Trends in Patient, Surgeon, and Procedural Characteristics of Intraocular Lens Exchange among Medicare Beneficiaries 2011-2020.

Purpose: To assess trends in prevalence and patient/surgeon characteristics of IOL exchange surgery in the United States and to evaluate the surgical complication rates.

Setting: Medicare beneficiaries.

Design: Retrospective cross-sectional analysis.

Methods: Medicare beneficiaries aged 65 years or older who underwent IOL exchange surgery between 2011-2020 were identified from 100% Medicare fee-for-service carrier claims data. Main exclusion criteria: missing demographic information and incomplete follow-up data. Main outcomes: incidence of IOL exchange, patient- and surgeon-level factors, and postoperative complication rates.

Results: 52,583 IOL exchanges were performed on 48,967 patients. The annual number of IOL exchanges increased from 4,621 in 2011 to 6,114 in 2019. Most patients were White (n=47,228, 89.8%), resided in urban locations (n=44,095, 84.0%), and had a Charlson comorbidity index of ≤2 (n=41,556, 79.0%). Of 7,493 surgeons, most were male (n=6,308, 84.2%), practiced in urban locations (n=6,907, 92.2%), and had an average of 24.7±11.2 years between medical school graduation and the last surgery they performed during the study period. The most common surgical indications were mechanical lens failure (n=22,252, 51.4%) and lens displacement (n=9,155, 21.1%). The most common complications were epiretinal membrane (n=531, 6.8%), mechanical lens complication (n=460, 5.9%), and dislocation of the replacement IOL (n=385, 4.9%).

Conclusions: The number of IOL exchange procedures performed among Medicare beneficiaries increased over the last decade. Male ophthalmologists in urban locations performed the majority of IOL exchanges. The most common post-operative complication was epiretinal membrane. The rates of corneal decompensation, retinal detachment, and endophthalmitis were low.