Feature: Behind the Scenes at the DGH - cataract treatment

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IN THE first of a series of features, Herald reporter Richard Morris meets one of the DGH’s top eye specialists, Mr Michael Wearne, and learns just how far cataract treatment has come in recent years.

MOST people would find themselves squeamish when having to watch an operation unfold and to a certain extent I am one of them.

However, based on the far lower thresholds of my colleagues, I ended up being the reporter dispatched to the DGH to see first-hand the state-of-the-art surgery the hospital now uses to treat cataracts.

Having seen part of a patient’s eye split open by a small-in-real-life but massive-on-a-TV-screen scalpel so a doctor can hoover out the troublesome cloudy cataract currently causing blurred vision, I get the definite sense of having drawn the short straw.

Or at least, I would, were it not for the enthusiastic consultant by my side, frantically talking me through the whistle-stop procedure with all the verve and excitement of the best Brazilian football commentators.

He might not have shouted “Goooooaaaaal” when the new lens slipped into place, but he only just stopped short of letting out a clenched-fist celebration.

Mike Wearne is one of four full-time consultant eye surgeons currently working on Jubilee Eye Suite and the man who generously invited me to visit the department and witness some modern eye surgery.

He explained, before his colleague Prabhakar Potu put knife to eye, that the operation has come on almost immeasurably since he entered the profession.

“In the past,” he revealed, “the surgeon would have to make a cut in the top of the eye through which the cataract would be removed.

“That would leave the patient with a wound of more than a centimetre which would require several stitches.

“Nowadays the cataract is removed via a small 2.75 millimetre tunnel and sutures are rarely used.

“Often it can be difficult to tell which eye has been operated on by the time the patient takes their protective shield off the following day.”

The advance is down to the introduction of an ultrasound device which, when slipped into the eye through the tiny gap, vibrates at several thousand times a second, smashing the cataract into smithereens.

A miniature Dyson-like implement is then inserted which sucks up the remaining cataract, before a new lens, which is just 6 mm, wide is slipped effortlessly down a tube and rotated into place.

The surgery has a very high success rate and complications are uncommon.

The entire operation often takes less than 10 minutes and, although the person I watched having it done had to have her eyes pinned open like the correctional scene in A Clockwork Orange, the patient is relatively untroubled.

This, my guide in the realm of ophthalmology says, is because at the DGH there are a variety of different anaesthetics on offer, tailored to suit the patient.

These range from an injection round the back of the eye, to anaesthetic eye drops.

The antibiotics are also easily administered round the new lens implant at the time of the operation.

Every year Mr Wearne’s team at the DGH performs around 1,800 cataract operations - far more than in years gone by, which is largely due to having the state-of-the-art Jubilee Eye Suite, a dedicated team and improvements in technology.

There have also been significant strides made in the way patients are referred up to the unit.

“We work very closely with local optometrists and we have established referral pathways whereby many patients do not need to go to their GP and can come direct to the department from their optometrist,” Mr Wearne explained.

“It also used to be the case that hospitals would wait for the cataract to significantly blur the vision before offering surgery.

“This was because the procedure was less predictable with a higher complication rate.

“Now using modern techniques there is far less trauma to the eye, the healing is much quicker and the risks have reduced.

“All this means that cataract surgery can be offered sooner which is obviously better for patients.

“Once the cataract has been removed that is that. It is like peeling away the layers of a cloudy onion.

“Once it has been done, and a new lens implant is positioned, it does not need to be done again.”

Other improvements relate to the eye nursing staff, so that when someone comes for their initial meeting everything can be done in one sitting.

This means the next time they visit the unit it would be for the operation and most people come in and go home within a few hours, often leaving with little more than a clear eye shield in place.

Cataracts, which can often cause blurred distance or reading vision, can affect people of any age, although the average age for someone to need an operation is around the 75-80-year-old mark.

That said, the DGH has recently dealt with someone in their thirties and Mr Wearne said that sufferers in their forties are not so rare.

Nevertheless, with Eastbourne home to an ever-ageing population, the Jubilee Eye Suite is always going to be one of the busier departments at the DGH.

The surprising thing though, is that it is also one of the most profitable departments.

While the trust as a whole struggles to earmark savings of £30million, ophthalmology has managed to improve quality of care for patients at the same time as cutting costs – simply by embracing new treatments, antibiotics and methods.

A shift to a new anaesthetic technique and a hard-fought negotiation with a lens supplier has saved the suite more than £64,000 this year.

Mr Wearne and his colleagues, it seems, are fast becoming the sort of consultants the trust is crying out for.

And judging by the post-operative patient I spoke to, he and his team are succeeding where other hospitals are not.

John Brooks, a pensioner from Polegate in for a quick-fire cataract removal, said he couldn’t have asked for better treatment.

“I had my left eye done in Brighton and it was completely different here – it was much better. I am very pleased with my treatment and they were very thorough.”

Flanked by his equally impressed family, Mr Brooks revealed it was his 28th time in hospital and that the time from his referral to operation was less than six weeks.

“Previously people could have gone up to a year-and-a-half waiting for their operation, an operation which would potentially make a big difference to someone’s life,” enthused Mr Wearne.

“The fact that time has been brought down so drastically is brilliant.”

As far as Mr Brooks was concerned, so was his treatment.