Clinical ophthalmologist Dr James McKelvie
Cataract surgery far outperforms hip and knee surgery in returning quality of life to affected individuals says New Zealand eye surgeon Dr James McKelvie.
Some studies put the return on investment for the health system at 4.567 per cent.
Speaking at a Cambridge U3A meeting this month, the consultant ophthalmologist said 30 to 40 million cataract surgeries were performed globally each year – including 40,000 in New Zealand – making it the most frequently performed surgical procedure.
Despite those numbers, the $170 million New Zealand spends on cataract surgery is a small fraction of its annual $30 billion plus health budget.
“That is low compared to other OECD countries,” he said. “That amount per person is well below that of similar countries, such as the United Kingdom and Australia, who spend roughly three times that amount.”
Surgery is the only treatment for cataracts, McKelvie said, and the procedure – typically performed under local anaesthetic and taking roughly 15 minutes – has a profound and immediate effect on patients that extend well beyond improved vision.
McKelvie said the technology around eye surgery was advancing at an explosive rate, and now incorporated artificial intelligence (AI), which was used to analyse surgery in real time and help improve the training of surgeons.
He outlined the difference between optometrists and ophthalmologists. After completing a four-year degree, optometrists generally focus on vision correction through glasses and contact lenses, and diagnose basic eye conditions. There are around 1500 in New Zealand. Ophthalmologists, of whom there are only about 150 in the country, can undertake up to 20 years of education. As fully qualified medical doctors and surgeons, they deal with a range of eye diseases and perform surgery.
The shortage of qualified ophthalmologists in New Zealand impacts the country’s ability to lessen waiting times for important surgical procedures, he said, among them glaucoma – when the condition is serious enough to warrant surgery – and corneal surgery.
There are about 500 to 1000 people awaiting corneal transplants in New Zealand a year and one to three years was the typical wait time, he said. Those numbers are impacted not only by a shortage of expertise – there are only about 20 corneal surgeons in the country, of which McKelvie is one – but primarily by a shortage of donated corneal tissue.
“That is because we have to transplant live tissue, which means we have to wait for donations of corneal tissue from recently deceased individuals, primarily through the New Zealand Eye Bank,” he explained, “and there is only a very small window of opportunity in which to do the transplant.”
He said about 25 per cent of the corneas available for this purpose in New Zealand come from just one hospice, and urged people to consider donations. They can be arranged through the New Zealand Eye Clinic.
“It can be transformational for those who receive the transplant,” he said. “Eye surgery can really change lives. It is widely acknowledged that vision is one of those things that is very closely related to our quality of life.”
Clinical ophthalmologist Dr James McKelvie spoke in Cambridge this month on the changes and challenges around eye surgery. Photo: Viv Posselt
