People we see for eye tests are getting cataract surgery just a short number of weeks (most recent was 3 weeks) after we referred them. This sounds unbelievable when waiting lists in some parts of the UK are measured in years (just spoke to a Scottish friend who was very jealous). It’s good news as people with cataracts can start to struggle with everyday tasks in their work, rest and play. The use of the word “work” there is deliberate, as many people associate cataracts with old age, but referrals for people in their, for example 50s, are not unusual. These people are often a bit surprised when we tell them cataracts are the problem and usually need a bit more help in getting their head around it - than the average 78 yr old, who knows a lot of people who have had thier’s “done”.

If you are diagnosed with cataracts that need operating on, then you should be offered choice as to where you are referred. To quote the NHS website “If you're referred for your first outpatient appointment, in most cases you've the right to choose which hospital in England to go to”. Therefore from our point of view, it makes sense to pick one with shorter waiting times. There are often choices of going to the local NHS hospital or a private location, that provides services for the NHS - you don’t pay for either.

So, are there times when you might consider paying for cataract surgery - even if waiting times are short? There are and it relates to the type of artifical replacement lens that is used to replace the lens in your eye (that is no longer as clear as it was, to the extent it is reducing your quality of vision). NHS procedures (i.e. ones you don’t pay for) will only use single vision replacement lenses. Generally these will leave most people afterwards needing specs for close work task, like reading/looking at phone, but not much prescription in the distance - for tasks like driving/watching TV. Wheras a private provider can offer multifocal lenses, whihc aim to give you good viison at all diatances witohut the need for any spectacles (Budget £3-4K per eye for this).

Related to this, is the fact that one of the postive things about needing cataract surgery, is that is you have had a lifetime dealing with a high prescription (myopia/short sight / hyerpopia/long sight), then after the procedure you will no longer hae that high prescription anymore. That can be an amazing feeling for some poeple, who for decades have reached for their specs first thing every morning and then suddenly can wake up and see! This explains why you might know people who have had lens replaement surgery (privately), even though they didn’t have cataracts - just to eliminate their need for glasses …. (useful for people who are unsuitable for LASER surgery).

So, if you or a relative/friend/colleague who mentons cataracts make sure they know that the surgery works brilliantly, they might not need to wait as long as they were worried and that recovery is quick with great vision within hours of having the 20 minute op done.

We start with, “can we get you a coffee from John St Kitchen next door?”, but I accept that’s not an essential one. But, it’s significant as the questions you are asked at the start of the examination should take a while - long enough for you to drink a coffee. The questions should be purposeful and orientated around making sure the optometrist understands what visual issues you are (and are not) facing - in everyday life, at work and at play.

Open questions are vital - “are you having any problems with your eyes?” and specific follow ups are needed when the initial questions don’t raise in any issues. Many eye tests are rushed and the optom exudes an attitude of let’s crack on and don’t make this too difficult and the great polite British public are suckers for complying … then finding themselves pushed out to somoene eager to make a sale (15 mins later) when they realise the thing they were anxious about has not been addressed.

Communication and clinical skills are absolutely intertwined.

So, here are some things you should defintley be asked:

1. Why have you come for any eye test?

2. How is your vision? Far away, close up - on screens?

3. Do you have specs/contacts and when do you wear them?

4. Any other issues likes headaches …

5. What are the visual demands of your life? At work, rest and play?

There are obvioulsy loads more things to cover, but this is how it should start.

Check out the @ethicaloptician YouTube channel for more on this …

This text accompanies the YouTube video 3 on the @EthicalOptician channel I have set up to provide advice and information, to help you get better eyecare and eyewear. (Link: https://youtu.be/meo9ct3RYCw?feature=shared)

There is a myopia epidemic across the world. In late 2019, the World Health Organization released its first ever World Report on Vision, “It recognised that myopia is increasing globally at an alarming rate, with nearly five billion people or 50% of the world’s population predicted to be affected by the condition by the year 2050, including 10% with high myopia.

Increased levels of myopia are not just inconvenient for the person who is experiencing it, but also as myopia goes up your risk of a whole range of eye health issues go up. As millions of people around the world become myopic the global health burden is massively increased. The World Health Organisation are rightly very concerned about this and this has led to a boom in research into myopia control: i.e.Is there anything we can do to stop myopia going up and up? Spoiler alert there is(!) and lots of optometrists, like myself, do myopia control - which means we have children who usually have a history of myopia in the family and start becoming myopic themselves and we get them special contact lenses and glasses to try and keep the prescription down. We're having some real success with that and all the global research shows it works too.

If you are a myopic parent and your child starts to struggle to see the board and it is determined that they are short-sighted and need glasses for their myopia, then you should be told about myopia control now. There's no excuse for you not being told and if your optometrist doesn't tell you they should have told you. As well as special kinds of contact lens and glasses they can give you some advice around lifestyle for example there is some strong research evidence that shows that time spent outside is good at helping reduce the speed of development of myopia, so a couple of hours outside day is a good thing, not just for the eyes obviously.

Myopia means that your eye brings images into focus in front of the retina and therefore when the image is processed it is blurred - myopic eyes are relatively longer in length. This is particularly an issue for distance tasks, but depending on the degree of myopia/levels of astigmatism it can be an issue all distances  (like your computer), therefore making the term short-sighted rather ambiguous/unhelpful.

When people become myopic, most commonly as a child, it can be upsetting. Some children don't want to wear glasses or are worried about it and, of course it's the same for their parents too. I vividly remember being told I needed glasses at the age of 15 and being quite unhappy about it and my prescription started around minus 0.75 /  minus 1.00 and now it is over minus 4.00. My prescription is not a big inconvenience at that level, but I am, as a consequence, at risk of a whole variety of high health conditions, for example retinal detachment, due to this prescription and if anything could have been done to reduce it I would have really welcomed it.

It's an interesting side point, but if you decide to have surgery to reduce your myopia you (laser surgery or lens replacement) then this does not decrease the risk of myopia associated eye health issues. You're still a myopic person really, even though you've had your cornea reshaped (that's the clear bit of the front) to reduce the prescription, you're still at risk of the eye health conditions as if you still have the long eye that you had before the surgery. So if you do have surgery make sure you keep up with the regular examinations to keep an eye on those things.

Why is there an epidemic of myopia? Well there was always thought to be a genetic component to myopia development, but in recent times we have found there is a strong environmental component and reduced time outside and therefore time inside (doing close work) seems to have really driven up levels of myopia. 

Parents obviously worry about kids being on screens too much and the way I think about this, is that time outside is the positive thing you need to talk about to them and encourage. The reality is that it's very difficult for young people to avoid times on screens through education, but if they are outside doing something enjoyable that’s got to be a win-win situation.

So, to summarise there is a myopia epidemic and millions more people around the world are becoming short-sighted. While there's a degree of convenience about being short-sighted and there is the cost of glasses and contact lenses, the main issue is that as you become more myopic you're a greater risk of the whole variety of eye health conditions - therefore we are now trying to look to control myopia through the use of some lifestyle changes specifically two hours a day outside for young people and also the use of special myopia control spectacle lenses and contact lenses. If your optometrist has not spoken to you about these things and you have a child that is at risk or has started to wear in glasses because they're myopic. then you need to ask your optometrist or change optometrist!

Link to my attempt to explain/demo myopia https://youtu.be/JQRqlQY2_zM