Introducing a single approach to cataract surgery for West Yorkshire and Harrogate

In 2017, NHS England identified eye care, or ‘ophthalmology’, as a challenged speciality for West Yorkshire and Harrogate so in early 2018, it was agreed that this would be a priority area for the Partnership. Our Improving Planned Care Programme is transforming the eye care services that are most in demand across the region and cataracts is one of those speciality areas.

What are cataracts?
Cataracts are a clouding of the lens inside the eye, causing vision loss that cannot be corrected with glasses or contact lenses. The condition is more common in older people but the good news is that it can be treated. Cataract surgery, where the cloudy lens is replaced by an artificial lens, is the most commonly performed planned surgical procedure in the UK today. In West Yorkshire and Harrogate, this accounts for around 25,000 procedures every year – a figure that is expected to increase as we are all living longer and the local population continues to rise.

Where are we now?
An eye care working group is reviewing our local commissioning policies, clinical pathways, quality standards, service specifications and workforce requirements for cataract services. The group is building on recommendations from the Clinical Council for Eye Health Commissioning to standardise these documents and processes following the most up-to-date clinical evidence available. Having a consistent approach across West Yorkshire and Harrogate means we can better meet the needs of all our eye care patients whilst removing any unnecessary differences in care that may currently exist. 

A standardised clinical pathway and a single commissioning policy for cataract surgery have now been developed as part of this work. The West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups met in public on Tuesday 14 January 2020 where it agreed the adoption of the pathway and policy for implementation across the region.

In addition to approving the cataract surgery pathway and policy, the Joint Committee also agreed the principle of making better use of the many community optometrists that are based in primary care services including high street opticians. Under the new pathway referral for cataract surgery will come directly from a community optometrist rather than a GP. This means that people are being assessed by eye care specialists – and it frees up GP time too. Many people already make regular visits to their local opticians so the opportunity to be assessed in a familiar environment offers a more personalised service usually much closer to home.

What will happen?
The new policy for cataract surgery states that a person’s total circumstances will be considered before surgery is offered, not just their visual acuity which is the sharpness or clarity of vision. ‘Normal’ vision is often referred to as 20/20 vision. Someone with 20/20 vision can see clearly at 20 feet what should normally be seen at that distance. As we generally use metres instead of feet these days, normal vision is now classified as 6/6 vision.

Cataract surgery is not usually offered to people with visual acuity better than 6/12. This measurement means that at a distance of 6 metres, the smallest letter on a chart clearly seen by someone with a visual acuity of 6/12 would be seen clearly by someone with normal 6/6 vision at a distance of 12 metres – so they’d see it at twice the distance. For some people with vision assessed as better than 6/12, other factors such as the need for good visual acuity in their occupations, or the need to drive at night for example, will be factored in when considering the option of having cataract surgery. 

Community optometrists will spend more time evaluating an individual’s suitability and willingness for cataract surgery, discussing options with them before a shared decision is made whether to go ahead with the surgery or not. It is expected that this will lead to fewer unnecessary referrals as patients will be better informed about the procedure and likely benefits and risks before seeing a cataract service provider. Patients who have had uncomplicated routine cataract surgery will have their follow-up checks carried out by a community optometrist. This will reduce the number of times patients need to visit a hospital which will result in a more convenient and timely appointment. 

Keith Davey, Consultant Ophthalmologist and Lead Clinician for the WYAAT Cataract Project said: 
“The main benefit of making better use of our community optometrists is that it gives patients a better service. In addition, there is the bonus that it releases capacity within challenged hospital eye services which means that hospitals are able to see higher risk patients with potentially sight-threatening conditions.”

The Joint Committee agreed a timescale for the implementation of the cataract pathway and policy of up to three years but this could be achieved within 12 months in some areas.

West Yorkshire and Harrogate Health & Care Partnership is hosted by NHS Wakefield Clinical Commissioning Group.
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