Edinburgh's Eye Pavilion: patients face 'nightmare' delays for sight-saving ops under new system

Patients who risk going blind without urgent specialist surgery face dangerous delays if plans to disperse eyecare services in Lothian go ahead, a celebrated eye surgeon has warned.

Dr Hector Chawla, former director of Edinburgh Princess Alexandra Eye Pavilion, said that patients with a detached retina, already terrified, would face an additional nightmare of delays built into the new system.

The Eye Pavilion has been deemed no longer fit for purpose, but the Scottish Government has said it will not fund the replacement hospital which was planned next to the Royal Infirmary and wants a new elective care centre due to be built at St John's Hospital in Livingston to be used for operations.

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Dr Chawla, recognised as a world expert in retinal surgery, said he would typically see two or three cases of detached retinas every week when he was working at the Eye Pavilion.

Dr Hector Chawla is former director of the Princess Alexandra Eye Pavilion.Dr Hector Chawla is former director of the Princess Alexandra Eye Pavilion.
Dr Hector Chawla is former director of the Princess Alexandra Eye Pavilion.

He said that currently, during normal hours, a patient suffering from a detached retina might typically go first to an optometrist and then be referred to the Eye Pavilion, where specialist surgeons could operate later that day if necessary and post-operative care was available in the same building.

But writing for the Evening News, he considered what would happen if there were no Eye Pavilion and their symptoms struck out of hours.

He said: "Their terror of total blindness, already acute, could only increase with the clock ticking and the uncertainty of what was going to happen to them

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"The dispersed model of proposed care, though confidently free of actual detail, would start them off on a long, slow and certainly bumpy journey."

Dr Chawla said the first step would be to go to A&E at the Royal Infirmary at Little France, where they could face a wait to be seen.

"The A&E doctor would diagnose ‘loss of vision’. Then - delay."

He said an ophthalmic surgeon would eventually come along and diagnose a retinal detachment.

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But then there would be more delay as staff searched for an ambulance to take the patient to Livingston.

"And the searches would continue – an available theatre at St. John’s, specialist nursing staff, a retinal surgeon, an anaesthetist. None of these would be instantly available, delay now increasing exponentially."

Dr Chawla said the ambulance journey could worsen the patient's condition and when the patient arrived, the theatre that had been arranged, could be still busy with another emergency like an infected appendix.

And once the patient finally made it to theatre, if the surgeon discovered the situation was more complicated than first diagnosed the non-specialist nurses might not have the skills required to use the equipment needed.

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Patients would need to stay in at least overnight, but it was unclear where a bed might be available

Dr Chawla said: "The predictable outcome would be avoidable visual loss and litigation and the predictable inquiry into who planned for such an outcome would echo with the words ‘It wisnae me’. The answer is clear – the new eye hospital as promised.”

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