Developing cataracts and waiting for your vision to blur is just a natural part of ageing isn't it? Why should it matter if you can no longer drive, read labels on your medicine bottles, see the use-by date on food or recognise the faces of your loved ones?
Well of course it should matter, it does matter and it does not have to be this way. So why are there so many people being denied treatment?
A cataract is a clouding of the lens within the eye and causes blurred vision. In the worst case, it can be like looking through a misted up bathroom mirror, where all you can see are the outlines.
Cataract surgery is a safe and cost-effective procedure that has the capacity to restore sight. It is also the third most common procedure carried out by the NHS. The operation involves removing and replacing the natural cloudy lens with a clear artificial implant. Surgery takes as little as 30 minutes and is usually performed as an out patient appointment, meaning many people will return home on the same day.
It is successful in 97 per cent of cases and is life changing for the patient - it means they will once again be able to drive, get out and about safely and end the isolation faced by so many people with sight loss.
The Department of Health believes that those who need surgery should get it. The guidance states that people should have the operation if;
• They have reduced vision from the cataract
• Are experiencing a negative impact on their quality of life
• Are willing to have the surgery
The official body for setting standards for clinicians, the Royal College of Ophthalmologists, agrees.
So what is the problem?
It is a complex picture but restrictive referral criteria and squeezed capacity in hospital eye departments are certainly contributing to the problem.
RNIB has undertaken a detailed analysis of cataract surgery data and found a huge variation in cataract service provision across England. The findings also reveal a significant national decline in the number of second eye cataract operations taking place - certainly not what we would expect to see with the ageing population.
More worrying is the fact that over 50 per cent of commissioners are using arbitrary criteria to restrict access to surgery. In some cases this rationing is taking place on the basis of cost alone. But NHS efficiency savings achieved by cutting cataract operations are a false economy - denying treatment leaves patients at risk of depression, social isolation and fall-related hip fractures - which are substantially more costly to the NHS and social care services than cataract surgery.
Restrictive criteria have also created the old cliché 'a postcode lottery'. Patients living in South Essex can be refused access to treatment if they can read too far down an eye chart (incidentally this is not a good measure of vision for cataract patients); while those in North Essex only need to show that the cataract is impacting on their everyday lives.
These restrictions do not make sense. Sight will only continue to deteriorate until the cataract is removed, so delaying surgery now only increases NHS waiting lists in the future.
What can we do about it?
RNIB believes there is a powerful case for a National Clinical Director for Eyecare based within NHS England. Posts already exist for conditions such as stroke, dementia, obesity and offender care. Without such a champion inside the NHS there is every danger that eye health and cataract surgery will yet again be sidelined. Failure to act now will simply widen health inequalities and deny a growing number of patients their sight.
Commissioners and clinicians should review local cataract provision and address poor performance. Local treatment policies and guidance must be fit for purpose and enable patients to access treatment when they and their clinician believe the time is right.
Finally, there needs to be up-to-date guidance for the NHS - we need a NICE Quality Standard for cataract surgery. This will help commissioners contract high-quality services and not allow poor provision to persist. It will also explain to patients what to expect so they can act if the system fails them. There is a standard in production but it will not be developed before 2018. This timeline is unacceptable, five more years of arbitrary rationing is simply disgraceful.
RNIB continues to campaign for equal access to cataract surgery and is keen to hear from anyone being denied treatment. If you would like to get involved in this important work, please contact us at firstname.lastname@example.org or @RNIB_campaigns