Cataracts

sassy_one

PterionPterion said:

This is going to be a long post but some misinformation regarding cataracts and the NHS often from hearsay or media needs to be clarified.

Very few of the practitioners I have worked with would turn down a cataract op based on funding. There are several guidelines upon which the decision to operate is based on. The main is the level of vision. 6/6 on the vision chart is considered normal vision or 20/20 as the americans say. Approximately 6/12 in the eye with the cataract is where many optometrists/GPs would refer and ophthalmologists would operate. This is akin to the driving standards. NOTE: this is referring to the affected eye only. It does not mean they only operate when you can no longer drive as with both eyes you would be well within driving standards- it is just an arbitrary measure. This is nowhere near blindness. 

The second guideline is based on the affect on quality of life. So for example even if your vision is better than 6/12 but you have significant difficulty with glare, haloes, depth perception, risk of falls, compromised work or sporting ability etc then this is a valid reason for the procedure. The cases where you hear people have been denied surgery is usually because there are other underlying issues which would make the risks of the op outweigh the benefits. 

Your optometrist is best placed to recommend when the surgery would be appropriate and they can initiate the referral. GPs are notoriously poor in dealing with eye related issues so see your optician. Depending on where you are based in the country some schemes allow for you to choose where you would like to go for the op (some cities have private providers who perform procedures on behalf of the NHS, again the availability of these options should be discussed with your optician. 

Regarding, the private consultant turning you down it is usually because general anaesthetic/sedation is a higher risk for them than the actual cataract op itself. Furthermore they may not have provisions to actually offer the service given the current climate and would require additional medical practitioners to be present in an adverse event (sedation) related. 

Mature dense cataracts are when you have little useful vision left in the eye. Again the NHS/CCG/consultants DO NOT want to wait this long. It is a far more costly and risky and so usually it is done much earlier (the optician is the best judge of this). Yes some people may have to wait longer but again that's because in their case the risks may outweigh the benefits. 

The progression of cataracts is different in each patient. Some with health conditions like diabetes, UV exposure, genetics, family history may see rapid decline in 12-24 months whereas others can go decades with no significant change. 

Finally, my personal opinion is the private route is a waste of money for something as straightforward as a cataract op that is readily available on the NHS (unless there are significant other factors involved. 

Thank you for the input!

I have now managed to get an appointment with a experienced consultant for investigative measures at this time, I am told if my cataract hasn't worsened in a few years it may be one of the ones that never get worser, here's hoping!

Either way they are going to see me, which is great and then at least I have all the information and what to expect.

The NHS won't accept me until I am literally unable to see, I have spoken with the hospital department which told me this, and the wait is a year plus at present!

I will see how the appointment goes and take things from there, so may come back here in the future if I need more direction.

I'm just really worried about the risks of the operation given I am very nearsighted, but I have had assurances that the increase in risk is very very small and won't be a problem.

It's also my better eye that has the damn cataract, as these things go, hence why I want to delay any operation until absolutely necessary, so hoping I've the type that won't get worse than it is, or at least won't get worse for a few decades to come.



Thank you for your indepth response, its really reassuring.


Thank you to everyone else who commented on this!


Enjoy your Bank Holiday 😃

elsien

The wait for cataract operations in my area has been hugely impacted by Covid.

There are people still waiting who should have had their procedures 12 months ago (- although with a caveat that I am involved with people who lack capacity and so often need the procedure done under general anaesthetic which causes further delays due to operating theatre space) so newer referrals are added on to the end of a list that's already big from last year. 
Plus the main consultant is retiring which has pushed all procedures back another 6 months. 

There are longer waiting lists in all areas as the NHS has been concentrating on other things - it's not great, but it's how things stand at the moment. 

PterionPterion

elsien said:

The wait for cataract operations in my area has been hugely impacted by Covid.

There are people still waiting who should have had their procedures 12 months ago (- although with a caveat that I am involved with people who lack capacity and so often need the procedure done under general anaesthetic which causes further delays due to operating theatre space) so newer referrals are added on to the end of a list that's already big from last year. 
Plus the main consultant is retiring which has pushed all procedures back another 6 months. 

There are longer waiting lists in all areas as the NHS has been concentrating on other things - it's not great, but it's how things stand at the moment. 

It would be interesting to know which areas you are in or this against forum rules? 
The turnaround in our catchment and surrounding CCG's is around 12 weeks but that is for local anaesthetic procedures. 
Is there only a single provider in the area as larger towns and cities have their junior docs clearing the backlog or are sending out to private providers to perform on behalf of the NHS.
 

kirtondm

In our areas waits down to 12 weeks as well. If you are prepared to travel your GP should be able to arrange for you to be seen on the NHS out of area.

Some surgeons will do the operation entirely with drops for anesthesia if you are worried about injections into the eye. It would be very unusual to do an op under general solely because a patient is nervous. Normally you can be given some dizapem or similar to calm you down.

Normally a chat with an experienced surgeon is enough to reassure most patients.

The risks are greater for high myopes but that only increases the more the cataract develops.