THE GOOD DOCTORS GUIDE
Exclusive: Britain’s best surgeons — as chosen by their fellow doctors
The series that could save your life
What are the hallmarks of a good doctor? technical expertise and skill, of course — but someone who understands you, and someone you trust, is also vital.
Indeed, research shows that a good relationship with your doctor can actually improve the chances of a successful outcome. But how do you find a specialist who fits the bill?
that’s where this unique series of guides, starting today and running every day next week in the Daily Mail, can help.
We have identified the country’s top consultants — as judged by their peers.
We’ve canvassed the views of more than 260 consultants across seven specialities from around the country and asked them this very simple, but key, question: ‘If your own nearest and dearest were to need treatment in your field, to whom would you refer them — and why?’ the consultants with the most votes from their peers are those who made it into our guides.
however, patients should bear in mind that this is not a scientific study and there are many superb, highly skilled specialists all over the country who didn’t make it on to our list, but who spend every day of their working lives making a real difference.
We’ve focused on some of the major areas in surgery, including cataracts, breast and prostate cancer, and gallstones — conditions that affect millions of Britons.
to help you make informed decisions on your care, we’ve also talked to experts about the latest thinking on treatment.
the Good Doctors Guides are essential reading for patients. Don’t miss Monday’s Mail for the next, in which we reveal top consultants for heart rhythm problems.
EYE OPS CAN BE A POSTCODE LOTTERY
CataraCt surgery is the most common operation performed by the NhS, with nearly 400,000 people a year undergoing it.
a cataract occurs when proteins in the eye’s lens — the transparent structure behind the coloured iris — clump together.
these proteins allow the eye to focus and normally keep the lens clear. as they clump together, vision becomes blurred and the lens itself becomes cloudy.
Nothing has been shown to slow cataracts’ progression and the only treatment is to remove the lens and replace it with an artificial one, explains Damian Lake, a consultant ophthalmic surgeon at the Queen Victoria hospital and the McIndoe Centre, both in East Grinstead, West Sussex.
the speed of deterioration can vary considerably.
‘Some people go downhill in weeks; others see the same level of deterioration over months or years,’ says Mr Lake.
‘there’s no rhyme or reason that we know of, so we presume it must be related to lifestyle.’
Understandably, patients can be anxious about getting the treatment promptly. But a postcode lottery means that, in some parts of the country, they can face very long waits.
In Grampian earlier this year, some patients were waiting a total of 546 days for the procedure, though steps were being taken to improve this and to send patients elsewhere
a report by the royal National Institute of Blind People (rNIB) in September 2016 found that people in Enfield, North London, wait 15 months from their first hospital appointment to cataract surgery, while patients in Luton, Bedfordshire, wait just 15 days.
What’s more, patients with cataracts in both eyes will often only get surgery on the worst eye, with the operation stalled on the second until sight deteriorates to the ‘treatment threshold’.
this threshold varies between health areas across the UK, ‘although official guidelines say this shouldn’t happen’, explains Mr Lake.
a delay can make surgery more challenging, as cataracts become denser over time.
Some patients turn to private treatment, which can typically cost between £2,000 and £4,000 per eye (depending on the type of replacement lens).
trying to negotiate this tricky area can be a minefield, as sound advice is hard to separate from the hype about some of the most advanced techniques, which are much more expensive, but have no proven benefit.
Cataract surgery is a simple, 20-minute procedure. It involves making a tiny incision in the eye, removing the cloudy lens by breaking it up with ultrasound (a technique known as phacoemulsification) and replacing this with a clear, artificial lens.
But a number of factors raise the stakes. ‘You see some patients with only one working eye and, for them, surgery is tragic or magic,’ says Julian Stevens, a leading cataract surgeon based at Moorfields Eye hospital in London.
‘If there is a complication in surgery in the working eye, then that can be a disaster.’
One of the most feared and potentially sight-threatening complications of the procedure is a rupture of the back of the capsule which holds the lens. although rare — nationally, the risk is 2 per cent — a good eye surgeon should halve this risk and the very best will shrink it to around 0.5 per cent.
With standard surgery, as is offered to many NhS patients, the lens is replaced with an artificial one that’s fixed to a single distance (for near or distance vision), which means glasses are needed for reading.
But more advanced techniques and lenses can be used to try to overcome this limitation.
Some contact lens-wearers are already familiar with what is known as monovision, where a lens for distance is used in one eye, and another for, say, computer work in the other, so the brain combines the images.
the same can work well with replacement lenses for cataracts.
all ophthalmologists in the NhS are general eye surgeons capable of all eye surgery to a greater or lesser degree.
But each will also have a sub-speciality. Back-of-the-eye specialists are typically experts in diseases such as glaucoma (where a build-up of pressure in the eye damages the optic nerve), while corneal, cataract and refractive surgeons are experts in the front of the eye. this matters because it’s likely
to influence options on offer for cataract surgery.
While a good glaucoma specialist may be supremely skilled with straightforward cataract surgery and single-distance lenses, chances are they won’t provide the full range of the most advanced lenses such as multifocals, which aim to help reduce the need for glasses.
Nor are they likely to be able to tweak the result post-operatively with minimal laser treatment.
But these extras come at a price. Premium lenses aren’t available on the NHS and will also require top-up fees for private health insurance patients.
And opinion is divided over advances such as Femto, a laser technology used to break up the cloudy lens. This is a three-minute process — the patient is then wheeled into theatre for the operation to insert the new lens.
Laser-assisted cataract surgery isn’t available on the NHS and some top surgeons don’t perform it privately because they say it offers no benefits but makes the procedure much more expensive.
‘Laser-assisted surgery was touted as a better and safer operation when it was introduced six years ago,’ says Professor David Spalton, president of the European Society of Cataract and Refractive Surgeons, who works at the private King Edward VII’s Hospital in London.
‘But large studies have shown the results for patients are the same.
‘In fact, some studies have shown patients have more complications from Femto, although there are some uncommon cases, such as for very dense cataracts, where it might have advantages.’
One of the UK’s foremost eye surgeons, Brian Little, of Moorfields Eye Hospital in London, says there is no doubt lasers are beneficial in some aspects of eye surgery, ‘but not for cataracts — it’s an invention looking for a use and it’s been pushed very hard by the industry because it stands to be so lucrative. It is not safer, nor cheaper.’
So, how do you bypass the hype to find the very best eye surgeon for your cataract operation?
We asked 40 leading eye surgeons who they believe are the top performers. Here, we reveal their choices, with comments about why they selected them.