Regional cataract surgery rates improve but inequality persists

Cataract surgery rates are improving in inland NSW but still lag behind those in coastal areas, according to new research that uses 45 and Up Study data to map cataract surgery across the state.

The research looked at data from more than 200,000 Study participants between the years 2007 and 2016. It found that over that time 8.9% of them received cataract surgery in private hospitals – where most of these interventions occur.

Surgery rates were then analysed according to the participants’ postcode and their private health insurance status, along with the socio-economic status of their area. With the help of geographic information system (GIS) software, cataract surgery rates could then be mapped across 88 different areas in NSW.

“Our research showed that there was inequality based on where people lived,” says the study’s lead author Professor Mingguang He from the University of Melbourne. “The coastal regions had higher rates of surgery, but inland it was generally lower.”

The study also showed that areas with higher levels of economic disadvantage and lower private insurance coverage tended to have lower rates of cataract surgery.

The good news is that this inequality reduced over time. Between 2007 and 2016, several inland areas have seen a significant increase in surgery rates. “These changes means that cataract surgery provision is getting better, we’re doing something right,” Professor He says.

Cataract surgery is the most common eye procedure in Australia, with around 250,000 people receiving the surgery each year. Almost three-quarters of those surgeries are done in private hospitals. It’s estimated that half the population will develop significant cataracts by their seventies.

What areas are in need?

The study also reveals two areas of NSW that were struggling to improve their surgery rates – the southwest region of Lachlan Valley as well as Dubbo in the state’s west.

“These areas had very low rates for cataract surgery, and also very low coverage of private health insurance,” says Professor He. “There are pockets of the state that still need improvement. We can’t change the social economy, but we can think about establishing an eye service clinic, or an eye health centre in those areas.”

The precision of the GIS technology, coupled with the breadth of 45 and Up Study data, means that this kind of research can provide policy makers with state-wide trends as well as localised data.

“The analyses were quite straightforward to perform, but it’s an area ignored by a lot of researchers,” Professor He says. He points out that countries like Singapore have been using this kind of data for years to plan where new hospitals or health centres are built. “I hope more studies use GIS to map our health needs for policy planners.”

Professor He has used 45 and Up Study data for other eye health research, such as investigating the link between diabetes and glaucoma – a serious eye condition that can lead to blindness. He considers the Study an extremely valuable resource.

“I love that the 45 and Up Study gives researchers real-world data on the onset of disease or a severe life event,” Professor He says. “It would be extremely expensive to enrol thousands of participants, follow-up with them in 10 years’ time and examine them. But with the 45 and Up Study, we can capture the same information accurately and cost-effectively.”