Cataract statistics in Singapore

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Around 95 million people worldwide are affected by cataracts (Yu-Chi, 2017). In 2010, 35.1 million people globally were visually impaired due to cataracts, which counters a third of all blindness worldwide (Moncef, 2010).

In Singapore, according to National University Hospital (1997), the percentage of elderly patients affected by cataracts is about 78.6%. Cataract cases in Singapore increased by 37% in the last 10 years, according to research from the Singapore National Eye Centre (2013). The number of people affected by cataracts also increases as they get older. It affects 63.6% of people between 60 and 64 years, and 94.6% of people 75 years and older.

Between 1991 and 1996, an average rate of 356.4 cataract operations per 100 000 persons per year were performed on Singapore residents, (95% confidence interval [CI], 353.6-359.2). The average rate was highest for Indians (age-sex adjusted rate of 396.5 per 100 000/year), followed by Chinese (371.2 per 100 000/year), and lowest for Malays (237.2 per 100 000/year).

Interestingly, women were observed to have 14% higher rates of cataract surgery than men of the same age group, with this pattern consistent across the 3 racial groups in this study (Wong, 2001).

Cataract surgery in numbers

Cataract surgery is the most prevalent surgical procedure of all medical specialties and is performed over 28 million times around the world every year. Globally, there are nearly 60,000 cataract procedures every day. Based on the data report from the Royal College of Ophthalmologists in 2022, with an aging population and increasing cataract prevalence, it is estimated there will have been a 50% rise in cataract procedures between 2015-2035.

Modern cataract surgery is a common, safe, and effective procedure. More than 30,000 cataract operations are carried out annually in Singapore (Poon, 2013). Cataract surgery has a high success rate in restoring vision too. Based on the data from Singapore National Eye Centre in 2019, 99% of all cataract patients achieved the best corrected visual acuity of 6/12 or better after surgery.

Types of cataract procedures

1. Phacoemulsification: This is the most common and widely performed procedure for cataract removal. It involves making a small incision in the eye, breaking up the cataract using ultrasound energy, and removing it through suction. An artificial intraocular lens (IOL) is then implanted to replace the natural lens.
2. Femtosecond Laser-Assisted Cataract Surgery: This advanced technique uses a femtosecond laser instead of a surgical blade to create precise incisions and soften the cataract for ease of removal.
3. Extracapsular Cataract Surgery (ECCE): This technique is similar to phacoemulsification but involves a larger incision and the removal of the cataract in one piece. This is often used in cases where phacoemulsification may not be suitable, such as in advanced cataracts or resource-limited settings.

Risk factors of cataract

• Age: The natural aging process of the crystalline lens in the eye leads to cataracts.
• Exposure to Ultraviolet (UV) Radiation: Prolonged and unprotected exposure to sunlight can increase the risk of cataracts.
• Diabetes: Individuals with diabetes are at a higher risk of developing cataracts. The high blood sugar levels can cause changes in the lens that contribute to cataract formation.
• Medical Conditions: Certain medical conditions such as hypertension, obesity, and prolonged exposure to ionizing radiation, have been associated with an increased risk of cataracts.
• Smoking: The harmful chemicals in tobacco smoke can accumulate in the crystalline lens and lead to oxidative stress, which can contribute to cataract development.
• Previous Eye Injury or Surgery: Having had an eye injury or previous eye surgery, such as surgery for retinal detachment, may increase the risk of developing cataracts.
• Certain Medications: Long-term use of certain medications, such as corticosteroids, may increase the risk of cataracts. These medications can affect the metabolism of the crystalline lens and lead to cataract formation.

Impact of cataracts

• Vision Impairment: Cataracts cause clouding of the lens, leading to blurry, hazy, or decreased vision. This can interfere with daily activities such as reading, driving, recognizing faces, and performing tasks that require clear vision. As cataracts progress, vision loss can become more severe, potentially leading to blindness if left untreated.
• Reduced Quality of Life: Cataracts can significantly reduce an individual's quality of life. Visual impairment can limit independence and participation in social, occupational, and recreational activities. It can also impact mental well-being, causing frustration, anxiety, and depression due to the loss of visual function.
• Economic Costs: Cataracts impose economic costs including expenses related to diagnosis, treatment, and management of cataracts, such as eye examinations, surgical procedures, medications, and post-operative care. Additionally, individuals with cataracts may experience reduced work productivity or early retirement due to vision impairment, resulting in income loss for themselves and their families.
• Burden on Healthcare Systems: Cataracts represent a substantial burden on healthcare systems. The prevalence of cataracts in aging population increases the demand for cataract surgeries. This places a strain on healthcare resources, including surgical facilities, specialized equipment, healthcare professionals, and post-operative care. Healthcare systems need to allocate sufficient resources to address the growing demand for cataract treatment.

Reference list

1. Celojevic, D. & Zetterberg, M. (2015). Gender and Cataract – the Role of Estrogen. Current Eye
   Research 40 (2).
2. SINGVISION Issue 1/2021. All About Cataracts.
3. Wong, T.Y. (2001). Arch Ophthalmol. 2001;119(5):727-732. doi:10.1001/archopht.119.5.727.
4. Zetterberg, M. (2016). Age-related Eye Disease and Gender. Maturitas 83.
5. Yu-Chi L, Mark W, Terry K, et al. Cataracts. Lancet. 2017;390:600-12. Retrieved from: https://doi.org/10.1016/S0140-6736(17)30544-5.
6. Moncef K, Rim K, Rupert B, et al. Number of people blind or visually impaired by cataract worldwide and in world regions, 1990 to 2010. Invest Ophthalmol Vis Sci. 2015;56:6762–9. Retrieved from: https://doi.org/10.1167/iovs.15-17201.
7. Poon Chian Hui. (2013). New Cataract Surgery Cuts Blindness Risk. Retrieved from: https://www.straitstimes.com/singapore/new-cataract-surgery-cuts-blindness-risk