The impact of chronic illness: partnerships with other healthcare professionals

To the Editor: The article by Brooks contains valuable forward-thinking for future healthcare management of the increasing burden of chronic illness.1 However, Brooks’s suggestion that non-medical practitioners might perform cataract extraction shows his lack of knowledge of the complexity and potential complications of modern cataract surgery.

Modern cataract surgery is the most commonly performed major operation, and one of the most rewarding in lifestyle improvement. It is done under local anaesthetic with almost no discomfort, and recovery is rapid. Thus, the patient sees it as being simple. However, it is far from simple for the surgeon.

The small-incision, phacoemulsification technique has made the operation more demanding than ever before. The learning curve is both long and steep. Posterior capsule rupture during phacoemulsification is an ever-present threat, and if it occurs, the sight-threatening complications of cystoid macular oedema, retinal detachment and endophthalmitis all become more likely. The modern, highly technical procedure that Australians demand and deserve is comparable with coronary artery bypass and joint replacement surgery in terms of the skill required.

There are three reasons that non-ophthalmologists think cataract surgery is simple. First, it is simple from the patients’ perspective. Secondly, cataract extraction can be done relatively cheaply in developing countries. However, the operation done in those countries is a different procedure, and comparisons are not valid. Thirdly, some unscrupulous ophthalmologists themselves have trivialised the procedure as a means of self-promotion.

Brooks and others would pay the operation much more respect if they took the trouble to view a few procedures in real life.