Oostra TD, et al. - Authors assessed the cost effect of surgeon and patient discretion in regard to cataract surgery and how this affects population health care costs. They determined 5-year cataract progression rates for a given patient age, sex, and type of cataract. A substantial cost effect with the potential to reduce surgical volume by as much as 13% by the decision to delay surgery as a result of patient mortality was demonstrated by the surgeon and patient discretion in regard to cataract surgery. Combined with 5-year death rates, at age 45, a 1.1% decrease in surgery for nuclear sclerosis was resulted by delaying surgery until progression occurred that increased to a 33.8% decrease by age 90; in surgery for cortical cataract at age 45, a decrease of 1.5% that increased to a 51.1% decrease by age 90; and a 1.6% decrease in surgery for posterior subcapsular at age 45 that increased to a 59.7% decrease by age 90.