Simon Liew, ophthalmic surgeon with Marsden Eye Specialists, Penrith, said he got the news from the Independent Ophthalmic Network.

``It was done very subtly by the Government,'' he said.

He said the most vulnerable people would be the uninsured private patients, who pick up the out-of-pocket costs for the surgery.

For surgeon fees of $1000, Dr Liew said Medicare would refund the patient about $623. But once the new federal budget measure is introduced, this will be reduced to $311.

``Who's going to cover that added cost?''

Where health insurers cover the balance for private, insured patients Dr Liew fears that gap cover offered by health insurers might be affected as a result of the reduced Medicare rebate.

Dr Liew said public patients would be unaffected by the rebate cut, but feared the added cost for private patients would push people into having the surgery under the public health system.

Health Minister Nicola Roxon has said: ``We are adjusting the Medicare benefit to a more appropriate fee for nine items relating to cataract surgery to better reflect the real cost of these now commonplace procedures.''

She said the fee for the most commonly performed cataract service which she said takes 15-20 minutes would be reduced from $831 to $409 from November 1.

But Dr Liew said, on average, cataract surgery took half an hour and said the Ms Roxon was ``probably a bit ambitious with that time''.

Dr Liew also said the procedure may take less time to perform thanks to better training and advanced technology, but that didn't make the operation easier.

Surgeon fees also included before-and-after care.

Ms Roxon said the Government was ``willing to set a new, higher Medicare Benefit Schedule item fee for more complex cataract procedures'' and was in ``active discussions with the profession in regard to that''.