By Shawna Davis-Monkman and Lauren Hayes
At 84 years old, Violet* was living on her own and struggling to take care of herself. The clouding from her cataracts was so severe she had lost nearly all of her vision. With pre-existing health conditions, Violet was unable to find a doctor willing to perform the outpatient procedure that would replace her cloudy lens with a clear lens to restore her vision. After four years of unsuccessfully navigating the healthcare system and desperate for help, Violet came to the emergency department at Trillium Health Partners (THP). Within a week, Violet’s first cataract surgery was performed and several weeks later her second surgery had been performed, restoring the vision in both of her eyes and allowing her to regain her independence.
Violet says the surgery was life changing, “I live alone and I couldn’t cook, I couldn’t read, I kept falling. It was very hard for me and I had to wait a long time for the surgery.” Cataracts primarily develop through aging and thereby greatly affect seniors, one of the fastest growing and most vulnerable populations.
A global leader in ophthalmology, Dr. Ike Ahmed, Division Head of Ophthalmology at THP, says stories like Violet’s are far too common. “In Ontario, the demand for cataract surgery is high and expected to increase as our population ages,” says Dr. Ahmed. “We are rethinking the model of care for cataracts with patients in mind, to create a system that includes the prioritization of patients based on need and appropriateness.”
Cataract surgery is the most commonly performed procedure in Ontario, yet costs and wait times vary drastically across the province. Surgical removal of a cataract is effective, but with high demand and lack of standardized measures for prioritization, it is not always available in a timely manner for those who need it most. Under the current model of care, a patient who is unable to work due to their cataract(s) may be waiting just as long, if not longer, than a patient whose cataract(s) has little impact on their daily life.
Dr. Ahmed, along with Institute for Better Health (IBH) Scientist, Dr. Morgan Lim and their team are working to develop an Electronic Cataract Appropriateness and Prioritization System (eCAPS) that would standardize the way patients with cataracts are referred and triaged for surgery. eCAPS would provide physicians with standardized measurement tools for the assessment of cataract(s) and act as an electronic interface between the hospital booking system, the wait time information system and clinic offices. eCAPS will not only help identify patients who are appropriate for cataract surgery, but also provide physicians with measurement tools to assess the impacts cataract(s) has on a patient’s quality of life to more appropriately prioritize and schedule patients, ensuring timely access for patients in greatest need of surgery.
An expert panel, comprised of ophthalmologists, optometrists and general practitioners, has been engaged to inform the creation of the standardized measurement tools. The panel has expertise in optical care and cataracts; however, they recognize the barriers in truly understanding the impact cataract(s) have on a patient’s quality of life. Barriers like time constraints, effective communication and power dynamics between patients and providers.
To better inform the panel, the research team conducted qualitative interviews with cataract(s) patients and compiled a video that captures diverse patient stories. Patients of different ages, with varied vision loss and social supports, shared their experiences of living with cataract(s) and navigating the health care system. The video brings the patient voice into the panel’s decision-making process to help shape a more equitable and patient-centred model of care.
“We want patients and experts to be engaged in the design process to ensure we create a new model of care that truly meets the needs of both patients and providers,” says Dr. Lim. “eCAPS will be tested locally in Mississauga first, but if successful, we believe it can be used across Ontario, Canada and even globally, to standardize cataract care and other elective surgeries.”
Trillium Health Partners’ Institute for Better Health recognizes that active participation of patients is necessary to develop a new model of care that will result in better practice, better outcomes and better experiences.
Violet was able to regain her independence, security and vision through cataract surgery. There are many patients like Violet waiting to receive this life changing surgery. By identifying and prioritizing appropriate surgeries, patients will be given greater access to quality care.
*Name has been changed for patient confidentiality.
Shawna Davis-Monkman is a Communications Intern and Lauren Hayes is a Communications Advisor at the Institute for Better Health, Trillium Health Partners.