The increase in life expectancy and the good health of the elderly population have led to a significant increase in the request for cataract surgery, a pathology mainly linked to advanced age which causes a significant visual impediment.
The excellent results obtainable, the quick rehabilitation and the possibility of correcting even previous visual defects have generated a growing demand, with waiting times that are getting longer. Organizational models also have an impact, such as the availability of spaces to operate in hospitals and the activity of many young ophthalmologists who no longer choose fixed-term contracts in public structures, preferring more flexible forms of professional organization not linked to fixed shifts in the same location.
The experts from the Italian Society of Ophthalmological Sciences (SISO) and the Italian Association of Ophthalmologists (AIMO) are taking stock, in Rome for the national congress.
What is the crystalline lens and why does it become opaque
The lens helps to focus images on the retina: it is located behind the colored part of the eye and when we focus it changes, allowing us to see both near and distant things well. It is made of water and proteins. Over time, these thicken, progressively removing transparency. The process leads to the appearance of cataracts and blurred vision. Cataracts are linked to the clouding of the transparent lens inside the eyeball. We are talking about a sort of biconvex magnifying glass. When the crystalline lens becomes opaque, the images of the affected eye may appear blurry, shrouded in fog, sometimes doubled, with faded colors: you may have difficulty observing the lights, your color vision may change and your glasses may be changed frequently.
In general terms, there is a cataract linked to advanced age, which is the most frequent form, but the picture can also present at birth or shortly after. In some cases the pathology occurs in people with diabetes or other eye diseases. To identify the picture, an eye examination is sufficient, provided that distance and near vision are checked and an examination of the lens is carried out. Tonometry with a careful examination of the retina is also useful.
How to guarantee the necessary interventions
“The healthcare system is subjected to strong pressure which makes the management of cataracts in hospital increasingly complex. Added to this is the generalized reduction in DRGs, i.e. the reimbursement paid to facilities for cataract surgery. A reduction which contrasts with the high technological standards required, which entail very high operating costs for the facilities”
explains Alessandro Mularoni, SISO vice-president and director of the Ophthalmology Unit of the State Hospital of the Republic of San Marino.
Faced with these problems, the specialists’ reflection focuses on possible solutions to guarantee everyone a high-quality intervention in an adequate time frame. One possibility is represented by the decentralization of cataract surgery outside traditional hospitals or in structures exclusively dedicated to this type of surgery. In fact, it is a low-complexity intervention compared to others, which lends itself particularly well to a process carried out entirely in one day.
“Already today the operation is performed as a day surgery in hospitals, private clinics and affiliated centers. The patient is operated on and discharged within a few hours. Performing it on a daily basis does not imply a lowering of standards: on the contrary, modern technology is what makes it possible. Current techniques use incisions smaller than two millimeters and foldable artificial lenses that allow rapid rehabilitation. Lenses that simultaneously correct near and distance vision and astigmatism are also available. Modern cataract extraction equipment guarantees such speed and safety that the patient can be discharged within one or two hours.”
explains Giovanni Alessio, Policlinico University Hospital of Bari, University of Bari.
Customized structures
In terms of proposals, it could be hypothesized that channeling interventions into structures dedicated exclusively to ophthalmology could offer various benefits.
“Specialized facilities can achieve better efficiency and lower operating costs, since the entire organization is optimized for the eye patient. For the patient, accessing a center where he has already been visited and prepared, rather than a more dispersed facility such as a hospital, means greater peace of mind and knowledge of the path”
adds Mularoni.
The central point, SISO underlines, remains the maintenance of safety standards.
“It is essential that the guidelines of national and international scientific societies are strictly respected, ensuring that efficiency, psychological and healthcare quality go hand in hand with maximum safety for the patient”
concludes the expert.
