Not enough staff, not enough financial resources and it’s the same throughout the UK. The same week I receive an e-mail telling me that the government is spending in excess of 80m euro to reduce the waiting time for cataract surgery to three months. Initially, we would all welcome this type of investment, but the bulk of this money will not necessarily go to the Government health service, but to independent overseas providers.

Audits have shown that our threshold for cataract surgery has been reduced such that we are now operating on patients before they develop a significant visual disability. Of course this magnanimous initiative is an easy way for the government to meet their own targets and is not based on the wider clinical needs of the population: their distorted vision.

Part of the problem is that we have made it too easy for governments, who regard a cataract as an intraocular chalazion: there appears to be no understanding of the logistics in performing surgery and the numbers that are safely achievable. Leaming’s survey is, as always, fascinating.

That the majority of surgeons in America perform 50 or fewer phacoemulsification procedures per month correlates with throughput in Europe. There are, in fact, very few surgeons worldwide who can reliably perform high volume cataract surgery and this is corroborated by the articles from France, with the majority performing less than 500 surgeries per annum.

It is also noteworthy that 60% of surgeons in the US reuse phaco tips, a practice which is outlawed by EU law. The attitude of the French Government is interesting, employing "divide and rule" tactics by empowering optometrists, a group with whom we should be working in harmony. These surveys provide us with a degree of realism: our undistorted vision.