Access to cataract surgery
Policy Position Statement (England Only)
April 2016
What we think
Cataract surgery is proven to be a safe, clinically and cost-effective intervention for both eyes. We believe that patients should be able to access cataract surgery if they experience disabling visual symptoms attributable to their condition. This is in line with the latest commissioning guidance from the Royal College of Ophthalmologists, which was developed using a NICE accredited process.
What’s happening now
Wide variations exist across England in the commissioning policies for the treatment of cataracts which is resulting in a “postcode lottery” for when people can access cataract surgery.
Clinical Commissioning Groups (CCGs) which plan and pay for the local healthcare are under increasing pressure to make spending cuts. Increasing evidence shows that CCGs are restricting access to cataract surgery by imposing arbitrary visual acuity thresholds that patients must meet in order to qualify for surgery. A person’s visual acuity is one measurement of their ability to see and relates to how many letters a person can read on an eye chart. It does not take into account other effects on vision such as glare.
If cataracts are left untreated, a patient’s sight will continue to deteriorate until it is removed. This impacts on patients’ quality of life and ability to undertake everyday tasks; cataracts can prevent people from driving, reading and recognising faces.
What should happen
Access to treatment should be in line with the Royal College of Ophthalmologists cataract commissioning guidelines which are NICE accredited.
The guidance notes that:
“The sole use of visual acuity can underestimate visual disability because it does not take account of symptoms such as glare or reduced contrast sensitivity”.
It also adds that: “Although visual acuity remains a useful component of the assessment of visual disabilityfrom cataract, cataract surgery should be considered in the first eye or second eye of apatient who has disabling visual symptoms attributable to cataract. For instance, a patientwho experiences disabling glare due to cataract when driving may still achieve a visual acuityof better than 6/9 under ideal conditions of illumination.”
CCGs must refrain from attempting to solve financial problems by introducing policies restricting access to cataract surgery. NHS “efficiency savings” achieved by cutting cataract operations are a false economy. Denying treatment leaves patients at risk of social isolation and fall-related hip fractures.Repairing hip fractures are substantially more costly to the NHS and social care services than cataract surgery.
Commissioning decisions must not be made on the basis of cost-cutting. Patients must be given the best and most appropriate care, based on clinical need.
What RNIB are doing
RNIB aims to end avoidable sight loss from cataracts and preserve patients’ ability to live independently. We are undertaking campaigning work across England and working with local commissioners and other decision-makers to improve access to cataract surgery.
Contact
For further information please contact the RNIB Policy and Campaigns Team at or on 020 7391 2123
END