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Eye surgery wait list a tough balancing act for health system

Many patients forced to wait as there are just three Halifax surgeons are able to do a certain eye surgery.

Only 3 Halifax surgeons for patients with crossed eyes, a condition called strabismus

Selena Ross · CBC News ·
In Canada's health system, emergencies go first.

Sometimes that idea gets complicated. Picture this: just three Halifax surgeons are able to do a certain eye surgery.

Hundreds of children are waiting to see them who don't need the operation urgently, but only have a certain window of time before their brains begin to develop wrong. 

There are hundreds of children and adults waiting for the same three surgeons. (CBC)
There are also hundreds of adults waiting for the same three surgeons. Some of them have double vision and are unable to work until they are treated. For others, there's no medical need for the surgery, but they'll probably have trouble getting jobs and will be stared at in public while they wait.

What are the surgeons to do? 

For patients with crossed eyes, a condition called strabismus, some adults end up waiting a very long time while the system struggles to meet the children's deadlines, says Dr. Marcelo Nicolela, chief of ophthalmology at Capital Health.

"It has been a long-term problem," he said. "It's basically lack of resources. I mean, we have tried to make the case for a fourth pediatric ophthalmologist for probably four or five years."

Provincial wait lists for strabismus surgery show that children in Halifax wait an average of 311 days, while Halifax adults wait around half that time, on average.

The wait for the surgery is the ninth-longest in the province, according to numbers provided by the health department.

There is also an exceptionally high volume of requests, and in a relatively big pool of patients, the averages don't tell the whole story.

As of Dec. 1., there are more people on the strabismus repair wait list — 238 — than for any other surgery except jaw surgery. There's also an unusually long list of referred patients waiting to meet with the surgeon, said Nicolela.

After being approved for the operation, one-tenth wait more than 15 months.

'It's not only cosmetic'

Those outliers are probably adults who are not experiencing double vision, said Nicolela. But it doesn't mean they aren't affected by developing a crossed eye, which can happen after a stroke or anything causing partial facial paralysis.

"If you have a significantly crossed eye ... it's not only cosmetic," he said.

"It has a lot of social problems with it. There's many studies showing that people with a strabismus have more difficulty getting employment and things like that, just because of misconceptions. If you're interviewing somebody and they have very crossed eyes, you might think they're not as smart and so on."

If the same adults developed double vision, they would be seen sooner because that interferes with driving, working and other daily activities, said Nicolela.

In children, there will generally be no symptoms, and that's exactly why they are considered a priority.

"As kids are developing, if the [condition] is not addressed, then that eye will never develop the right neural connections to the brain," he said. "That eye, it will always be what people call a 'lazy eye.'"

There are no plans to hire a strabismus surgeon dedicated to adults. In fact, a fourth pediatric surgeon is "essential," Nicolela said, though if hired, that surgeon would do some adult surgeries, like the current three.

Health Minister Leo Glavine said he was aware of "exceptional need" in ophthalmology and would be reviewing the province's physician resource plan, which looks at surgeon staffing, this spring.
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