Evaluation of Clinical Threshold Policies for Cataract Surgery and the Regional Variation in Rates of Surgery

Abstract

Background/Aims To characterise the national patterns in rates of cataract surgery across England, review clinical thresholds against NICE guidance, and determine how far variable access to cataract surgery is attributable to regional variation in policy stringency and social deprivation. Methods 127 Clinical Commissioning Groups ('CCGs') provided cataract surgery data and threshold policies in response to a Freedom of Information request. Local cataract surgery rates were grouped by threshold stringency and analysed on an age group-corrected basis. ANOVA testing was used to assess effect of policy stringency on regional rates of cataract surgery. Results In England, rates of cataract surgery vary threefold across CCGs, from 1,980 to 6,427 per 100,000 population over 60, with a standard deviation (784.76) of 22% of the mean value, 3,598. Threshold policies vary across CCGs: 33 had no policy, 45 utilised policies accessible on the basis of Quality of Life ('QoL') impact, and 39, against NICE guidance, required a Visual Acuity ('VA') threshold be exceeded. Rates of surgery by CCG were negatively correlated with restrictiveness of policy (η2 =0.18, p<0.01), and positively correlated with the Index of Multiple Deprivation (IMD), (R2=0.11, p<0.01). Prior approval processes are not significantly associated with reduced rates of surgery. Conclusion Over two-thirds of CCGs continue to use threshold-based policies for access to cataract surgery, with one-third doing so solely on the basis of VA requirements, despite NICE guidance to the contrary. For NHS operations, variation in policy restrictiveness accounts for more of the variation in surgery rates than socioeconomic deprivation.