By DAVID ZITNER (AIMS Senior Fellow)
Chronicle Herald, 31 January 2017

My welcome to medical care for seniors helps me understand what some people mean when they say “I’m not getting older. I’m getting better.”

Science and medical innovations lead to improved function and comfort despite the influence of age on our vision, teeth, muscles, joints and body organs.

Bionic appliances, for example artificial knees, hips and eye lens, confer major improvements in comfort and function, and rarely inflict bothersome or dangerous complications.

As people age, the eye muscles become weaker. The lenses yellow, harden and often become cloudy (cataract formation). The retina (the receptor in the back of the eye) gets less light.

The result is increasing difficulty in focusing to read and decreased appreciation of light and colour.

Most people, other than those who were far sighted to begin with, eventually need to buy reading glasses for reading and close work.

One of the seeming miracles of modern medicine is that a 20-minute cataract surgery is all it takes to remove and replace the older, now yellowed, lens you were born with and replace it with a clear new lens. For most people the result is a dramatic improvement in vision with an increased appreciation for colours and texture.

In Nova Scotia, rationing by wait times leads to excessive waiting times for important procedures, including cataract surgery. The average waiting time for cataract surgery in Nova Scotia is more than a year — almost three times longer than the recommended wait time reported by the Canadian Institute for Health Information.

According to Melissa Brown, writing in the prestigious British Journal of Ophthalmology, lengthy waits for cataract surgery impose a 21 per cent decrease in quality of life.

She writes that health care providers should do all they can to maximize the value of health care and that “shortening the waiting time from the start of visual disability until the cataract is removed and shortening the waiting time for other effective health care interventions is a good way to begin.”

Nova Scotians who have cataract surgery are given a choice between lenses that were designed 50 years ago, provided free by the health authority, and a more modern lens.

The “free lens” requires a larger incision and eye stitches. Nova Scotians having cataract surgery may purchase more expensive lenses. The modern lens, the one most commonly used around the world, costs about $280 per eye and patients do not require eye stitches after surgery.

The Nova Scotia Health Authority support for an inexpensive lens is not surprising and is compatible with an overall approach to health care. A 2014 article published by Dr. Hennig in the peer reviewed publication Eye concludes, “Using an inexpensive rigid intraocular lens will make cataract surgery more affordable for poor patients in low- and middle-income countries.”

I feel embraced by age now that my own vision is clear and bright, helped by new $280 intraocular lenses — a bargain at the price. Fortunately I was allowed to purchase, as most people do, a modern lens for each eye.

And most of my own wait time was increased by my own reluctance to embrace and recognize, in advance, the life enhancing benefits of having cataract surgery, new lenses and new vision.