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Melbourne ophthalmologist questions logic behind ban as elective surgery resumes

Anton van Heeerden elective surgery

A Victorian ophthalmologist has been critical of the state government’s month-long ban on non-urgent elective surgery, as cataract patients sat at home with deteriorating quality of life while day surgeries remained empty ready to operate.

Dr Anton van Heerden, who heads the Surgical Ophthalmology Services Department at the Royal Victorian Eye and Ear Hospital and is a director of Armadale Eye Clinic and Mornington Peninsula Eye Clinic, has questioned the point of suspending elective ophthalmic procedures in both public and private settings, which came into effect on 6 January.

Dr Anton van Heerden.

The temporary suspension – which excluded urgent Category 1 cases – was introduced as the state grappled with a rise in Omicron COVID-19 cases. It was lifted this week on Monday 7 February, with hospitals now able to operate at 50% of pre-pandemic capacity.

However, van Heerden is concerned about the impact this has had on ophthalmic patients who have already waited long periods for surgery when surgeons, nurses and hospitals had the ability to perform the procedures if it wasn’t for the suspension.

“The logic behind a blanket ban like this doesn’t make sense, especially for ophthalmology. The ban is to prevent elective surgery patients occupying hospital and ICU beds. Our patients very rarely require a hospital stay or end up in ICU as the vast majority return home the day of their surgery,” he said.

In the public system, van Heerden said the pause also translated to patients needing to attend clinics that would have ensured they were referred and placed on surgical waiting lists. This meant the current wait lists were unlikely to reflect the true number waiting for surgery.

“And the occasional patients we were seeing in clinic were blind from cataract,” he said.

“Several public patients have had appointments rescheduled time and again, and now their surgery has been on hold while sitting at home blind which is really disappointing.”

In terms of the private system, van Heerden said it was reliant on income from surgeries. With staff generally not allocated to help with the COVID-19 response, there was little for them to do as their facilities sat idle.

“Day surgeries have been sitting empty and meanwhile the business is trying to stay afloat – once again the logic behind it is ridiculous; you can have 75% capacity at the tennis, but you couldn’t have a cataract operation in one of the safest environments,” he said.

“The blanket ban on elective surgeries will have had zero influence on the state’s overall COVID-19 response but will have a massive and devastating impact on public health.”

Full return remains ‘our goal’

In a statement, the Victorian Government said now that hospitalisations had reduced to a seven-day average of 1000-800 cases in hospital, it could take the first steps towards resuming all elective surgeries, starting with 50% capacity.

“A return to normal elective surgery arrangements remains our goal as soon as it can be safely achieved,” the state government said.

“Subject to the continued decline of the rolling seven-day average for hospitalisations to safe operating levels and formalising arrangements with private hospitals to have capacity to support the public health system for COVID-19 response as required, the Minister for Health will consider resuming more elective surgery – at up to 50% in Melbourne and up to 75% in regional areas.

“When the average drops under 600 hospitalisations, the Minister will review the settings and consider if metropolitan public hospitals can resume some non-urgent elective surgery, pending an assessment of staff availability and furloughs.”

In NSW, a temporary suspension of non-urgent elective surgery came into effect on 10 January, but this only pertained to cases “requiring an overnight stay” in both public and private hospitals. It returned to 75% capacity on Monday 7 February.

All emergency surgery and urgent elective surgery in NSW continued during the NSW shutdown, and the majority of non-urgent elective day surgery had also been continuing in public and private hospitals.

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