Br J Ophthalmol 2000;84:4-8
( January )
The deficit in cataract surgery in England and Wales and the
escalating problem of visual impairment: epidemiological modelling of
the population dynamics of cataract
D C Minassiana, A Reidyb, P Desaib, S Farrowc, G Vafidisd, A Minassiane
a Institute of
Ophthalmology, University College London, Bath Street, London EC1V 9EJ
and Moorfields Eye Hospital, City Road, London EC1V 2PD, b Moorfields Eye Hospital, London, c Barnet
Health Authority, Hyde House, The Hyde, Edgware Road, London NW9 6QQ, d Central Middlesex Hospital,
London NW10 7NS, e Imperial
College School of Medicine, University of London
Correspondence to: A Reidy, Department of Preventive
Ophthalmology, Institute of Ophthalmology, University College London,
Bath Street, London EC1V 9EJ
Accepted for publication 19 July 1999
BACKGROUND The pool of
old cases of cataract, the expected new cases, and the shortfall in
cataract surgery and consequently the numbers dying with poor vision
without the benefit of cataract surgery are regarded as escalating
problems worldwide. Successive governments and the professional
ophthalmic bodies have not had the wherewithal to estimate the
magnitude or interaction of these elements in the population of the UK.
This study has collected and applied the best available epidemiological
data on cataract prevalence, incidence and service utilisation, and
demography to address the problem of control of the cataract pool in
the population of England and Wales.
METHODSData from
recent surveys undertaken by the authors, both on prevalence of vision
impairing cataract and on patterns of cataract surgery, were used
together with demographic and service utilisation information obtained
from government departments. These were integrated within a holistic
model, which was run under varied assumed levels and patterns of
service provision.
RESULTSThe study
shows that there is a serious pool of unoperated vision impairing
cataract in the population aged 65 and older, reflecting a shortfall in
cataract surgery. Continuing with the present level and pattern of
service provision, the pool will increase to over 2.5 million by the
year 2001. In addition, more than 700 000 will die with unoperated
impaired vision.
CONCLUSIONSTargeting
of existing or new additional operations to those below the visual
acuity of 6/12 will have relatively little effect on numbers dying
without surgery, but should have a substantial controlling effect on
the pool of vision impairing cataract in the population.
© 2000 by British Journal of Ophthalmology
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