The Royal College of Ophthalmologists has published its fifth annual report for the National Ophthalmology Database Audit for cataract surgery. Overall the audit findings indicate high-quality cataract surgery is being delivered to NHS patients with a continuation in the trend seen over the past decade towards improvement.
Included in this fifth prospective report are operations undertaken between 01 April 2020 and 31 March 2021 which corresponds to the 2020 NHS year, with data collected from 182,606 cataract operations, accounting for approximately 72.5% of operations performed in England and Wales during the 2020 NHS year.
Cataract surgery remains the most frequently undertaken NHS surgical procedure with approximately 456,000 publicly funded cataract operations undertaken in England and 20,000 in Wales during the 2019 NHS year. The annual cost to the NHS of cataract surgery is estimated at around £500 million. By 2020, the number of cataract surgeries was reduced to approximately 246,000 in England and 5,700 in Wales, due to COVID 19 service disruption, cancellations and national lockdowns.
Since the original proof of concept of a national cataract audit in 2010, there has been around a 50% reduction in PCR complications and a 38% reduction in visual acuity loss following cataract surgery, equating to approximately 4,500 fewer complications annually across the NHS and an estimated annual saving from avoided additional treatments of £2.5 million.
The audit continues to quality assure NHS and publicly-funded cataract surgery. It is a powerful driver of quality improvement, with year on year reductions in complication rates. The RCOphth continues to work with sponsors, NHS trusts and organisations to ensure that the NOD increases the number of contributors, gathers data and develops insightful analysis to improve overall national cataract surgery services, both in the NHS primarily but also private providers.
The NOD cataract audit provides risk-adjusted results for centres and surgeons, enabling them to benchmark their own performance against their peers and prompts actions and solutions for improvement in service delivery and patient care; individual surgeons are stimulated by seeing their performance to be more mindful of quality generally and to improve performance where needed.
Outcomes for named consultant surgeons will be separately published on the RCOphth NOD Audit website and results for English and Welsh centres will be submitted to the Care Quality Commission (CQC).
What the NOD reveals:
- For all surgeons, 0.91% of operations were affected by PCR. This is slightly below the current consultant only based average rate of 1.1% used for risk adjustment and approximately 50% lower than in 2010
- Overall, the VA Loss rate was 0.42%, lower than the 0.9% rate used for risk adjustment and approximately 38% lower than in 2010
- In 2020, the number of cataract surgeries performed by experienced trainees (20,806 (12.1%)) was half that of 2019 (prior to the pandemic). The reduction in training opportunities seen in 2020 may not automatically revert to pre-pandemic levels as more surgery is now undertaken in the independent sector centres, which have hitherto not participated in training
- Uptake of ISBCS has more than doubled from 540 patients in the 2019 NHS year to 1,243 patients in the 2020 NHS year
- Patients from more deprived postcodes are presenting for cataract surgery with worse Visual Acuity (VA) overall
The report goes on to make recommendations for patients, commissioners, regulators and contributing surgeons/trusts and providers:
- Patients should discuss and understand the risks and potential outcomes of eye surgery with their surgeon, including for their own particular risk profile
- Providers should use the RCOphth NOD audit for quality improvement by comparing their results against other cataract surgery providers and their past performance to identify and act on specific areas that may need improvement
- Commissioners should use quality-focused service specification contracts with providers of cataract surgery, which include submission of full data to the RCOphth NOD audit
- Regulators should expect NHS services to participate in all national audits, with RCOphth NOD audit results made available to them when inspecting NHS organisations
The National Ophthalmology Database Cataract Audit continues to showcase how high-quality management, engagement with contributors and continuing insightful analysis of data can directly impact patient care, make savings and improve efficiencies for the NHS.
The RCOphth NOD Cataract Audit is now included on the Quality Accounts List meaning all NHS Trusts in England are required to participate or justify non-participation (eg due to non-utilisation of ophthalmic EMR) in their annual report to the Secretary of State for Health.
Dr John Buchan, Clinical Lead – RCOphth National Ophthalmology Database Cataract Audit, said, ‘The National Cataract Audit results are very encouraging. Despite the challenges of the pandemic, and the reduction in the quantity of surgery performed in the UK in 2020, the quality of that surgery continued the trend of improvement. As we build back NHS cataract services and address the backlog of operations that have been delayed due to Covid, the RCOphth NOD will continue to offer publicly visible quality assurance so that patients and surgeons alike can be confident that quality is being maintained.’
Read the full Report: National Ophthalmology Database Audit
Read the Executive Summary: National Ophthalmology Database Audit National Cataract Audit
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