Cataract waiting list

As head of the Ophthalmic Department at Mater Dei Hospital, the cataract waiting list is a cause of tremendous daily worry and concern to me. It is equally a grave concern to my colleagues within the department, dedicated doctors and nurses, who are doing more than their very best to deal with what has become an exasperating and frustrating matter. It is a matter of concern because it is unacceptable that anyone should wait such a long time to have a cataract operation.

The reason behind the waiting list is a combination of factors.

The first is the fact that we have become victims of our own success. Up to 15 years ago, with the limited technology and expertise available, hundreds of Maltese patients went abroad, particularly the United Kingdom to have their cataracts extracted naturally at a considerable expense. Since the introduction of up- to-date surgical procedures, particularly cataract extraction by means of phaco emulsification (which meant that cataracts could be extracted through a micro incision with an incredibly high success rate) much younger and many more people were coming forward locally to have their cataracts extracted. This has saved the exchequer millions of euros over the years.

Today, we carry out over 1,400 cataract extractions every year at Mater Dei Hospital and, for the record, a cataract extraction in medical terms is considered as a major operative procedure notwithstanding the fact that it only takes 20 minutes. The time in which the procedure is effected does not detract from its gravity or seriousness. I say this because I have read a number of articles by those who, of course, have no idea what the procedure really entails medically, referring to the procedure as a "quick" matter, as though they are talking about getting a hair cut, not appreciating at all that what we are effectively talking about here is the removal of the lens of the eye, which becomes opaque, through a micro incision and replacing the entire lens with an artificial implant.

However, the tremendous increase in volume was not accompanied by an increase in man power. The man power plan recommended in 1998 to deal with what was clearly foreseen as an increasing trend in the demand for this procedure has to this day not yet been implemented and today we have the same man power but more than double the patients!

In reading about the "cataract waiting list", the public would be forgiven for thinking that this is the only procedure carried out at the hospital. Nothing could be farther from the truth. The same number of doctors as those available 10 years ago also have to deal with the numerous ophthalmic problems associated with one of the most prevalent diseases in this country - diabetes. Suffice it to say that before 1992 we did not have a vitreo retinal service. Patients presenting themselves with complex retinal detachments and severe eye complications of diabetes requiring a highly-complex surgical intervention called a vitrectomy were all sent to the UK. All of these are now treated here in Malta.

In every outpatients clinic the two doctors in the clinic see an average of 80 patients in a single morning. Apart from this, the department takes care of other patients needing squint surgery, glaucoma operations, corneal transplantation, and numerous minor eyelid operative procedures as well as the recently-introduced new service to treat patients with macular degeneration by an intraocular injection of a new drug.

In the meantime and running parallel to this, we strive and succeed in ensuring that all treatments and surgical procedures we are offering are the latest and the best and in line with what centres of ophthalmic excellence around Europe are offering their patients.

And this is where the problem lies: More patients, more procedures, more interventions, more successes and the same number of doctors and the same theatre time.

As can perhaps be now appreciated the doctors and nurses available are doing their very best. In fact, they cannot do more under the present circumstances limited by man power and theatre time. Very few except our own families know for instance that we have a cataract operating list every Sunday so that we can make use of available theatre time.

This Sunday, Father's Day, I will be at Mater Dei Hospital carrying out a scheduled cataract list. I would like to invite the editor of The Times to come and keep me company.

Perhaps he can then start to understand what it is that the dedicated surgeons and nurses within the Ophthalmic Department at Mater Dei Hospital are really doing.

Perhaps he can also then understand how terribly misinformed, incorrect, insensitive and downright hurtful his comment in last Monday's editorial was when he said: "What is not understandable is the attitude taken by certain members of the medical profession who, at times, are seen to be more willing to put money and their private practice before the general good of patients."

Mr Editor, my department puts nothing before the general good of patients; sadly, not even our own families. See you tomorrow.

Mr Fenech MBBS, FRCS (Eng.), FRCOphth is chairman, Department of Ophthalmology, Mater Dei Hospital.