We need better means of assessing priorities for surgery

Cataract extraction is the most common elective surgical procedure performed in older people, with over 105 000 NHS operations each year. Advances in surgical and anaesthetic techniques over the past 15 years have transformed it into a day case procedure using local anaesthetic. These advances, combined with an ageing population and higher patient expectations, mean that demand continues to rise, with increasing numbers waiting for cataract surgery. The effectiveness of first eye cataract surgery is well established. However, up to a third of current cataract operations in the United Kingdom are done on second eyes, and now there is evidence that the outcome is better when they are done soon after the first procedure rather than later.1 Given these demands, how are ophthalmologists to prioritorise their waiting lists?

In a randomised trial of expedited second eye surgery (within six weeks of the first) versus routine surgery (within 7-12 months of the first) Laidlaw et al in Bristol reported major benefits in terms of objective measures of visual function and reported visual symptoms and quality of life.1 This study supports the need for second eye surgery, but how may this affect patients awaiting first eye surgery? Public concern is increasing that the outcome of first eye cataract surgery may be …