Delays to cataract treatments could put half a million patients at risk of severe depression and other mental health issues. This was the warning from to Stephen Hannan, clinical services director at Optical Express, speaking of the dangers of backlogged waiting lists during Mental Health Awareness Week last week (May 10-16).
Hannan explained over 500,000 people currently on NHS waiting lists for cataract surgery across the country were being impacted by the Covid-19 exacerbated backlog. Noting a 2020 study on the links between cataracts and an increased risk for depression, he explained that patients would continue to suffer until the backlogs were reduced.
‘Lengthy waiting lists for NHS cataract surgery are not just risking patient’s eyesight, but also having a potentially damaging effect on their mental wellbeing,’ he said.
‘The evidence shows that the risk of depression is significantly decreased in cataract patients who have surgery compared with those who did not. This demonstrates the life-changing power of vision correction surgery, but it also sends a clear message: the current backlog for NHS cataract surgery is neither fair nor safe.’
Studied risks
The study Hannan referred to investigated the impact of cataracts on the risk of depression, along with the benefits of cataract surgery. Published in Nature in August 2020, the research studied a cohort of 233,258 patients, half of who were newly diagnosed with cataracts and half of who had no cataracts at all. Mitigating factors, such as age, sex and study year were minimised by matching each cataract study participant with a similar profile of non-cataract participant.
In their introduction, researchers explained that they were inspired to study the risks of depression in cataract patients because depression was often left unrecognised or untreated in optical practices even though it could negatively affect treatment outcomes and overall quality of life.
Their results showed cataracts were significantly associated with an increased risk of developing depression. A group of 75,381 patients with no cataracts were compared to the same number of people with the condition, and results showed those with cataracts were just under twice as likely to develop depression. A total of 3,906 patients with cataracts became depressed while 1,794 of those in the no cataract group developed the condition.
Results also delineated between those with cataracts who underwent surgery and those who did not. The rate of developing depression was found to be 3.13 per thousand in those with no cataracts, 5.24 per thousand in those with cataracts who underwent surgery and 7.03 per thousand in those who had cataracts but did not have surgery.
In their discussion of these results, the study’s authors said: ‘By taking into account these findings, we suggest ophthalmologists be vigilant about hidden depression and cooperate with psychiatrists. In addition, as we know that cataract may contribute to the development of depression and that cataract surgery may effectively correct this risk, psychiatrists could ask their patients about their visual acuity condition and refer them to an ophthalmologist if needed.’
Personal impacts
As the most commonly performed surgical procedure in the country, with around 400,000 operations usually performed annually, cataract surgery was in high demand even before the pandemic struck. Following the cancellation of all elective surgeries waiting times for the procedure have risen drastically, with some patients facing waits of more than two years.
Anxieties about when surgery will be available have become increasingly common for those on waiting lists. Audrey Smith, a cataract patient who recently underwent the operation privately, explained: ‘When you’re living with cataracts, to a certain extent you just start to cope. And then you realise, after a few weeks and months, that you’re not quite coping as well as you did, and it just got worse and worse.
‘There didn’t seem to be any headway in where I was, and I wasn’t given a timeframe for getting cataracts treated through the NHS. If I think I wasn’t coping well at all in the latter stages, I just think it must be absolutely horrendous for some people.’
- To view the study online, visit nature.com/articles/s41598-020-70285-7