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Dr. Samuel Kimball of La Grande Family Eye Care in La Grande performs a cataract evaluation for patient Diana Rhinevault. CHRIS BAXTER/The Observer
By Trish Yerges / Observer correspondent
Cataract surgery is one of the most common surgeries performed, and optometrists are being used to diagnose and co-manage post-operative care for cataract patients, especially in underserved areas like Northeast Oregon.
Optometrists are diagnosing age-related cataract with increasing frequency, according to La Grande optometrist Dr. Samuel Kimball, who recently spoke at a health series program at Eastern Oregon University.
“I spend a lot of time seeing cataract patients,” said Dr. Kimball.
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. According to the National Eye Institute, by age 80, more than half of all Americans either have a cataract or have had cataract surgery.
The main non-modifiable risk factor for cataract is aging. However, other risk factors may include smoking, diabetes, steroid use, diuretic use and certain major tranquilizers.
Cataracts cannot spread from one eye to another, yet many patients develop cataracts in both eyes. Two separate surgery dates are customarily scheduled to remove the operable cataract.
“Cataracts are formed in the inner eye,” said Kimball. “It is kind of cloudy, which causes a lot of vision problems. In the United States, cataract surgery is the most commonly performed surgery. Ophthalmologists perform cataract surgery. Optometrists do not have that right.”
Worldwide, cataracts are responsible for 48 percent of the world blindness, according to the Vision 2020 organization, and cataract surgery has proven to be one of the most cost-effective medical interventions available.
“It takes about six minutes to take a cataract out of a person’s eye,” said Kimball. “It’s very, very fast, and again the result is almost immediate improved vision.”
Though optometrists do not currently perform cataract surgery, their role in cataract patient care is expanding.
“One of the things that I do because we live in an underserved area is that I help to co-manage cataract surgery,” said Kimball. “So if someone needs cataract surgery and has to go out to Tri-Cities, Portland or Boise to get their cataract surgery, I can see them for their post-operative care so they don’t have to keep traveling back and forth to their surgeon. I get to see a lot of cataract surgery and the complications, so there’s a new way that optometry is spreading into the medical field.”
In Union County, there is an aging population that comprise 2,185 households with at least one member that is 60 years and older, according to the 2000 U.S. Census. This is the population that typically present with age-related cataract and other low-vision disorders.
“A growing area of interest has to do with the aging population. There are more people who don’t see so they need a lot of help, and so there’s a need for this kind of low-vision service,” said Kimball.
In 2010, the Community Eye Health Journal forecasted the rate of growth of patients potentially at risk for cataract.
“The population aged over 60 years will double during the next 20 years from approximately 400 million now, to around 800 million in 2020,” stated the Community Eye Health Journal. “This increase in the elderly population will result in a greater number of people with visual loss and blindness from cataract who will need eye services.”
Optometrists comprise about 50 percent of all eye care professionals, said Kimball. These professionals want to better care for their patients, especially in rural settings where there may not be someone specialized within 100 miles. So there is a continued push for expanded rights.
“Now more and more, optometrists have the right to do diagnostic things, which 10 or 15 years ago wasn’t the case, so this is another kind of landscape that is changing in the world of optometry,” said Kimball. “There is more and more emphasis on disease and medical care, which is pretty interesting because it changes our relationship with other practitioners.”
Reform in the field of optometry is almost inevitable.
“With the aging population there’s probably going to be an even bigger push toward the medical side of optometry,” said Kimball. “There’s always a place for the glasses and contacts-— that’s not going to go away — but the medical side of this becomes really, really important.”
Poverty plays a large part in the cataract surgical rate worldwide. Patients in poorer countries often cannot pay for the cataract surgery or may not even inquire about surgery. Consequently, there is a great backlog of needed cataract surgeries in these countries.
However, most surgeries for seniors in the United States are at least partially covered by Medicare. Consequently, the cataract surgical rate in the United States is around 5,500 per million population per year, according to the Community Eye Health Journal.
With some progress already gained in the field of optometry, Kimball hopes to see optometrists gain greater medical and perhaps one day even surgical rights so that they can offer cataract patients more comprehensive and convenient care close to home.