National Cataract Survey 1997

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Royal College of Ophthalmologists Guidelines (Focus)

National Cataract Survey 1997 - 1998

The Survey has reported on 19,000 cataract patients in the NHS from over 100 eye units across the UK.

This National Cataract Surgery Survey describes the management and clinical outcomes of contemporary cataract surgical practice in the NHS. Ophthalmologists and nurses in NHS eye units together with community ophthalmologists were all involved in its conduct. The Royal College of Ophthalmologists in collaboration with the Royal College of Nursing and the College of Ophthalmologists, facilitated and endorsed this multidisciplinary initiative.

The survey is a collation of standardised local audits conducted in over 100 eye units in the country, integrating local audit activity into a national process. Each hospital was provided with a tool pack containing: a manual for conducting the audit; forms for data collection (before and during surgery; after surgery at last recorded visit post-operatively; and at final refraction from the community ophthalmologist) ; and a customised computer database and reporting package. The audit period was either a period of activity (3 consecutive months), or a volume of activity (300 consecutive patients). On completion of their audit, each hospital was able to generate a report of their local findings for departmental feedback and subsequently, for comparison with the national results.

The national findings have contributed to the Royal College of Ophthalmologists guidelines on cataract surgery (currently under review) and to the SIGN Guidelines for day case cataract surgery. In so doing, the Survey has provided updated national benchmarks for cataract surgery, for clinical governance and ongoing clinical audit. In practice, the national survey tools continue to be used by many eye units across the country for both departmental and personal clinical audit, reinforcing the local-national link.

Beyond ophthalmology, the Department of Health has adopted the Survey's collaborative, multidisciplinary approach integrating local and national audit activity, as a model for all its subsequent national audits in other clinical specialities.

A summary of the national findings are presented overleaf.

Acknowledgements

All clinical and audit staff of participating eye units across the country for their outstanding support; the Royal College of Ophthalmologists; the Steering Group members from the Royal College of Ophthalmologists, Royal College of Nursing and College of Optometrists; and the NHSE, Department of Health, for project funding. Photograph from the Medical Illustration Department, Moorfields Eye Hospital.

Paul Desai, Moorfields eye Hospital, London

Angela Reidy, Moorfields Eye Hospital, London

DC Minassian, Institute of Ophthalmology, University College, London

PATIENT PROFILE 1
Mean Age Male : Female	76.3 Years 1 : 2
Co-existing serious eye disorders
ARM Glaucoma Diabetic retinopathy Amblyopia	17% 11% 3.4% 1.1%

SNELLEN VISUAL ACUITY BEFORE SURGERY (in eye for surgery) 1
At time of wait listing for surgery 69% of patients had worse than 6/1
On admission for surgery 73% of patients had worse than 6/12
CLINICAL OUTCOMES OF SURGERY Snellen Visual Acuity in Operated Eye 2
Visual Acuity at Discharge (from post-operative hospital to follow-up) 77% (all patients) achieve 6/12 or better
Visual Acuity at Final Refraction (within 3 months of surgery) 86% (all patients) achieve 6/12 or better
CLINICAL OUTCOMES OF SURGERY Surgically Related Complications 2
Events During the Operation
Any complication during surgery Capsule rupture and vitreous loss	7.5% 4.4%
Immediate Post-Operative Period (within 48 hours of surgery)
Any complication at this time Corneal Oedema Wound leak External infection Endophthalmitis	23.3% 9.5% 1.2% 0.06% 0.03%
Sight Threatening Complications (within 3 months of surgery)
Endophthalmitis Retinal detachment / tear	0.1% 0.1%
SURGICAL PROCESS 1
Type of admission Second Eye procedure Type of Anaesthetic	70% day cases 35% of all patients 86 % local anaesthesia
Type of Procedure	77% Phako-emulsification 23% ECCE <1% ICCE
Grade of Surgeon Performing Operation
Consultant Associate Specialists Specialist Registrar Senior House Officer Other Grade	63% 7% 16% 6% 8%

References

1. Desai P, Reidy A, Minassian DC. Profile of patients presenting for cataract surgery in the UK: National data collection. Br J Ophthalmol 1999;83:893-896.

2. Desai P, Minassian DC, Reidy A. The National Cataract Surgery Survey 1997/98. A report of the results of the clinical outcomes. Br J Ophthalmol 1999;83;1336-1340.

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