Throwing light on the long wait for cataract care

Surgical Ophthalmology is one of several high volume specialties which the government has listed for special focus in its 2023 Waiting List Action Plan, as it was in its 2022 action plan. In his introduction this year to this multi-annual approach to tackling waiting lists, Minister for Health Stephen Donnelly said 2022 was the first year since 2015 in which overall waiting list numbers decreased – a 4% reduction was achieved.¹ This year, the government has allocated €443 million to build on the work already done – up from €350m last year – to deliver additional capacity and reduce waiting lists. While the planning is laudable, the waiting list for eye care alone remains at around 42,300.²

Cataract surgery is once again on the list of high-volume procedures for which the National Treatment Purchase Fund (NTPF) will offer treatment for all clinically suitable patients who have been waiting more than three months (in last year’s action plan a wait of more than six months was required for an NTPF procedure). Cataract removal is the most common surgical procedure with an estimated 3.7 million per year in the US, 7 million in Europe and 20 million worldwide.³ Covid-19 may have curtailed this somewhat, but for those who can cope with waiting, the average patient stands to benefit greatly by sight restoration.

Cataract surgery dates back some 2000 years. The Greek philosopher Celsius described ‘couching’ in his work De Medicina. A sharp needle through the cornea pushed the lens downwards allowing light to reach the retina once again. In 1748, the French ophthalmologist Jacques Daviel devised a new technique involving a c-shaped incision in the cornea and a tiny spatula to free the lens. The procedure was painful and, as there were no sutures small enough for use in the eye, healing took some time. In 1967, the US ophthalmologist Charles Kerman invented ‘phacoemulsification’ which employed ultrasound vibrations to emulsify the lens before it was sucked out via a hollow needle. His technique left the rear of the lens capsule in place, paving the way for the development of synthetic lenses.

On March 22 last year, Richard O’Donoghue, independent TD for Limerick, posed a question to the Minister for Health in relation to the long waiting times for cataract operations at University Hospital Limerick, leaving many having to travel to Northern Ireland for their procedure.⁴ In response, the Minister cited the opening of a stand-alone, high-volume, consultant-led cataract theatre by the University of Limerick Hospital Group in Nenagh Hospital in 2018 and a consequent reduction in waiting times for cataract procedures. According to the Minister, there were 5,043 patients awaiting cataract surgery in February 2022 compared to 6,276 in February 2019.

Fast forward to 2023, in a recent radio interview on RTE’s Morning Ireland, the then president of Optometry Ireland John Weldon described a waiting list for eye care of around 42,300.⁵ According to Mr Weldon, the numbers awaiting procedures through the NTPF alone were 9,500 at the end of January, with more than 1,000 waiting for more than a year. One of the two principal issues was cataracts (the other being eye care for children). Mr Weldon advocated for the proper use of services already available, namely some 300 optometry practices nationally with state-of-the-art equipment and more than 700 highly-trained practitioners. He pointed out potential savings of 50% and cited a scheme that began in the HSE Western Region centred around Sligo University Hospital in 2012, whereby surgeons delegated some cataract procedures to optometrists in the local community. This resulted in a cutting of the waiting list from over three years to just six months. It’s always nice to encounter a scheme with a bit of foresight.

References

1. Department of Health. 2023 Waiting List Action Plan, 2023, Mar 7, https://www.gov.ie
2. Eye-care Waiting Lists Unacceptable at 42,300. https://optometryireland.ie/
3. Kauh CY, Blachley TS, Lichter PR et al. Geographic variation in the rate and timing of cataract surgery among US communities. JAMA Ophthalmol 2016; 134:267-6
4. www.oireachtas.ie/en/debates/question/2022-03-22/1011/#:~:text=At%20the%20end%20of%20February,NTPF%20to%20reduce%20waiting%20lists. (Retrieved 28/2/2023).
5. Optometrists warn over eye care waiting list. RTE. (Retrieved 27/2/2023)