New analysis conducted by leading Australian research institutes has found cutting wait times for cataract surgery to three months could significantly reduce the number of avoidable falls and save the health system millions of dollars.
The authors of the paper, published this week in Public Health Research & Practice, a journal of the Sax Institute, conducted an analysis to estimate government costs and outcomes associated with different waiting times for cataract surgery.
They found waiting times for cataract surgery in the public health system can be as long as two and a half years in some parts of Australia. But if the wait for surgery was capped at three months, over a three-year period they said it would result in 50,679 fewer falls that “can have devastating and even fatal consequences for older people”.
Avoiding the cost of treating those falls would save around $20 million, resulting in an overall cost saving of $6.6 million, once the costs of bringing forward surgeries were included.
The seven-strong research team featured prominent members of the ophthalmic research community, including the University of Melbourne’s Professor Hugh Taylor, the University of Sydney’s Professor Peter McCluskey, director of the Save Sight Institute, and Professor Lisa Keay, head of the UNSW’s School of Optometry and Vision Science. UNSW early career researcher Dr Jessie Huang-Lung was the lead author, with the UNSW’s Blake Angell and Anna Palagyi – who are also both part of The George Institute for Global Health – and the University of Sydney’s Associate Professor Andrew White also involved.
According to the study, NSW patients were waiting the longest in Australia for cataract surgery at public hospitals before the pandemic, according to 2018-19 data from the Australian Institute of Health and Welfare, with 50% the patients on the list waiting at least eight months to be admitted. Victoria was the shortest with 50% waiting one month and 90% four months.
The findings prompted the authors to call for greater investment in public cataract services, which could include the establishment of high-volume surgery services to increase capacity, as well as standardising referral and triage processes, fast-tracking of referrals when necessary, and prioritising surgery for Indigenous patients to reduce health inequities.
“Eliminating unnecessary delays to cataract surgery would not only lead to better outcomes for patients but also alleviate an economic burden on the health system,” the authors concluded.
The ‘wait for the wait’
While wait times for cataract surgery vary greatly across Australia, they report the official waiting time statistics also do not capture what the authors call “the wait for the wait”, or the time it takes after diagnosis to get on the official public hospital elective surgery waitlist.
They calculate that overall, in the best-case scenario, a patient could have surgery only four months after diagnosis, but in the worst-case scenario, the wait would be 30 months. These estimates do not include the extra waits created by the COVID-related elective surgery pause.
The comparative analysis in the paper, funded by Vision 2020 Australia, considered the impact of reduced waiting times on the estimated direct hospital costs for bilateral cataract surgery, as well as the costs of pre- and post-operative assessments and indirect hospital costs associated with treating fall- and motor vehicle crash–related injuries.
The authors say the $6.6 million cost saving is “likely to be an underestimate” as it does not account for longer-term costs to society and individuals from falls and motor vehicle crashes, including loss of life, disability care, loss of income, legal system costs, property damage and reduced quality of life.
Nearly a quarter of a million people are living with visually significant cataracts in Australia, the authors estimate based on data from the 2016 National Eye Health Survey. Cataract is a leading cause of vision loss, affecting 20% of Aboriginal and Torres Strait Islander people aged 40 and over, and 14% of non-Indigenous people aged 50 and over. It significantly affects people’s ability to work, drive, and care for themselves and others.
“Extended waits for treatment place patients at heightened risk of falls, car crashes and other ill effects, including social isolation,” the authors report.
“These risks are more commonly felt by the 30% of Australians who do not have private health insurance, cannot afford the out-of-pocket costs associated with private treatment and rely on public hospital services.”
Cataract tip of the iceberg
The Australian Society of Ophthalmologists says the analysis highlighted the chronic underfunding of public eye care in Australia. It said governments can no longer bury the issue under the guise of pandemic-related pressure on our health system.
“Cataract surgery in the public system is in crisis – and this predates COVID-19 – but it’s just the tip of the iceberg,” ASO president Associate Professor Ashish Agar said.
“There is chronic underfunding of public eyecare in general. Waiting times for diabetic retinopathy, glaucoma and macular degeneration treatments are even worse than waits for cataract surgery. Cataracts get attention because they are a KPI, but the other eye conditions are the hidden bulk of the iceberg.” he said.
Citing cataract surgery waits in NSW of up to two-and-a-half years, the study outlines the flow on effects for Australians left languishing on waiting lists; namely thousands of preventable falls and fractures.
Agar said the findings support what ophthalmologists have been telling the state health departments for years.
ASO vice-president and Sydney cataract surgeon Dr Peter Sumich added: “We have already seen the closure of St Vincent’s and St George Hospital eye surgery and a chronic underfunding of public eye clinics which require specialist expertise. The lack of commitment to public hospital ophthalmology is a long and vexed story and limits our ability to train new eye specialists.”
Sumich said the ASO hoped the study’s release would bring the broader issue of public eye care to the forefront.