RANZCO shuns new Australian cataract standard

It was disappointing that the ACSQHC did not listen to the experts when making their final decision, he added. “A VA threshold to qualify for cataract surgery is just one piece in the puzzle, which excludes some patients whose lives are being negatively impacted by their condition.” Comparing it with a New Zealand CPAC case, for example, he said, some of the standard lines on the Snellen chart are missing entirely (6/7.5, 6/30, 6/48 and others). “So clinicians are required to round acuity values for scoring. The rounding methods are not intuitive, inconsistently applied and are likely to skew results based on the clinician. Further, using Snellen acuity does not align with any international standard and there is a real risk that some, such as hospitals or private health insurers, will apply this standard in isolation and not consider all factors that inform a decision about cataract surgery… there has been no rigorous validation of the impact-on-life tool for measuring vision-related quality of life and overrides are often variably applied. The best judge as to how and why cataract surgery should be performed is the ophthalmologist.”

In New Zealand, “The nationwide mean BSCVA of 6/30 (prioritised eye) at the time of prioritisation indicates that a significant level of visual impairment is required to access public-funded surgery in New Zealand,” with Māori and Pasifika having even worse levels, wrote Hamilton-based ophthalmologist and Auckland University senior lecturer Dr James McKelvie in 2020. “Over one quarter of patients who were declined for surgery did not meet the VA requirement for driving a private vehicle in New Zealand… (while) a small but significant number of patients who were declined for public-funded surgery had such advanced visual impairment they would be eligible for registration with Blind Low Vision New Zealand.”

Consultant and surgeon Dr Dean Corbett of Auckland Eye added, “The issues are complex. Cataract surgery is a critical service that needs to be incorporated into the public delivery of service, but there are significant variances in the skillset of different ophthalmologists and also surgical centres with regard to cataract surgery efficiency and outcomes, such as the time taken for a case and the quality of the surgery in regard to the technical outcome and patient experience.”

New Zealand’s ophthalmologists have been vocal about a nationwide standard of clinical care being adopted here. “In our view, a single national CPAC threshold seems like a fair and reasonable goal for public-funded surgery and is something that New Zealand ophthalmologists would like to push for,” said Dr Hadden. “Australia’s move will make us wary but will not put us off this proposal.”

For more, see: tinyurl.com/ACSQHCstandard; and for New Zealand, https://www.eyeonoptics.co.nz/articles/archive/battling-for-better-eye-care-in-nz/