Cataracts - in younger person

GlasweJen

teddysmum wrote: »

To be deemed capable of driving because of sight, you need to be able to read a car number plate, whose letters are quite large, at a specified distance away.


It looks like the decision for cataract surgery is made if the sight goes below the standard required to perform this task and will be a specific prescription, so no need to actually refer to whether or not someone drives.

Not quite, refraction doesn't always correlate to acuity. I have a good friend who is -5 and can see better than me without his glasses on and I'm only a -3, we both correct to 6/4 when wearing glasses

wondercollie

I can honestly say in two decades of nursing, I've never heard of GA increasing the risk of dementia.

Yes, some drugs can increase the risk of post op confusion, which clears.

Yes, some elderly become institutionalized while in hospital and have meals, etc provided for them.

But the risk of dying increases after a hip replacement and the elderly don't turn down hip replacements.

fred246

I have no experience of this but I imagine this is one of those areas where the NHS tries to save money by putting people off but a little bit of persistence on the part of the patient will normally pay off. As far as I understand there is no way to test how dense a cataract is. So the criteria are always based on the effect it has on your life. Many of the CCGs criteria are available online. So complain to the hospital, the CCG your MP and you will get what you want. A cataract will only get worse so they know if they put you off now you'll be back again later. I learned from a lawyer to focus on safety in your dealings. "I am really worried that if I don't have my cataracts operated on I will cause a serious road traffic accident". The tories want you to go private so they will be trying to obstruct access to healthcare and they will try and increase waiting times.

GlasweJen

fred246 wrote: »

I have no experience of this but I imagine this is one of those areas where the NHS tries to save money by putting people off but a little bit of persistence on the part of the patient will normally pay off. As far as I understand there is no way to test how dense a cataract is. So the criteria are always based on the effect it has on your life. Many of the CCGs criteria are available online. So complain to the hospital, the CCG your MP and you will get what you want. A cataract will only get worse so they know if they put you off now you'll be back again later. I learned from a lawyer to focus on safety in your dealings. "I am really worried that if I don't have my cataracts operated on I will cause a serious road traffic accident". The tories want you to go private so they will be trying to obstruct access to healthcare and they will try and increase waiting times.

Stick to what you know. You measure cataract density by looking at it. If I am looking in your eye and can see the fundus then I know that you can see me back because I can see that light is getting in there. If it wasn't I'd have no view. Think of it as a dirty window, you can see how dirty they are just by looking at them.

Also we don't want your cataract to go too dense but we also don't want to damage a fairly healthy eye. 1 in 1000 cataract surgeries result in worse vision than the person had when they went on the table and thats permanent and not correctable by glasses, the sort of damage that will take away your driving license and possibly register you blind if you don't have a good second eye. We wait until it's difficult to live with but still giving us that all important view of the back of your eye. I've done work ups for people who are irreversibly blind who are getting cataracts done because their consultant is starting to struggle to monitor their condition.

Dense cataracts make it impossible for us to work out what lens we are putting into your eye, no one wants to guess what size and strength lens we need and there's no straight forward way to work it out if we don't have a fundus view. It's not the sort of thing you can leave until we get to theatre either.

fred246

I find it quite scary that people don't realise what is happening. If this patient sees a surgeon privately they will say:
You have a cataract
It is affecting your life
We can operate - these are the benefits and risks
This patient would almost undoubtedly have the operation very quickly.
In the NHS the CCGs may stop you seeing the surgeon in the first place or they will tell the surgeon that the hospital won't get paid if they operate. Hospitals don't want to operate without payment. This rationing is to save money - no other reason.
So we end up with a 2 tier health care system. The state will always provide some sort of back up to stop the poor becoming totally blind but rich people will pay for their operations or be insured. The politicians are making the NHS worse by restricting treatment and people haven't realised what's happening. Clever by them. Sad for the population.
If this patient goes private she will tell all her friends how she went to the NHS and it failed her. She went private and a week later she could see perfectly.

GlasweJen

fred246 wrote: »

I find it quite scary that people don't realise what is happening. If this patient sees a surgeon privately they will say:
You have a cataract
It is affecting your life
We can operate - these are the benefits and risks
This patient would almost undoubtedly have the operation very quickly.
In the NHS the CCGs may stop you seeing the surgeon in the first place or they will tell the surgeon that the hospital won't get paid if they operate. Hospitals don't want to operate without payment. This rationing is to save money - no other reason.
So we end up with a 2 tier health care system. The state will always provide some sort of back up to stop the poor becoming totally blind but rich people will pay for their operations or be insured. The politicians are making the NHS worse by restricting treatment and people haven't realised what's happening. Clever by them. Sad for the population.
If this patient goes private she will tell all her friends how she went to the NHS and it failed her. She went private and a week later she could see perfectly.

