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PMRGCAuk
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Cataract Surgery

I have just been reading the article in today's Times about cataract surgery. The heading says "cataract surgery doesn't work, says NHS in cost cutting drive". I know how much I was dependant on it five years ago when the prednisolone I needed for my GCA had had a devastating effect on my sight. Can our Charity please let the NHS know how important it is for us that cataract surgery is a priority. Sight is so precious.

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21 October 2017 The Times article.

thetimes.co.uk/article/nhs-...

Could not find the one of today...............have you the link?

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Oh dear I'm not very good with computers. Where do I find this?

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It’s there, but only if you are a subscriber - thetimes.co.uk/edition/news...

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No I'm not a subscriber, I'm afraid. Buy it every day along with the Daily Mail locally.

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No I’m not a subscriber which is why I couldn’t read full post.

I used to get Times every day, sometimes still on a Saturday.

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Thank you Freya, hope you are feeling a tad better. I did have a word with the Norse Gods 😉

We do not have anyone in the village who will do a paper round.......a neighbour picks mine up on Saturday and Sunday, so I survive on two papers for two days which takes me one week to read them both.

The silent bit is "we will close the NHS down one way or another.....and allow the god profit in".

BTW, when you are given pred, long term, make sure you wear sunglasses all the time it shines, pred and sunshine do not go together and if you have the start of cataracts they will be encouraged to grow.

If you wear glasses, change to re-actolite rapide..............I was lucky, my opthamologist changed my glasses straight away when I was diagnosed with GCA. I had the beginning of cataracts. 12 years later they are still the same size. It never occurred to me to ask why the change, too busy trying to get my head around the GCA. At the same time she also gave me night driving glasses.

Then a few years later an optician whose mother had GCA and PMR came along to a support group meeting and gave a very informative talk on pred, GCA and PMR in relation to the effect on eyes and why opthamologists are trained to spot GCA.

Everyone at that support group meeting who wore glasses came to the next meeting with re-actolite lens.

We really need a place/section to go to read what patients have discovered. We tried with 'Living with PMR & GCA' a small bookle

I think a pinned section headed 'Tips and Tricks'that you can read and if you want to add one to it send to the admin people for addition. It could carry a disclaimer saying this has been found out be patients........and should be checked with medics etc. No-one can add without it going to admin.

I have loads from the booklet and more since we printed it twice.

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Feeling better thanks, about to update my last post!

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Hello DorsetLady

My Eye clinic have told me that I have the beginnings of cataracts - Maybe steroid-induced, maybe old-age induced. This has made me extremely apprehensive, since I only have one eye to play with - like you.

I worry that if the op was to go wrong, there would be no second chance with a second eye for me.

Have you gone through a cataract op on your single eye, dear DorsetLady?

Should I pay for a private op when things get bad enough - to maximise my chances?

Any thoughts?

Kindest Regards

Arthur

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What makes you think a private op is any better than an NHS one? It is the same eye surgeons who do both.

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Yes I guess I know that. Just me being nervous.

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Hi Arthur,

As PMRpro says it’s probably the same surgeon anyway!

Yes I did have my cataract done - almost 5 years ago now. The feeling beforehand is scary I will admit, but you just have to trust the surgeon - as with any operation. The success rate is 98%, can’t get a lot better than that!

He will be fully aware that you only have one eye and may be more concerned than most patients, so talk to him. If you do nothing, you will end up not being able to see much anyway - a successful operation will give you a new lease of life.

Be brave, and go for it! I’m sure you won’t regret it.

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Thanks for that.

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I can understand your apprehension when you have only one eye to play with. I have two and still felt frightened for the first eye incase it went wrong. Ask your usual optometrist if he can recommend a surgeon or if you are in the London area

go to Moorfields who also have outreach clinics.

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Thank you Prunus. It's still early days, but I will take your kind advice into consideration when the time comes.

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What do they mean doesn’t work”? I think countless people who’ve had it would say it rather does. Or do they mean for Pred induced cataracts?

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It works for them as well!

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😆 oh yes, I rather imply it doesn’t.

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It's nothing to do with pred induced cataracts. The first sentence says "Patients in half the country are being denied cataract removal operations by NHS cost cutting policies that wrongly suggest the surgery does not work", according to a study.

