Study highlights need for use of fair criteria for surgery waiting lists

This large prospective study examined factors that influence waiting time for cataract surgery and the effect of waiting time on surgical outcomes in Spain. The authors say the results confirm previous reports that patients often receive cataract surgery in a somewhat haphazard manner dictated by the first-in, first-out principle rather than by careful consideration of the severity of visual problems or the urgency for cataract extraction. They found that contradictory sociodemographic factors were related to the time spent on a waiting list for cataract surgery, which they say suggests that rational, explicit and homogeneous appropriateness and priority criteria are not being applied. They conclude that the use of such criteria could improve waiting times and ensure that patients who need cataract extraction the most receive it soonest.

The study included 3,787 consecutive cataract surgery patients treated at 12 hospitals in three geographically distinct areas of Spain. The authors collected sociodemographic and clinical data and Visual Function 14 (VF-14) questionnaire results before surgery and approximately three months after surgery. 

The results indicate that patients with social support spent significantly more time (1.04 times) on the waiting list (P = 0.0188), while those with contralateral visual acuity better than 0.5 and those with vision-related daily living difficulties spent less time on the waiting list. Patients who waited longer than five months for cataract extraction had smaller gains in visual acuity than those who waited fewer than three months (P = 0.0348). Waiting time did not significantly influence changes in the VF-14 results or surgical complications.

The authors conclude that the results highlight the need for timely intervention for patients in need of cataract extraction, given the association between longer waiting times and poorer postoperative gains in visual acuity. They say that longer wait times appear to adversely affect cataract patients, many of who are older with a fragile health status. They say that reducing cataract surgery waiting times may also have beneficial economic impacts on the health system.