BMJ investigation reveals rationing of cataract surgery

  • BMJ

  • curated by Dawn O'Shea
  • UK Medical News
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Clinical commissioning groups (CCGs) in England are ignoring clinical guidelines by rationing access to cataract surgery, an investigation by the BMJ has concluded.

The journal says it has gathered new evidence which shows that more and more patients are being denied the treatment. In 2018-2019 more than a fifth (22%) of patients in England who needed cataract surgery were screened, three times the proportion of 7 per cent in 2016-2017.

The 2017 NICE guideline on the management of cataracts concluded that cataract removal is cost-effective and should not be restricted to more severe cases.

Despite the recommendation, the BMJ collated data from 185 CCGs and found that almost 2900 prior approval or individual funding requests for cataract surgery were rejected last year, more than double the number two years ago. Although the proportion of prior requests for cataract surgery being rejected has fallen since 2016-2017, the absolute number is rising.

Mr Mike Burdon, president of the Royal College of Ophthalmologists, who also chaired the 2017 NICE guideline committee, told the BMJ that it is his mission before he steps down as president to convince CCGs to stop rationing cataract surgery.

“Health economists spent 18 months reviewing the evidence for cataract surgery on both first eye and second eye, and they convincingly concluded that there was no justification to ration cataract surgery on the basis of acuity. This was independent of ophthalmologists, including myself,” Mr Burdon said.

“What is the point of NICE doing detailed evaluation if CCGs are just going to knowingly ignore that advice? The health service budget is limited, but you should make those spending decisions on the basis of the clinical evidence. Cataract surgery comes out as probably the most cost-effective thing in the NHS,” he said.