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Cataract Surgery Postcode Lottery

Cataracts are a clouding of the lens, a part of the eye that lies just behind the coloured iris. Relatively common over the age pf 65, cataracts also occur in younger people as a result of trauma to the eye or as a side effect of other visual conditions such as Retinitis Pigmentosa, Macular Oedema or Myopia.

I developed cataracts in my 20’s as a consequence of having the condition Retinitis Pigmentosa [RP]. RP is a degenerative condition of the retina that has already left me severely sight impaired [SSI]. Fast forward a decade and my cataracts are deemed ‘ripe enough’ for surgery.

The operation itself can only be described as ‘space age’, even in today’s advancing world. Videos available online show the intricate medical procedure as it is performed. But to be in the place of those patients, wide awake whilst the eye is operated on and a new lens fitted, really is an experience.

It is now over a fortnight since my first cataract operation. The eye will continue to heal over the next month, although I was eye patch free within 24 hours of surgery. The results have been quite a revelation. I am still have a sight impairment; the best way I can explain what has happened to people with no experience of sight loss is to say pre-op I had around 10% of my vision remaining but now that 10% is much brighter.

After years of being unable to differentiate colours I can now correctly identify my nail polish shades. I can now also read bus numbers. These might be perceived as little improvements but to me they signify greater independence and less reliance on others. For many the effects of vision loss can be difficult to comprehend. Visual impairment doesn’t just affect the tasks you would expect like reading or navigating outdoors, it quite literally impacts on every aspect of life from the tasks you can do to the adaptions needed to do them.

If a person undergoing cataract surgery doesn’t have the complications of other visual conditions the results must be quite phenomenal. It is therefore very disheartening to hear via an RNIB campaign of a cataract surgery ‘postcode lottery’. I waited just over three months from consultation to operation at St James Hospital, Leeds, yet the RNIB quotes the same process in Enfield, London takes 15 months. Conversely, patients in Luton face an average wait of just 15 days.

The charity has also identified significantly disproportionate rates of surgery, with 1166 procedures per 100,000 of population in Scarborough, compared to just 328 in Tower Hamlets. It is unclear whether these particular disparities are due to costs, resource provision, staffing or policy, but an NHS Efficiency Savings Report, released by the Governments Public Accounts Committee in March 2013, raised concerns over operation cutbacks. Margaret Hodge MP, highlighted, “The NHS has achieved its financial savings target…we are concerned…savings are being achieved by rationing patients access to certain treatments, these include cataract surgery”.

Whilst many hospital trusts aim to bring the waiting time from initial consultation to surgery to within a 16 week period, there appears to be no measures by the Department for Health to enforce this, so what are the options should your NHS Trust not fit this criteria. Accept a longer wait? Go without the operation? Pay one of the many private healthcare providers ready to plug the gap?

Private Healthcare UK provides information on from 156 private hospitals and shows an average cost per eye of £2,408, with prices ranging from £1,855 at The Chelmsford Private Day Hospital to £4,295 in the BNI Princess Margaret Hospital. These may offer a good alternative service for those able to afford it, but some could be forced to choose between a lengthy wait for free NHS treatment or a lengthy loan repayment period if opting for a financial package to cover private costs.

I know from personal experience that sight loss, whatever the cause, can have an extensive personal cost, socially, emotionally and financially. Isn’t it time the government vowed to end this unfairness and ensured everyone applicable got the gift of restored vision in a timely manner? And isn’t it time the NHS adopted a ‘Same condition-Same Solution policy and put uniformity back into the national framework?

By Sam Heaton

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