Dear Editor

According to the Canadian Community Health Survey, approximately 82% of the population of seniors aged 65 – 80+ (3,000,000 seniors) reported having vision problems in Canada. [1] Cataracts are the leading cause of vision impairment among seniors. Between the period of 1994 – 2003, proportions of seniors with cataracts rose from 14% – 20% with populations aged 75 and over accounting for higher percentages. [1]

Cataract surgery is among non-emergency surgical procedures with highest wait times in Canada. There was a 32% increase in cataract surgeries over 5 years between 1997/1998 and 2002/2003. In British Columbia, there were 11,816 patients waiting for surgery and 7897 patients completed in the 3 months from 31 August 2006 to 31 October 2006. [2] In addition to being a barometer of accessibility to health care services, cataract wait times are also a determinant of patient satisfaction which in turn is correlated with increased health-related quality of life [3] and possibly decreased injury risk. [4]

Delay of care is a persistent and undesirable feature of current health care systems. [5] Waits and delays plague health care systems worldwide, and wait times for most specialists exceed those for primary care practices. [6] From clinical perspective delay in necessary treatment due to surgical wait lists is a major concern. [7] Establishing a clinically appropriate time that patients can safely wait for the operation is generally perceived as a method to prevent adverse outcomes of delay. [8]

The cost effectiveness of cataract surgery has been well-established. [9, 10] In fact, modern techniques used for cataract surgery today result in rapid visual improvement with 50% of patients experiencing good vision by 24 hours and 96-99% experiencing good vision by 4 weeks. [11] Evidence supports cataract surgery among older drivers in producing significant improvements in driving performance (best predicted by the concomitant improvement in contrast sensitivity), subsequent crash rates half that of older drivers with cataracts who opted not to have surgery, and self-reported improved visual function and distance estimation. [4]

References

(1). Millar, W. J. Vision problems among seniors. Health Reports. 2004; 16; 45-49.

(2). BC Ministry of Health (2006). Surgical Wait Times: Cataract Surgery in BC. [Online]. Available at URL: http://www.swl.hlth.gov.bc.ca/swl/swl_db/swl.WaitlistPkg.GetHospitalListBySurgSpecNLF?IEvent=27

(3). Conner-Spady, B.L., Sanmugasunderam, S., Courtright, P., McGurran, J.J., & Noseworthy, T.W. Determinants of patient satisfaction with cataract surgery and length of time on the waiting list. British Journal of Ophthamology. 2004; 88; 1305-1309.

(4). Owsley, C., McGwin, G., Sloane, M., Wells, J., Stalvey, B.T., Gauthreaux, S. Impact of cataract surgery on motor vehicle crash involvement by older adults. JAMA. 2002; 21; 288(7):841-9.

(5). Hodge, W., Horsley, T., Albiani, D., Baryla, J., Belliveau, M., Buhrmann, R., O'Connor, M., Blair, J., Lowcock, E. The consequences of waiting for cataract surgery: a systematic review. CMAJ. 2007 176: 1285 - 1290.

(6). Murray, M.F. Improving access to specialty care. Jt Comm J Qual Patient Saf. 2007; 33(3):125-35.

(7). Sobolev, B., Mercer, D., Brown, P., FitzGerald, M., Jalink, D., Shaw, R. Risk of emergency admission while awaiting elective cholecystectomy. CMAJ. 2003; 169; 662–665. (8). MacCormick, A.D., Collecutt, W.G., Parry, B.R. Prioritizing patients for elective surgery: a systematic review. ANZ J Surg. 2003; 73; 633–642. doi: 10.1046/j.1445-2197.2003.02605.x.

(9). Laidlaw, D.A.H., Harrad, R.A., Hopper, C.D., Whitaker, A., Donovan, J.L., Brookes, S.T., Marsh, G.W., Peters, T.J., & Sparrow, J. M. Randomised trial of effectiveness of second eye cataract surgery. Lancet. 1998; 352; 925-929.

(10) Sach, T.H., Foss, A., Gregson, R., Zaman, A., Osborn, F., Masud, T., Harwood, R.H. Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol. 2007 Jun 21; [Epub ahead of print]

(11). Harwood, R. H., Foss, A. J. E., Osborn, F., Gregson, R.M., Zaman, A., & Masud, T. Falls and health status in elderly women following first eye cataract surgery: A randomized controlled trial. British Journal of Ophthamology. 2005; 85; 53-59.