Increase in Cataract Operations Linked to Advances : Eye Surgery Abuse Called Exaggerated

An estimated 1.2 million Americans faced with vision loss underwent cataract surgery last year, making it the most common operation covered by Medicare.

Given the popularity of the procedure, reports of abuse in the medical industry stirred a congressional investigation that resulted in charges of unnecessary surgery, overcharges and kickbacks.

But the chairman of a national peer review committee believes the allegations have been exaggerated.

“I can’t believe that there are that many ignorant patients out there who would allow a doctor to operate on their eyes” unnecessarily, said Dr. Frederick A. Richburg, a Fresno ophthalmologist who heads peer review for the Out-Patient Ophthalmic Society. “Eyes are entirely too precious.”

He attributed a phenomenal increase in the number of cataract operations in recent years to advancement in medical techniques.

Patients with cataracts gradually lose their vision as the lens behind the iris grows cloudy with age.

The standard treatment was surgery in a hospital to remove lenses on severely impaired patients, who then were required to wear thick glasses. Their field of vision was cut 30%, and the glasses magnified objects, leaving patients impaired even after surgery.

Many ophthalmologists now attain 95% perfect or near-perfect surgical results by implanting synthetic lenses in outpatient clinics, a procedure that takes a matter of hours, said Richburg, who owns one such clinic.

“We have cut down the post-operative disability from what at one time was two weeks in the hospital to four days in the hospital to not being in the hospital at all,” Richburg said. “The surgical process has been simplified, the post-operative process has been simplified, and we have lowered the cost.”

He estimated surgical costs have fallen from $5,500 in 1972 to $3,500 now.

Richburg acknowledged reports of a lens company placing kickbacks in the name of doctors at Caribbean banks, but he noted that the company has gone out of business.

“There’s no question there have been some very, very shady things going on out there,” he said. “Just because a man has an M.D. does not mean his morals are above reproach and that peer review is not necessary.

“I think that any honest, sincere ophthalmologist, as I believe most of them are, are very happy to see honest, sincere peer review. The thing that they’re unhappy about is when arbitrary standards are established.”

Richburg noted a standard of 20/70 vision has been set as the minimum for Medicare reimbursement on cataract surgery. However, he said some patients pass a standard vision test in darkened rooms but can perform better or worse on more specialized examinations that mimic conditions for outdoor vision and predict potential improvement after surgery.

“When you do all those things, it’s pretty hard for me to believe somebody’s fudging the whole thing and doing unnecessary surgery,” he said.

Richburg is developing a computer program to analyze indoor and outdoor visual acuity, the age of patients and other factors provided by doctors to show deviation.

For instance, a doctor performing surgery on a greater percentage of patients below age 40 than the national average would be notified.

“The system would have a tendency to modify behavior” by encouraging physicians to come within the norms, Richburg said.

He charged the federal government has “little interest in the quality of care and in the needs of our senior citizens, but has primary interest on dollars and how to stop payment.”

Richburg’s answer to fraud is that the government should “pay one reasonable fee” for cataract surgery.

“If we can help them see and improve their vision, I think we’re doing a lot to help our country,” he said.