Progressive improvements in refractive outcomes in National Health Service public cataract surgery over fifteen years

Session Details

Session Title: Training & Surgical Practice

Session Date/Time: Tuesday 25/09/2018 | 16:00-18:00

Paper Time: 17:36

Venue: Room A2

First Author: : D.Gunn UK

Co Author(s): :    S. Tavassoli   K. Darcy                 

Abstract Details

Purpose:

There have been significant changes in the delivery of ophthalmic health services over recent years with improved biometry equipment and staff training, IOL model preference shifts, IOL formula adjustments and A-constant modifications. Since 2003, electronic surgical records have been kept locally and these allow longitudinal assessment of the refractive performance of the health services. This report examines the refractive outcomes of routine cataract surgery performed in Bristol Eye Hospital and Cheltenham General Hospital from 2003 to 2017.

Setting:

Bristol Eye Hospital (University Hospitals Bristol NHS Foundation Trust) and Cheltenham General Hospital, UK.

Methods:

Retrospective deidentified patient data was collected from the electronic surgical databases of two tertiary hospitals. All operations involving cataract surgery were collected from the period of January 2003 to December 2017. Surgeries combined with vitrectomy or other complex procedures were excluded. Outcomes with corrected distance visual acuity (CDVA) less than 6/12 were excluded. The data was analysed in five year periods. Statistical analysis between the groups was performed with contingency tables and Pearson's chi-squared tests.

Results:

The audit collected 108862 surgical events that included cataract surgery of which 85784 were primary uncomplicated cataract surgery with a postoperative CDVA of at least 6/12. Of these cases, 53082 (61.9%) had a recorded postoperative refraction. Over the entire period, 89.2% of patients achieved within +/- 1.0 dioptres (D) of their predicted postoperative spherical equivalent. There was a significant increase (P<0.0001) in the rate of obtaining a refraction within +/- 1.0 D over the study periods 2003-07 (86.0%), 2008-12 (87.8%), 2013-17 (92.3%). A similar trend (P<0.0001) was seen within +/- 0.5 D 2003-07 (56.5%), 2008-12 (59.5%), 2013-17 (68.5%).

Conclusions:

This report describes encouraging trends in the accuracy of obtaining predicted refractive outcomes in public cataract surgery in the UK. It shows that perceived improvements in service delivery are in fact delivering real world effects on patient refractive outcomes. Current NHS benchmarks established in 2009 stipulate that 85% of patients should be within +/- 1.0 D and 55% should be within +/- 0.5 D of their predicted refractive outcome. Considering the significantly improved results reported herein, perhaps it is time to revise the national guideline targets.

Financial Disclosure:

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