News

Cataract surgery rationed according to visual acuity

Patients in over half of English PCTs are being denied cataract surgery based on optometrists’ test chart results, medical professionals have reported.

Surgery is being denied unless patients’ ability to read the charts falls below a certain level. 

The Royal College of Ophthalmologists (RCO), College of Optometrists, Optical Confederation and Local Optical Committee Support Unit issued a joint statement labelling such blanket restrictions as “unacceptable”. 

Visual acuity, as measured by test charts, is only one part of the assessment of visual performance and one symptom of cataract, the groups state. Decisions based solely on this criterion must therefore be avoided, they warn. 

RCO president Professor Harminder Dua said: “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: 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. 

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

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

She called for additional factors, such as patients’ ability to maintain their independence and the potential for further deterioration in their health, to be considered when advising on surgery. 

But Wade added: “We must remember that the NHS is facing an unprecedented financial challenge and commissioners must live within their means while providing high quality care.” 

However, the royal colleges insisted cataract surgery was a “highly cost-effective” procedure and added: “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.” 

Tell us what you think – have your say below, or email us directly at [email protected]

Image c. www.freeimages.co.uk