Communication with patients about cataracts can reduce negative stigmas about the procedure and create co-management opportunities for optical practices. With cataract awareness month underway, Amir Hamid, medical director and consultant ophthalmic surgeon at Optegra eye hospital, advised the industry to spread awareness by reaching out to the community more regularly: ‘Make people aware that some of the visual problems that they may be having could be due to cataracts, and thus an eye test is the first step in ensuring eye health into the future and being able to prevent detrimental progression.’
Private Rates
Waiting times from referral to cataract surgery in NHS hospitals were at an average of nine months in 2021, after increasing by 61% from pre-pandemic 2019 to 2021, with an 89% rise for London trusts, according to an OCL Vision report. Therefore, it was a logical next step for the independent sector to get more cases commissioned from the NHS to alleviate demand across the healthcare system.
Hamid told Optician how Optegra adapted its model to help after the NHS postponed many cataract surgeries between 2020 and 2021 due to the pressure put on its services created by Covid. Once Optegra transitioned to implement Covid safety guidelines and restrictions, like many private eye hospitals, it took on a significant amount of backlogged treatments. He said: ‘We changed our focus from Optegra being an A-Z of ophthalmology to addressing NHS cataracts, but also providing private cataract and vision correction surgery. So, we’re very focused on two legs of our offering, and ensuring things are carried out in a highly efficient and high-volume way.
‘We’ve subsequently ratcheted up our ability to deliver NHS cataract surgery, from pre-pandemic levels at about 5,000 a year, to around 30,000 surgeries by the end of this year. If you look back to a few years ago, we were providing about 10% of NHS cataract surgery. Now, it’s approximately half of cataract surgery provision in the independent sector.’
He added that, unfortunately, the surgeries needed will increase for at least another few years as many people who are still hesitant and cautious about exposing themselves to Covid infection risks have not come forward for cataract treatment.
Pre- and post-op coordination
As a result of the uptake by the private sector, hospitals and practices have had to finetune referrals and coordination for pre- and post-surgery care.
Hamid said they achieved this by creating awareness around Optegra’s eye hospital services. ‘We have our representatives going out into the community communicating with optometrists. We also have an accredited shared care programme with our optometry partners. Practices will refer patients to us and we will perform the surgery, and then they will perform the follow-ups in the community, which is much more convenient for the patients.
‘We know that, although patients are quite happy to travel for their surgery, they would prefer to have their follow-up visits performed much closer to home. So, it’s a win win for everyone.’
Optegra has also built awareness with ECPs through regular webinars with optometry colleagues where cataracts, the latest advances in the surgery, and Optegra’s provisions are discussed. Now, as restrictions have been eased, in-person CPD ophthalmology events have started, including for cataracts, dry eye, red eye, macular disease and OCT.
While similar referrals have been done in the past, the eye hospital has implemented the processes in a ‘much more formal and structured way,’ which has enabled continuity of care to be more seamless than it was before.
Brian Tompkins, director of Tompkins, Knight & Son Optometrists in Northampton, agreed that every optometrist should have a good link to their local hospital. He commented: ‘Invite the consultant into the practice and visit them at their workplace to get a better understanding of how you both work and how you can help each other. Ensure your referrals are on point, avoiding any unnecessary referrals, which end up wasting everybody’s time.’
It is useful to have the resources to provide pre-management of cataracts and aftercare. Tompkins said that its technology has allowed the practice to help with any pre- or post-operative care, removing the need for certain hospital appointments.
Regarding the most important part of management and aftercare, Tompkins added: ‘Regular appointments help massively, and we like to see patients for weekly, monthly or three-monthly reviews, plus a six-month review. Prescriptions can change and it’s important to let the patient know those changes are not set in stone and may change again. As with everything, communication is key.
‘It’s also worth checking the retinal structure rather than simply looking at the front of the eye and assuming everything is OK. If you are thorough you can pick up on other potential problems at an earlier stage.’
Communication ends stigma
Many patients were well-informed about cataract surgery already, as it was the most commonly performed operation in the UK, said Hamid. However, ophthalmologists should try to provide information to the patient before they come in for clinic appointments so they are not starting at square one during the hospital appointment. This could be in the form of patient information booklets, emailed, posted or ¬ if it is a referral from a shared care partner ¬ provided to patients at the time of diagnosis, and then subsequent referral, as well as animations, posters and diagrams on site.
Tompkins explained that early communication and preparation with patients, such as on aspects like diagnosis, addressing fears, and long wait times, is key: ‘Discussing cataracts should be part and parcel of the eye examination. It is vital to begin the conversation as early as possible and reassure patients that cataracts are really nothing to worry about. Normalising them is important, we talk about it in a way that equates developing cataracts to getting grey hair.
‘It allays fears and makes them aware of what is coming further down the line, so there are no nasty shocks. By getting in early, plans can be made in advance for operations and the management of the cataract before it becomes an emergency.’
When communicating specifically with dementia, special needs, or non-English speaking patients, Hamid said: ‘We have various policies and procedures in place to help in different situations like these, and ensure you have a safe and effective service. For example, for dementia we have systems in place to ensure that we are doing the right things for the patient, such as obtaining consent in the appropriate way. Similarly, for patients that don’t speak English, we have to ensure that they understand the information provided to them – either through appropriate literature or by using a translator.’
He outlined that health providers should regularly monitor data of cataract surgeries to understand and collect surgery results that could be used to reassure and educate patients beforehand.
‘We regularly audit our results, and we are in excess of the benchmark, meaning there are quality results in terms of visual performance post-operatively, and very low complication rates – that’s a useful resource to have to hand.’
Hamid highlighted that: ‘Patients should know it’s one of those operations where the visual rehabilitation can leave people much better off post-surgery than they were even before they developed the cataract. Although it’s not guaranteed, we try and make people as spectacle-independent as possible.’
What does the future hold?
When addressing professionals on best practices, Hamid advised that ECPs must practice differently to how they did before the pandemic. ‘We have to be as efficient as possible in terms of how long we want patients to be in hospital for (eg pre- and post-surgery). If we can reduce their transit time within our hospital while maintaining high quality and a good experience for our patients, then that’s what we need to aim for.’
With the establishment of advances in technology and new research, cataract management and surgery options have room to grow and improve. Hamid told Optician there are lots of exciting developments coming in the next few years, including even safer ways of doing surgery, more robotic involvement in the surgery, the use of lasers, and then, eventually, preventing cataracts from developing in the first place.
‘There’s lots of research going on into pharmacological agents currently in the form of injections that can stop the process of cataract development occurring, or even eyedrops that can stop the development of cataracts,’ he added.