New federal guidelines on cataract surgery

Aging, Fall, 1994

Are you considering cataract surgery? Before proceeding, you may want to look at a recently issued set of federal guidelines on cataract surgery that recommend putting off such surgery unless a person's vision has become so impaired that it interferes with daily activities. The guidelines were developed by a group of ophthalmologists and issued last spring by the Agency for Health Care Policy Research in the Public Health Service. Preparation of the guidelines followed Congressional and Department of Health and Human Services investigations that found evidence of needless cataract surgery being performed on Medicare patients. The guidelines were approved by the American Academy of Ophthalmology.

Cataracts are a clouding of the lens of the eye, a condition experienced by most people over 60. In the operation, the lens is removed and replaced with a plastic lens -- a procedure that often restores visual clarity. However, once a cataract is diagnosed, people may think they need to rush into surgery when, in fact, says a spokesman for the Academy of Ophthalmology, it could be 5 to 15 years before they need surgery.

More Medicare dollars are used to pay for cataract surgery than for any other single procedure, according to an article by Peter Vilbig, a reporter for Maturity News Service which appeared last spring. The article said that in 1991, for example, about 1.4 million cataract operations cost Medicare $3.4 billion. While the guidelines don't have the force of law, they are likely to influence the way many physicians practice.

Not everyone agrees with the recommendations of the panel. Critics such as the American College of Eye Surgeons and the Outpatient Ophthalmic Surgery Society warn that the guidelines will lead HMOs and insurers to tighten rules on coverage, denying it to patients who need it. Some critics expect the guidelines to reduce by 30 to 35% the number of Medicare patients undergoing cataract operations.

However, proponents assert that the guidelines are not meant to discourage those who really need the operation from getting it. Ultimately, the determining factor is a person's level of impairment -- and that can only be decided by you and your physician. For a free a copy of the new guidelines, call 1-800-358-9295, or send your return mailing address on a postcard to Cataracts, Box 8547, Silver Spring, MD 20907.