Cataract surgery threshold concerns
AUCKLAND: More than one in four New Zealanders declined cataract surgery had sight so bad they could not legally drive, a study has found — and how likely people are to get their vision restored depends on where they live.
Hamilton ophthalmologist and University of Auckland senior lecturer James McKelvie led an analysis of all 44,000 patients referred for cataract surgery from 2014 to 2019.
The findings were published in the New Zealand Medical Journal yesterday.
‘‘You basically have to lose your licence before you get surgery,’’ Dr McKelvie said.
‘‘And, in fact, in many district health boards it is significantly worse than that.’’
Maori and
Pacific patients developed cataracts at a younger age, and ‘‘have worse visual acuity, and typically severe visual impairment, compared to other ethnic groups at the time of prioritisation’’.
The Royal Australian and New Zealand College of Ophthalmologists (Ranzco) is now taking the rare step of calling on the health minister to reduce this glaring example of socalled ‘‘post code healthcare’’ by setting a nationwide threshold for acceptance for surgery.
At present, DHBs give referred patients a score from 0 to 100 (lowest to highest priority), according to clinical and social need, using the ‘‘clinical priority assessment criteria’’ (Cpac) system.
However, each DHB sets a different threshold for surgery, meaning people living in central Auckland get cataract surgery more easily than in Counties Manukau, for example.
‘‘The lack of a single national threshold . . . creates significant geographic disparity in access,’’ the research, coauthored by
Stephen Ng, Corina Chilibeck and Jeremy Mathan, stated.
‘‘Over onequarter of patients who were declined for surgery did not meet the visual acuity requirement for driving a private vehicle in New Zealand.
‘‘A small but significant number of patients [26] who were declined for publicfunded surgery had such advanced visual impairment they would be eligible for registration with Blind Low Vision New Zealand [formerly the Blind Foundation].’’
The percentage of referrals declined varied greatly by DHB. The Lakes DHB approved just over half of referrals, for example, while the West Coast DHB approved 93%.
Most declined patients with visual acuity of 6/12 or worse — meaning at 6m you can read something which a person with normal vision could read at 12m, and the point at which driving is no longer legally allowed — were from the Waikato and Bay of Plenty DHB regions, but on a perpopulation basis, the highest rates were in the Southern and NelsonMarlborough DHBs.
New Zealand compares badly with other OECD countries.
Canadian guidelines recommend surgery when visual acuity drops to 6/12 with symptoms of glare, for example, while just 35% of New Zealand patients had visual acuity of 6/12 or better in the operative eye at the time of prioritisation.
Of surgeries done per 100,000 population, per year, the rate in Canada and Australia was more than double that of New Zealand, which ranked 23 of 27 OECD countries.
Something had to change, Dr McKelvie said.
‘‘Cataracts are like wrinkles. They affect us all, eventually.
‘‘It brings people’s lives to a standstill, and it’s so straightforward to fix these patients, if we can just get the resources to do it.’’
Health Minister Chris Hipkins said any response to Ranzco’s call for a nationwide surgery threshold would be a matter for whoever was appointed minister after the impending postelection reshuffle. — The New Zealand Herald