Declining cataract surgery rates affect seniors across ontario
What:
Paper Presentation | Présentation d'article
When:
4:12 PM, Saturday 2 Jun 2018
(3 minutes)
Where:
How:
Authors: Shicheng Jin, Sze Wah Samuel Chan, Neeru Gupta
Author Disclosure Block: S. Jin: None. S. Chan: None. N. Gupta: Employment/honoraria/consulting fees; Name of Commercial Company(s); Senju, Valeant, Alcon. Membership on an advisory panel, standing committee or board of directors; Name of Commercial Company(s); International Council of Ophthalmology, Pan-American Academy of Ophthalmology, American Academy of Ophthalmology, African Ophthalmology Council, The Glaucoma Foundation, Human Eye Biobank for Research, World Glaucoma Association.
Abstract Body:
Purpose: To assess recent cataract service delivery in Ontario municipalities and population centres using cataract surgery rate (CSR) as recommended by the WHO Universal Eye Health: Global Action Plan 2014-2019.
Study Design: Retrospective population-level study.
Methods: Population-level data from April 1st 2009 to March 31st 2014 was accessed from the Ontario Ministry of Health and Long-Term Care (MOHLTC) IntelliHealth database by fiscal year. Cataract surgery and demographic data was extracted for Ontario’s municipalities using Ontario Health Insurance Plan billings codes. Municipalities were sorted as large urban (≥100,000 persons), medium (30,000 - 99,999 persons), and small (1,000 - 29,999 persons) population centres. Wait times were extracted from the MOHLTC wait times database. Cataract surgery rate (CSR) was defined as the number of cataract surgeries performed per million. Ethics approval was not required for this population based study.
Results: Ontario’s total cataract surgery volumes were 145,302 (2010), 147,550 (2011), 143,617 (2012), 144,341 (2013), and 145,239 (2014). The female:male ratio of 1.3:1.0 and mean patient age of 71.6±10 years were consistent from 2010-2014. By age, mean cataract volumes for 45-64 yrs was 21%, for 65-74 yrs was 36%, and for 75+ yrs was 42%. Approximately 98% of cataract surgeries were performed as a single procedure. Glaucoma procedures accounted for 44% of surgeries performed in combination with cataract surgery. Over 5 years, Ontario’s CSR decreased by 4% from 11,062 to 10,619, impacting females more than males (5% vs 2%) and those 75 years and older the most (-16%). CSRs by municipality varied significantly with large percent changes during the 5-year period ranging from 1,030 to 254,114. 50 Ontario municipalities had billings for cataract surgery, 22 were large urban, 19 medium, and 9 small population centres. Over the 5-year period, mean CSR declined across all population centres: large urban (-3.6%), medium (-2.3%), and small (-0.7%). Regardless of centre size, the 75+ yr age group showed the largest absolute reduction in CSR, with seniors in small population centres most affected (-29%). Mean wait times increased by 28.0% during the 5 years. CSR is projected to decrease by 35% for the 75+ yr age group by 2025 with current unchanged cataract volumes.
Conclusions: Declining cataract surgical rates have increased the burden of vision loss among our most vulnerable seniors, in rural and urban communities across Ontario. Further research and evidence-based advocacy is needed to prevent avoidable sight loss due to cataracts in Ontario.
Author Disclosure Block: S. Jin: None. S. Chan: None. N. Gupta: Employment/honoraria/consulting fees; Name of Commercial Company(s); Senju, Valeant, Alcon. Membership on an advisory panel, standing committee or board of directors; Name of Commercial Company(s); International Council of Ophthalmology, Pan-American Academy of Ophthalmology, American Academy of Ophthalmology, African Ophthalmology Council, The Glaucoma Foundation, Human Eye Biobank for Research, World Glaucoma Association.
Abstract Body:
Purpose: To assess recent cataract service delivery in Ontario municipalities and population centres using cataract surgery rate (CSR) as recommended by the WHO Universal Eye Health: Global Action Plan 2014-2019.
Study Design: Retrospective population-level study.
Methods: Population-level data from April 1st 2009 to March 31st 2014 was accessed from the Ontario Ministry of Health and Long-Term Care (MOHLTC) IntelliHealth database by fiscal year. Cataract surgery and demographic data was extracted for Ontario’s municipalities using Ontario Health Insurance Plan billings codes. Municipalities were sorted as large urban (≥100,000 persons), medium (30,000 - 99,999 persons), and small (1,000 - 29,999 persons) population centres. Wait times were extracted from the MOHLTC wait times database. Cataract surgery rate (CSR) was defined as the number of cataract surgeries performed per million. Ethics approval was not required for this population based study.
Results: Ontario’s total cataract surgery volumes were 145,302 (2010), 147,550 (2011), 143,617 (2012), 144,341 (2013), and 145,239 (2014). The female:male ratio of 1.3:1.0 and mean patient age of 71.6±10 years were consistent from 2010-2014. By age, mean cataract volumes for 45-64 yrs was 21%, for 65-74 yrs was 36%, and for 75+ yrs was 42%. Approximately 98% of cataract surgeries were performed as a single procedure. Glaucoma procedures accounted for 44% of surgeries performed in combination with cataract surgery. Over 5 years, Ontario’s CSR decreased by 4% from 11,062 to 10,619, impacting females more than males (5% vs 2%) and those 75 years and older the most (-16%). CSRs by municipality varied significantly with large percent changes during the 5-year period ranging from 1,030 to 254,114. 50 Ontario municipalities had billings for cataract surgery, 22 were large urban, 19 medium, and 9 small population centres. Over the 5-year period, mean CSR declined across all population centres: large urban (-3.6%), medium (-2.3%), and small (-0.7%). Regardless of centre size, the 75+ yr age group showed the largest absolute reduction in CSR, with seniors in small population centres most affected (-29%). Mean wait times increased by 28.0% during the 5 years. CSR is projected to decrease by 35% for the 75+ yr age group by 2025 with current unchanged cataract volumes.
Conclusions: Declining cataract surgical rates have increased the burden of vision loss among our most vulnerable seniors, in rural and urban communities across Ontario. Further research and evidence-based advocacy is needed to prevent avoidable sight loss due to cataracts in Ontario.
