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Raising the benchmark for the 21st century—the 1000 cataract operations audit and survey: outcomes, Consultant-supervised training and sourcing NHS choice
  1. Farhan H Zaidi1,
  2. Melanie C Corbett2,
  3. Ben J L Burton3,
  4. Philip A Bloom4
  1. 1Dept of Ophthalmology, Kings, College Hospital, Denmark Hill, London, UK
  2. 2The Western Eye Hospital, St. Mary’s NHS Trust, London, UK
  3. 3Moorfields Eye Hospital and St Thomas’ Hospital, London, UK
  4. 4The Western Eye Hospital, London, UK
  1. Correspondence to: Farhan H Zaidi Dept of Ophthalmology, Kings, College Hospital, Denmark Hill, London SE5 9RS, UK; fhz12{at}hotmail.com

Abstract

Purpose: Clinical outcomes for phacoemulsification surgery are still compared with the almost 10-year-old benchmark of the 1997–98 National Cataract Surgery Survey (NCSS) published in this journal. Extraneous to the peer-reviewed research literature, more recent databases suggest much better results may be being obtained. This offered the rare opportunity to perform an audit as research investigating if this was indeed the case and a new benchmark is needed, with the additional standard of rigorous study peer review by independent senior ophthalmologists. At this pilot centre for Patient Choice provision, all cataract surgery was performed on Consultant-supervised training lists, a novel extension in-sourcing care using public resources rather than to an independent sector that may not be supervised by NHS Consultants. Patient satisfaction was also surveyed. We asked whether the NCSS is out-of-date, and whether good outcomes on Choice schemes are compatible with Consultant-led training within the National Health Service?

Methods: An audit of 1000 consecutive patients undergoing cataract surgery on Patient Choice at the Western Eye Hospital between October 2002 and September 2004. All subjects were scheduled for phacoemulsification. A novel policy was extending “choice” onto training list slots for this period. A validated questionnaire assessed patient satisfaction.

Results: A best corrected visual acuity of 6/12 or better was obtained in 93% of cases. Over 80% of cases were ±1 D of target refraction (65.7% within 0.5 D). The total incidence of complications was 8.7%. Overall incidence of major complications was 2.4%. Incidence of vitreous loss was 1.1% and that of endophthalmitis 0.1%. Complications rates were lowest for consultants (less than 1%). User satisfaction with having cataract surgery on “patient choice” was high.

Conclusions: Cataract surgery under patient choice on supervised training lists is associated with a visual outcome and an incidence of complications at least as good as the published national average. User satisfaction is high. Cataract surgery under patient choice is compatible with training activity in receiving hospitals. The improvement in outcomes since the 1997–98 NCSS suggest that the accepted standards for complication rates should be updated to reflect the fact that phacoemulsification has become an established procedure.

  • BCVA, best corrected visual acuity
  • IS-TC, independent sector treatment centre
  • NCSS, National Cataract Surgery Survey
  • SHO, Senior House Officer
  • SpR, Specialist Registrar
  • WEH, Western Eye Hospital
  • cataract surgery
  • outcomes
  • training
  • patient choice
  • independent treatment centres
  • BCVA, best corrected visual acuity
  • IS-TC, independent sector treatment centre
  • NCSS, National Cataract Surgery Survey
  • SHO, Senior House Officer
  • SpR, Specialist Registrar
  • WEH, Western Eye Hospital
  • cataract surgery
  • outcomes
  • training
  • patient choice
  • independent treatment centres

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Footnotes

  • Published Online First 18 October 2006

  • We are grateful to St Mary’s NHS Trust providing additional funds to facilitate the large volume of data collection and retrieval.

  • Competing interests: None.

  • This work was presented at the podium of the United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS) Annual Meeting, Chester, England, September 2004 and at the podium of the Royal Society of Medicine, London, June 2005

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