This summer the Chronicle is bringing you another look at some of the best content of 2019. This story originally ran on April 2, 2019
Cataracts sapped Jan McLeod's confidence and ability to easily do everyday things like read labels or move around without bumping into objects.
Her optometrist referred her to Whanganui Hospital for straightforward surgery that would restore her vision overnight, but the 69-year-old was told she didn't meet the threshold for help.
"To me, 70 is the new 50," the former ballet teacher said. "I don't feel mentally debilitated, but to be physically debilitated actually impacts on your nerve to go and do things."
McLeod has contended with short-sightedness since she was a girl, and in the last couple of years has developed cataracts on both eyes.
By late last year they were bad enough for her optometrist to send her for surgery, which would replace the clouded lens over each eye. However, despite McLeod's sight being below driving level, she was told she didn't meet the threshold for surgery and sent away.
"I obviously wasn't disastrous enough for them," she recalled. "They basically said I wouldn't get on their list."
McLeod has lived alone since the death of her husband, and couldn't afford to go private. Being declined treatment and effectively left to get worse was unnerving, she said.
"I'm very tentative in unfamiliar places. I feel as though I'm more liable to bump into things or fall over...the deterioration in my vision makes me less confident than I used to be. Which is [hard] when you are trying to recover from the loss of the mainstay of your life.
"Different light means you can see one minute, and the next minute you can't. The focus misbehaves - things fall in and out of focus... it's scary and worrying."
Reading became difficult - hard to get used to for someone whose life has revolved around the arts and written word. McLeod wrote ballet reviews for the Herald, The Listener and The Dominion Post, and is working on a book about her time living in China and working with the Beijing Dance Academy in the 1960s.
Everyday tasks became challenging, such as reading product or prescription labels or recipes.
Fortunately, McLeod's optometrist knew about Auckland Regional Charity Hospital (Arch), which lets volunteer surgeons use private theatres at no cost to the qualifying patient.
She received free surgery on both eyes at Re:Vision in Mt Wellington, carried out by Dr Trevor Gray and his team last week. The Herald was able to film McLeod as she underwent the surgery, and video is available with the online version of this article.
Gray hopes other ophthalmologists will support the scheme, by agreeing to carry out a 20-minute cataract surgery once a fortnight or month. He partnered with Arch after realising how many people were being denied life-altering treatment by a public system that he recently left after 20 years.
"We'd love for the government to make us redundant," he said. "But there are patients that really highlight the fact the public hospital system is letting society down. They have paid taxes for years, and all they need is a cataract operation to keep driving and working."
Patients needing electives (medical or surgical services that aren't required immediately) must be treated in order of priority. DHBs do this by assigning each person a score from 0 to 100 (lowest to highest priority), according to clinical and social need.
If the score reaches a certain threshold – set by each DHB according to capacity and demand – a patient will be accepted for cataract surgery, to be carried out within four months.
Only those who clear the lofty thresholds are counted as "waiting". The others are simply sent away, and political pressure and scrutiny is avoided.
A Herald survey of the country's 20 DHBs has found cataract surgery thresholds vary by as many as 16 points. That creates so-called "postcode healthcare", given a person in Auckland would get surgery well before having to stop driving, but not in nearby DHBs such as Counties Manukau.
• Read the full investigation by clicking here
Whanganui's threshold is 53, which a spokesman said was consistent with the national score. Factors considered included a person's ability to sustain their independence, he said, and clinicians could override the scoring system where appropriate.
The New Zealand branch of the Royal Australian and NZ College of Ophthalmologists and the NZ Association of Optometrists support bringing cataract surgery thresholds inline, and a national threshold has been discussed by clinical leaders at Counties Manukau DHB.
Whanganui DHB communications manager Mark Dawson said yesterday: "Finite resources mean surgery must be prioritised, and this is achieved by use of thresholds which consider the patient's needs and ability to sustain independence."
The Whanganui District Health Board threshold of 53 for cataract surgery fell in the middle of New Zealand's 20 DHBs and was consistent with the national score, he said.
"For reasons of confidentiality, the Whanganui DHB cannot discuss individual cases, but is delighted with the successful outcome for Ms McLeod."
• To seek possible access to Auckland Regional Charity Hospital-supported surgery (cataract or other) your GP, ophthalmologist or optometrist must submit application forms available on www.aucklandcharityhospital.org