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Waiting for cataracts

Cataracts are common in older people. There are more older people, with a huge expansion in the over-65 population predicted in western countries over the next 20-50 years. Something like eight out of 10 people over the age of 75 years will develop cataracts within a 10 year period. For providers of healthcare, cataract surgery is a major issue, and planning for provision stimulates the government neurone.

Whatever the benefits of cataract surgery, one of the issues that causes great controversy is the amount of time someone has to wait for it. After all, six months, or a year, may be a large percentage of time available to someone in their 70s or 80s, especially when impaired vision makes life increasingly difficult. A systematic review [1] looks at the evidence about the consequences of delay.

Systematic review

The review examined a large number of electronic databases and searched conference abstracts for studies that might throw light on the question. There were sensible limitations on studies allowed. For instance, studies had to be relatively modern, reflecting current procedures, have a suitable diagnostic method or examination, and relate to industrialised countries (it was specifically Canadian in its focus). The aim was to examine the visual, adverse event, and quality of life relationships for waiting time for cataract surgery.

Results

The search found two randomised trials, three prospective cohort studies, and 22 descriptive studies.

Visual

No studies examined postoperative visual outcomes, though the decline in visual acuity during the course of the wait was documented in many of the studies.

Adverse events

One randomised study in the UK noted that people who waited had increased rate of falls and more fractures (12% of them had a fracture) compared with expedited surgery, where the fracture rate was 3%.

Quality of life

A number of studies found that quality of life was reduced in people who waited for cataract surgery, with increased dissatisfaction when the wait was longer than about three months.

Comment

Patients who wait six months or more for cataract surgery experience negative outcomes during the wait period, including vision loss, reduced quality of life, and falls. Managers might ask for evidence about what constitutes an acceptable wait. Given that waiting begins when a patient experiences symptoms sufficient to warrant a GP visit and referral, that seems to be a useful time to start the clock.

While there is little evidence that, say, three months is worse than two months, there seems no good reason to set the barrier at longer than six weeks.

Reference:

  1. W Hodge et al. The consequences of waiting for cataract surgery: a systematic review. Canadian Medical Association Journal 2007 176: 1285-1290.

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