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That doesn't say it DOESN'T work, it says it IMPLIES it doesn't work.

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I sincerely hope it does work! I'm having mine done this Friday!!

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Had mine done 7 weeks ago - was a complete success!

Good luck with yours.

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Thanks Telian xxx

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I had mine done some years ago. Amazing difference! Downside, as my vision was so good everyone including myself look liked they had aged ten years.😊 . Good luck.

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Thanks again xxx

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My neighbour, who lost his sight 5 weeks ago due to untreated PMR causing GCA, is having the first eye done this morning as he has 'dense' cataracts as well - can't wait to hear if he has any better vision!

Let us know how you get on Stella.

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Will do Telian

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Exactly what I said to hubby, 'I've aged since I had the op' - he said 'no you haven't you don't look any different' - 'you mean I've always looked this old!'

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Good luck. I'm going with my neighbour for hers on Tuesday. Don't think she reads The Times; I do hope not as I spent some time reassuring her. Mine were wonderfully effective, done 10 and 9 years ago and my sight has never been better. Still taking steroids as well.

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Not having access to the Thunderer - what is the justification for saying it doesn't work? Strikes me there is a difference between being able to see and not...

However, for those who can't see the Times, the Guardian is "free-to-air"

theguardian.com/politics/20...

I understand it to mean they are making the criteria far harder, you have to have more loss of acuity - so you have to wait longer before fulfilling them. It's a crude and temporary means of cutting waiting times. It catches up eventually though.

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It says : "Doctors and campaigners have condemned the policies as "wrong" and "shocking" but health chiefs said they did not have the money to treat everyone"

I don't follow their logic. How can they then say it doesn't work?

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They haven't said it doesn't work - the implication is it doesn't work. And the media are milking it!

It is probably a consequence of the fact that in the UK the social implications of not doing an operation and the health implications are paid for out of different pockets. All the social stuff is paid for by councils - and, increasingly, the person or their family. Not being able to see won't bring the patient back to the hospital for monitoring or other treatments, so they become invisible. The fact they may fall, need someone to take them places as they can't drive, help them to dress doesn't cost the Commisioning Group, it doesn't bother them and their waiting lists are shortened.

And whether you like it or not, it won't improve soon. The NHS is haemorrhaging staff at all levels. No surgeons - no ops.

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I think it’s good if the media milk it as it gets up the political agenda. The criteria is getting harder as patients are told they aren’t bad enough However the Ophthalmologist advise the sooner the better.

The treatment is life changing, relatively inexpensive and significantly cost effective. As you rightly point out the health budget is being saved at the cost of the Local Authority.

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Oh dear the NHS does sound much worse than the options we have in OZ. Mind you if you don't have private full cover health insurance here things can be pricey or you just 'wait'. I am paying $4K for my worse eye to be fixed in a month or so - to avoid a longer wait as I am travelling soon after and then will wait - probably about 3 months to get the other done in a regional hospital which will be at no charge but i will still have the same surgeon who is already a Professor though quite 'young'. I was worried about the gap between the ops which is not necessarily an issue although some have probs. Still no dissembling here about the necessity for cataract ops - and there appear to be plenty of surgeons around to perform them - though they generally seem to be in the private system.

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I don't think the dissembling is anything to do with necessity - but in a state-funded system with inadequate state funding something has to give. As jinasc says: £sd. They don't have it so they can't spend it. Emergency medicine is struggling but must be kept going. Even cancer surgery is being delayed - and anyone would admit if there is some money, then the cancer op should be ahead of a cataract op.

In the UK everyone can do the same as you - pay out of pocket or wait for it to be "free at point of service".

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Not a 'good' situation however you look at it ...

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Nope.

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If you had normal vision before your cataracts I would not expect there to be a problem. In my case I was very myopic and the difference between the eyes in between the ops when my optometrist tried to prescribe was more than my brain could cope with so I was glad to have the second eye done quickly.

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This is just awful beyond belief.

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Short answer for justification not printed.........'.Pounds, shilling and pence, which CCG's are not prepared to spend'.

