Recently, during a visit by my practice development consultant, we got on the subject of Baby Boomers and the impact they will have on health care in America. When I was a resident back in the mid-1980s, the Baby Boomers were in their 30 and 40s. Now, they are crashing the gates of Social Security and Medicare. I once read a funny description of a Boomer as an individual who completely expects all in return from the government in terms of benefits they contributed to during working years as they zip all around Tuscany. Honestly, that pretty much sums up my wife and me.

Realistically speaking, this country has a big problem on its hands. As physicians, we realize this. We are trained to face facts, be honest and be realistic. This could be quite sobering. Presently, there about 50 million Americans aged 65 or older. By 2025, that number will balloon to 83 million. Last I looked, there are no specific plans to train more physicians, and how are we going to foot the bill for all this health care? Keep in mind, these are not the “Brokaw generation” that was more accepting of the limitations of health care. Boomers are highly educated, thanks to the Internet, and they expect more from health care.

Physicians MUST play an active roll as we move forward in crafting solutions through this process. We cannot be viewed as the cause of the rising cost of health care, but more so as part of the solution. If we do not, then the consequences of decisions that may be made to cope with this issue may stress the medical profession to the breaking point.

Stephen Pascucci, MD, FACS

To report the prevalence of cataract and its subtypes in patients with type 2 diabetes mellitus and the risk factors associated with these cataracts, researchers in India enrolled 1,283 eligible subjects with type 2 diabetes mellitus from a cross-sectional study. These patients underwent examination and a trained ophthalmologist graded lens opacity according to the Lens Opacity Classification System (LOCS) III system.

The researchers reported that the age- and sex-adjusted prevalence of cataract in the study was 65.7% (95% confidence interval [CI], 65.6–65.8) and that mixed cataracts were more common than monotype ones (41.6% vs. 19.4%). They also noted that the prevalence of cataract was higher in women, subjects with known diabetes and those with longer duration of diabetes (51.4%, 50.3% and 64.5%, respectively). The risk factors for any type of cataract were increasing age (odds ratio [OR], 1.14; 95% CI, 1.11–1.16), macroalbuminuria (OR, 4.61; 95% CI, 1.56–13.59) and increasing glycosylated hemoglobin (OR, 1.92; 95% CI, 1.22–3.00); higher hemoglobin (OR, 0.38; 95% CI, 0.22–0.64) was the protective factor.

The risk factors for nuclear cataract included increasing age (OR, 1.15) and high serum triglycerides (OR, 6.83). For cortical cataract, increasing age (OR, 1.14) and poor glycemic control (OR, 2.43) were the risk factors; increasing hemoglobin (OR, 0.14) was the protective factor. The study researchers found that for posterior subcapsular cataract, the risk factors included increasing age (OR, 1.11), being of the female sex (OR, 9.12), employment (OR, 9.80) and duration of diabetes (OR, 21.37).

They determined that nearly two-thirds of the diabetic population showed evidence of cataract; mixed cataracts were more common than the monotypes ones.