Clearing the cataract backlog in a (not so) developing country.

There is a significant backlog of patients waiting for cataract operations in the United Kingdom. In England in the first quarter of 1989, there were 74,000 patients in total on ophthalmology waiting lists, of which approximately 75% were cataract cases. Although there is currently a significant shortfall of around 225 consultant ophthalmologists, as defined by the College of Ophthalmologists' standard, the backlog is also due to the imbalance in, and inefficient use of, resources. There are a number of possible ways of clearing the backlog, including local initiatives, contracting for clinical services and the expansion of day-case surgery, which has been shown to be a cost-effective alternative to in-patient surgery. However, not only are reorganisations in the provision of surgical services required, managerial initiatives also need to be taken.