Newspaper headlines last week proclaimed a surfeit of NHS operations with the clear implication that many were frivolous, of little benefit or occurring at too low a threshold. Whoever briefed the journalists had a clear intention to get this message across and to ensure that cataracts were top or near top of the list.
Fifteen years after ‘Action on Cataracts’, which revolutionised cataract management, we seem to be heading back to square one. Surprising as it may seem, cataracts are mostly not a disease process, they are characterised by occurring with age and heck, there are more older people. It doesn’t take brain of Britain to work out that more surgery is taking place and more is needed. Unless of course there is some magic treatment that delays cataract we don’t know about.
Although there are perhaps one or two exceptions, most cataract referral is now made under clear guidance; that it is cataract causing the visual loss, that there is an impact on quality of life and that the patient desires surgery. Some criteria are more sophisticated with questionnaire systems, while some ill-advised clinical commissioning groups do retain the useless 6/12 acuity threshold. Clearly, optometrists are the gatekeepers to this process.
You can tell by the tone of this column that I have little time for this press manipulation. Of course, the wrong questions are being asked and as usual the NHS does not link medical and social/disability aspects. The loss of contrast perception is a major cause of trips and falls and cataract is the principal cause of this. Delay cataract surgery and people lose mobility, gain dependency and in some cases are catapulted into bed blocking with broken hips. It should also be remembered that late surgery is frequently more complex under phacoemulsification.
I would very much prefer the NHS concentrated on other issues around cataract. For example, joined-up thinking around second eye surgery (booking both in close proximity and only postpone the second in the case of complication). Optometrists are frequently in an invidious position managing the anisometropia. The other issue is the hinted at but never enacted dreaded ‘top-up’ payment enabling access to better IOLs such as toric IOLs.
Many of us in the community sense the barometer shifting back towards longer waits and more overt rationing of the most successful surgical procedure. Now optometry and ophthalmology are working closer together perhaps we can head this nonsense off at the pass.
