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Suzanne Harrison

Ophthalmologist Christopher Yu  performs two or three cataract surgeries per week on outpatients at  Matilda Hospital.  In a public hospital, he says, a surgeon would  perform between four and eight per week.
That's because, as Yu and other doctors confirm, cataract  removal is the most common surgery performed in Hong Kong, and with an ageing population,  demand for it is increasing.
Cataracts are the leading cause of visual loss in adults aged 55 and older and the leading cause of blindness worldwide (the vast majority of cases are in poorer nations), according to  cataractsurgery.com.
By age 65,  about half of  all people will experience  cataracts and,  by age 75, almost everyone  will have a cataract, says cataractsurgery.com.
'The  lenses in our eyes become opaque with time,' Yu says of the first signs of a cataract. 'The eye wasn't designed to live beyond 40 years of age ... our  lenses  have outgrown the [rest of] the body.'
Cataracts are caused mostly by exposure to UV light over time, which causes changes in the  lenses as we  live beyond the previous life expectancy of about 40. Some cataracts, however, are  hereditary and as such are (very rarely) found in young children. Others are related to  conditions such as diabetes.
Yu says cataracts in Hong Kong are most common in those over the age of 50.  By 80, he says, 'a much larger percentage of people will  have cataracts'.
This has  led to  longer waiting lists for surgery, which, as  the population ages, is a problem the  Health Department has had to address.
According to the World Health Organisation, about  9 million people  on the mainland are living with blindness.   Cataracts  account for 42 per cent of  that figure.
In Hong Kong, cataract surgery is more  accessible - after a wait.
Ian Watson, who is in his 70s, had successful cataract surgery on each of his eyes in both a public and private hospital two years ago.
He waited 18 months for the  operation at the public hospital, which cost HK$1,500.  The private hospital surgery on another eye cost about HK$14,000.
For  Enoch Yiu, having cataract surgery at a private hospital in her 40s was a simple and  pain-free experience overall.
'It only took about 20 minutes,' Yiu says.   'My vision improved immediately after the operation.'
It was likely a family predisposition to cataracts resulted in her having them earlier in life as her aunt and mother both had cataracts.
A Central-based ophthalmologist says it is not considered a difficult procedure for surgeons if done using the phacoemulsification  method (an inpatient procedure that  usually requires a local anaesthetic).
He says the lens is emulsified by an ultrasonic hand-piece and a foldable, synthetic lens is inserted.
The ophthalmologist says this lens unfolds once it is inserted into the eye. The patient can walk out of the clinic  the  day after  the procedure.
Yu - who says more than 90 per cent of such operations are successful - explains it in detail: 'A small incision is made  in the eye.' The smaller the incision, the shorter the post-operative recovery. This is also why the new lens is foldable, as it needs to be small to be inserted into the tiny incision. The surgeon then inserts an implement to emulsify the lens.
'It shatters the lens material and makes it 'liquid' so it can be sucked out,' Yu says. 'Once we have cleaned the whole of the cataract we can insert the artificial lens.'
The foldable lenses are 'very elastic', Yu says. He says this procedure has been around for more than 10 years and is very time effective.
'Before this, we used to have to have a big wound [on the eye], and the bigger the wound, the more chance of an astigmatism [after the operation].  There is much less chance of reshaping the cornea [which causes astigmatism] with this surgery,'  he says.
Most of the time, this is done with a topical anaesthetic -  drops or a jelly  applied to the eye and the operation takes about 30 to 45 minutes (speculums keep the eye open). 'If they don't want to know what's going on, then we can give them a regular anaesthetic around the eye and that stops the eye moving.
'If you want to be completely out, you can. But that's rare. This is day surgery: you're in and out in half a day, and you're able to see fairly well the next day; there's no stitches and the eyes look pretty normal', Yu says.
It sounds safe and straightforward, but there is one problem: an ageing population means longer waiting lists.
Yu points out that the public health system says patients need to wait  until the cataract is mature to have the procedure. The problem is that, as  we live longer, the  number of people with mature cataracts has also increased.
The health authority  has taken notice. In February last year it launched a new scheme to reduce the time public hospital patients must wait for cataract surgery.
The government earmarked  a one-off allocation of HK$40 million for the authority to implement the Cataract Surgeries Programme,  and 70 private ophthalmologists enrolled in it when it was introduced.
A fixed subsidy of HK$5,000  is provided for each  surgery performed by participating  private ophthalmologists, and patients may  need to co-pay up  to HK$8,000.
The authority's  director of cluster services,  Cheung Wai-lun,  said at the time there were 50,731 patients on the waiting list at public hospitals. The annual  number of cataract surgeries is around 17,000 cases while the number of new cases is 21,000 a year.
'Given the increasing demand, the average waiting time for cataract surgery is about three years. Since cataract prevalence increases  with age, we expect demand for surgery will continue to grow with our ageing population.'
To learn more about available programmes, patients can call  2300 6600



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