Cataract

PARIS – Substantial differences among the health care systems of European countries make reimbursement rates for cataract surgery difficult to compare, according to a survey conducted by French ophthalmologists. However, a constant factor that emerged from the survey is that wherever compensation is low, the quality of care is declining.

Today’s column will be a short, practical description of our “love-hate relationship” with topical anesthesia and how we finally made it work consistently and reliably on our cataract and, more importantly, our refractive lens exchange patients.

The restoration of reading vision for patients with presbyopia is shaping up to be one of the most important components of lens-based refractive surgery. We increasingly hear about the emergence of the baby boomers as an entire generation of eager candidates for a permanent surgical solution. In my last column I tried to discourage this sort of hyperbolic demographic projection that could lead us to overreach and repeat the “next new thing” problem we encountered with LASIK.

There are definite advantages to combining cataract and glaucoma surgeries, and the choice of surgical methods significantly affects outcomes, according to a meta-analysis of published reports.

ANTWERP, Belgium — Reimbursement for outpatient ophthalmic procedures has improved over time in Belgium, but the climate is still not right for freestanding outpatient facilities. Outpatient surgery is paid for by the government only if performed in a hospital’s day-surgery department, according to a surgeon who has worked for change in this policy.

The Akreos Disc IOL helped prevent posterior capsular opacification in cataract patients, according to two surgeons discussing two separate studies.

BALTIMORE — Over the past two decades, strabismologists have noticed an increase in the number of patients with strabismus after cataract surgery that seems to be caused by the anesthetic used in the procedure.

Disruption of corneal endothelium function after cataract surgery results in corneal edema, decreased cell density and hexagonal cell change, although the return to the normal state is rapid in most cases.

In order to control the amount of money spent on health care, the government in the Netherlands has prearranged a set number of medical specialists permitted to practice in the country. Health care providers worry that not increasing the number of doctors to match the growing rate of the population will result in detrimental effects on the way health care procedures are performed and will limit access to health care. Long waiting lists for needed procedures are already a problem here, with some cataract patients having to wait up to a year for surgery.

VENICE — Patient selection is important with the Array multifocal IOL (Allergan, Irvine, U.S.A.), and the surgeon must take into account ocular health, refractive error and the patient’s personality and lifestyle, according to David F. Chang, MD, who spoke about multifocals at the Venice 2000 meeting, sponsored by Ocular Surgery News, the Italian Association of Cataract and Refractive Surgery and the International Society of Refractive Surgery.