[Shocking Insurance Fraud④] Hospitals Removing Healthy Lenses Saying "Get Presbyopia Correction"

Some Ophthalmology Clinics Recommend Cataract Surgery Despite Early Stage, Leading to Increased Over-treatment, Vision Deterioration, and Higher Insurance Premiums Affecting the Public

[Asia Economy Reporter Changhwan Lee] # Mr. Jinseok Kim (58, male, pseudonym) usually wore reading glasses only when reading books or looking at his smartphone because the letters were hard to see, and he did not notice any cataract symptoms such as blurry or narrowed vision. When he visited an ophthalmology clinic, he was diagnosed with senile cataracts and recommended surgery. Two days later, he underwent multifocal lens implantation surgery. Right after the surgery, his vision was so clear that he discarded his reading glasses and hoped to live without them for the rest of his life. However, three months later, complications (retinal tear) were discovered, causing narrowed vision and objects to appear wavy. Although he chose presbyopia cataract surgery to avoid using reading glasses, his vision is now worse than before the surgery.

# Ms. Kyungja Park (50, female, pseudonym) found it bothersome to wear reading glasses every time she read books or documents due to presbyopia, so she visited a famous ophthalmology clinic in Gangnam, Seoul last year. The doctor explained that she had early-stage cataracts and recommended multifocal lens implantation surgery that could correct both early cataracts and presbyopia simultaneously. Six months after the cataract surgery, her astigmatism and dizziness worsened to the point where she could neither read nor carry out daily activities. When she visited the hospital to request lens replacement, she was told that it was not a simple lens but that the eye’s natural lens had been removed and replaced with an artificial intraocular lens, and although reoperation was possible after a significant amount of time had passed since the surgery, it was very risky.

As excessive cataract treatments have surged, cases of so-called “live lens” surgeries?removing perfectly healthy lenses?have increased. These are cases where the hospital recommends cataract surgery even when symptoms are minimal, leading to complications such as visual impairment afterward.

Cataracts occur when the eye’s lens, which focuses light, becomes cloudy and opaque, causing vision to become blurry as if looking through fog. In the early stages, progression can be delayed with medication or eye drops, making surgery unnecessary. However, some clinics excessively recommend surgery, which has become a problem in recent years.

According to the National Health Insurance Service, cataract surgery ranked first in both the number of procedures and growth rate among 33 major surgeries performed on Korean citizens from 2016 to 2020. The average annual growth rate was 7.9%, which is excessively high compared to the -0.5% growth rate of the other 32 major surgeries excluding cataracts.

Although cataract surgery is typically performed on people in their 60s and 70s, the number of surgeries and patients in their 40s and 50s has rapidly increased over the past five years, driving the overall increase in surgery numbers. From 2016 to 2020, the number of surgeries for people in their 40s increased by 61.7%, and for those in their 50s by 107.8%. During the same period, the number of patients increased by 36.0% for those in their 40s and 61.7% for those in their 50s, significantly exceeding the 22% increase rate for cataract surgery patients of all ages.

With the surge in cataract surgeries, insurance payouts for actual expenses have also increased significantly. According to the insurance industry, the amount paid for actual expense insurance claims related to cataract surgery in South Korea reached a record high of approximately 457 billion KRW (provisional) in the first quarter of this year alone. In March alone, the payout reached about 205.3 billion KRW, accounting for about 17% of total actual expense insurance payouts.

The insurance industry reports that the number of cataract patients has greatly increased due to excessive surgeries, such as some ophthalmology clinics recommending multifocal lens surgery purely for vision correction to patients without cataract symptoms or who do not need surgery, as well as surgery inducement and false claim solicitation linked to broker organizations.

In particular, excessive treatment suspicions have arisen as insurance claims for cataract surgeries have concentrated in some large ophthalmology clinics located in Gangnam, Seoul. As of the first quarter of this year, the average insurance payout for cataract surgery at the top 10 ophthalmology clinics receiving payments from four major non-life insurance companies was 4.9 billion KRW, which is 29 times higher than the average of 170 million KRW for other clinics. Most of these clinics are known to be located in the Gangnam area of Seoul.

As excessive cataract treatments increase, complications have also grown. According to the Korea Consumer Agency, among 84 ophthalmology-related damage relief applications received from 2017 to 2019, 47.6% (40 cases) were related to cataracts. Of these, 95% (38 cases) involved surgical complications.

By age group, those in their 60s accounted for the highest proportion at 32.5% (13 cases), but cases were also high among those in their 50s (20%, 8 cases) and 40s (12.5%, 5 cases), similar to those aged 70 and above (32.5%, 13 cases). Among the 38 complication cases, 42.1% (16 cases) suffered severe damage, including failure to recover pre-surgery vision and progression to visual impairment.

A representative from the Korea Consumer Agency emphasized, "Multifocal lens implantation surgery, which has become common recently, is not covered by medical insurance, so examination and surgery costs are relatively high. There are also cases where complications such as astigmatism and glare occur due to poor focus." They added, "To prevent damage, patients should demand accurate diagnosis of eye conditions and sufficient information about surgical effects and complications before deciding on surgery."

This content was produced with the assistance of AI translation services.