period were patient age of 80 years or greater, one or more hospitalizations within the past year, chronic pulmonary disease, cirrhosis, multiple myeloma, leukemia and metastatic solid tumor.

The study authors concluded the risk of mortality within 90 days after cataract surgery is low, even for high-risk patients such as the elderly and those with significant preoperative systemic diseases.

A full report of the study appears in this month’s issue of Ophthalmology.

Here’s good news if you like to enjoy a daily libation: A new study suggests drinking one to two alcoholic beverages per day may reduce your risk of cataracts.

A daily glass of wine or other alcoholic beverage may reduce your risk of cataracts.

Researchers in Australia assessed whether alcohol consumption is associated with the long-term incidence of cataracts or cataract surgery.

A total of 2,564 adults ages 49 and older were examined at the beginning of the study and again after five and/or 10 years. Lens photographs were taken at each visit, and the presence of cataracts was evaluated using a standardized lens opacity grading system. Information about alcohol consumption was obtained via interviewer-administered questionnaires.

After adjusting for age, gender, smoking, diabetes, myopia, socio-economic status and steroid use, the researchers found a U-shaped association of alcohol consumption with the long-term risk of cataract surgery: Moderate consumption (one to two drinks per day) was associated with 50 percent lower cataract surgery incidence, compared with both abstinence and greater alcohol consumption (more than two drinks per day).

The study appears in the September 2010 issue of American Journal of Ophthalmology.

Five-year results from NASA’s Study of Cataracts in Astronauts (NASCA) suggest that exposure to solar ultraviolet radiation in space accelerates cataract progression, though the effect was small and varied with different types of cataract.

Solar UV radiation in space may increase astronauts' risk for cataracts.

Leo T. Chylack Jr., MD, reported the results of the study at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). Dr. Chylack is clinical professor of ophthalmology at Harvard Medical School and one of the study’s investigators.

The researchers compared the rate of cataract progression in U.S. astronauts who had flown at least one space mission with that of control groups without exposure to UV radiation in space.

Though the study was limited by the number of astronauts completing the study and other factors, the five-year NASCA outcomes suggest that astronauts may experience cataract progression on prolonged space missions, according to Dr. Chylack.

He cautioned, however, that further study is needed to better understand the effects of space radiation exposure on the development and progression of cataracts.

Resource: NASA studies cataract in astronauts. Ophthalmology Times. September 1, 2010.