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Leading ophthalmologist vows to stamp out “unjustified” screening for cataract surgery

BMJ 2019; 365 doi: (Published 29 May 2019) Cite this as: BMJ 2019;365:l2326

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  1. Gareth Iacobucci
  1. The BMJ

NHS commissioners are ignoring clinical guidelines by rationing access to cataract surgery, an investigation by The BMJ finds

New evidence gathered by The BMJ shows that patients with cataracts are being screened and that those who don’t meet visual acuity thresholds are being denied surgery. This is despite NICE’s guideline, which says that cataract removal is cost effective and should not be restricted to the more severe cases.12

In 2018-19 more than a fifth (22%) of patients in England who needed cataract surgery were screened, three times the proportion of 7% in 2016-17 (fig 1).

Fig 1

Screening referrals

Mike Burdon, president of the Royal College of Ophthalmologists, who also chaired NICE’s guideline committee, said that it was his mission before he stepped down as president in a year’s time to convince clinical commissioning groups (CCGs) to stop rationing cataract surgery and not to label it a procedure of “limited clinical value.” He said that this approach was “unjustified whatever way you look at it.”

He added that it was a false economy for CCGs to apply criteria for cataract surgery as a way to control costs.

Rationing on the rise

Cataract surgery is the most common operation in the NHS, with more than 400 000 procedures performed every year in the UK.

Experts had hoped that NICE’s 2017 guideline would make it harder for NHS commissioners in England to ration treatment for financial reasons. But The BMJ’s analysis shows that rationing has actually risen in parts of the country since then, with patients increasingly having to meet strict criteria before they can be referred for surgery.

Among the 185 CCGs that provided data (95% response rate), the investigation found that almost 2900 prior approval requests or individual funding requests for cataract surgery were rejected last year, more …

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