IT is not generally recommended to have cataracts in both eyes treated at the same time in Australia, but this may change with a recent study pointing to significant potential benefits. Finland, Spain and Canada are well-advanced in the adoption of treating both eyes in the same procedure, will Australia follow suit?
For and against of both-eyes-same-day surgery
Having both eyes treated in one procedure has a number of potential benefits. It would mean faster patient recovery (from an overall six weeks to four weeks).
It would also prevent a disbalance from developing when one eye has already been operated on while the other hasn’t been.
Potential cost benefits are obvious. Patients would need less care. Surgery time and theatre time would be reduced.
In a health system where demand outstrips supply of ophthalmology services, the introduction of both-eyes-same-day surgery has the potential to increase system capacity: more people can get treatment than before.
Waiting times for cataract surgery in Australia are long. NSW has the longest median wait time in Australia at 278 days. The national average is 158 days. These wait times include patients with private health insurance and without, so the average time for people without private health cover would be significantly longer.
Each year in Australia, more than 250,000 people undergo cataract surgery to replace the clear eye lens with an artificial one. Most people who need cataract surgery suffer from cataracts in both eyes.
There also are potential disadvantages associated with both-eyes-same-day cataract surgery.
Obviously, during recovery patients’ vision will be severely impaired.
There is also a low risk of infection in both eyes.
In addition, when eyes are operated on in two procedures, the surgeon can take the results of the first operation into consideration when operating on the second eye. Both-eyes-same-day surgery doesn’t give the surgeon that option.
Evidence from the latest big study
A big trial in ten large hospitals in The Netherlands has attempted to find a definitive answer to the question whether the benefits of performing cataract surgery on both eyes in one procedure outweigh the risks.
The recently completed study suggests that cataract surgery on both eyes in the same procedure can be effective, generally safe and certainly cheaper.
The study looked at adults who had cataracts in both eyes which needed surgery. Patients were screened for anything that might complicate recovery after surgery. In other words, the patients selected were, other than the fact they had cataracts, in reasonable to good health.
The people selected were then split into two groups. One group had both eyes done in one procedure, while the other group had their eyes done in two procedures, one eye at a time.
The most important thing the study looked for was how both groups would score on what ophthalmologists call the ‘refractive outcome’, that is, how people’s sight improved in four weeks after they had had surgery.
Also important was if one group had more complications than the other and how people felt about their experience.
And although the abstract for this study mentions them last, the study looked very closely at “cost-effectiveness and budget impact”.
The results of the trial seem to have demonstrated that both-eyes-same-day surgery for otherwise healthy people is as safe and effective as spreading the surgery out over two procedures weeks apart.
Never in doubt, the results also demonstrated that the costs associated with both-eyes-same-day surgery are lower.
This means that one day soon Australia, too, will ponder whether or not to adopt both-eyes-same-day cataract surgery as the default option for otherwise healthy people.
Government policy response
This also means that Government policy makers will probably start thinking about who the cost savings achieved by both-eyes-same-day surgery are going to benefit.
Will ophthalmologists be able to simply up their fees to compensate them for loss of revenue earned through one-eye-at-a-time cataract surgery?
Will private health insurers be able to up the excess on both-eyes-same-day cataract surgery?
Or will governments act to ensure the cost savings are translated exclusively in a reduction in the cataract surgery waiting list?