The connection between cataracts, presbyopia and Refractive Lens Exchange
Posted by Dr. Germann Bianchi, MD on Jun 14, 2018 12:37:00 PM
With a rate of 33%, cataracts are the second leading cause of visual impairment after refractive errors in the world. In the UK alone, it is estimated that 30% of people older than 65 have a visually-impairing cataract in one or both eyes. Cataracts affect 24 million Americans aged 40 and older. However, more than 95% of cataract surgeries are successful.
Ninety-five percent of cataracts are age-related. In the 1970s and 1980s, the average age of a cataract patient was 72, but there is now evidence that this number is dropping and currently may be between 65 and 70 in many developed nations. In the UK, 10% of people aged 65 or over have already had cataract surgery.
As lens opacification is gradual, and identifying the point where a cataract is present is subjective, the change may be due to earlier diagnosis and treatment.
Using Medicare data combined with Market Scope survey data for the US, we estimated that nearly 3.0 million cataract surgeries (77%) were performed on individuals age 65 and older in 2016. An estimated 900 thousand cataract surgeries were performed in patients younger than 65, with most of these patients ages 55 to 64.
Western Europe and Japan, with aging demographics much like those in the US, are likely to have a similar distribution of cataract occurrence by age.
In addition to older patients suffering from cataracts, ophthalmologists are also starting to see younger patients who are suffering from "old age" eye problems such as presbyopia and other pre-cataract vision impairments. There are multiple reasons for this, including increased exposure to digital devices.
Advancements in vision-correcting technologies
However, as the number of younger patients suffering from presbyopia and other pre-cataract vision impairments increases, so too do advancements in vision technologies. These advancements include combined treatments for presbyopia correction at the pre-cataract stage – Refractive Lens Exchange (RLE) with premium, full range intraocular lenses (IOLs).
Younger patients opting for RLE with premium lenses
In the past, IOLs were more commonly used for cataract patients with an average age of 75. Today however, statistics show that younger, pre-cataract patients with an average age 55 are opting for RLE with premium presbyopia-corrective intraocular lenses (IOLs) while older patients are opting for cataract surgery with monofocal IOLs.
This main reason for the increased demand amongst younger individuals is that a growing number of younger patients are seeking higher-quality options, a faster recovery, and better post-op outcomes.
In fact, global studies have shown that post-op results after using multifocal lenses show improvement in near vision and reduced dependence on eyeglasses. Currently, the percentage of US patients who receive premium IOLs averages at 65% and of those receiving monofocal IOLs averages at 35%.
Due to the increasing demand, the numbers of cataract surgeons in the US who offer RLE procedures has also increased exponentially and a 5% compounded annual rate of growth (CARG) in this arena is projected for 2016 through 2021.
RLE and IOL market trends in the near future
The global expenditure on intraocular lens procedures is expected to exceed 30 million by 2022. Continuous market growth in the field of IOLs combined with an increased willingness to pay more for technological advancements and improvements in the current IOLs have driven demand.
In addition, the development of more advanced technologies is expected to further expand this segment of ophthalmologic treatments by over 12% in IOL procedures. This means that projected future IOL market revenues may be as high as 41%. The continued growth in the number of presbyopia-correcting IOL options available for cataract patients who seek to be independent of glasses is expected to drive a yearly unit growth of more than 9% over the next five years.
Costs in the US also play a role in choices for younger patients. For Medicare patients RLE is an elective vision correction procedure that is almost identical to cataract surgery. Average costs in the US per eye for cataract surgery are approximately $3,500 – roughly the same as elective RLE.
In just a few years, it is estimated that over 120 million people in the US alone will be diagnosed with traditionally age-related presbyopia. Research has shown that younger individuals prefer contact lenses over glasses. Unfortunately, up to 50% of lens wearers find lenses uncomfortable and multifocal contact lenses hard to accommodate so 20% stop using them when they become presbyopic. According to one study, approximately 59% rely on generic reading glasses, while an equal portion rely on magnifying glasses as opposed to being fitted with contact lenses.
Among this age group, it is estimated that a large number are unaware of available alternative treatment and correction options. For this reason, it’s important that both ophthalmologist surgeons and solution manufacturers play an active role in increasing awareness amongst potential patients about the more advanced and premium options now available to them.
Uncorrected presbyopia can severely reduce quality of life and lifestyle. RLE procedures with multifocal IOLs are a common treatment method for pre-cataract patients with presbyopia and have been proven to greatly benefit such patients.
Results show that today, when using premium intraocular lenses, patient satisfaction, reading ability, and visual performance increase. Use of these lenses provides near, intermediate, and distance visual acuity following cataract surgery.