The back log in eye surgeries needs to be addressed

In the Sou'Wester this morning is my article on the need to address the backlog in eye surgeries.  The article is below, as it appeared in the Sou'wester.   In case it is difficult to read I have shown the same article typed below it. 

Addressing the need for quick access to eye surgeries

Vision and ophthalmology are important.  Prompt attention to eye surgeries is essential.  I was approached to look into this by a River Heights constituent.  Retinal detachment surgery is urgent, to prevent irreversible damage to the retinal (nerve) tissue and permanent vision loss.

 

Cataract surgery, in contrast, is viewed as elective. But, if left too long, cataracts can be difficult to remove and the surgery can become complicated.  Delayed surgery can take longer and may require further surgery; it may cost more and have slow or poor vision recovery.  Doing cataract surgery in a timely manner can avoid these unnecessary difficulties.

 

Most cataract surgeries are in people over age 65.  In an older person, poor eyesight can lead to a fall which can result in a broken hip or head injury; these can be life threatening or life altering.   I know. Both my parents suffered from declining vision as they aged.  Both had life limiting falls and broken hips.  In both cases, the declining vision almost certainly contributed to the falls.

 

In 2018, 415,923 cataract surgeries were performed in Canada.  On a population basis, this is about 15,000 cataract surgeries for Manitoba.  But in 2019, only 11,802 cataract surgeries were done, about 3,200 surgeries short.  Consistent with this, there were long waits for cataract surgery in Manitoba in 2018 and 2019 even before the pandemic.   During the pandemic, the number of cataract surgeries in Manitoba fell from 11,802 in 2019 to 6,940 in 2020, a shortfall of 4,862 when compared to 2019.  In 2021, we are likely to fall below 11,802 again, and the backlog will increase further.

Other consequences of vision loss include depression or anxiety (sometimes in part related to the loss of a driver’s license and mobility), admission to a long term care facility and/or increased need for home care or caregiver services. 

These outcomes are associated with significant hospital, physician and/or drug costs.   Overall, ophthalmologic interventions in Canada can avoid 82,500 secondary medical outcomes (3,000 in Manitoba).  The savings due to timely ophthalmologic interventions, calculated in the Conference Board of Canada’s report “Ophthalmology in Canada”, is $6.4 billion for Canada in 2020 alone ($230 million for Manitoba). 

With such major savings and major improvements in individual’s quality of life, we must do everything possible to improve access to ophthalmological services in Manitoba so that the backlog can be addressed and ophthalmologic interventions can be provided in a timely fashion.  

Currently, at the Misericordia Buhler Eye Care Centre the average waiting time for an ophthalmology consultation is 4.6 months.  After consultation there is an average wait of 11.0 months before the cataract surgery is done.   The full waiting time, 15.6 months, is far too long. 

The provincially reported waiting time is less because the province only reports the time from when the surgery is booked till when it is done. Perhaps Manitoba should look to British Columbia where half of all cataract surgeries are completed in 7 weeks.

Manitoba should plan for an annual level of 15,000 cataract surgeries a year.  In addition, extra surgeries are needed to catch up with the backlog.  The effort will need effective planning.  

Manitoba Liberals have already called for such a plan.  The current provincial government needs to deliver and implement the badly needed plan.  Ophthalmology, the fourth largest field of medical specialization, accounts for 6% of direct health care costs. It should be getting more attention.