Surgical intervention rates (SIR) provide a proxy measure of disease burden, surgical capacity, and the relative risk-benefit ratio of surgery. The current study assessed decade trends in ophthalmic surgery and calculated SIRs for all major classes of commonly performed ophthalmic procedures in New Zealand.
Retrospective population-based analysis of all ophthalmic surgical procedures performed in New Zealand from 2009 to 2018. National and regional datasets from public and private health sectors and industry were analysed. SIRs were calculated for all major ophthalmic procedures, and subgrouped by patient demographics.
There were 410,099 ophthalmic surgical procedures completed with a 25.3% overall increase over 10 years. Procedures were mostly government-funded (51%, n = 210,830) with 71% of patients aged over 64 years. Cataract surgery (78%, n = 318,564) had the highest mean SIR (703/100,000/year) and increased by 25% during the study period, consistent with population growth in the over 64 years old age group. Vitrectomy surgery had the second highest mean SIR (67/100,000/year) and increased by 50%, well above national population growth during the study period. Other SIRs included conjunctival lesion-biopsy (38/100,000/year), glaucoma (33/100,000/year), strabismus (20/100,000/year), dacryocystorhinostomy (10/100,000/year), and keratoplasty surgery (4/100,000/year).
This comprehensive review of New Zealand ophthalmic surgery reports increasing SIRs that cannot be explained by population growth alone. Cataract surgery numbers increased year on year consistent with the increase in the over 64 years old population. Vitrectomy surgery growth exceeded that of the national population, including those over 64 years.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Data for all government-funded ophthalmic procedures from 2009 to 2018 fiscal years are available from the New Zealand Ministry of Health. Private-funded data on ophthalmic surgical procedures was obtained by personal communication from New Zealand’s largest single private healthcare insurer, industry records from intraocular lens implant sales, vitrectomy packs and New Zealand National Eye bank keratoplasty recipient numbers. See Supplementary Table 2 for dataset annual summaries.
Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120:2367–76.
Roberts TV. Social and public health value of cataract surgery: More than meets the eye. Clin Exp Ophthalmol. 2020;48:551–3.
Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–44.
Rao GN, Khanna R, Payal A. The global burden of cataract. Curr Opin Ophthalmol. 2011;22:4–9.
OECD. Health Care Utilisation: Surgical procedures. https://stats.oecd.org/index.aspx?queryid=30167 [Accessed 6 Aug 2021].
Wubben TJ, Talwar N, Blachley TS, Gardner TW, Johnson MW, Lee PP, et al. Rates of Vitrectomy among Enrollees in a United States Managed Care Network, 2001-2012. Ophthalmology. 2016;123:590–8.
Kerr NM, Kumar HK, Crowston JG, Walland MJ. Glaucoma laser and surgical procedure rates in Australia. Br J Ophthalmol. 2016;100:1686–91.
Pahlitzsch M, Pahlitzsch M-L, Sumarni U, Pahlitzsch T. Can we improve the efficacy of modern cataract surgery by using different tip designs? A comparison of balanced and tapered tip in femtosecond laser-assisted cataract surgery and manual phacoemulsification. Clin Exp Ophthalmol. 2018;46:35–45.
Recchia FM, Scott IU, Brown GC, Brown M, Ho AC, Ip MS. Small-Gauge Pars Plana Vitrectomy: A Report by the American Academy of Ophthalmology. Ophthalmology. 2010;117:1851–7.
Erie JC, Baratz KH, Hodge DO, Schleck CD, Burke JP. Incidence of cataract surgery from 1980 through 2004: 25-year population-based study. J Cataract Refract Surg. 2007;33:1273–7.
Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12.
Shalaby WS, Jia J, Katz LJ, Lee D. iStent inject: comprehensive review. J Cataract Refract Surg. 2021;47:385–99.
Kerr NM, Wang J, Barton K. Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma. Clin Exp Ophthalmol. 2017;45:393–400.
Hooshmand J, Rothschild P, Allen P, Kerr NM, Vote BJ, Toh T. Minimally invasive glaucoma surgery: Comparison of iStent with iStent inject in primary open angle glaucoma. Clin Exp Ophthalmol. 2019;47:898–903.
New Zealand Ministry of Health. Standard Operating Procedures for Health and Disability Ethics Committees. Wellington, NZ: New Zealand Ministry of Health; 2014. https://ethics.health.govt.nz/operating-procedures/.
Stats NZ. Stats NZ. Stats NZ. http://nzdotstat.stats.govt.nz/wbos/Index.aspx?_ga=2.72091283.1403606890.1628319138-382778807.1624961304 [Accessed 7 Aug 2021].
Ministry of Health.Health expenditure trends in New Zealand 2000-2010. Ministry of Health; 2012. https://www.health.govt.nz/system/files/documents/publications/health-expenditure-trends-in-new-zealand-2000-2010.pdf.
OECD. OECD Statistics. https://stats.oecd.org/Index.aspx?ThemeTreeId=9 [Accessed 7 Aug 2021].
Environmental Health Intelligence New Zealand (EHINZ). Available at: https://ehinz.ac.nz/indicators/population-vulnerability/age-profile/ [Accessed 22 Apr 2021].
Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:e1221–e1234.
Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol. 2017;28:98–103.
Teo ZL, Tham Y-C, Yu M, Cheng C-Y, Wong TY, Sabanayagam C. Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective. Eye. 2020;34:1255–61.
Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, et al. Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. Ophthalmology. 2018;125:1608–22.
Mohamed S, Claes C, Tsang CW. Review of Small Gauge Vitrectomy: Progress and Innovations. J Ophthalmol. 2017;2017:6285869.
