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When is a cataract a ‘cataract’?
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Eye care, and health care in general, is changing rapidly, as new technologies offer higher standards of care at an increased cost that the system can no longer bear. In eye care, the growing demand for cataract surgery will continue over at least the next decade while the supply of surgeons in the U.S. will slowly decline.
Something has to give.
On one hand, premium offerings (presbyopia-correcting lenses, femtosecond lasers, wavefront analyzers, etc.) will separate patients into those who can or can’t afford to pay more for premium services and separate practices into those that offer or don’t offer them.
On the other hand, I believe we will very soon see a more stringent definition of cataract by Medicare and other third-party payers to limit the cost burden on the system.
Currently, different states enforce different definitions of “visually significant cataract”; some require a strict best corrected visual acuity standard while others rely primarily on patient symptoms. All require some impact on functional activity to qualify for surgery as a covered service. In other words, we are already rationing health care, and a further tightening of standards should come as no surprise.
Such increasing standards will not be popular with either doctors or patients. However, this evolution of the system will further drive patients into “premium surgery,” which would increasingly include refractive lensectomy on patients whose lens opacity would formerly qualify for covered surgery.
Like it or not, these kinds of upcoming changes are one more reason for practices to become familiar now with premium cataract surgery options and to begin offering them.
I welcome comments from readers on how the system might change in the near future.