A 76-year-old lost her sight and ability to drive - but was told her cataract wasn't bad enough for treatment.
Glennis Keoghan couldn't get to the shops or doctors without asking a neighbour for a ride, and watching television and reading became difficult.
"It was a little devastating," she said of being told she didn't meet the threshold for cataract surgery.
Keoghan lives with her partner in Leamington, near Cambridge. His health problems means he can't drive, and the closest shops are about five blocks away. The doctors and other support is further still.
Macular degeneration has taken much of the vision from Keoghan's left eye, but her right side vision was relatively good - until a cataract worsened, and progressively clouded out the world.
Vision could be easily restored through a 20-minute procedure to replace the clouded eye lens. However, Keoghan was declined surgery by Waikato DHB, which has one of the toughest thresholds in the country.
She stopped driving, despite being aware of what that would mean for their quality of life, having had to temporarily stop a couple years earlier after an operation.
"I actually went to milk powder so I didn't have to call on somebody just to go and buy me some milk," she said.
"It's a big thing when you can't just get in your car and do something [but] I just felt I was not seeing good enough to drive.
"I couldn't see the TV too well. Everything was just slightly blurry. Reading was very difficult."
Keoghan suffers other conditions including arthritis and a damaged spine, and gets about with the help of crutches and a walker.
It's not the easiest life, but she keeps a positive outlook. That comes from her childhood, she said - her mother died when she was four, and her father brought up 13 children.
"Dad always taught us to do for ourselves," she said. "I could sit home and grizzle, but I'm not one of those people. But I was very disappointed about not having my eye done."
Fortunately, Keoghan's optometrist heard about Auckland Regional Charity Hospital (Arch), which lets volunteer surgeons use private theatres at no cost to the qualifying patient.
In November last year a neighbour drove Keoghan to Auckland for free cataract surgery, carried out by Dr Trevor Gray, at his private practice, Re:Vision in Mt Wellington.
Gray has partnered with Arch to carry out cataract surgeries, after realising how many people were being denied life-altering treatment by a public system that he recently left after 20 years.
He hopes other ophthalmologists will support the scheme, by agreeing to carry out a 20-minute cataract surgery once a fortnight or month.
"We'd love for the government to make us redundant," he told the Herald. "But there are patients that really highlight the fact the public hospital system is letting society down. They have paid taxes for years, and all they need is a cataract operation to keep driving and working."
Patients needing electives (medical or surgical services that aren't required immediately) must be treated in order of priority. DHBs do this by assigning each person a score from 0 to 100 (lowest to highest priority), according to clinical and social need.
If the score reaches a certain threshold – set by each DHB according to capacity and demand – a patient will be accepted for cataract surgery, to be carried out within four months.
A Herald survey of the country's 20 DHBs has found cataract surgery thresholds vary by as many as 16 points.
• Read the full investigation by clicking here
Auckland DHB, for example, has the joint-lowest threshold in the country at 45. A person with cataracts as bad as Keoghan's would likely get surgery well before having to stop driving.
When Keoghan applied for surgery Waikato DHB residents had to get a priority score of 58 or higher to be accepted. That has since dropped to 56, but remains one of the highest in the country.
A Waikato DHB spokeswoman said for privacy reasons she couldn't comment on Keoghan's case, including her priority scoring. The threshold is based on supply and demand, she said, and Waikato had an increasingly ageing population.
Factors accounted for include vision, the form and structure of the cataract and a patient's quality of life.
"The threshold will never be low enough to capture everyone. There will always be patients who don't meet it."
Cataracts mostly affect the elderly, but the Herald has confirmed cases where people of working age have had their drivers licence cancelled and employment imperilled - and still didn't clear the bar for surgery. People who can muster enough money go private. The rest suffer.
Thanks to charity, Keoghan has her licence and freedom back. Daily life is immeasurably better.
"The minute I came out of the operation I could see a lot better," she said. "I was really grateful to that crowd in Auckland. I was on the brink."
• To seek possible access to Auckland Regional Charity Hospital-supported surgery (cataract or other) your GP, ophthalmologist or optometrist must submit application forms available on www.aucklandcharityhospital.org
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