Cataract surgery is one of medicine’s great achievements.
We have gone from what you could describe as barbaric surgery to what is now an elegant, controlled and exacting five minute miracle. Most patients see well enough to drive without glasses the next morning. The safety profile easily exceeds virtually all other major surgical procedures.
When the natural lens of your eye ages sufficiently to create glare, haloes, and decreased vision, cataract surgery is indicated. Until 2005, surgeons were free to replace your cataractous lens with the implant they deemed most appropriate for you.
All of these lens implants could correct for nearly perfect distance vision without glasses but all required spectacles for reading and some intermediate vision. In the early 1990‘s 3M corporation designed a lens implant that could provide both excellent distance and near vision without glasses. This implant never achieved FDA approval. In 2001. AMO (now Abbott) developed the first FDA approved multifocal intraocular lens implant, the Array. Surgeons were free to use this lens for any appropriate patient without additional cost.
Medicare, as well as almost all insurance companies cover the cost of the intraocular lens up to $150. Not surprisingly, manufacturers almost always charged $150 for their implant. The manufacturing cost for almost all lenses is under ten dollars!
A very effective salesman/business man convinced Medicare that patients should be able to pay extra for a better implant. His company manufactured Crystalens™, an implant selling for $1000 rather than the standard $150. In fact, the recommendation was that surgeons charge $2000 – $2500 giving surgeons a profit motive for using this implant.
AMO soon withdrew their $150 Array implant from the market and replaced it with a modestly modified $1000 replacement called ReZoom™. Alcon (soon to be Novartis) launched the ReSTOR implant also priced at $1000 with the same recommendations. These Premium Implants started a new income stream for surgeons and implant manufacturers.
In my opinion Medicare violated its fundamental principle, that their clients were all deserving of the best possible medical care. They had essentially created two classes of patient, Standard and Premium. This was a sad day for cataract surgeons and an even sadder day for patients.
While some will say these funds stimulate innovation, I just don’t buy it.
