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Leading eye health bodies slam PCTs over cataract surgery restrictions

Criteria “clinically unsound” and will store up costs further down the line

Caroline White

Monday, 13 August 2012

An alliance of leading eye health bodies has issued a joint statement warning that primary care trust restrictions on access to cataract surgery are “clinically unsound,” and fly in the face of government recommendations.

Earlier this year, it emerged that patients in more than half of PCTs in England are being denied cataract surgery as trusts continue to tighten eligibility criteria in a bid to save cash.

Reports indicate that access to surgery is being based on a standard eye test alone, while those with cataracts in both eyes are being told they can only get treatment for one, despite substantial evidence in favour of treating both.

In a joint statement issued today the Royal College of Ophthalmologists, College of Optometrists, Optical Confederation and Local Optical Committee Support Unit call for trusts to abandon these criteria as a matter of urgency.

“We strongly advise that it is clinically unsound to determine access to cataract surgery on the basis of visual acuity alone. Patients should be offered treatment for cataract if: the cataract is adversely affecting their daily living; they fully understand the risks and benefits of surgery; and, they want to have, and are fit enough, for surgery,” says the statement.

“We urge commissioners, clinicians and patient groups to work together to implement this advice as a matter of urgency,” it continues.

It goes on to say that the signatories back the Department of Health’s “strong stance against rationing access to cataract surgery through blanket visual acuity criteria, which ignore patients’ individual circumstances,” such as the impact on their ability to work, drive or look after themselves.

And it points out that health secretary Andrew Lansley made a commitment to ban “caps on operations that do not take account of the healthcare needs of individual patients” by March 2012,”  yet new evidence shows that many commissioners are still imposing unfair restrictions on cataract surgery. “This is not clinically justified,” says the statement.

Measuring visual acuity is only part of an assessment of visual performance and does not take into account other elements that impact on the quality of life of patients, says the statement, emphasising that patients with cataracts can experience other serious symptoms, such as double vision or disabling glare from lights, even though their visual acuity is relatively unaffected.

The statement says that only treating one affected eye can be dangerous as patients lose their ability to judge distances effectively, and point out that health minister Simon Burns has “rightly branded such blanket restrictions that ignore clinical judgements as ‘unacceptable’.”

The statement continues: “We understand the financial pressures the NHS faces but cataract surgery is a highly cost effective treatment that improves sight loss and preserves patients’ ability to live independent lives.

Using visual acuity thresholds to impose limits on cataract surgery is economically counterproductive when it leads to higher health and social care costs because patients’ vision deteriorates.”

Elizabeth Wade, head of commissioning policy for the NHS Confederation’s PCT Network said the overriding principle for determining any access to treatment should be clinical need.

“It is vitally important that patients are seen and treated as quickly as required to meet their clinical needs,” she said.

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