Cataract surgery rates soar

The increase has led doctors to question whether the surgery is now undertaken too readily in some NHS cases and whether the long backlogs of clinical need are still being cleared.

National data on hospital admissions for cataract surgery in England from 1968 to 2004 were analysed by researchers from the Oxford Eye Hospital and Oxford University. They also looked at similar data for the former regional health authority area of Oxford.

Both national and regional data showed a five-fold increase from the late 1980s to 2003. Admission rates in England rose from 62 per 100,000 of the population in 1968, to 173 in 1989, and then to 637 in 2004. The increases occurred in every age group.

Wide geographical variation in admissions were also noted in the study published in the British Journal of Ophthalmology. These ranged from from 172 to 548 people per 100,000 of the population, depending on location. The highest rates tended to be in more deprived areas. Either this is down to real differences in the prevalence of cataract or differences in referrals, it was suggested.

The report says: "The fact that there is substantial geographical variation in cataract surgery raises similar questions as to whether areas with high rates are 'overservicing' in relation to need or whether areas with low rates are 'underproviding' care."

It suggests that "appropriate thresholds for intervention" could be agreed nationally taking into account symptoms such as the visual strength and health of the eyes.

The push to provide more cataract surgery was kick-started in the 1990s when eye and public health doctors predicted a major shortfall in provision, made worse by an ageing population. New techniques such as using an ultrasound to break up the clouded lens, combined with shorter hospital stays, may have helped cases be more quickly dealt with.

England should learn from New Zealand, where patients are prioritised according to clinical need rather than the availability of surgeons or waiting time targets, the report adds.

Possible over capacity in England would have profound financial implications for the commissioning of surgery by primary care trusts, and for professional training, they conclude.