Dear members,

On behalf of the Board of the AOI can I thank you for completing the recent survey on Cataract and Children waiting list.
This forms a very important part of our strategy when dealing with the HSE and Department of Health.
Below is the press release that was issued to all National and Local media and we shall be meeting with members of the Oireachtas later today. The results can be found in the members section of the AOI website.
Kindest Regards

Sean
CEO

A Press release – Issued by the Association of Optometrists Ireland
Wednesday, May 16th, 2018.

Average wait for public cataract surgery is 28 months – Optometrists survey

Five year wait for Cataract Surgery in South West

Inconsistency and major gaps in children’s eye-care services

Half of country has no public eye-care scheme for 12-16 year olds

The average wait for cataract surgery across the country is 28 months – and up to five years in some parts of the country – according to a survey of eye-services carried out by Optometrists.

The nationwide survey of members carried out by the Association of Optometrists (AOI) found that the longest wait for public cataract surgery was in West Cork (60 months) with the shortest delay in Sligo and Leitrim (15 months) – where an award-winning scheme is in place involving greater co-working between Optometrists and the regional Hospital eye department.

In contrast the survey found that the average wait for private cataract surgery across the country was three months.

The survey of hundreds of practising Optometrists broke down responses per constituency and also looked at children’s eye-care, where major inconsistency and gaps in services were identified.

The survey found an average wait of 15 months for children’s public eye-care (under twelves) ranging from 24 months in East Cork to five months in Cavan and Monaghan.

The survey found that in 36 of 40 constituencies, the sixth-class vision screening service had been ceased and an alternative local arrangement had been put in place in just a quarter (9) of those constituencies. (In 2016 the HSE wrote to local health offices recommending the ending of the sixth-class service and that alternative local arrangements for children would be developed.)

For 12-16 year olds the survey found that local HSE Offices will not authorise public eye-care in 19 of the 40 constituencies for children who have their own medical cards, while local arrangements are in place in 21 constituencies.

AOI President Triona Culliton said the survey showed the urgent need for the Minister for Health to intervene and affect an overhaul of eye-care services.

She said the problem in Ireland was an over reliance HSE Eye Clinics and Hospital Ophthalmology departments to provide almost all public care, including even the most basic and routine care. These services are overwhelmed and far short of capacity.

“Optometrists can provide routine care such as eye examinations, glasses fitting, pre and post-surgery check-ups in the community. Only more complex cases need be referred to our colleagues in HSE Eye Clinics or hospital eye Departments.

“The findings from the AOI survey are very clear: With regard to cataract surgery, the Sligo Leitrim constituency has the shortest waiting time and is the core region where the award-winning Sligo Cataract Scheme is in operation. AOI has estimated that rolling out the scheme nationwide could save up to 20,000 hospital appointments per annum and reduce system costs.

We are calling on the Minister for Health to intervene and sanction the HSE to roll out this scheme nationwide immediately.

Ms Culliton also said that the survey showed children’s eye-care services to be inconsistent across the country, very limited and ad hoc.
“AOI is calling for the introduction of a national eye-care scheme for all children up to 16. Optometrists in the community should deliver eye examination and spectacles fittings, while medical cases requiring surgical management are referred to eye Doctors as necessary,” she said.

The capacity crisis identified by the survey is also reflected in the latest National Treatment Purchase Fund waiting list figures which show that those waiting longer that 18 months for outpatient eye appointments (which would be significantly comprised of those requiring cataract surgery) has more than doubled from 4,300 at the end of March 2017 to almost 9,000 at the end of March 2018.

Overall there are 41,000 patients on the Ophthalmology outpatient waiting list, an 18% increase since the end of March 2017.

In terms of inpatient eye-care waiting lists, there are 11,000 of the list for Ophthalmology the second largest in any medical area.

The survey also asked AOI members if they would be willing to contribute towards relieving pressure on the overburdened hospitals and clinics.

97% said they were immediately available to deliver the Sligo Cataract Scheme model and 87% said that they would support the non-medical and non-surgical elements of a national children’s eye-care programme.

“It is time that we stopped tolerating these terrible delays and take action to make services better for patients,” Ms. Culliton said.

“We need all eye-care providers to work together better by providing basic and routines care in the community via Optometry, with specialised care referred as appropriate to Eye Clinics and Ophthalmology Departments.”

AOI stressed that they have 650 trained Optometrists working in 350 locations across the country who could meet all clinical requirements necessary and most already have the necessary equipment in situ. They can also offer local access for patients in all cities, towns and many villages across the country.