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...and they have to measure up - literally - I won’t get my second cataract done as it doesn’t meet government guidelines! Am discharged now - if it worsens start a new referral and the long haul to get seen! Well worth it though - my eyesight is brilliant yet they said the cataract was only small!

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With the irritating thing being you need specs until the other is done...

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I'm managing at the moment, only need specs for close work and the optician, that did my post-op check, said they were still suitable and to go back if things worsened.

Out of interest - I asked why I hadn't had the post-op check at the hospital - he said due to staff shortage and besides he was cheaper than a hospital consultant so saves the NHS money!

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In the same way they are encouraging you to go to the Pharmacist instead of the Dr.

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I’ve always used Pharmacy for advice.....but never been encouraged by my surgery.

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How ridiculous.

Cataract surgery is one of the most commonly performed and most successful surgical procedures in modern times, and certainly eliminates one of the major sources of disability among the elderly with a simple and cost effective procedure with few incidents of recovery problems. In fact, post-op, most patients report being able to see better than they have in decades.

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A study by the Medical Technology Group, found that 104 of 195 clinical commissioning groups are classing cataracts as "procedures of low clinical value" in defiance of the Nice guidance.

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Well, they are darn foolish, then.

Cataract surgery restores vision acuity allowing the patient to thoroughly regain their vision, and therefore regain their independence.

The costs of accidents and injuries due to low vision must be weighed against the cost of the surgery, not to mention the remarkable increase in the quality of life.

Whatever is going on over there in the UK, you guys had better straighten it out.

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Couldn't agree more - it's false economy.

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I'm glad I had my cataracts operated on 7 years ago and that I had an arthroscopy on my left knee the following year. I believe this is another operation that the penny-pinching NHS are limiting due to phony questions about its efficacy.Without both procedures I would have been both crippled and sight diminished - a serious accident waiting to happen.

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I have the Times and I have just read it and that’s not what it says “ The National Institute of Clinical Evidence states that it is almost always a good use of money” That was 2017

The issue is that where Authorities are looking for cuts it’s an easy hit because of the client group. NICE however recognises it’s false economy as people have more falls.

It’s not all areas it’s very much a postcode lottery.

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If I can’t see, I’m going to fall over! When I fall over (of late) I’m more than likely going to break something! How does that save money?! (Feeling playful...)

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Exactly - but on balance they seem to think they will come out on top. And quite a few will go and pay for cataract surgery in the meantime...

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How much does it cost?

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Not sure - and it does depend a lot on the type of replacement lens you choose. Starting from about £2K per eye for a monofocal lens which is what you get on the NHS . If you go privately you can choose to have multifocal which are more and I don't think there is any mechanism to choose them on the NHS - but you shouldn't need glasses at all afterwards or just very cheap reading specs. Given the price of new specs it doesn't seem unreasonable.

opticalexpress.co.uk/catara...

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That article is rubbish - good eyesight prevents falls etc so SAVES nhs money in long run

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Having mine done next We'd,courtesy of BUPA, in NHS hospital, only two weeks since I saw consultant. Am looking forward to being able to read and crochet in comfort again,let alone feeling happy driving

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Ive copied and pasted the whole article from yesterday’s Times:

‘Patients in half of the country are being denied cataract removal operations by NHS cost-cutting policies that wrongly suggest the surgery does not work, according to a study.

People needing hernia surgery and hip replacements are also routinely refused care by “indiscriminate rationing” policies that class common treatments as ineffective, it concluded.

Doctors and campaigners have condemned the policies as “wrong” and “shocking” but health chiefs said that they did not have the money to treat everyone. Cataract removal is the most common procedure carried out by the NHS, with 300,000 operations a year.

In 2017 the National Institute for Health and Care Excellence concluded that cataract surgery was virtually always a good use of NHS resources because patients who struggle to see are more likely to injure themselves. Its guidance demanded the health service end rationing of the 20-minute procedure that restores sight.

A study by the Medical Technology Group, a forum for patient charities and device manufacturers, found that 104 of 195 clinical commissioning groups (CCGs) that pay for care locally are classing cataracts as “procedures of low clinical value”, in defiance of the Nice guidance.