And if she'd ended up with endophthalmitis, a surgical induced astigmatism, a retinal tear or detachment, a ptosis, a lens dislocation or even something as simple as an inflamed eye lid and face I'm going to bet she would be at A&E and not treated privately.

And in 5 years time if she gets cloudy vision through her new IOL she will no doubt end up in front of an NHS ophthalmologist because no one will pay the thousands for 5 minutes of YAG laser.

wondercollie

GlasweJen wrote: »

And if she'd ended up with endophthalmitis, a surgical induced astigmatism, a retinal tear or detachment, a ptosis, a lens dislocation or even something as simple as an inflamed eye lid and face I'm going to bet she would be at A&E and not treated privately.

And in 5 years time if she gets cloudy vision through her new IOL she will no doubt end up in front of an NHS ophthalmologist because no one will pay the thousands for 5 minutes of YAG laser.

Thank You! I don't work in the UK but in Canada and see this constantly. People don't want to wait, go private and come back to the Province expecting them to fix it!

People don't realize that LASIK can thin the cornea and may result in the need for a corneal transplant years late. Then they get upset because they can't get a cornea privately. I actually met one patient that was going to fly to the US for a private corneal transplant at over $10K because of the waitlist. She came in for the "free" procedure one month before her US appointment date. She moaned that her room wasn't as pretty as the one at the private place was offering. She didn't offer to donate the USD10K to the province though!

Retinal specialists should never do a cataract and vice versa. That's when we see infections and dislocated or dropped lenses.

GlasweJen

wondercollie wrote: »

Thank You! I don't work in the UK but in Canada and see this constantly. People don't want to wait, go private and come back to the Province expecting them to fix it!

People don't realize that LASIK can thin the cornea and may result in the need for a corneal transplant years late. Then they get upset because they can't get a cornea privately. I actually met one patient that was going to fly to the US for a private corneal transplant at over $10K because of the waitlist. She came in for the "free" procedure one month before her US appointment date. She moaned that her room wasn't as pretty as the one at the private place was offering. She didn't offer to donate the USD10K to the province though!

Retinal specialists should never do a cataract and vice versa. That's when we see infections and dislocated or dropped lenses.

Our waiting lists would be considerable smaller if people didn't moan at their optician until they cave and refer early wasting a clinic appointment and if the private sector was forced to clean up their own messes instead of using NHS doctors time and NHS bed spaces to fix their problem. Funny thing is the patient never gets a refund when it all goes wrong and the consent forms are so water tight that the patient can't even sue.

fred246

From what I can see the National Guidance from NICE states:
Consider referral for cataract surgery when the person has:
Visual impairment caused by the cataract, and the cataract is affecting the person's lifestyle (for example driving or reading), and the person wants to undergo cataract surgery.
The eye surgeons organisation (rcopth) states:
Visual acuity on its own is not an adequate measure of visual disability from cataract and cataract surgery should be considered in the first or second eye of patients with significant visual symptoms due to cataract.
It is the local kangaroo courts (CCGs) that issue guidance that they will only pay for certain acuities. And yes you will be treated differently if you are a driver. These CCGs are there to save money and prevent surgeons operating (rationing) . They are local and so create a 'postcode lottery' in the NHS. People don't want unnecessary operations. If I was suffering and my surgeon agreed that an operation was a good idea I would want it. I wouldn't want to be told 'Sorry but your local kangaroos won't pay. In their opinion you are not blind enough yet.'

GlasweJen

fred246 wrote: »

From what I can see the National Guidance from NICE states:
Consider referral for cataract surgery when the person has:
Visual impairment caused by the cataract, and the cataract is affecting the person's lifestyle (for example driving or reading), and the person wants to undergo cataract surgery.
The eye surgeons organisation (rcopth) states:
Visual acuity on its own is not an adequate measure of visual disability from cataract and cataract surgery should be considered in the first or second eye of patients with significant visual symptoms due to cataract.
It is the local kangaroo courts (CCGs) that issue guidance that they will only pay for certain acuities. And yes you will be treated differently if you are a driver. These CCGs are there to save money and prevent surgeons operating (rationing) . They are local and so create a 'postcode lottery' in the NHS. People don't want unnecessary operations. If I was suffering and my surgeon agreed that an operation was a good idea I would want it. I wouldn't want to be told 'Sorry but your local kangaroos won't pay. In their opinion you are not blind enough yet.'

I can assure you that in my hospital trust no one is treated differently for being a driver. I'm in Scotland though.