AOI said it is 50% cheaper for a patient to be seen at their Optometrist than at a HSE Clinic or Hospital and has estimated that annual savings of €32.3m can be made by reforming eye-care services.

“In Scotland Optometrists are utilised as the front line for public eye-care which helps deliver ready access for patients and affordability for the taxpayer. They do not have any significant waiting list problems there, as Clinics and Hospitals are freed up to carry out specialised medical and surgical care.

“AOI is calling on the HSE, under the leadership of the Minister for Health Simon Harris, to reform Irish eye-care, to tackle the waiting list crisis – and better serve the interest of patients.”

Information on the survey findings can be found at www.aoi.ie.

Ian’s opinion, and it is just my own opinion!

Personally and very cynically – I have become a very cynical person! But which parent in all honesty would abide by this waiting list if they could scrape together a hundred or so Euro to “skip” the queue? Any parent who could get the money together would likely wish to bypass the queue to have their child seen (privately), if they could manage to.

It is annoying how many times we have had a child’s prescription written out on an HSE authorisation to dispense, when the child was actually seen privately, and therefore should not be entitled to any help toward spectacles, but the HSE staff do not seem to mind this “anomaly”. ?Look after you own? – now maybe the ophthalmologist is trying to save the parents a few Euro, but private tests should absolutely preclude a public dispense, as we were advised! The ophthalmologist is not even able to supply his own paper to write the prescription on!

Where is the incentive within the Medical Professionals to reduce these waiting times? There are none, at all, for the reason stated in the two paragraphs above.

Given that cataract problems require surgical intervention, which Optometrists obviously cannot do, where would the harm be to allow Optometrists to work out which child failed their visual screening in school because they were not paying attention, or did not feel good on the day, or didn’t really understand what they were supposed to do? Or didn’t know their letters?

Many visual screenings at school result in an appointment in the community clinic, and most appointments in the community clinic result in a prescription for spectacles. 7, 8 or 9 out of 10 of those prescriptions, had I found that prescription, I would have said that no spectacles were required. But without knowing all of the details and testing their eyes myself, I have no other option but to “sell” the parent spectacles for their child. “When do they need to wear them?” I don’t actually know when (or even if) they need to!

I once worked in the Cumbria NHS area. In the UK, all children under 16 are entitled to free eye examinations, and Cumbria NHS Trust used to send them a Birthday Card on their third Birthday, stating that now that they were a BIG three, they should go for an eye test. Under this scheme I once saw a boy who was so “long sighted” -Hyperopic, that he had never been able to see a clear world – he did not realise that there was any more “world” out there than that he could see! At an age of 40 months (ish), this lad had the vision of a newly born baby, because he didn’t learn, and couldn’t know that better vision was available! Had this boy been left until he was in junior or senior infants, it is likely that he would have been left partially sighted!

I felt so sorry for his mother on the day, as she was immediately beating herself up with mentions that he constantly runs into things, constantly bumps his head and other things, such as being unable to find things. I had to say that in my experience, that is just what children were like, having had a few of similar ages at that time.

My son was wearing spectacles for over 2 years before he had a screening at school (in Ireland) – in senior infants I recall, but that is not because I am an optometrist, it is because he couldn’t see! He may have missed the screening on the day, but not to my knowledge.. It was Victoria, my wife who realised he had an issue.

The hyperopic boy was seen within the hospital within a couple of months, and his mum came back to thank me – they had reduced his prescription a little bit, but in those few months his visual acuity had improved significantly. I never found out the end result, but to this day I hope that he was caught in time (I hope he was) and managed to catch up with his peers, but his peers had mostly a 32 month head start on what one should have been able to see. Had he had to wait to “go public” in the community clinic, or go “private” at the optician, I am certain that this boy, who would likely now be in his 20’s would be partially sighted? Here, in Ireland, exactly when would this lad have been picked up?

Humans learn to see for the first 7 to 8 years – yes you need to learn to see! Any interruptions to that process can have lifelong consequences – in Ireland you cannot trust your children’s eyesight to the state!

The state would argue, perhaps correctly that children’s allowance is better here than elsewhere – it sure is higher than in the UK! That is their “excuse” for poor children’s care ( and eye care)  as best I can fathom! Pay for it yourself! Much like adults – isn’t it fabulous that many more adults are entitled to a “Government Funded” “Free” eye test? Well, it isn’t free – they took it out of your pay packet, in the hope you never try to use it?

The longest post ever, but most of it wasn’t mine!