This means that they will not fund them unless doctors make an exceptional case for individual patients. The figure includes a third of groups that pay for surgery only when patients’ vision has deteriorated past a certain point.

Barbara Harpham, chairwoman of the group, said: “It’s simply not fair that patients up and down the country are being denied access to vital treatments because of where they live. This indiscriminate rationing by local NHS organisations must stop now.”

Helen Lee, of the Royal National Institute of Blind People, said: “It’s shocking that access to this life-changing surgery is being unnecessarily restricted.” Mike Burdon, president of the Royal College of Ophthalmologists, said that there was no justification for the policies: “CCGs must take notice of the Nice recommendations which reinforce the message that cataract surgery should be delivered at point of clinical need. It is one of the most efficient procedures in the health service.”

The survey also found that 78 groups class hip and knee replacements of limited clinical value and 95 limit access to hernia repair via the same method or in policies that say surgery must be delayed for more tests. Twenty-five CCGs limit all three procedures. Bedfordshire also restricts continuous glucose monitoring for diabetics.

The Royal College of Surgeons said: “It is wrong to label hip and knee replacements, and hernia surgery, as of limited value. With the NHS about to receive a cash boost in April, we need a clear message from government that restricting such treatment is wrong.”

The NHS Clinical Commissioners, which represents CCGs, said: “The NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“They are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. There are tough choices to be made, which we appreciate can be difficult for some patients.”’

I had my annual eye examination at optician last week. She said in 20 years of practice, she’s only seen 2 cases of steroid induced cataracts. Her view it’s not common but is easily treated. Some small consolation I guess.

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Absolutely ridiculous isn’t it.Having my cataract done just before Christmas has made such a difference to me. Before I couldn’t see my face properly in the mirror and it also came on very quickly. I hopefully have the other one done in 3 weeks time. What I didn’t realise was that bright light,as jinsac says, makes the cataracts grow quicker. We had just moved to a very bright house, especially the kitchen , and I hadn’t at that point, got blinds, that’s when suddenly everything was very fuzzy.

I did also have my cataract done privately but if I’m honest the operation was painful although I’d read that it was a painless procedure. I don’t know if it was because there was a reaction of the anaesthetic drops with the medication I was on at the time- lefludomide and Pred and the drops were not effective as they could have been. The Opthalmic surgeon didn’t know why the operation was painful for me. This next time I am having an injection. Did folk who have had a cataract removed increase their Pred at all on the day of the procedure or not? I didn’t for the previous cataract op but as I will have more anaesthesia I was wondering what the best thing would be to do. If no one sees this as it is at the end of a thread and there are no comments, I might repost as separate post.

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I've seen it but can't help - probably a better idea to make a new post.

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Yes thought so. Thanks

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I was on a high dose of pred when I had my cataracts operated on. However there was a question that one of the anaesthetics used I had a reaction to so the next time they used more of the other instead and it worked. In my experience there was no pain whatsoever. I had two different Moorfields Consultants. I may have the names of the anaesthetics but I

would have to look at my records as it's five years ago now. How experienced is your Consultant?

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Thank prunus. Well I thought he was very experienced. He is an Opthalmic surgeon and I am having it done privately- but I suppose you never know!! Xx

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As regards the predisolone I just carried on as normal with it. The drop I might have been allergic to was proxymetacaine and fluorescein. This is no longer available though the two components are available separately.

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Thank you

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My hubby has just had second eye cataract removed. He went for the post op check at opticians and the opthalmist couldn't see the back of his eye due to his droopy eyelid. He was told by one consultant a couple of months ago that his droop wasn't servete enough and that an op might sort his droopy eyelid in the short term, but it was likely to recurrent since he was overweight! The optician is furious. She said she had had customers with less droop who had had the op and hubbys eyesight, in recently operated eye is showing quite a steep decline rather than improvement, so it is likely that he may have an infection again this time. Opthalmist has written to the consultant on both countd and I am going to get him to ring the hospital tomorrow by which time they should have received the letter. Apparently they are clamping down on droopy eyelid ops too!

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What an awful experience for you both. I was only speaking to someone on Sunday and because of this clamping down has finished up going privately. Vision is so precious and accidents happen without it. Hope you have some better news.

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