Few ailments in life are more fearful and restrictive than a loss of clear vision. Of all the senses sight is probably the most precious. To discover you can no longer see properly is to face the inability to read, drive a car or even walk any distance easily. That is the fate of too many people waiting for cataract surgery in this country.

They wait longer in some health board districts than others. It is a case of "postcode healthcare", as Nicholas Jones reports today. But the numbers in need everywhere are unknown because, as he explains, DHBs do not put them all on waiting lists. Each board sets its own threshold of need for getting onto its list for ophthalmology surgery.

Those who do not meet the threshold are simply sent away to get by as best they can until their cataract gets worse, when they might try again. Or they can pay for private surgery at an approximate cost of $4000. It is not a major operation. It takes about 20 minutes. New Zealand's Fred Hollows Foundation provides the surgery at little cost in the Pacific Islands. But here the charge is beyond the means of many of the afflicted.


And the cost will be a a major consideration for DHBs too. Ophthalmologists are among the highest paid health specialists in this country. Not surprisingly, the area of greatest unserviced need is South Auckland. The Counties Manukau DHB imposes a much higher threshold than the Auckland board for admission to its waiting list.

That might not be just because a larger proportion of its poulation cannot afford private surgery. Counties Manukau's clinical head of ophthalmology, Simon Dean, told us its cataract threshold reflects higher rates of smoking, obesity, diabetes and other risk factors for eye problems. Whatever the reason, it seems unfair that someone on the south side of the boundary through Otahuhu should have to wait much longer than someone in the same condition on the other side.

Waiting lists are no longer a guide to real need. Governments used to be embarrassed by waiting lists because people languished on some of them for years. So 20 years ago they were abolished and replaced with waiting times. Now DHBs are required to ensure nobody waits longer than four months, so they set a threshold of acceptance for surgery that will keep the numbers down at a level they can treat within that time.

It is a system that works well for politicians, less well for people in need. It used to be that they waited to get into hospital, now they wait to get on a waiting list. And they wait invisibly, not recorded, known only to their optometrist who can do nothing more for them.

In Counties Manukau, Jones reports, people whose cataracts are so bad optometrists have told them not to drive, are being refused surgery.

One Auckland ophthalmologist, Dr Trevor Gray, who provides a free operation once a week to someone in dire need, but below their DHB threshold, says, "When you realise how low cost a cataract operation is, and how high impact it is — it transforms things overnight and painlessly — there is no other operation in the Western world that has as positive an impact on an individual and an extended family."

It's provision should not depend on your postcode, ophthalmology should make cataract surgery affordable for all DHBs for all in need.