Outlook is bright for refractive cataract surgery
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This issue’s cover story on refractive cataract surgery is timely.
The American Society of Cataract and Refractive Surgery just hosted the successful first Business of Refractive Cataract Surgery Summit under its president Vance Thompson, MD’s, direction in Irving, Texas.
The American Society of Retina Specialists has presented a Business of Retina meeting for 25 years. Increased access to quality educational programs on the business of ophthalmology is, in my opinion, a major unmet need.
Cataract surgery with IOL implantation is a modern-day miracle. In the past 25 years, more than 300 million patients worldwide have benefited from this amazing procedure. Nearly 130 million people alive today have had their sight restored and, in many cases, enhanced by cataract/IOL surgery. Approximately 60,000 cataract/IOL surgeries are performed every day in the world, and in America, 12,000 daily by 10,000 U.S. cataract/IOL surgeons. According to the American Academy of Ophthalmology IRIS Registry, the average age of a patient undergoing cataract/IOL surgery in the U.S. is 73 years. The older than age 65 years and Medicare-eligible population in the U.S. is growing as life expectancy increases, catalyzing a 3.5% growth in cataract/IOL procedure volume and a 7% growth in total revenue to surgeons, other participating eye care professionals, surgery facilities and industry. According to Market Scope, while providers and industry both benefit financially, refractive cataract surgery with cash-pay patient-shared responsibility for the cost is one of the few examples in which the providers’ share of the total revenue has been greater than the surgery facility or industry share. Refractive cataract surgery is a critical component of the financially healthy and sustainable comprehensive ophthalmology practice.
While refractive cataract surgery has been positive for surgeons and industry, the greatest beneficiary has been our patients. Our increasingly active older than age 65 years population has been provided not only vision restoration but also a once-in-a-lifetime opportunity for vision enhancement. Our ability to enhance vision with refractive cataract surgery has been accelerated by significant investment in new diagnostics, cataract removal devices and pharmaceuticals by our industry partners. The next step will be incorporating AI/machine learning and robotics into an already amazing procedure to make it even safer and more reproducible from one surgeon to another.
Today in the U.S., approximately 10,000 cataract/IOL surgeons perform 4.5 million procedures each year or, on average, 450 each per year. In the face of growing demand for the cataract/IOL surgeon, workforce studies suggest every year there will be about at least 100 fewer ophthalmologists. With a growth rate of 3.5%, which may accelerate as technology and outcomes improve, we can anticipate performing at least 9 million cataract/IOL surgeries each year in the U.S. in 20 years with 2,000 fewer surgeons. The typical U.S. cataract/IOL surgeon in 2045 will need to perform more than 1,100 cataract/IOL surgeries each year, and if current trends continue, at least 40% of them will be refractive cataract surgery. This is a positive projection for the refractive cataract surgeon of the future and our industry but will require us to become more efficient in our office-based and surgical practices. This will require continuing investment and innovation in technology as well as more efficient practice care patterns.
A reasonable question to ask is: How will the refractive cataract surgeon of the future meet this demand? I see a future in which most of the preoperative and postoperative care is rendered by adjunct employee eye care professionals. An attractive eye care model for the future will be the ophthalmologist-led integrated eye care practice. Immediate same-day bilateral cataract surgery with an AI/robotic-enhanced surgical workstation will become routine. Following safe and reproducible natural lens removal, a power adjustable aspheric monofocal, extended depth of focus, multifocal or accommodating IOL will be implanted, restoring and, for those patients who upgrade to refractive cataract surgery, enhancing vison to a performance similar to a 40-year-old emmetropic patient with no cataract. There will be no IV, no preoperative or postoperative eye drops other than topical anesthetic and antiseptic, and for many patients no eyeglasses for the rest of their lives. The outcomes achieved will drive the age of cataract/IOL surgery in the U.S. below the Medicare age, and refractive cataract surgery will evolve to look much like refractive corneal surgery does today, an office/ASC-based lifestyle-enhancing cash-pay procedure.
I see a positive future for refractive cataract surgery for all stakeholders, including the surgeon, their practice, every eye care professional, industry and even the payers as cash-pay dominates over third-party pay. But the greatest beneficiary will continue to be our patients. The future is bright indeed for refractive cataract surgery.
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