Znaor L, Medic A, Binder S, Vucinovic A, Marin Lovric J, Puljak L. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2019;3:CD009562.
Jung JH, Lee JK, Lee JE, Oum BS. Results of vitrectomy for breakthrough vitreous hemorrhage associated with age-related macular degeneration and polypoidal choroidal vasculopathy. Retina. 2010;30:865–73.
Kim BZ, Lee K-L, Guest SJ, Worsley D. Long-term survival following diabetic vitrectomy. N. Z Med J. 2017;130:69–77.
Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol. 1990;108:958–64.
Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020;61:49.
Leasher JL, Bourne RRA, Flaxman SR, Jonas JB, Keeffe J, Naidoo K, et al. Global Estimates on the Number of People Blind or Visually Impaired by Diabetic Retinopathy: A Meta-analysis From 1990 to 2010. Diabetes Care. 2016;39:1643–9.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843 https://doi.org/10.1016/j.diabres.2019.107843.
Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311:1901–11.
Newman AR, Andrew NH. Changes in Australian practice patterns for glaucoma management. Clin Exp Ophthalmol. 2019;47:571–80.
Conlon R, Saheb H, Ahmed IIK. Glaucoma treatment trends: a review. Can J Ophthalmol. 2017;52:114–24.
Botha VE, Taylor SK, Benefield J, Ah-Chan J. Approach to collaborative glaucoma care in New Zealand: An update. Clin Exp Ophthalmol. 2019;47:798–9.
Williams KA, Muehlberg SM, Lewis RF, Coster DJ. Influence of advanced recipient and donor age on the outcome of corneal transplantation. Australian Corneal Graft Registry. Br J Ophthalmol. 1997;81:835–9.
Keenan TDL, Carley F, Yeates D, Jones MNA, Rushton S, Goldacre MJ, et al. Trends in corneal graft surgery in the UK. Br. J Ophthalmol. 2011;95:468–72.
Crawford AZ, McKelvie J, Craig JP, McGhee CNJ, Patel DV. Corneal Transplantation in Auckland, New Zealand, 1999-2009: Indications, Patient Characteristics, Ethnicity, Social Deprivation, and Access to Services. Cornea 2017;36:546–52.
Kim BZ, Meyer JJ, Brookes NH, Moffatt SL, Twohill HC, Pendergrast DG, et al. New Zealand trends in corneal transplantation over the 25 years 1991-2015. Br J Ophthalmol. 2017;101:834–8.
Lu LM, Boyle AB, Niederer RL, Brookes NH, McGhee CNJ, Patel DV. Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure. Clin Exp Ophthalmol. 2019;47:987–94.
Park CY, Lee JK, Gore PK, Lim CY, Chuck RS. Keratoplasty in the United States: A 10-Year Review from 2005 through 2014. Ophthalmology. 2015;122:2432–42.
Gokul A, Ziaei M, Mathan JJ, Han JV, Misra SL, Patel DV, et al. The Aotearoa Research Into Keratoconus Study: Geographic Distribution, Demographics, and Clinical Characteristics of Keratoconus in New Zealand. Cornea. 2021. https://doi.org/10.1097/ICO.0000000000002672.
Repka MX, Lum F. Burugapalli B. Strabismus, Strabismus Surgery, and Reoperation Rate in the United States: Analysis from the IRIS Registry. Ophthalmology. 2018;125:1646–53.
Hashemi H, Pakzad R, Heydarian S, Yekta A, Aghamirsalim M, Shokrollahzadeh F, et al. Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis. Strabismus. 2019;27:54–65.
Arora A, Williams B, Arora AK, McNamara R, Yates J, Fielder A. Decreasing strabismus surgery. Br J Ophthalmol. 2005;89:409–12.
Nihalani BR, Hunter DG. Adjustable suture strabismus surgery. Eye. 2011;25:1262–76.
Akhter M, Toy B. Big Data-Based Epidemiology of Uveitis and Related Intraocular Inflammation. Asia Pac J Ophthalmol. 2021;10:60–62.
Cheng C-Y, Soh ZD, Majithia S, Thakur S, Rim TH, Tham YC, et al. Big Data in Ophthalmology. Asia Pac J Ophthalmol. 2020;9:291–8.
Cunningham WJ, Brookes NH, Twohill HC, Moffatt SL, Pendergrast DG, Stewart JM, et al. Trends in the distribution of donor corneal tissue and indications for corneal transplantation: the New Zealand National Eye Bank Study 2000-2009. Clin Exp Ophthalmol. 2012;40:141–7.
Edwards M, Clover GM, Brookes N, Pendergrast D, Chaulk J, McGhee CNJ. Indications for corneal transplantation in New Zealand: 1991-1999. Cornea. 2002;21:152–5.
Thank you to the Ministry of Health, New Zealand Eye Bank, PricewaterhouseCoopers, Hoya, Alcon and Dorc.s.
RH’s Clinical Research Fellowship was partially funded by The Waikato Eye Foundation and The University of Auckland.
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplemental Table 1. List of ICD-10 procedure descriptions that met the inclusion criteria. All other ICD-10 codes / descriptions excluded
Supplemental Table 2: Annual number of all included government-funded, private-funded private (main insurer) and private (other) procedures in New Zealand from 2009-2018
About this article
Cite this article
Hossain, R.R., Guest, S., Wallace, H.B. et al. Ophthalmic surgery in New Zealand: analysis of 410,099 surgical procedures and nationwide surgical intervention rates from 2009 to 2018. Eye (2022). https://doi.org/10.1038/s41433-022-02181-5