# Trends in Ophthalmic Surgery Among Older Patients in Japan (Fiscal Years 2018 to 2022): A National Claims Database Study on Surgical Shifts and the COVID-19 Pandemic's Impact

## TL;DR

This study examines how ophthalmic surgeries among older Japanese patients changed from 2018 to 2022, including the effects of the pandemic and shifts in surgical practices.

## Contribution

The study provides new insights into the impact of the COVID-19 pandemic and surgical practice evolution on ophthalmic procedures in Japan's aging population.

## Key findings

- Cataract and vitrectomy surgeries increased overall but dipped in 2020 due to the pandemic.
- Glaucoma surgeries, especially minimally invasive ones, showed significant growth despite a small 2020 increase.
- Surgical volumes rose faster than population growth in older age groups.

## Abstract

Background: Japan has the highest proportion of older adults globally, making its healthcare data crucial for understanding worldwide aging trends. This study investigates trends in ophthalmic surgeries among older Japanese patients using the National Database of Health Insurance Claims (NDB), with a particular focus on the impact of the COVID-19 pandemic.

Methods: This retrospective database analysis utilized publicly available aggregated data from the Japanese NDB Open Data portal, managed by the Ministry of Health, Labour and Welfare (MHLW), covering fiscal years (FY) 2018 to 2022. We examined annual trends in the number of cataract surgeries (procedure code K282), glaucoma surgeries (K268), and vitrectomies (sum of K272-K281), stratified by three age groups based on the Japanese Society of Gerontology classification: 65-74 years ("pre-old"), 75-89 years ("old"), and ≥90 years ("super-old"). Glaucoma surgery (K268) encompassed iridectomy, outflow reconstruction, trabeculectomy, tube shunt implantation without a plate, tube shunt implantation with a plate, and trabecular micro-bypass stent implantation combined with phacoemulsification. Laser procedures were excluded. We performed a descriptive analysis of surgical counts and calculated the percentage change between FY2018 and FY2022. Population data for the same age groups were obtained for comparison.

Results: Cataract surgery demonstrated an increasing trend across all age groups from FY2018, with a transient decrease in FY2020 attributable to COVID-19-related postponements, followed by renewed growth. Vitrectomy also exhibited a temporary decline in FY2020. Glaucoma surgeries displayed a consistent upward trend, although the increase in FY2020 was marginal. While the population aged 65-74 decreased to 80% of its 2018 level, the populations aged 75-89 and ≥90 years grew to 101% and 123%, respectively. In contrast, increases in surgical volumes far outpaced population growth. Glaucoma surgery volumes, for instance, increased to 169%, 168%, and 170% of 2018 levels across the respective age groups. Vitrectomy increased to 103%, 113%, and 139%, and cataract surgery to 111%, 113%, and 115%. Among glaucoma procedures, outflow reconstruction, tube shunt implantation with a plate, and especially trabecular micro-bypass stenting with phacoemulsification showed marked increases.

Conclusion: Ophthalmic surgeries generally increased among older adults in Japan from FY2018 to FY2022, with a transient decrease in FY2020 linked to the COVID-19 pandemic. The significant rise in specific glaucoma procedures, particularly minimally invasive glaucoma surgery (MIGS) combined with cataract surgery, signals an evolution in surgical practices. These trends have important implications for healthcare resource planning and surgeon training.