While agreeing wholeheartedly with you in your views on the cost effectiveness and efficacy of cataract surgery (Comment 29.06.12) in my view some form of triage is necessary to determine who has it done and when.
Each PCT has only a finite number of cataract operation slots available and they would be in dereliction of their duty if they did not ensure that those with the greatest need were seen first.
Consider two patients Mrs Jones and Mrs Smith both have best corrected vision of 6/18 R+L due to cataracts in both eyes. Mrs Jones has her right eye operated on and now sees 6/6 and 6/18. It is sensible that Mrs Smith should now have priority over Mrs Jones for the next cataract removal as her vision is far worse.
I would find it very difficult to justifying a delay for Mrs Smith just so Mrs Jones could have her second eye done. In fact if you present this to patients most are quite happy to wait to have their second eye done in order for others to have their first operation.
Clearly there are cases where a rapid operation on the second eye is indicated, for example gross anisometropia. However, in the great scheme of things I feel it is better to have two patients seeing quite well rather than one seeing superbly and the other seeing poorly.
Also the overall budget available to the health service is limited so cataract surgery has to take its place at the table with renal surgery, mental health care and the remaining multitude of different specialities potentially available through the health service.
Finally it is naive to assume that rationing and limiting should not exist in any healthcare system.
Surely we should be seeking to ensure that the maximum benefits accrue from the operations that are available and work to increase those numbers rather than starting an emotive debate with loaded phrases like ‘discrimination against the elderly’.
Steven Tilley Stonehouse, Gloucestershire