NICE publishes serious eye disorders quality standard
12 February 2019
The Royal College of Ophthalmologists supports the quality standard but believes the implementation will be challenging for the overwhelmed hospital eye service.
The National Institute for Health and Care Excellence (NICE) has published its first quality standard looking at serious eye disorders, covering the diagnosis and management of cataracts, glaucoma and age-related macular degeneration (AMD) and the prevention of sight loss. The standard consists of a prioritised set of specific, concise and measurable statements based on recommendations in previous key NICE guidance for ophthalmology. This standard has been widely consulted, including with members of The Royal College of Ophthalmologists (RCOphth).
NICE recognises that levels of achievement for the standard will vary nationally and recommends that desired levels of achievement should be defined locally, taking account of safety, shared decision-making, choice and professional judgement.
At a time when the hospital eye service is overwhelmed by increasing demand, measurable quality standards are crucial to identify areas of poor performance or reduced patient safety. This helps to inform policy makers, commissioners and providers of the need for more resources and staff. The RCOphth 2018 Workforce Census demonstrates a sever workforce shortage in ophthalmology services which contributes to ongoing patient safety issues.
The RCOphth National Ophthalmology Database (NOD) is a prime example of how ophthalmology has been able to lead the way in demonstrating how to collect meaningful metrics which are driving improvements in patient outcomes. Over the past nine years the NOD has documented a 30% reduction in Posterior Capsular Rupture or Vitreous Loss complications, a significant improvement in patient outcomes and a cost saving to the NHS.
Given the current capacity issues facing the hospital eye service, the RCOphth highlights the following standards will be challenging to achieve:
- Statement 2 – Where referral for cataract surgery is concerned, adults with cataracts should not be refused surgery based on visual acuity alone.
- Statement 3 – Adults with late age-related macular degeneration (AMD) (wet active) start treatment within 14 days of referral to the macular service.
- Statement 4 – Adults with late AMD (wet active) have monitoring for both eyes.
- Statement 5 – Adults with COAG or related conditions have reassessment at specific intervals.
- Statement 6 – Adults with serious eye disorders are given a certificate of vision impairment as soon as they are eligible.
Following its publication, the RCOphth recommends that all members familiarise themselves with the quality standard and work with their commissioning body, clinical leads and medical directors to implement where possible.