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Editor,

Cataract is the world-leading cause of blindness and impaired vision mainly because of lack of access to surgery in developing countries (Waddell & Heseltine 2007). Although blindness from cataract is rare in the Western world, cataract remains an important health care and socio-economic problem. An estimated 46 000 cataract surgeries are performed in Denmark each year (Olsen et al. 2004). The reimbursement from the Danish Ministry of Health is 670 Euro (5079 Danish kroner) for a cataract surgical procedure using local anaesthetics. Thus, the annual expenses paid by the Danish health care system related to cataract surgery exceed 31 mio Euro.

Cataract is predominantly a disease of old age with ¾ of the patients being 70 years or older (Olsen et al. 2004) and with the increasing age of the general population, the demand for cataract surgery is expected to increase in the future. Whereas the general population is expected to increase by 10% from the current 5.4 mio to 5.9 mio in 2050, the proportion of the population aged 70 or older is predicted to double from 10.5% (in 2009) to 20.4% (in 2050) (Statistics Denmark 2009). Correspondingly, the number of cataract surgeries will increase from 46 000 in 2004 to 86 000 in 2050 (Fig. 1) assuming that age-dependent surgery frequencies and the diagnostic criteria do not change in the period.

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Figure 1.  The graph shows the expected demographic changes in the Danish population from 2004 to 2050 based on information from Statistics Denmark (Statistics Denmark 2009). The general population is expected to increase from 5.4 mio (in 2004) to 5.9 mio (in 2050), and the number of inhabitants aged 70 years or older is expected to double from 57 000 (in 2004) to 121 000 (in 2050). The expected development in number of cataract surgeries is also shown.

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The demographic changes are even greater for the ≥100-year age group that is expected to increase from 600 in 2004 to 20 000 in 2050. Because the number of cataract surgeries performed in this age group in 2004 was too low to allow for a valid surgery frequency calculation, the ≥100-year age group was not included in the estimation of future need for cataract surgery. The graph presented in Fig. 1 is thus a conservative estimate.

The demand for surgery may prove hard to meet in the future unless actions are taken to reduce the prevalence of cataract. Cataract is a multifactorial disease associated both with nonmodifiable risk factors, such as age, female sex, and genetic predisposition and modifiable risk factors, such as tobacco smoking, diabetes mellitus and environmental exposure to UVB radiation (Vrensen 2009). There is no alternative nonsurgical treatment to cataract, so the only way to reduce the expected rise in surgeries will be to postpone the need for surgery. The effect of postponing the age at the time of surgery has a dramatic effect on the number of surgeries required, e.g. postponing the need for surgery by 10 years will reduce the number of surgeries by 60% (see Fig. 2).

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Figure 2.  Effect on cataract surgery rates by changing the age at surgery assuming a life expectancy of 80 years. The data were calculated using the latest publicly available data on cataract surgery in Denmark (Olsen et al. 2004).

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Most of the well-established modifiable risk factors for cataract are related to the change in lifestyle that has characterized the Western world since World War II and is seen with increasing speed in developing countries with tobacco smoking and diabetes mellitus being the most prominent. It is unquestionable that cessation of tobacco smoking will shift the cataract surgery curves towards an older age at the time of surgery, and hence a decreasing demand for surgery, although we do not at present have scientific data to estimate the exact effects. Hopefully, the ban on smoking in public areas seen in many countries will help to reduce the burden of tobacco related health care problems like cataract. Contradictory to this, the global epidemic of type 2 diabetes mellitus is anticipated to shift the cataract surgery curves towards a younger age at the time of surgery.

In conclusion, cataract remains an important health care problem even in our part of the world. Cataract is not the only age-related eye disease and if all age-related eye diseases are to be considered the future demand for ophthalmic services is overwhelming (Tuulonen et al. 2009). At present the only preventive mean is to raise public awareness of risk factors for age-related eye diseases.

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