‘Their vision will be worse’:Experts call for rethink on cataract surgery wait time

Eye health experts have called for a focus on reducing wait times for cataract surgery,claiming a quicker road to treatment could save state health systems millions.

In a paper published by the Sax Institute on Wednesday,leading Sydney surgeons and researchers from UNSW,the University of Sydney and the University of Melbourne criticised significant inequality between public and private patients in accessing cataract surgery in Australia,noting that,while private patients could receive their operation within a number of weeks,many public patients were waiting more than a year.

A group of eye health experts have called for a focus on bringing down wait times for cataract surgery.

A group of eye health experts have called for a focus on bringing down wait times for cataract surgery.iStock

The authors conducted an analysis that suggested having no Australian patient wait longer than three months for the surgery would result in 50,679 fewer falls for elderly people,saving the health systems $6.6 million nationwide once the cost of bringing the surgery forward was taken into account.

“There will always be competing resources,but we need a dedicated pathway to get cataract surgery done because we know it has got such strong cost-effectiveness,” said Professor Lisa Keay,a researcher at UNSW’s School of Optometry and Vision Science and co-author of the paper.

“The delay means we have people who have worse cataracts;their vision will be worse and the surgery is less ideal.”

Although elective surgery shutdowns have significantly blown out wait times,Professor Keay said long waits for cataract extractions,the most common elective surgery procedure,was an issue “well before COVID”.

NSW patients were waiting the longest in Australia for cataract surgery at public hospitals before the pandemic,according to 2018-19 data from the Australian Institute of Health and Welfare,with half of the patients waiting at least eight months for treatment.

Data from the NSW Bureau of Health Information showed more than 18,000 patients in NSW were waiting for cataract surgery when the state’s Delta wave hit in June.

However,the paper’s authors said these figures were an under-reporting of the actual wait time for most patients,noting there is a “wait for the wait” – the time taken to receive a referral to a public outpatient ophthalmology service,a statistic which is not publicly reported in NSW.

In Victoria,the median referral wait time in 2019 was three months,but in South Australia it was 15 months. In Queensland,depending on the severity of a person’s vision impairment,10 per cent of patients waited between 10 and 20 months for a referral.

Category 3 surgeries,including cataract surgery,were shut down again in NSW public hospitals in late July and in private hospitals by mid-August to free up resources for pandemic operations.

It was allowed to recommence alongside other day surgery from October 4.

The number of cataract patients waiting more than a year for surgery – the longest recommended wait time for category 3 surgery – in NSW blew out to more than 1950 following the initial elective surgery shutdown last year,according to Bureau of Health Information data.

But figures recovered significantly over the following 12 months – just 76 patients on the waitlist in June had waited over a year.

Sydney Eye Hospital surgeon Professor Peter McCluskey,who also co-authored the paper,said it was likely the impact of the most recent shutdown would not be seen until early 2022,given the delay in referrals.

“A lot of eye care providers,outside of ophthalmology such as optometrists,have had to restrict their practice – it is going to take months before the system recalibrates itself and we know what things are like,” he said.

Payal Mukherjee,NSW chair of the Royal Australasian College of Surgeons,said patients waiting for category 3 surgery could still experience substantial disruption to their livelihoods and wellbeing. She said the one-year recommended time for the surgery to be completed was a “worst case”.

“Obviously we should do it sooner if we can,” she said,noting it was category 3 procedures – such as ENT,orthopaedics and ophthalmology – which had their waitlists blown out most significantly by pandemic shutdowns.

Professor Keay said the pandemic recovery and the speed at which the elective surgery backlog had been tackled presented an opportunity to reconsider what was an acceptable wait time for cataract surgery in Australia.

“We had to innovate to get things done during COVID – maybe we can keep innovating,” she said.

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Mary Ward is a reporter at The Sun-Herald.

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