Are there benefits to second eye cataract surgery?

A recent new story has just emerged that a clinical commissioning group (CCG) has decided to limit cataract surgery to just one eye. I thought I would explain why this measure might not be in the best interest of the patient.

Why have they done this? And are there benefits to second eye cataract surgery?

The NHS does a fantastic job of treating patients with cataracts. Each year the NHS performs thousands of successful cataract operations. These patients have excellent results and high patient satisfaction.

Unfortunately, the NHS faces severe financial challenges when providing this care. The funding for hospital operations comes from clinical commissioning groups known as CCGs. Many patients do not understand that.

The CCG replaced the old primary care trusts. These CCGs have clinically-led NHS bodies that are responsible for planning and commissioning healthcare for their local areas.

In effect, the CCG decides how they will spend their fixed budget on all the healthcare requirements of their region.

When you have a cataract, the NHS will refer you to a hospital to see an eye specialist. The CCG will pay the hospital a fee (or tariff) for that hospital visit.

If the hospital decides that you would benefit from a cataract operation and performs cataract surgery, the CCG pays an agreed tariff to the hospital for your cataract operation.

This situation results in CCGs making tough decisions about who gets cataract surgery. From their point of view, they cannot afford to pay for anyone who has a cataract to get cataract surgery. They have to decide to pay for cataract surgery only in those who most need it and in those who would benefit the most.

The recent news report states that the South Norfolk Clinical Commissioning group will limit cataract surgery in their region. They will now only provide funding for patients to have cataract surgery in one eye.

They will only provide funding for cataract surgery in both eyes if there are exceptional circumstances. Second, hospital doctors must apply to this CCG stating the reasons why both cataracts need surgery.

This CCG having a large £6.6 million deficit in their budget for this financial year has prompted this action. They feel that making this change is necessary to reduce that deficit.

About 40% of patients get cataracts in both eyes. That may mean that certain people in this region will not get the benefits of getting cataract surgery on their second-eye cataract.

This situation is symptomatic of the increasing financial strain on the NHS. This situation is not the fault of the CCGs, but more so from the lack of government funding for the NHS on the whole.

We have more patients each year on the NHS. Each year we have more expensive treatments to pay for which makes the situation even worse.

What I want to highlight here is that doing cataract surgery on both eyes is much better for patients than just doing one.

Studies show that patients having both cataracts treated have better binocular function than patients having only one eye treated. Better binocular function improves the chances of patients passing the DVLA visual field tests for driving.

Other studies have shown that second eye cataract surgery improves visual function and quality of life beyond those patients who have just one eye cataract surgery.

Interestingly, studies show that rationing second eye cataract surgery does not save significant money either.

More CCGs are imposing restrictions on patients having cataract surgery, and I have listed a few examples with the links below.

Surrey Downs CCG

Page 30 for cataract surgery restrictions – Link

North West Surrey CCG

Page 25 for cataract surgery restrictions – Link

Cambridge and Peterborough CCG – Link

North West London

(NHS Brent CCG, NHS Central London CCG, NHS Ealing CCG, NHS Hammersmith and Fulham CCG, NHS Harrow CCG, NHS Hillingdon CCG, NHS Hounslow CCG and NHS West London CCG) – Link

NHS Crawley CCG, NHS Horsham and Mid Sussex CCG

Page 26 for cataract surgery restrictions – Link

Mid Essex CCG – Link

Thankfully none of the above restrictions are as drastic as rationing second eye cataract surgery, and most are reasonable in the light of the current NHS financial climate.

Let’s hope, however, that other CCGs do not follow South Norfolk as many patients may find it increasingly difficult to get both eyes cataract surgery done on the NHS in the future.

If you have a cataract or think you might need a cataract operation on the NHS or privately, please feel free to call me on 020 7952 2826 and we can chat some more.

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